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One commenter requested that CMS seek alternative, more current data sources to rebase and revise the MEI if the AMA PPIS data proves insufficient, stating that the 2017-based MEI derived predominantly from the 2017 US Census Bureau's Service Annual Survey (SAS) are outdated and should not be used for updates

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This limitation should be considered when interpreting the metabolic rate data, as body size differences may affect energy expenditure normalization

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