The program was created and required by the Patient Protection and Affordable Care Act (PPACA), which amended the Social Security Act (where the Medicare legislation is found). The law further required that the program be established no later than Jan. 1, 2012. The proposed rule had been published by CMS in the April 7, 2011, issue of the Federal Register . CMS stated that it received more than 1,300 public comments to it.
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