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In addition, we proposed removing the reference to as defined in 400.200 of this chapter. For the methodologic updates: Stage 1: Implement a 4-Star Cap for Hospitals in the Lowest Quartile of the Safety of Care Measure Group Performance Beginning in 2026 ( 412.190(d)(9)(i)) We proposed to limit hospitals in the lowest quartile of Safety of Care (based on at least three measure scores) to a maximum of 4 stars out of 5