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Although the provisions in this proposed rule that require section 1899(i) of the Act authority are estimated to increase spending by only $60 million over 10 years, the cumulative impact of all policies (including those in this proposed rule) are estimated to result in more than $4.9 billion in greater program savings compared to a hypothetical baseline payment methodology that excludes the policies that require section 1899(i)(3) of the Act authority

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And need to develop infrastructure to address the impact of SLT mediated epidemiological effect

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Importantly, developing new perhaps more rigid policies to regulate hookah use is not only needed in youth but must also expand to control use during pregnancy