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Since the minimum possible Overall Hospital Star Rating will remain 1 star, hospitals already getting one star would not get a further star reduction and therefore would effectively be exempt from this adjustment consistent with established assignment of ratings between 1-5 whole stars (85 FR 86193)

doi:10.1080/1028415x.2019.1627770 Peikert A, Wilimzig C, Kohne-Volland R

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