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As the MEI cost shares are updated, we would typically propose to modify steps 3 and 10 to adjust the aggregate pools of PE costs (direct PE in step 3 and indirect PE in step 10) in proportion to the change in the PE share in the rebased and revised MEI cost share weights, and to recalibrate the relativity adjustment that we apply in step 18 as described in the CY 2023 PFS final rule (87 FR 69414 and 69415) and CY 2014 PFS final rule (78 FR 74236 and 74237)

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Collectively, these microbial, physiological, and oxidative changes triggered by smoking may amplify its detrimental impact on health, exacerbating a wide range of diseases and impairing the bodys ability to repair and protect itself