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Funding This study was funded by the National Institute for Health Research by a Grant No: 17/63/76 to support a Global Health Research Group on Addressing Smokeless Tobacco and building Research capacity in south Asia (ASTRA)

We noted that we would take these comments into consideration in the future, and that any additional measures added to the Star Ratings Program would need to be added through rulemaking

[342] The DPP model test successfully met statutory criteria for model expansion, [343] demonstrating 5 percent weight loss from their starting weight by participants (a key metric of the program's success) along with statistically significant reductions in Medicare spending, emergency department (ED) visits, and inpatient stays

We note that the results of this exchange are not identical between the baseline and final policies model