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On March 1, 2013, the Centers for Medicare & Medicaid Services (CMS) released Change Request 8214, which outlines rules related to the extension of the Low Volume Adjustment (LVA) and Medicare Dependent Hospital (MDH) regulations, as authorized by the American Taxpayer Relief Act of 2012 . The Federal Register notification related to these extensions, CMS 1588-N, was released on March 4, 2013, and officially published March 7, 2013. Hospitals will need to move quickly to take full advantage of the LVA extension, and they may be surprised by some of the requirements of the MDH extension