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Crumble Cake Tobacco means that a blend is made into loose ribbon and then it is pressed, but not pressed as tightly as if it were a plug or flake A crumble cake plug has been pressed using ribbon-cut tobacco rather than large pieces of leaf or whole leaves such as in flakes

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These lines represent the employee benefits costs for visiting RNs, visiting LPNs, laboratory technicians, registered dietician/Certified DSMT/MNT educators, PTs, OTs, and other allied health personnel

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As discussed under section IV.A.4.g.(2)(b) of this proposed rule, we are proposing to continue using the mean as the methodology for determining the performance threshold for the 2027, 2028, and 2029 MIPS payment years