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Archived from the original on 23 January 2018

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As previously stated, section 1886(e)(4)(A) of the Act requires that the Secretary, taking into consideration the recommendations of MedPAC, recommend update factors for inpatient hospital services for each fiscal year ( that take into account the amounts necessary for the efficient and effective delivery of medically appropriate and necessary care of high quality

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They are thick and decurrent, with much variation in leaf shape between the upper and lower leaves on the stem, ranging from oblong to oblanceolate, and reaching sizes up to 50 cm long and 14 cm across (19 inches long and 5 inches wide)