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The enzyme is complex, with four copper atoms, two or more disulfides, glycosylation, optimal activity at acidic pH (pH 45) and an electron transfer pathway that is strongly interrupted by modest concentrations of hydroxyl anions or halides (for example, NaCl and KCl) in cell culture media 21

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In addition, we proposed removing the reference to as defined in 400.200 of this chapter. For the methodologic updates: Stage 1: Implement a 4-Star Cap for Hospitals in the Lowest Quartile of the Safety of Care Measure Group Performance Beginning in 2026 ( 412.190(d)(9)(i)) We proposed to limit hospitals in the lowest quartile of Safety of Care (based on at least three measure scores) to a maximum of 4 stars out of 5