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Large extraparenchymal arteries, including the vessels of the circle of Willis and major pial arteries, possess a well-developed tunica media with multiple layers of smooth muscle (ranging from 20 layers in the internal carotid artery to 23 layers in smaller pial arteries) and a prominent internal elastic lamina ( Penetrating arterioles, which branch from pial vessels within the Virchow-Robin space, exhibit fewer layers of smooth muscle and reduced elastic structures, marking the transition toward greater local control ( 2 and K + and play a larger role in NVC and CVR

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Response: We thank commenters for their support of the proposed modification to the Overall Hospital Quality Star Rating methodology which aligns with our vision to emphasize the importance of patient safety across CMS programs