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We found several sections in part 405, subpart X, that use the term grandfathered. For example, in 405.2462(f)(1) a grandfathered tribal FQHC is a FQHC that is operated by a tribe or tribal organization under the Indian Self-Determination and Education Assistance Act (ISDEAA)

Response: We appreciate and acknowledge these comments related to the implementation of the transfer of care modifiers proposal

Cooling towers, being basically evaporative coolers with about 80% of the input heat load being removed by evaporation, increase cooling water solids content rapidly with the result that routine blowdown is required to prevent scale formation

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Accordingly, rather than static policy documents or action plans, they are conceived as dynamic, continuously negotiated, and adaptable governance frameworks