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In recognition of these barriers, the anticipated implementation burden, as well as in response to public comments recommending that CMS add eCQMs as optional measures initially (88 FR 82070), we proposed that the Emergency Care Access & Timeliness eCQM would not be a required measure under the REHQR Program, and that REHs could thus elect to report either the Emergency Care Access & Timeliness eCQM or the Median Time for Discharged ED Patient measure for a given reporting period/program determination (90 FR 33771 and 33772)

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82,83 Conversely, adults with Laron syndrome have reduced circulating IGF1 and increased insulin sensitivity