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Lastly, certain vitamin deficiencies, that occur often after bariatric surgery, are the source of extreme fatigue and lack or energy

DSNP Contracting with States To improve the integration of Medicare and Medicaid benefits, MIPPA--as amended by the Affordable Care Act--required all DSNPs to have contracts with the states in which they operate, effective January 1, 2013 (CMS, 2016b)