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With respect to commenters urging the need for CMS to provide ACOs with written responses to ACO requests for certain codes to be considered SAHS billing activity, we note that in the rare case when CMS will determine that SAHS billing activity occurred in the previous calendar year, CMS will notify all program participants of this finding including the codes removed and the per capita expenditure amount for their assigned beneficiary population

(2) a neutral adjustment, if their final score meets the performance threshold

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They aren't interchangeable, and their properties dictate the entire process