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We are finalizing our proposal, without modification, to revise 425.224(b)(1)(ii)(A) to state that, as part of the factors we evaluate when determining whether to approve a renewing ACO's or re-entering ACO's application, we will evaluate whether the ACO demonstrated a pattern of failure to meet the quality performance standard and alternative quality performance standard (if applicable), or met any of the criteria for termination at 425.316(c)(1)(ii), (c)(2)(ii), or (c)(3)(ii)

High B12 is a marker, not a cause