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However, how much substance is there to this claim

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We are finalizing that if CMS determines the ACO meets the requirements of 425.512(c)(1), then, in alignment with 425.512(c)(2)(ii) (as amended by this final rule), the ACO's minimum quality score will be set to the equivalent of the 40th percentile MIPS quality performance category score, excluding entities/providers eligible for facility-based scoring, for the relevant performance year

It's not an emergency care system