Under this proposal, if CMS determined that an ACO used prepaid shared savings for a prohibited use under proposed 425.640(e)(2), allocated over 50 percent of their annual maximum prepaid shared savings on staffing and healthcare infrastructure as proposed at 425.640(e)(1)(i), or failed to spend at least 50 percent of the annual maximum prepaid shared savings on direct beneficiary services, CMS would require the ACO to reallocate the funding in compliance with 425.640(e) and submit an updated spend plan demonstrating the reallocation by a deadline specified by CMS and may withhold or terminate the ACO's receipt of prepaid shared savings under proposed 425.640(h)(1)
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