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In the event that CMS stops or reduces an ACOs quarterly payments during the performance year below the quarterly payment amount previously requested by the ACO, the reduction does not impact the total maximum amount they are permitted to spend on each category of allowable uses identified at the start of each year, as it would not be appropriate to subject ACOs to mid-year spend plan changes when they may have entered into contracting or other arrangements with staff or suppliers which could impact continuity of care

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