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If the ACO fails to meet the applicable quality performance standard established in 425.512 or the alternative quality performance standard, the ACO is subject to 1st dollar losses at a rate of 75 percent ( 425.610(f)(4)(ii))

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(a) * * * (4) At least 75 percent of the MIPS eligible clinician, group, virtual group, subgroup, and APM Entity's patients that meet the measure's denominator criteria, regardless of payer for MIPS payment years 2026, 2027, 2028, 2029, and 2030