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In the December 2018 final rule (83 FR 67925 through 67929), we revised 425.110(b) to provide for the use of a variable MSR/MLR when performing shared savings and shared losses calculations if an ACO's assigned beneficiary population fell below 5,000 for the performance year regardless of whether the ACO had previously selected a fixed or variable MSR/MLR

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doi: 10.1093/oxfordjournals.humrep.a135885