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Additionally, while unspent funds received for a performance year must be reallocated in the spend plan for the ACO's next performance year as noted in 425.640(e)(3), if an ACO fails to spend a majority of the prepaid shared savings they receive in a performance year, CMS may withhold future quarterly payments until the ACO spends the funding they have already received and reports this spending to CMS through an updated spend plan
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Many of the features included in the HEIC are associated with urbanicity (e.g., land use mix, residential density, and lower speed limits), thereby resulting in low HEIC scores for many rural areas in the study region
