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As we explained in the CY 2025 PFS proposed rule (89 FR 61596, 61874), if a staff member is hired or directed to provide these services, ACOs may, but are not required to, use dollars designated for direct beneficiary services to cover the percentage of their salary that aligns with the percentage of time the staff member spends providing direct beneficiary services that are not otherwise covered by Traditional Medicare, instead of fully including those staff expenses under the staffing category, where ACOs are limited in their ability to use prepaid savings

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