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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 at 425.640(e)(3), if an ACO fails to spend a majority of the prepaid shared savings received in a performance year, we may withhold future quarterly payments until the ACO spends the funding already received and reports this spending to CMS through an updated spend plan

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The spend plan must be updated annually for each performance year of the agreement period during which the ACO receives prepaid shared savings

Current guidelines for B12 replacement Vitamin B12 is available in four different formulationscyanocobalamin (CN-Cbl), hydroxocobalamin (OH-Cbl), methylcobalamin (methyl-Cbl), and adenosylcobalamin (adenosyl-Cbl)depending on the R residual group attached to the core cobalamin molecule