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Rare side effects have been reported and they will be discussed during the consent process

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Response: In response to commenters indicating it was unclear from the discussion in the proposed rule our considerations for determining if an improper payment is of sufficient magnitude to reopen a payment determination, for one, we note that in the CY 2025 PFS proposed rule (89 FR 61896) we specified that we would be highly unlikely to exercise our discretion to reopen a payment determination to address particular instances of low-value improper payments which, in an individual case may be to the benefit of either the ACO or CMS and in the aggregate are likely to have a de minimis net effect on program expenditures in the long run

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