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We proposed to revise 425.512(a)(7) introductory text and (a)(7)(i) and proposed to add new paragraphs (a)(7)(i)(A) and (B) to indicate for performance year 2024, we will use the higher of the ACO's health equity adjusted Quality performance ( category score or the equivalent of the 40th percentile MIPS Quality performance category score when an ACO reports all of the required measures, meeting the data completeness requirement for each measure in the APP quality measure set and receiving a MIPS Quality performance category score and the ACO meets either of the following: ++ The ACO's total available measure achievement points used to calculate the ACO's MIPS Quality performance category score are reduced under 414.1380(b)(1)(vii)(A)

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Acknowledgments We thank the drawing tools provided by Figdraw and BioRender