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We acknowledged that this assumption may understate or overstate the costs of reviewing this rulemaking

In summary, we are proposing CMS will use the payment amount in quarterly pricing files to determine if a Part B rebatable drug should have an adjusted beneficiary coinsurance, the calculation to determine the adjusted Medicare payment (if applicable) will not be adjusted for sequestration, and drugs excluded from the identification of Part B rebatable drugs will not be subject to the inflation-adjusted beneficiary coinsurance

Few ACOs have had a beneficiary population that fell below 5,000

We did not prepare an analysis for section 1102(b) of the Act because we determined, and the Secretary certified, that this rulemaking will not have a significant ( impact on the operations of a substantial number of small rural hospitals