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The rationale is mechanistic (complementary pathways with no known antagonism) and supported by clinical experience from physicians who prescribe both
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The current definition of “beneficiary eligible for Medicare CQMs” requires, in (1)(ii), “at least one claim with a date of service during the measurement period from an ACO professional who is a primary care physician or who has one of the specialty designations included in § 425.402(c), or who is a physician assistant, nurse practitioner, or clinical nurse specialist.” For performance year 2025 and subsequent performance years, the revised definition we proposed in (1)(ii)(B) would align with our modifications to the stepwise assignment methodology and approach to identifying the beneficiaries assignable to an ACO, as finalized in the CY 2024 PFS final rule (88 FR 79162) and described at § 425.402(a)(5), where physician assistants, nurse practitioners, and clinical nurse specialists were added to the process for identifying beneficiaries assignable to an ACO beginning in performance year 2025
