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Specifically, we propose to modify 425.312(a)(2)(iii) to state in the case of an ACO that has selected preliminary prospective assignment with retrospective reconciliation, the beneficiary notice must be provided by the ACO or ACO participant to each beneficiary who received at least one primary care service during the assignment window or applicable expanded window for assignment (as defined in 425.20) from a physician who is an ACO professional in the ACO and who is a primary care physician as defined under 425.20 or who has one of the primary specialty designations included in 425.402(c), a FQHC or RHC that is part of the ACO, or an ACO professional in the ACO whom the beneficiary designated as responsible for coordinating their overall care under 425.402(e)

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There have been few exceptions to this characterization