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(2) If CMS determines that an ACO receiving prepaid shared savings is using the funds for a prohibited use under 425.640(e)(2), fails to spend the funding in accordance with 425.640(e)(1)(i) and (ii), or spends more than 50 percent of the estimated annual payment amount on staffing and healthcare infrastructure CMS: (i) Will require the ACO to reallocate the funding as permitted by 425.640(e) and submit an updated spend plan demonstrating the reallocation by a deadline specified by CMS

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For sublingual use, methylcobalamin may offer advantages because it is absorbed directly into the bloodstream without requiring conversion