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Further, the timing of the reopening must be consistent with the timeframes specified in 425.315(a)(1)(i) and (ii), respectively, either (i) at any time in the case of fraud or similar fault, or (ii) not later than 4 years after the date of the notification to the ACO of the initial determination of savings or losses for the relevant performance year for good cause

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[466] Additionally, we stated that we would like to understand if OTPs already receive payment from States who might already cover these services under State Medicaid programs, including through section 1115 waiver demonstrations and delivery system reform incentive payments, State plan amendments, managed care contracts, or other service benefits and payment arrangements, [467] and if new coding under the Medicare OTP benefit may unintentionally supplant coverage for dually eligible beneficiaries

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