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Another commenter recommended that CMS utilize the nursing facility as a key site of primary care and account for it in our beneficiary assignment methodology to facilitate greater partnership between ACOs and nursing facility staff and mitigate issues in misalignment which occurs when new institutionalized beneficiaries are misaligned to their historic community based primary care providers. Another commenter opposed the inclusion of caregiver training service codes (97550-97552), which were finalized in the CY 2024 PFS final rule (88 FR 79168), as 2024 is the first year they were in the CPT book and there are no claims data available on these codes