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From the University Archives .

If the amount of shared savings earned by the ACO is revised downward by CMS for any reason, the ACO will not receive a refund of any portion of the prepaid shared savings previously recouped or otherwise repaid, and any prepaid shared savings that are now outstanding due to the revision in earned shared savings must be repaid to CMS upon request

They can also roll their own cigarettes, although Rhode Island is notorious among smokers of both tobacco and cannabis for its high prices on rolling papers, which are taxed as if they were cigarettes

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