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In response to the comment that stated that flat benchmarks for Medicare CQMs and the health equity adjustment are not duplicative because the former is uniformly applied and does not account for the worse health outcomes consistently observed in underserved populations, we note that while the methodology for the application of the health equity adjustment and flat benchmarks for Medicare CQMs differ, as discussed in the CY 2026 PFS proposed rule (90 FR 32678), the use of flat benchmarks in a Medicare CQM measure's first two performance periods in MIPS may allow ACOs with high scores to earn maximum or near maximum measure achievement points while allowing for room for quality improvement and rewarding that improvement in subsequent years and to help ensure that ACOs with high quality performance on a measure are not penalized as low performers