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Step 2 only applies to assignable beneficiaries who have not had a primary care service rendered by any primary care physician, nurse practitioner, physician assistant, or clinical nurse specialist, either inside the ACO or outside the ACO and were therefore not assigned in assignment Step 1

however, heart failure with reduced ejection fraction also has a regional cause

Some research has looked at indirect redox-balance crosstalk between the two, but if your goal is raising NAD, use a targeted NAD precursor

It is a regulatory boundary

This is because a Herxheimer Reaction is typically due to the endotoxins released in response to the presence of the sprirochetes