Please summarize the paragraph using the information provided and references using your own words

In the case, "Constraints of the ACA on Evidence-Based Medicine" the rules that are proposed by Medicare are laid out, and the laws implemented by the secretary are improvised.The ACA specified the way the evidence obtained would be used and who were eligible for the findings and those who were not. This evidence was limited in use primarily during reimbursements and incentive programs under title XVIII. The constraints also would not include practice guidelines, payments and policy recommendations.There are five grades of recommendations used in evidence-based medicine. "The Secretary may only use evidence and findings from research conducted under section 1181 to make a determination regarding coverage under title XVIII (Medicare) if such use is through an iterative and transparent process which includes public comment and considers the effect on sub-populations" (McLaughlin & McLaughlin, 2014)