,,ii  #aadth ,,congress  #ast ,session  
,s4 #adef  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #bb1 #bjae
 ,ms4 ,cantwell 7for herself1 ,mr4      
,thune1 and ,mrs4 ,murray7 introduced   
the following bill2 which was read twice
 and referred to the ,committee on      
,finance  ,a ,,bill  ,to amend title    
,,xviii of the ,social ,security ,act to
 improve the way beneficiaries are      
assigned under the ,medicare shared     
savings program by also basing such     
assignment on primary care services     
furnished by ,federally qualified health
 centers1 rural health clinics1 nurse   
practitioners1 physician assistants1 and
 clinical nurse specialists4  #a4 ,short
 title  ,this ,act may be cited as the  
,rural ,,aco ,improvement ,act of #bjae4
  #b4 ,improvements to the assignment of
 beneficiaries under the ,medicare      
shared savings program ,section         
#ahii7;c7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;jjj7c77 is         
amended-- 7#a7 by striking utilization  

of primary and inserting 8utilization   
of--  7#a7 in the case of performance   
years beginning on or after ,april #a1  
#bjab1 primary  2  7#b7 in paragraph    
7#a71 as added by paragraph 7#a7 of this
 section1 by striking the period at the 
end and inserting a semicolon2 and  7#c7
 by adding at the end the following new 
paragraphs3  7#b7 in the case of        
performance years beginning on or after 
,january #a1 #bjaf1 primary care        
services provided under this title by an
 ,,aco professional described in        
subsection 7h77#a77;,b72 and  7#c7 in   
the case of performance years beginning 
on or after ,january #a1 #bjaf1 primary 
care services provided under this title 
by a ,federally qualified health center 
or rural health clinic 7as those terms  
are defined in section #ahfa7;aa771 as  
determined by the ,secretary4  4