,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #ebab  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ba1       
#bjai,mr4 ,arrington 7for himself1 ,ms4 
,del,bene1 ,mr4 ,marshall1 and ,mr4     
,bera7 introduced the following bill2   
which was referred to the ,committee on 
,ways and ,means1 and in addition to the
 ,committee on ,energy and ,commerce1   
for a period to be subsequently         
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
amend title ,,xviii of the ,social      
,security ,act to improve the           
benchmarking process for the ,medicare  
,shared ,savings ,program4  #a4 ,short  
title ,this ,act may be cited as the    
,accountable ,care in ,rural ,america   
,act4  #b4 ,exclusion of ,medicare      
fee-for-service beneficiaries assigned  
to an ,,aco from aspects of other       
payment models in certain circumstances 
including determination of regional     

adjustments ,section #ahii7;i77#c7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;jjj7i77#c77 is amended--
  7#a7 in subparagraph 7,a71 by striking
 subparagraph 7,b7 and inserting        
subparagraphs 7,b7 and 7,c72 and  7#b7  
by adding at the end the following new  
subparagraph3  7,c7 ,exclusion of       
assigned beneficiaries in certain       
circumstances including determination of
 regional adjustments ,for performance  
periods beginning on or after the date  
of the enactment of this subparagraph1  
in determining any shared savings for   
any ,,aco under a model described in    
this paragraph1 the ,secretary shall--  
7i7 remove ,medicare fee-for-service    
beneficiaries who are assigned to that  
,,aco from the methodology for          
calculating regional expenditures used  
to establish1 update1 and adjust the    
benchmark expenditures2 and  7ii7       
otherwise ensure that no such ,,aco is  
in a less favorable financial position  
due to differences between the share of 

,medicare fee-for-service beneficiaries 
assigned to the ,,aco of all such       
beneficiaries in the counties an ,,aco  
operates in compared to the share of    
such beneficiaries assigned to other    
,a,c,os4  4