,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ebab  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #ba1         
#bjai,mr4 ,arr+ton 7= himself1 ,ms4     
,del,bene1 ,mr4 ,m>%all1 & ,mr4 ,b]a7   
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to improve !     
b5*m>k+ process = ! ,m$ic>e ,%>$ ,sav+s 
,program4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,acc\ntable ,c>e 9 ,rural  
,am]ica ,act4  #b4 ,exclusion ( ,m$ic>e 
fee-=-s]vice b5efici>ies assign$ to an  
,,aco f aspects ( o!r paym5t models 9   
c]ta9 circum/ances includ+ det]m9ation (
 regional adju/m5ts ,section            
#ahii7;i77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;jjj7i77#c77 is    
am5d$--  7#a7 9 subp>agraph 7,a71 by    

/rik+ subp>agraph 7,b7 & ins]t+         
subp>agraphs 7,b7 & 7,c72 &  7#b7 by    
add+ at ! end ! foll[+ new subp>agraph3 
7,c7 ,exclusion ( assign$ b5efici>ies 9 
c]ta9 circum/ances includ+ det]m9ation (
 regional adju/m5ts ,= p]=mance p]iods  
beg9n+ on or aft] ! date ( ! enactm5t ( 
?is subp>agraph1 9 det]m9+ any %>$ sav+s
 = any ,,aco "u a model describ$ 9 ?is  
p>agraph1 ! ,secret>y %all--  7i7 remove
 ,m$ic>e fee-=-s]vice b5efici>ies :o are
 assign$ to t ,,aco f ! me?odology =    
calculat+ regional exp5ditures us$ to   
e/abli%1 update1 & adju/ ! b5*m>k       
exp5ditures2 &  7ii7 o!rwise ensure t no
 su* ,,aco is 9 a less favorable        
f9ancial position due to diff]5ces      
betwe5 ! %>e ( ,m$ic>e fee-=-s]vice     
b5efici>ies assign$ to ! ,,aco ( all su*
 b5efici>ies 9 ! c\nties an ,,aco       
op]ates 9 comp>$ to ! %>e ( su*         
b5efici>ies assign$ to o!r ,a,c,os4  4