,,ii  #aafth ,,congress  #ast ,session  
,s4 #bfdh  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,october #ba1  
#bjai ,ms4 ,cortez ,masto 7for herself  
and ,mr4 ,roberts7 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 benchmarking process for the        
,medicare ,shared ,savings ,program4    
#a4 ,short title ,this ,act may be cited
 as the ,rural ,,aco ,improvement ,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 ,july #a1 
#bjai1 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