,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bfdh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,octob] #ba1 #bjai ,ms4
 ,cortez ,ma/o 7= h]self & ,mr4 ,rob]ts7
 introduc$ ! foll[+ bill2 :i* 0 read    
twice & ref]r$ to ! ,committee on       
,f9ance  ,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 ! ,rural ,,aco  
,improvem5t ,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] ,july 
#a1 #bjai1 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