II 116th CONGRESS 1st Session S. 2648 IN THE SENATE OF THE UNITED STATES October 21, 2019 Ms. Cortez Masto (for herself and Mr. Roberts ) introduced the following bill; 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 Program.

1. Short title This Act may be cited as the Rural ACO Improvement Act . 2. 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 1899(i)(3) of the Social Security Act ( 42 U.S.C. 1395jjj(i)(3) ) is amended— (1) in subparagraph (A), by striking subparagraph (B) and inserting subparagraphs (B) and (C) ; and (2) by adding at the end the following new subparagraph: (C) Exclusion of assigned beneficiaries in certain circumstances including determination of regional adjustments For performance periods beginning on or after July 1, 2019, in determining any shared savings for any ACO under a model described in this paragraph, the Secretary shall— (i) remove Medicare fee-for-service beneficiaries who are assigned to that ACO from the methodology for calculating regional expenditures used to establish, update, and adjust the benchmark expenditures; and (ii) 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 ACOs. .