,,ii  #aafth ,,congress  #ast ,session  
,s4 #bijb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #bj1 
#bjai,ms4 ,smith 7for herself and ,mr4  
,barrasso7 introduced the following     
bill2 which was read twice and referred 
to the ,committee on ,health1           
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to enhance the rural health    
workforce1 and for other purposes4  #a4 
,short title ,this ,act may be cited as 
the ,strengthening ,our ,rural ,health  
,workforce ,act of #bjai4  ,i           
,supporting primary care workforce      
#aja4 ,reauthorization of primary care  
training and enhancement program        
,section #gdg of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #bick7 is  
amended-- 7#a7 in subsection 7a71 by    
adding at the end the following3  7#c7  
,priorities in making awards  7,a7 ,in  
general ,in awarding grants or contracts
 under paragraph 7#a71 the ,secretary   
shall give priority to qualified        
applicants that train residents in rural

 and ,tribal training locations for     
equal to or greater than #ej percent of 
training time4  7,b7 ,rural training    
location ,in this paragraph1 the term   
rural training location means a location
 in which training occurs that1 based on
 the #bjaj census or any subsequent     
census adjustment1 meets one or more of 
the following criteria3  7i7 ,the       
training occurs in a location that is a 
rural area 7as defined in section       
#ahhf7;d77#b77;,d7 of the ,social       
,security ,act74  7ii7 ,the training    
occurs on an ,indian reservation1 public
 domain ,indian allotment1 former       
,indian reservation in ,oklahoma1 or    
land held by an incorporated ,native    
group1 regional corporation1 or village 
corporation under the provisions of the 
,alaska ,native ,claims ,settlement     
,act4  7iii7 ,the training occurs in a  
location that has a rural-urban         
commuting area code equal to or greater 
than #d4j4  7iv7 ,the training occurs in
 a location that is within #aj miles of 

a sole community hospital 7as defined in
 subsection 7d77#e77;,d77iii774  2 and  
7#b7 in subsection 7c7-- 7,a7 in        
paragraph 7#a71 by striking #abe1jjj1jjj
 and all that follows through the period
 at the end and inserting #abe1jjj1jjj  
for fiscal year #bjbj1 and such sums as 
may be necessary for each of fiscal     
years #bjba through #bjbd42 and  7,b7 in
 paragraph 7#c71 by striking #bjaj      
through #bjad and inserting #bjbj       
through #bjbd4  #ajb4 ,reauthorization  
of area health education centers        
,section #gea7;j77#a7 of the ,public    
,health ,service ,act 7#db ,u4,s4,c4    
#bid;a7j77#a77 is amended by striking   
#abe1jjj1jjj for each of the fiscal     
years #bjaj through #bjad and inserting 
#abe1jjj1jjj for each of fiscal years   
#bjbj through #bjbd4  ,,ii ,rural       
,health ,care ,workforce ,commission    
#bja4 ,rural ,health ,care ,workforce   
,commission  7a7 ,purpose ,it is the    
purpose of this section to establish a  
,national ,rural ,health ,care          

,workforce ,commission that develops    
short- and long-term solutions to       
address the systemic workforce shortages
 in rural and frontier localities1 and--
  7#a7 communicates and coordinates with
 the ,department of ,health and ,human  
,services 7including the ,indian ,health
 ,service71 the ,department of          
,agriculture1 the ,department of ,labor1
 ,the ,department of ,veterans ,affairs1
 the ,department of ,homeland ,security1
 the ,department of ,education1 the     
,department of the ,interior1 and any   
,federal advisory committees determined 
appropriate by the ,secretary of ,health
 and ,human ,services1 on related       
activities administered by one or more  
of such ,departments and committees2    
7#b7 develops and commissions           
evaluations of education and training   
activities needed to address shortages  
in geographically diverse rural and     
,indian ,tribal communities2  7#c7      
identifies legislative1 administrative1 
and other barriers to addressing        

shortages and improving coordination at 
the ,federal1 ,state1 ,tribal1 and local
 levels and recommend ways to address   
such barriers2  7#d7 encourages the     
development and implementation of       
strategies to address rural1 ,tribal1   
and frontier population needs2 and  7#e7
 identifies innovative models used to   
improve access to and quality of care in
 underserved rural areas with shortages4
  7b7 ,establishment ,there is hereby   
established the ,national ,workforce    
,commission on ,rural and ,frontier     
,health ,care 7referred to in this      
section as the ,commission74  7c7       
,membership  7#a7 ,number and           
appointment ,the ,commission shall be   
composed of not less than #i members to 
be appointed by the ,comptroller        
,general1 without regard to section #e  
of the ,federal ,advisory ,committee    
,act 7#e ,u4,s4,c4 ,app471 and shall    
consult with the ,administrator of the  
,health ,resources and ,services        
,administration 7referred to in this    

section as the ,administrator74  7#b7   
,qualifications  7,a7 ,in general ,the  
membership of the ,commission shall     
include a diverse composite of          
individuals-- 7i7 who are--  7,i7       
leaders of rural1 ,tribal1 and frontier 
health care workforce education or      
training programs or rural training     
tracks2  7,,ii7 nationally recognized   
for their expertise in-- 7aa7 rural1    
,tribal1 or frontier health care labor  
market analysis2  7bb7 rural1 ,tribal1  
or frontier health care facility        
management2  7cc7 rural health          
integrated delivery systems2  7dd7      
providing rural1 ,tribal1 and frontier  
health care services2  7ee7 rural1      
,tribal1 and frontier health care needs1
 trends1 and disparities2  7ff7 rural1  
,tribal1 and frontier behavioral health2
 or  7gg7 rural1 ,tribal1 and frontier  
health workforce shortages2  7,,iii7    
rural health workforce recruitment and  
retention experts2 and  7,,iv7 relevant 
professional association members2 and   

7ii7 who will provide a combination of  
professional perspectives1 and broad    
geographic representation of rural and  
frontier communities4  7,b7 ,ethical    
disclosure ,the ,administrator shall    
establish a system for public disclosure
 by the ,commission of financial and    
other potential conflicts of interest   
relating to the members of the          
,commission4 ,such members shall be     
treated as employees of ,congress for   
purposes of applying title ,i of the    
,ethics in ,government ,act of #aigh4   
,such members shall not be treated as   
special government employees under title
 #ah1 ,united ,states ,code4  7#c7      
,terms  7,a7 ,in general ,the terms of  
members of the ,commission shall be for 
#c years except that the ,comptroller   
,general shall designate staggered terms
 for the members first appointed4  7,b7 
,vacancies ,any member appointed to fill
 a vacancy occurring before the         
expiration of the term for which the    
member's predecessor was appointed shall

 be appointed only for the remainder of 
that term4 ,a member may serve after the
 expiration of that member's term until 
a successor has taken office4  7#d7     
,compensation ,while serving on the     
business of the ,commission 7including  
travel time71 a member of the           
,commission shall be entitled to        
compensation at the per diem equivalent 
of the rate provided for level ,,iv of  
the ,executive ,schedule under section  
#ecae of title #e1 ,united ,states      
,code1 and while so serving away from   
home and the member's regular place of  
business1 a member may be allowed travel
 expenses1 as authorized by the         
,chairman of the ,commission4  7#e7     
,chairman1 vice chairman ,the           
,comptroller ,general shall designate a 
member of the ,commission1 at the time  
of appointment of the member1 as        
,chairman and a member as ,vice         
,chairman for that term of appointment1 
except that in the case of vacancy of   
the chairmanship or vice chairmanship1  

the ,comptroller ,general may designate 
another member for the remainder of that
 member's term4  7#f7 ,meetings ,the    
,commission shall meet at the call of   
the chairman1 but no less frequently    
than on a biannual basis4  7d7 ,duties  
7#a7 ,identify needs and barriers ,the  
,commission shall-- 7,a7 identify       
administrative1 regulatory1 and         
statutory barriers that prevent maximum 
utilization of current rural and ,tribal
 health workforce programs with a       
special focus on ,tribal and frontier   
workforce programs2 and  7,b7 identify  
population health needs and trends1     
health disparities1 and minority        
population health needs in rural1       
,tribal1 and frontier localities4  7#b7 
,recommend solutions to barriers ,the   
,commission shall-- 7,a7 recognize the  
efforts of ,federal1 ,state1 ,tribal1   
and local partnerships to support       
careers in the provision of health care 
services in rural areas2  7,b7 explore  
and report on nontraditional care       

settings and delivery of care2  7,c7    
disseminate information to rural health 
care administrators on promising        
retention practices for rural1 ,tribal1 
and frontier health care professionals2 
and  7,d7 recommend solutions to        
,federal administrative1 regulatory1 and
 statutory barriers that impact the     
recruitment1 education and training1 and
 retention of the rural1 ,tribal1 and   
frontier health care workforce4  7#c7   
,specific topics to be reviewed ,in     
carrying out this subsection1 the       
,commission shall review-- 7,a7 current 
rural1 ,tribal1 and frontier health care
 workforce supply and distribution1     
including demographics1 skill sets1     
public health expertise1 and demands1   
with projected demands during the       
subsequent #aj- and #be-year periods2   
7,b7 rural1 ,tribal1 and frontier health
 care workforce education and training  
capacity1 including the-- 7i7 number of 
students who have completed education   
and training1 including registered      

apprenticeships2  7ii7 number of        
qualified faculty2  7iii7 the education 
and training infrastructure2 and  7iv7  
the education and training demands1 with
 projected demands during the subsequent
 #aj- and #be-year periods2  7,c7 the   
impact of the rural and ,tribal hospital
 and rural hospital unit closures on    
rural1 ,tribal1 and frontier            
communities2  7,d7 the ,national ,health
 ,service ,corps under subpart ,,ii of  
part ,d of title ,,iii of the ,public   
,health ,service ,act 7#db ,u4,s4,c4    
#bed;d et seq471 the ,state ,loan       
,repayment ,program under section       
#cch;,i of the ,public ,health ,service 
,act 7#db ,u4,s4,c4 #bedq-#a71 the      
education loan1 scholarship1 and grant  
programs under titles ,,vii and ,,viii  
of the ,public ,health ,service ,act    
7#db ,u4,s4,c4 #bib et seq4 and #bif et 
seq471 as well as public service loan   
forgiveness programs administered by the
 ,department of ,education2 and  7,e7   
the impact of care delivery models1 some

 of which include the use of technology1
 community health workers1 and          
non-traditional partners that leverage  
team-based care to improve outcomes and 
address health care costs4  7#d7 ,high  
priority areas ,in carrying out this    
subsection1 high priority should be     
given to-- 7,a7 the education1          
development1 recruitment and retention  
of individuals--  7i7 to fill primary   
care shortages of all levels of         
licensure2  7ii7 to undertake rural and 
,tribal physician training tracks and   
programs2  7iii7 to fill obstetric      
services shortages2  7iv7 to address    
oral health care workforce capacity at  
all levels2  7v7 to address behavioral  
health care workforce capacity at all   
levels2  7vi7 to address addiction      
medicine workforce shortages2  7vii7 to 
fill the emergency medical service      
workforce2  7viii7 to address the       
workforce needs of an aging population2 
and  7ix7 to serve as telehealth        
providers2 and  7,b7 the development of 

new rural and ,tribal workforce and     
delivery models to better meet changing 
needs of rural communities4  7#e7       
,recommendations ,the ,commission shall 
submit recommendations to the ,committee
 on ,health1 ,education1 ,labor1 and    
,pensions of the ,senate and the        
,committee on ,energy and ,commerce of  
the ,house of ,representatives1 and     
appropriate departments of the          
,administration4  7#f7 ,consult and     
obtaining data ,the ,commission shall   
consult with and obtain necessary data  
from all relevant ,federal agencies     
7including the ,department of ,health   
and ,human ,services1 the ,department of
 ,agriculture1 the ,department of       
,labor1 ,the ,department of ,veterans   
,affairs1 the ,department of ,homeland  
,security1 the ,department of           
,education1 and the ,department of the  
,interior71 ,congress1 the ,medicare    
,payment ,advisory ,commission1 the     
,medicaid and ,,chip ,payment and       
,access ,commission1 and1 to the extent 

practicable1 ,state and local agencies1 
voluntary health care organizations1    
professional societies1 and other       
relevant public-private health care     
partnerships4  7#g7 ,detail of federal  
government employees ,an employee of the
 ,federal ,government may be detailed to
 the ,commission without reimbursement4 
,the detail of such an employee shall be
 without interruption or loss of civil  
service status4  7#h7 ,data collection  
,in order to carry out its functions    
under this section1 the ,commission     
shall-- 7,a7 utilize existing           
information1 both published and         
unpublished1 where possible1 including  
in coordination with the ,bureau of     
,labor ,statistics2  7,b7 carry out1 or 
award grants or contracts for the       
carrying out of1 original research and  
development1 where existing information 
is inadequate1 and  7,c7 adopt          
procedures allowing interested parties  
to submit information for the           
,commission's use in making reports and 

recommendations4  7e7 ,state health care
 workforce development grants  7#a7     
,establishment ,the ,secretary of       
,health and ,human ,services 7referred  
to in this subsection as the            
,secretary71 acting through the         
,administrator of the ,health ,resources
 and ,services ,administration1 shall   
establish a competitive health care     
workforce development grant program     
7referred to in this subsection as the  
program7 to award grants to accomplish  
the objectives described in paragraph   
7#d74  7#b7 ,eligibility ,the           
,secretary1 acting through the          
,administrator of the ,federal ,office  
of ,rural ,health ,policy1 shall        
determine eligibility criteria for      
grants under this subsection4  7#c7     
,fiscal and administrative agent ,the   
,health ,resources and ,services        
,administration of the ,department of   
,health and ,human ,services shall be   
the fiscal and administrative agent for 
grants awarded under this subsection4   

,such ,administration is authorized to  
carry out the program1 in consultation  
with the ,commission1 which shall review
 reports on the development1            
implementation1 and evaluation          
activities under the grant program1     
including--  7,a7 administering the     
grants2  7,b7 providing technical       
assistance to grantees2 and  7,c7       
reporting performance information to the
 ,commission4  7#d7 ,grants ,the        
,secretary1 acting through the          
,administrator of ,rural ,health        
,policy1 shall award grants under the   
program for a period to be determined by
 the ,secretary--  7,a7 to enable       
grantees to develop a comprehensive plan
 to address workforce shortages in rural
 areas2  7,b7 to implement the          
recommendations of the ,commission2     
7,c7 to carry out activities leading to 
comprehensive rural and ,tribal health  
care workforce development strategies1  
including public health workforce       
development1 at the ,state and local    

levels2 and  7,d7 in a manner that      
ensures such grants supplement rather   
than supplant the efforts of grantees to
 address rural health workforce         
challenges4  7f7 ,authorization of      
appropriations  7#a7 ,authorization     
,there are authorized to be appropriated
 such sums as may be necessary to carry 
out this section4  7#b7 ,set aside ,the 
,secretary shall set aside #e percent of
 amounts appropriated under this        
subsection for direct grants to ,indian 
,tribes 7as such term is defined in     
section #d of the ,indian ,health ,care 
,improvement ,act 7#be ,u4,s4,c4 #afjc77
 and ,tribal organizations 7as such term
 is defined in section #d of the ,indian
 ,self-,determination and ,education    
,assistance ,act 7#be ,u4,s4,c4         
#dej;b774  7#c7 ,gifts and services ,the
 ,commission may not accept gifts1      
bequeaths1 or donations of property1 but
 may accept and use donations of        
services for purposes of carrying out   
this section4  7g7 ,definitions  7#a7   

,health care workforce ,in this section1
 the term health care workforce has the 
meaning given such term in section      
#eaja7;i77#a7 of the ,patient           
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #bidq74  7#b7 ,tribal ,in
 this section1 the term ,tribal has the 
same meaning given such term in section 
#d of the ,indian ,health ,care         
,improvement ,act 7#be ,u4,s4,c4 #afjc74