,,ii  #aafth ,,congress  #b;d ,session  
,s4 #cdcg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,march #aa1    
#bjbj,mrs4 ,loeffler 7for herself and   
,ms4 ,smith7 introduced the following   
bill2 which was read twice and referred 
to the ,committee on ,health1           
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to reauthorize certain programs
 regarding rural health care4  #a4      
,short title ,this ,act may be cited as 
the ,improving ,care in ,rural ,america 
,reauthorization ,act of #bjbj4  #b4    
,rural health care services outreach1   
rural health network development1 and   
small health care provider quality      
improvement grant programs ,section     
#ccj;,a of the ,public ,health ,service 
,act 7#db ,u4,s4,c4 #bed;c7 is amended--
 7#a7 in subsection 7d77#b7-- 7,a7 in   
subparagraph 7,a71 by striking essential
 and inserting basic2 and  7,b7 in      
subparagraph 7,b7-- 7i7 in the matter   
preceding clause 7i71 by inserting to   
after grants2 and  7ii7 in clauses 7i71 

7ii71 and 7iii71 by striking to each    
place such term appears2  7#b7 in       
subsection 7e7-- 7,a7 in paragraph      
7#a7-- 7i7 by inserting improving and   
after outreach by2  7ii7 by inserting 1 
through community engagement and        
evidence-based or innovative1           
evidence-informed models before the     
period of the first sentence2 and  7iii7
 by striking #c years and inserting #e  
years2 and  7,b7 in paragraph 7#b7-- 7i7
 in the matter preceding subparagraph   
7,a71 by inserting shall after entity2  
7ii7 in subparagraph 7,a71 by striking  
shall be a rural public or rural        
nonprofit private entity and inserting  
be an entity proposing to serve rural   
underserved populations2  7iii7 in      
subparagraphs 7,b7 and 7,c71 by striking
 shall each place such term appears2 and
  7iv7 in subparagraph 7,b7-- 7,i7 in   
the matter preceding clause 7i71 by     
inserting that after members2 and       
7,,ii7 in clauses 7i7 and 7ii71 by      
striking that each place such term      

appears2  7#c7 in subsection 7f7-- 7,a7 
in paragraph 7#a7-- 7i7 in subparagraph 
7,a7-- 7,i7 in the matter preceding     
clause 7i71 by striking promote1 through
 planning and implementation1 the       
development of integrated health care   
networks that have combined the         
functions of the entities participating 
in the networks and inserting plan and  
implement integrated health care        
networks that collaborate2 and  7,,ii7  
in clause 7ii71 by striking essential   
health care services and inserting basic
 health care services and associated    
health outcomes2 and  7ii7 by amending  
subparagraph 7,b7 to read as follows3   
7,b7 ,grant periods ,the ,director may  
award grants under this subsection for  
periods of not more than #e years4  2   
and  7,b7 in paragraph 7#b7-- 7i7 in the
 matter preceding subparagraph 7,a71 by 
inserting shall after entity2  7ii7 in  
subparagraph 7,a71 by striking shall be 
a rural public or rural nonprofit       
private entity and inserting be an      

entity proposing to serve rural         
underserved populations2  7iii7 in      
subparagraph 7,b7-- 7,i7 in the matter  
preceding clause 7i7-- 7aa7 by striking 
shall2 and  7bb7 by inserting that after
 participants2 and  7,,ii7 in clauses   
7i7 and 7ii71 by striking that each     
place such term appears2 and  7iv7 in   
subparagraph 7,c71 by striking shall2   
7#d7 in subsection 7g7-- 7,a7 in        
paragraph 7#a7-- 7i7 by inserting 1     
including activities related to         
increasing care coordination1 enhancing 
chronic disease management1 and         
improving patient health outcomes before
 the period of the first sentence2 and  
7ii7 by striking #c years and inserting 
#e years2 and  7,b7 in paragraph 7#b7-- 
7i7 in the matter preceding subparagraph
 7,a71 by inserting shall after entity2 
7ii7 in subparagraphs 7,a7 and 7,b71 by 
striking shall each place such term     
appears2 and  7iii7 in subparagraph     
7,a77ii71 by inserting or regional after
 local2  7#e7 in subsection 7h77#c71 in 

the matter preceding subparagraph 7,a71 
by inserting 1 as appropriate1 after the
 ,secretary2  7#f7 by amending          
subsection 7i7 to read as follows3  7i7 
,report ,not later than #d years after  
the date of enactment of the ,improving 
,care in ,rural ,america                
,reauthorization ,act of #bjbj1 and     
every #e years thereafter1 the          
,secretary shall prepare and submit to  
the ,committee on ,health1 ,education1  
,labor1 and ,pensions of the ,senate and
 the ,committee on ,energy and ,commerce
 of the ,house of ,representatives a    
report on the activities and outcomes of
 the grant programs under subsections   
7e71 7f71 and 7g71 including the impact 
of projects funded under such programs  
on the health status of rural residents 
with chronic conditions4  2 and  7#g7 in
 subsection 7j71 by striking #de1jjj1jjj
 for each of fiscal years #bjjh through 
#bjab and inserting #gi1ejj1jjj for each
 of fiscal years #bjba through #bjbe4