,,ii  #aah? ,,congress  #a/ ,session    
,s4 #cdaj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #e1 #bjbc,mrs4
 ,fis*] 7= h]self1 ,mr4 ,te/]1 ,mr4     
,m>%all1 ,mr4 ,lank=d1 ,mr4 ,man*91 ,ms4
 ,s9ema1 ,mr4 ,wick]1 ,ms4 ,coll9s1 &   
,mr4 ,k+7 introduc$ ! foll[+ bill2 :i* 0
 read twice & ref]r$ to ! ,committee on 
,f9ance  ,a ,,bill  ,to prohibit !      
,secret>y ( ,heal? & ,human ,s]vices f  
f9aliz+ a propos$ rule reg>d+ m9imum    
/aff+ = nurs+ facilities1 & to e/abli%  
an advisory panel on ! nurs+ home       
work=ce4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,protect+ ,rural ,s5iors'   
,access to ,c>e ,act4  #b4 ,f9d+s       
,congress makes ! foll[+ f9d+s3 7#a7    
,accord+ to ! ,bureau ( ,labor          
,/ati/ics1 betwe5 ,febru>y #bjbj &      
,augu/ #bjbc1 nurs+ homes 9 ! ,unit$    
,/ates lo/ ne>ly #bjj1jjj employees4    
7#b7 ,=ty-five p]c5t ( nurs+ home       
provid]s h report$ a wors5+ work=ce     
situation s9ce ,may #bjbb4  7#c7        
,n9ety-six p]c5t ( nurs+ home provid]s h

 report$ difficulty 9 hir+ /aff4  7#d7  
,m ?an n9ety p]c5t ( nurs+ home provid]s
 h increas$ wages & bonuses to recruit &
 reta9 /aff4  7#e7 ,ne>ly eighty p]c5t (
 nurs+ home provid]s h hir$ tempor>y    
/aff1 :o are (t5 mu* m exp5sive ?an     
p]man5t /aff4  7#f7 ,! ,c5t]s = ,m$ic>e 
,m$icaid ,s]vices report$ t #abi nurs+  
homes clos$ 9 #bjbb1 ?reat5+ access =   
,am]ica's s5iors1 especially 9 rural    
areas4  7#g7 ,! m9imum /aff+ m&ate 9 !  
propos$ rule entitl$ 8,m$ic>e & ,m$icaid
 ,programs2 ,m9imum ,/aff+ ,/&>ds =     
,long-,t]m ,c>e ,facilities & ,m$icaid  
,in/itutional ,paym5t ,transp>5cy       
,report+0 publi%$ by ! ,dep>tm5t (      
,heal? & ,human ,s]vices on ,septemb]   
#f1 #bjbc 7#hh ,f$4 ,reg4 #faceb-fadbi71
 w result 9 nurs+ home closures1        
displac+ an e/imat$ #dej1jjj nurs+ home 
resid5ts1 h>m+ access to nurs+ home c>e1
 especially 9 rural areas 7z def9$ 9 !  
propos$ rule74  7#h7 ,! m9imum /aff+    
m&ate 9 ! propos$ rule may exac]bate    
work=ce %ortages1 especially 9 rural    

areas 7z def9$ 9 ! rule74  #c4          
,prohibition on f9aliz+ propos$ /aff+   
rule ,! ,secret>y ( ,heal? & ,human     
,s]vices may n implem5t1 en=ce1 or      
o!rwise give effect to ! propos$ rule   
entitl$ ,m$ic>e & ,m$icaid ,programs2   
,m9imum ,/aff+ ,/&>ds = ,long-,t]m ,c>e 
,facilities & ,m$icaid ,in/itutional    
,paym5t ,transp>5cy ,report+ publi%$ by 
! ,dep>tm5t ( ,heal? & ,human ,s]vices  
on ,septemb] #f1 #bjbc 7#hh ,f$4 ,reg4  
#faceb-fadbi71 & may n promulgate any   
sub/antially simil> rule4  #d4 ,advisory
 panel on nurs+ home work=ce  7a7 ,9    
g5]al ,n lat] ?an #fj days aft] ! date (
 ! enactm5t ( ?is section1 ! ,secret>y (
 ,heal? & ,human ,s]vices 79 ?is section
 ref]r$ to z ! ,secret>y7 %all e/abli% !
 ,advisory ,panel on ! ,nurs+ ,home     
,work=ce 79 ?is section ref]r$ to z !   
,panel74  7b7 ,memb]%ip  7#a7 ,numb] &  
appo9tm5t ,! ,panel %all be compos$ (   
#ag memb]s repres5t+ v>i\s geographic   
areas1 appo9t$ by ! ,secret>y z foll[s3 
7,a7 #a repres5tative ( ! ,secret>y1 :o 

%all s]ve z ! *air ( ! ,panel4  7,b7 #b 
regi/]$ nurses :o actively furni%       
s]vices 9 a skill$ nurs+ facility or    
nurs+ facility1 "o ( :om %all repres5t a
 rural area4  7,c7 #b lic5s$ pr(essional
 nurses :o actively furni% s]vices 9 a  
skill$ nurs+ facility or nurs+ facility1
 "o ( :om %all repres5t a rural area4   
7,d7 #b nurse aides :o actively furni%  
s]vices 9 a skill$ nurs+ facility or    
nurs+ facility1 "o ( :om %all repres5t a
 rural area4  7,e7 #b physicians :o     
actively furni% s]vices 9 a skill$ nurs+
 facility or nurs+ facility1 "o ( :om   
%all repres5t a rural area4  7,f7 #a    
repres5tative ( ! ,c5t]s = ,m$ic>e      
,m$icaid ,s]vices4  7,g7 #a             
repres5tative ( ! ,heal? ,res\rces &    
,s]vices ,adm9i/ration4  7,h7 #b        
individuals ) pr(essional exp]tise      
relat$ to ! nurs+ home work=ce1 "o ( :om
 %all h exp]i5ce ) respect to ! nurs+   
home work=ce 9 rural & und]s]v$ areas4  
7,i7 #a lic5s$ adm9i/rator or           
repres5tative ( a rural n-=-pr(it skill$

 nurs+ facility4  7,j7 #a lic5s$        
adm9i/rator or repres5tative ( a rural  
=-pr(it skill$ nurs+ facility4  7,k7 #b 
repres5tatives ( ,/ate bo>ds ( nurs+4   
7#b7 ,tim+ ( appo9tm5ts ,ea* ( !        
appo9tm5ts "u p>agraph 7#a7 %all be made
 n lat] ?an #fj days aft] ! date ( !    
enactm5t ( ?is section4  7#c7 ,t]ms2    
vacancies ,ea* memb] %all be appo9t$ = a
 t]m n to exce$ #b ye>s1 & a vacancy 9 !
 ,panel %all be fill$ 9 ! mann] 9 :i* ! 
orig9al appo9tm5t 0 made4  7#d7 ,quorum 
#ac memb]s ( ! ,panel %all con/itute a  
quorum4  7#e7 ,f$]al ,advisory          
,committee ,act ,*apt] #aj ( title #e1  
,unit$ ,/ates ,code1 %all apply to !    
,panel4  7c7 ,duties  7#a7 ,meet+s  7,a7
 ,frequ5cy ,! ,panel %all meet n lat]   
?an #ahj days aft] ! date on :i* !      
appo9tm5ts describ$ 9 subsection 7b7 are
 made1 & n less frequ5tly ?an twice p]  
ye> !reaft]4  7,b7 ,public access ,!    
,panel %all make available on a public  
website ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices-- 7i7 real-"t virtual access to

 ea* meet+ ( ! ,panel2 &  7ii7 n lat]   
?an #cj days aft] ea* su* meet+1 a      
record+ & transcript ( ! meet+4  7#b7   
,reports  7,a7 ,initial report ,n lat]  
?an #fj days aft] ! initial meet+ ( !   
,panel "u p>agraph 7#a77;,a71 ! ,panel  
%all submit to ! ,secret>y1 ! ,committee
 on ,ways & ,means & ! ,committee on    
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives1 & ! ,committee on      
,f9ance ( ! ,s5ate1 & %all publi% on a  
public website ( ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices1 a report on ! /ate ( 
! nurs+ home work=ce1 :i* %all include--
 7i7 an assessm5t ( ! /ate ( ! nurs+    
home work=ce 9 rural & und]s]v$ areas1  
includ+ an analysis (-- 7,i7 work=ce    
%ortages2 &  7,,ii7 ) respect to        
individuals entitl$ to b5efits "u "p ,a 
( title ,,xviii ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acie et seq47 &    
individuals entitl$ to m$ical assi/ance 
"u title ,,xix ( su* ,act 7#db ,u4,s4,c4
 #acif et seq471 b>ri]s to access to    
skill$ nurs+ facilities & nurs+         

facilities caus$ by su* %ortages2  7ii7 
an analysis ( regulations1              
sub-regulatory guidance1 & guidance to  
,/ate survey ag5cies issu$ by !         
,secret>y ) respect to skill$ nurs+     
facilities & nurs+ facilities1 & !      
effects ( su* regulations & guidance on 
! nurs+ home work=ce2  7iii7            
recomm5dations = ! ,secret>y to /r5g!n !
 nurs+ home work=ce1 includ+            
recomm5dations = decreas+ regulatory    
burd5s = skill$ nurs+ facilities & nurs+
 facilities & mak+ f9ancial inve/m5ts 9 
tra9+ = heal? pr(essionals2 &  7iv7 o!r 
in=mation z ! ,panel det]m9es necess>y4 
7,b7 ,subsequ5t reports ,n lat] ?an #a  
ye> aft] submitt+ ! initial report "u   
subp>agraph 7,a71 & annually !reaft]1 ! 
,panel %all submit & publi% an updat$   
report 9 ! same mann] z requir$ "u su*  
subp>agraph4  7d7 ,def9itions ,9 ?is    
section1 ! foll[+ def9itions apply3 7#a7
 ,nurs+ facility ,! t]m nurs+ facility  
has ! mean+ giv5 su* t]m 9 section      
#aiai7;a7 ( ! ,social ,security ,act    

7#db ,u4,s4,c4 #acifr7a774  7#b7 ,nurs+ 
home work=ce ,! t]m nurs+ home work=ce  
means ! work=ce ( heal? pr(essionals t  
provide direct resid5t c>e 9 skill$     
nurs+ facilities & nurs+ facilities4    
7#c7 ,rural area ,! t]m rural area means
 any area outside a metropolitan        
/ati/ical area4  7#d7 ,skill$ nurs+     
facility ,! t]m skill$ nurs+ facility   
has ! mean+ giv5 su* t]m 9 section      
#ahai7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;i-#c7;a774  7#e7   
,und]s]v$ area ,! t]m und]s]v$ area     
means an area t is-- 7,a7 a heal?       
pr(essional %ortage area1 z su* t]m is  
def9$ 9 section #ccb7;a77#a77;,a7 ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bed;e7a77#a77;,a772 or  7,b7 
designat$ z a m$ically und]s]v$ area    
pursuant to section #ccj7;b77#c77;,a7 ( 
su* ,act 7#db ,u4,s4,c4                 
#bed;b7b77#c77;,a774