‘‘(f) RESERVATION OF STATE POWERS.—Nothing in 
this section shall be construed to limit the power of a 
State, including the power of a State to pursue civil and 
criminal penalties under State law against any individual 
or entity that misuses, or engages in fraud or abuse re-
lated to, the funds provided to a State under this title. 
‘‘SEC. 2204. NONDISCRIMINATION PROVISIONS. 
‘‘(a) NO DISCRIMINATION AGAINST INDIVIDUALS.— 
No individual shall be excluded from participation in, de-
nied the benefits of, or subjected to discrimination under, 
any program or activity funded in whole or in part with 
amounts paid to a State under this title on the basis of 
such individual’s— 
‘‘(1) disability under section 504 of the Reha-
bilitation Act of 1973 (29 U.S.C. 794); 
‘‘(2) sex under title IX of the Education 
Amendments of 1972 (20 U.S.C. 1681 et seq.); or 
‘‘(3) race, color, or national origin under title 
VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d 
et seq.). 
‘‘(b) COMPLIANCE.— 
‘‘(1) If the Secretary of the Treasury deter-
mines that a State or an entity that has received 
funds from amounts paid to a State under a grant 
under this title has failed to comply with a provision 
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of law referred to in subsection (a), the Secretary of 
the Treasury shall notify the chief executive officer 
of the State of such failure to comply and shall re-
quest that such chief executive officer secure such 
compliance. 
‘‘(2) If, not later than 60 days after receiving 
notification under paragraph (1), the chief executive 
officer of a State fails or refuses to secure compli-
ance with the provision of law referred to in such 
notification, the Secretary of the Treasury may— 
‘‘(A) refer the matter to the Attorney Gen-
eral with a recommendation that an appropriate 
civil action be instituted; or 
‘‘(B) exercise the powers and functions 
provided under section 505 of the Rehabilita-
tion Act of 1973 (29 U.S.C. 794a), title IX of 
the Education Amendments of 1972 (20 U.S.C. 
1681 et seq.), or title VI of the Civil Rights Act 
of 1964 (42 U.S.C. 2000d et seq.) (as applica-
ble). 
‘‘(c) CIVIL ACTIONS.—If a matter is referred to the 
Attorney General under subsection (b)(2)(A), or the At-
torney General has reason to believe that a State or entity 
has failed to comply with a provision of law referred to 
in subsection (a), the Attorney General may bring a civil 
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action in an appropriate district court of the United States 
for such relief as may be appropriate, including injunctive 
relief. 
‘‘SEC. 2205. EMERGENCY ASSISTANCE. 
‘‘(a) IN GENERAL.—A State that receives a grant 
under this title for a fiscal year shall provide payment for 
health-care-related items and services provided to a cit-
izen, legal resident, or an alien who is not lawfully admit-
ted for permanent residence or otherwise permanently re-
siding in the United States under color of law, consistent 
with the requirements of section 1867, if— 
‘‘(1) such health-care-related items and services 
are— 
‘‘(A) necessary for the treatment of an 
emergency medical condition; and 
‘‘(B) health-care-related items and services 
that such State would provide payment for 
under this title, if provided to an indigent indi-
vidual; 
‘‘(2) the individual meets all necessary eligi-
bility requirements for health-care-related items and 
services under the State program funded under this 
title, except for any requirement related to immigra-
tion status; and 
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‘‘(3) such items and services are not related to 
an organ transplant procedure. 
‘‘(b) EMERGENCY MEDICAL CONDITION.—For pur-
poses of this section, the term ‘emergency medical condi-
tion’ means a medical condition (including emergency 
labor and delivery) manifesting itself by acute symptoms 
of sufficient severity (including severe pain) such that the 
absence of immediate medical attention could reasonably 
be expected to result in— 
‘‘(1) placing the patient’s health in serious jeop-
ardy; 
‘‘(2) serious impairment to bodily functions; or 
‘‘(3) serious dysfunction of any bodily organ or 
part. 
‘‘SEC. 2206. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) HEALTH-CARE-RELATED ITEMS AND SERV-
ICES.—The term ‘health-care-related items and serv-
ices’ shall be defined by a State with respect to use 
of such term for purposes of the application of this 
title to the State. 
‘‘(2) HIGH-RISK POPULATION.—The term ‘high- 
risk population’ means individuals who are described 
in one of the following subparagraphs: 
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‘‘(A) Individuals who, by reason of the ex-
istence or history of a medical condition, are 
able to acquire health coverage only at rates 
which are at least 150 percent of the standard 
risk rates for such coverage. 
‘‘(B) Individuals who are provided health 
coverage by a qualified high risk pool. 
‘‘(3) INDIGENT INDIVIDUAL.—The term ‘indi-
gent individual’ shall be defined by a State with re-
spect to use of such term for purposes of the appli-
cation of this title to the State. 
‘‘(4) QUALIFIED HIGH RISK POOL.—The term 
‘qualified high risk pool’ has the meaning given such 
term in section 2745(g)(1)(A) of the Public Health 
Service Act. 
‘‘(5) 
RISK-ADJUSTMENT
MECHANISM
DE-
FINED.—For purposes of this section, the term 
‘risk-adjustment mechanism’ means any risk-spread-
ing mechanism to subsidize the purchase of private 
health insurance for the high-risk population, includ-
ing a qualified high risk pool.’’. 
(b) REPORT ON REDUCTION OF FEDERAL ADMINIS-
TRATIVE EXPENDITURES.—Beginning not later than Oc-
tober 31, 2014, and annually thereafter until October 31, 
2023, the Secretary of Health and Human Services, in 
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