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PROBLEM: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Community-Based Health Care
Retraining Act''.

SEC. 2. HEALTH PROFESSIONS TRAINING DEMONSTRATION PROJECT.

Section 171 of the Workforce Investment Act of 1998 (29 U.S.C.
2916) is amended by adding at the end the following:
''(e) Health Professions Training Demonstration Project.--
''(1) Definitions.--In this subsection:
''(A) Covered community.--The term 'covered
community' means a community or region that--
''(i) has experienced a significant
percentage decline in positions in the
manufacturing or service sectors; and
''(ii) is determined by the Secretary of
Health and Human Services (in consultation with
the medical community) to be an area with a
shortage of health care professionals described
in clause (i) or (ii) of subparagraph (C).
''(B) Covered worker.--The term 'covered worker'
means an individual who--
''(i)(I) has been terminated or laid off,
or who has received a notice of termination or
layoff, from employment in a manufacturing or
service sector;
''(II)(aa) is eligible for or has exhausted
entitlement to unemployment compensation; or
''(bb) has been employed for a duration
sufficient to demonstrate, to the appropriate
entity at a one-stop center referred to in
section 134(c), attachment to the workforce,
but is not eligible for unemployment
compensation due to insufficient earnings or
having performed services for an employer that
were not covered under a State unemployment
compensation law; and
''(III) is unlikely to return to a previous
industry or occupation; or
''(ii)(I) has been terminated or laid off,
or has received a notice of termination or
layoff, from employment in a manufacturing or
service sector as a result of any permanent
closure of, or any substantial layoff at, a
plant, facility, or enterprise; or
''(II) is employed in a manufacturing or
service sector at a facility at which the
employer has made a general announcement that
such facility will close within 180 days.
''(C) Health care professional.--The term 'health
care professional'--
''(i) means an individual who is involved
with--
''(I) the delivery of health care
services, or related services,
pertaining to--
''(aa) the identification,
evaluation, and prevention of
diseases, disorders, or
injuries; or
''(bb) home-based or
community-based long-term care;
''(II) the delivery of dietary and
nutrition services; or
''(III) rehabilitation and health
systems management; and
''(ii) with respect to a covered community
to be served through a grant made under
paragraph (3), includes individuals in health
care professions and jobs for which there is a
shortage in the community, as determined by the
Secretary of Health and Human Services (in
consultation with the medical community),
giving consideration to the amount of training
time required to retrain the covered workers
for the health care professions and jobs.
''(D) Tribal college or university.--The term
'tribal college or university' means--
''(i) a tribally controlled college or
university, as defined in section 2 of the
Tribally Controlled College or University
Assistance Act of 1978 (25 U.S.C. 1801);
''(ii) Dine College, authorized in the
Navajo Community College Act (25 U.S.C. 640a et
seq.); and
''(iii) any of the 1994 Institutions, as
defined in section 532 of the Equity in
Educational Land-Grant Status Act of 1994 (7
U.S.C. 301 note).
''(2) Establishment of project.--In accordance with
subsection (b), the Secretary shall establish and carry out a
health professions training demonstration project.
''(3) Grants.--In carrying out the project, the Secretary,
after consultation with the Secretary of Health and Human
Services, shall make grants to eligible entities to enable the
entities to carry out programs in covered communities to train
covered workers for employment as health care professionals.
The Secretary shall make each grant in an amount of not less
than $100,000 and not more than $500,000.
''(4) Eligible entities.--Notwithstanding subsection
(b)(2)(B), to be eligible to receive a grant under this
subsection to carry out a program in a covered community, an
entity shall be a partnership that is--
''(A) under the direction of a local workforce
investment board established under section 117 that is
serving the covered community; and
''(B) composed of members serving the covered
community, such as--
''(i) an institution of higher education
that provides a 4-year program of instruction;
''(ii) an accredited community college;
''(iii) an accredited vocational or
technical school;
''(iv) a tribal college or university;
''(v) a health clinic or hospital;
''(vi) a home-based or community-based
long-term care facility or program; or
''(vii) a health care facility administered
by the Secretary of Veterans Affairs.
''(5) Applications.--To be eligible to receive a grant
under this subsection, an entity shall submit an application to
the Secretary at such time, in such manner, and containing such
information as the Secretary may require, including, at a
minimum--
''(A) a proposal to use the grant funds to
establish or expand a training program in order to
train covered workers for employment as health care
professionals (including paraprofessionals);
''(B) information demonstrating the need for the
training and support services to be provided through
the program;
''(C) information describing the manner in which
the entity will expend the grant funds, and the
activities to be carried out with the funds;
''(D) information demonstrating that the entity
meets the requirements of paragraph (4); and
''(E) with respect to training programs carried out
by the applicant, information--
''(i) on the graduation rates of the
programs involved;
''(ii) on the retention measures carried
out by the applicant;
''(iii) on the length of time necessary to
complete the training programs of the
applicant; and
''(iv) on the number of qualified covered
workers that are refused admittance into the
training programs because of lack of capacity.
''(6) Selection.--In making grants under paragraph (3), the
Secretary, after consultation with the Secretary of Health and
Human Services, shall--
''(A) consider the information submitted by the
eligible entities under paragraph (5)(E); and
''(B) select--
''(i) eligible entities submitting
applications that meet such criteria as the
Secretary of Labor determines to be
appropriate; and
''(ii) among such entities, the eligible
entities serving the covered communities with
the greatest need for the grants and the
greatest potential to benefit from the grants.
''(7) Use of funds.--
''(A) In general.--An entity that receives a grant
under this subsection shall use the funds made
available through the grant for training and support
services that meet the needs described in the
application submitted under paragraph (5), which may
include--
''(i) increasing capacity, subject to
subparagraph (B), at an educational institution
or training center to train individuals for
employment as health professionals, such as
by--
''(I) expanding a facility, subject
to subparagraph (B);
''(II) expanding course offerings;
''(III) hiring faculty;
''(IV) providing a student loan
repayment program for the faculty;
''(V) establishing or expanding
clinical education opportunities;
''(VI) purchasing equipment, such
as computers, books, clinical supplies,
or a patient simulator; or
''(VII) conducting recruitment; or
''(ii) providing support services for
covered workers participating in the training,
such as--
''(I) providing tuition assistance;
''(II) establishing or expanding
distance education programs;
''(III) providing transportation
assistance; or
''(IV) providing child care.
''(B) Limitation.--To be eligible to use the funds
to expand a facility, the eligible entity shall
demonstrate to the Secretary in an application
submitted under paragraph (5) that the entity can
increase the capacity described in subparagraph (A)(i)
of such facility only by expanding the facility.
''(8) Funding.--Of the amounts appropriated to, and
available at the discretion of, the Secretary or the Secretary
of Health and Human Services for programmatic and
administrative expenditures, a total of $25,000,000 shall be
used to establish and carry out the demonstration project
described in paragraph (2) in accordance with this
subsection.''.

SOLUTION: Community-Based Health Care Retraining Act - Amends the Workforce Investment Act of 1998 to require the Secretary of Labor to establish and carry out a health professions training demonstration project that awards grants to eligible entities to train certain unemployed workers from the manufacturing or service sector for employment as health care professionals in communities with manufacturing and service sector job loss and health care professional shortages.

PROBLEM: SEC. 1. SHORT TITLE.

This Act may be cited as the ''Postal Service Enhancement Act''.

TITLE I--RATEMAKING FLEXIBILITIES

SEC. 101. COMPETITIVE AND NONCOMPETITIVE PRODUCTS DEFINED.

Section 102 of title 39, United States Code, is amended by striking
''and'' at the end of paragraph (3), by striking the period at the end
of paragraph (4) and inserting a semicolon, and by adding at the end
the following:
''(5) 'competitive product' refers to any postal product
which the Postal Rate Commission has determined, based on
appropriate economic factors prescribed by the Commission,
competes for business in a competitive market; and
''(6) 'noncompetitive product' refers to any postal product
that is not a competitive product.''.

SEC. 102. RATES AND FEES FOR NONCOMPETITIVE PRODUCTS.

(a) Current Ratemaking Procedures Cease To Apply With Respect to
Competitive Products.--Section 3622(a) of title 39, United States Code,
is amended by adding at the end the following: ''This section shall
apply only in the case of noncompetitive products.''.
(b) Prohibition on Subsidizing Competitive Products.--Section
3622(b) of title 39, United States Code, is amended by striking ''and''
at the end of paragraph (8), by redesignating paragraph (9) as
paragraph (10), and by inserting after paragraph (8) the following:
''(9) the requirement that no rate or fee for a
noncompetitive product shall subsidize any rate or fee for a
competitive product; and''.

SEC. 103. AUTHORITY TO INCREASE RATES FOR NONCOMPETITIVE PRODUCTS
INCREMENTALLY.

Section 3624 of title 39, United States Code, is amended by adding
at the end the following:
''(e) If a request made by the Postal Service under section 3622
proposes that one or more rates of postage or fees for postal services
be changed incrementally, the recommended decision of the Commission
may include provisions responsive to that proposal.''.

SEC. 104. NEGOTIATED SERVICE AGREEMENTS.

Title 39, United States Code, is amended by inserting after section
3642 the following:
''Sec. 3643. Negotiated service agreements
''(a) The Postal Service may enter into negotiated service
agreements with mail users under this section and in accordance with
the policies of this title.
''(b) A negotiated service agreement may not be entered into unless
each of the following conditions is met:
''(1) The agreement can reasonably be expected to result in
net benefits to the operation of a nationwide postal system.
''(2) The Postal Service remains willing and able to enter
into similar negotiated service agreements with other similarly
situated mail users (determined without regard to size).
''(3) Rates and fees payable during the term of the
negotiated service agreement are reasonably calculated to yield
to the Postal Service total revenues (after taking into account
any costs avoided, and any additional costs incurred, by the
Postal Service pursuant to the agreement) at least equal to the
revenues that would be generated over that same period of time
by application of the rate or rates chargeable under the
classification or classifications of mail service most similar
to the services performed under the agreement.
''(c) A negotiated service agreement that involves one or more
noncompetitive products shall not become effective unless the Postal
Rate Commission first certifies, in accordance with such expedited
procedures as the Commission shall by regulation establish, that the
agreement meets the requirements of this section. Certifications under
this subsection may, notwithstanding section 3628, be appealed to any
court of appeals of the United States.
''(d) For purposes of this section, the term 'negotiated service
agreement' means an agreement between a mail user and the Postal
Service requiring performance by the mail user, the Postal Service, or
both, of any combination of activities that, with respect to one or
more classes of mail, differs significantly from those that would
otherwise apply.''.

SEC. 105. COMPETITIVE PRODUCTS.

Subchapter II of chapter 36 of title 39, United States Code, is
amended by adding at the end the following:
''Sec. 3630. Competitive products
''(a) The Postal Service may offer competitive products under this
section and in accordance with the policies of this title.
''(b) A competitive product may not be offered unless each of the
following conditions is met:
''(1) The product can reasonably be expected to result in
net benefits to the operation of a nationwide postal system.
''(2) The rates or fees for the product--
''(A) comply with the factors specified in section
3622(b); and
''(B) are not subsidized by any rates or fees for
noncompetitive products.
''(c)(1) Interested parties who believe the Postal Service is
offering a competitive product which does not conform to the policies
set out in this title may lodge a complaint with the Postal Rate
Commission in such form and in such manner as it may prescribe. The
Commission may, in its discretion, hold hearings on such complaint and
may issue an order providing for such interim relief as the Commission
considers appropriate. The Commission shall issue an order deciding the
complaint as expeditiously as possible.
''(2) The Postal Service shall comply with orders of the Commission
under this subsection. Such orders may, notwithstanding section 3628,
be appealed to any court of appeals of the United States.
''(3) Section 3662 shall not apply to complaints relating to
competitive products.''.

SEC. 106. TECHNICAL AND CONFORMING AMENDMENTS.

(a) The heading for section 3622 of title 39, United States Code,
is amended to read as follows:
''Sec. 3622. Rates and fees for noncompetitive products''.
(b) The table of sections for chapter 36 of title 39, United States
Code, is amended--
(1) by striking the item relating to section 3622 and
inserting the following:

''3622. Rates and fees for noncompetitive products.'';
(2) by adding after the item relating to section 3629 the
following:

''3630. Competitive products.''; and
(3) by inserting after the item relating to section 3642
the following:

''3643. Negotiated service agreements.''.

SEC. 107. SAVINGS PROVISIONS.

(a) Postal Products; Rates and Fees.--Until otherwise provided in
accordance with title 39, United States Code (as amended by this title
or as deemed to have remained in effect under subsection (b), as the
case may be)--
(1) all postal products offered immediately before this Act
takes effect shall continue being offered; and
(2) all rates and fees in effect under such title
immediately before this Act takes effect shall remain in
effect.
(b) Proceedings Pending.--This title shall not affect any
proceedings pending immediately before the date of enactment of this
Act, and any such proceedings shall continue under applicable
provisions of title 39, United States Code, as last in effect before
such date of enactment, until completed or terminated in accordance
therewith.

TITLE II--NATIONAL COMMISSION ON POSTAL EFFICIENCY AND ENHANCEMENT

SEC. 201. ESTABLISHMENT.

There is established a commission to be known as the ''National
Commission on Postal Efficiency and Enhancement'' (hereinafter in this
title referred to as the ''Commission'').

SEC. 202. FUNCTIONS OF THE COMMISSION.

The Commission shall review the present practices and
organizational structure of the United States Postal Service, with a
view toward identifying--
(1) areas of inefficiency or waste; and
(2) methods for improving operations involved in the
collection, processing, or delivery of mail.

SEC. 203. MEMBERSHIP.

(a) Number and Appointment.--The Commission shall be composed of 8
members appointed by the President, except that of those members--
(1) 2 shall be appointed from among individuals recommended
by the majority leader of the Senate; and
(2) 2 shall be appointed from among individuals recommended
by the Speaker of the House of Representatives.
(b) Qualifications.--An individual appointed to serve on the
Commission shall have expertise in mail delivery, organizational
efficiency, labor relations, or other relevant subject areas.
(c) Initial Appointments.--It is the sense of the Congress that the
members of the Commission should be appointed within 90 days after the
date of enactment of this Act.
(d) Chairman.--The Chairman of the Commission shall be designated
by the President.
(e) Pay.--Members shall be paid at a rate to be established by the
President, not to exceed the rate payable for level I of the Executive
Schedule under section 5312 of title 5, United States Code.

SEC. 204. ADMINISTRATION.

(a) In General.--The Chairman of the Commission shall exercise the
executive and administrative functions of the Commission, and may
appoint such staff as may be necessary for the operation of the
Commission.
(b) Information From Agencies.--The Commission may secure from any
department, agency, independent establishment, or other instrumentality
of the United States, any information necessary to enable it to carry
out its functions under this title. Upon receiving a request under the
preceding sentence, the head of the instrumentality involved shall, to
the extent authorized by law, furnish such information directly to the
Commission.

SEC. 205. REPORTING REQUIREMENTS.

The Commission shall transmit to the President and the Congress,
within 2 years after the date of enactment of this Act, a report
containing a detailed statement of the findings and conclusions of the
Commission, together with its recommendations for any legislation or
administrative actions which the Commission considers appropriate.

SEC. 206. TERMINATION.

The Commission shall terminate as of the date on which the work of
the Commission has been completed.

TITLE III--ENHANCED AUTHORITIES FOR THE POSTAL RATE COMMISSION

SEC. 301. ENHANCED AUTHORITIES.

Section 3604 of title 39, United States Code, is amended by adding
at the end the following:
''(f)(1) Any Commissioner of the Postal Rate Commission, any
administrative law judge appointed by the Commission under section 3105
of title 5, and any employee of the Commission designated by the
Commission, may administer oaths, examine witnesses, take depositions,
and receive evidence.
''(2) The Chairman of the Commission, any Commissioner designated
by the Chairman, and any administrative law judge appointed by the
Commission under section 3105 of title 5 may, with respect to any
proceeding conducted by the Commission under this title--
''(A) issue subpoenas requiring the attendance and
presentation of testimony, or the production of documentary or
other evidence in the possession, of any covered individual;
and
''(B) order the taking of depositions or responses to
written interrogatories by a covered individual.
''(3) In the case of contumacy or failure to obey a subpoena or
order issued under this subsection, upon application by the Commission,
the district court of the United States for the district in which the
person to whom the subpoena or order is addressed resides or is served
may issue an order requiring such person to appear at any designated
place to testify or produce documentary or other evidence. Any failure
to obey the order of the court may be punished by the court as a
contempt thereof.
''(4) For purposes of this subsection, the term 'covered
individual' means an officer or employee or agent of the Postal Service
or of a contractor of the Postal Service.
''(g)(1) If the Postal Service determines that any testimony,
document, or other matter provided pursuant to a subpoena or order
issued under subsection (f), or otherwise provided by the Postal
Service to the Postal Rate Commission in connection with any proceeding
or other purpose under this title, contains information which is
described in section 410(c) of this title, or exempt from public
disclosure under section 552(b) of title 5, the Postal Service shall,
at the time such matter is provided to the Commission, notify the
Commission, in writing, of its determination (and the reasons
therefor).
''(2) The Commission shall establish procedures for ensuring, where
appropriate, the confidentiality of any information as to which it has
been notified under paragraph (1).''.

SOLUTION: (Sec. 104) Outlines conditions under which the Postal Service (Service) may enter into negotiated service agreements with mail users, including that: (1) the agreement will result in net benefits to the nationwide postal system; and (2) rates and fees payable under the agreement are calculated to yield revenues to the Service that are at least equal to revenues generated by rates chargeable for other mail services. Allows any such agreement that involves one or more noncompetitive products to be effective only after the Postal Rate Commission (Commission) first certifies that such agreement meets requirements applicable to all mail service agreements.
(Sec. 105) Outlines conditions under which the Service may offer competitive products. Provides conditions under which a party who believes that the Service is offering a competitive product which does not conform to such conditions may lodge a complaint with the Commission.
Title II: National Commission on Postal Efficiency and Enhancement
- Establishes the National Commission on Postal Efficiency and Enhancement to review and report on the present practices and organizational structure of the Service, with a view toward identifying waste or inefficiency and improving the collection, processing, and delivery of mail.
Title III: Enhanced Authorities for the Postal Rate Commission
- Authorizes any Commission commissioner, any administrative law judge appointed by the Commission, and any Commission employee to administer oaths, examine witnesses, take depositions, and receive evidence. Authorizes the Commission Chairman, any designated commissioner, or any Commission-appointed administrative law judge to issue subpoenas and order the taking of depositions or responses to written interrogatories.

PROBLEM: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Medicaid Flexibility Act of 1995''.

SEC. 2. BLOCK GRANTS TO THE STATES FOR HEALTH CARE SERVICES TO NEEDY
INDIVIDUALS.

Title XIX of the Social Security Act (42 U.S.C. 1396-1396V) is
amended to read as follows:

''TITLE XIX--BLOCK GRANTS TO STATES FOR HEALTH CARE SERVICES TO NEEDY
INDIVIDUALS

''purpose; implementation

''Sec. 1901. (a) Purpose.--The purpose of this title is to
strengthen families by helping them move from dependence on government
benefits to economic independence by consolidating Federal assistance
to the States for health care services and assistance to needy
individuals into a single grant for such purpose, thereby giving States
maximum flexibility to--
''(1) require beneficiaries who are parents to ensure that
their school-age children attend school;
''(2) require minors who are beneficiaries to attend
school;
''(3) require parent beneficiaries to ensure that their
children receive the full complement of childhood
immunizations;
''(4) limit the amount of time able-bodied beneficiaries
may receive assistance;
''(5) require beneficiaries not to use illegal drugs or
abuse other drugs;
''(6) require each mother to identify the father of any
child for whom she seeks assistance;
''(7) deny assistance to illegal aliens;
''(8) require individuals who sponsor the residency of
legal aliens to support those they sponsor; and
''(9) involve religious and charitable organizations,
voluntary associations, civic groups, community organizations,
nonprofit entities, benevolent and fraternal orders,
philanthropic entities, and other groups in the private sector,
as appropriate, in the provision of health care services and
assistance to needy individuals with the funding States receive
under this title.
''(b) Implementation.--This purpose shall be implemented in
accordance with conditions in each State and as determined by State
law.

''payments to states

''Sec. 1902. (a) Amount.--
''(1) In general.--Each State shall, subject to the
requirements of this title, be entitled to receive quarterly
payments for fiscal years 1996, 1997, 1998, 1999, and 2000 in
an amount equal to 25 percent of the annual amount determined
under paragraph (2) for such fiscal year for carrying out the
purpose described in section 1901.
''(2) Annual amount.--The annual amount determined under
this paragraph is equal to--
''(A) in fiscal year 1996, 105 percent of the
amount received by a State in fiscal year 1995 under
this title (as in effect in fiscal year 1995); and
''(B) in each fiscal year thereafter, 105 percent
of the amount received by a State in the preceding
fiscal year under this title (as in effect in such
preceding fiscal year).
''(b) Funding Requirements.--The Secretary of the Treasury shall
make quarterly payments described in subsection (a)(1) directly to each
State in accordance with section 6503 of title 31, United States Code.
''(c) Expenditure of Funds; Rainy Day Fund.--Amounts received by a
State under this title for any fiscal year shall be expended by the
State in such fiscal year or in the succeeding fiscal year; except for
such amounts as the State deems necessary to set aside in a separate
account to provide, without fiscal limitation, for unexpected levels of
assistance during periods of high unemployment or other events which
cause unexpected increases in the need for health care services or
assistance for needy individuals. Any amounts remaining in such
segregated accounts after fiscal year
2000 shall be expended by a State for the purpose described in section
1901 of this title as in effect in fiscal year 2000.
''(d) Authority To Use Portion of Grant for Other Purposes.--
''(1) In general.--A State may use not more than 30 percent
of the annual amount paid to the State under this title for a
fiscal year to carry out a State program pursuant to any or all
of the following provisions of law:
''(A) Part A of title IV of this Act.
''(B) Title XVI of this Act.
''(C) The Food Stamp Act.
''(2) Applicable rules.--Any amount paid to the State under
this title that is used to carry out a State program pursuant
to a provision of law specified in paragraph (1) shall not be
subject to the requirements of this title, but shall be subject
to the requirements that apply to Federal funds provided
directly under the provision of law to carry out the program.

''administrative and fiscal accountability

''Sec. 1903. (a) Audits; Reimbursement.--
''(1) Audits.--
''(A) In general.--A State shall, not less than
annually, audit the State expenditures from amounts
received under this title. Such audit shall--
''(i) determine the extent to which such
expenditures were or were not expended in
accordance with this title; and
''(ii) be conducted by an approved entity
(as defined in subparagraph (B)) in accordance
with generally accepted auditing principles.
''(B) Approved entity.--For purposes of
subparagraph (A), the term 'approved entity' means an
entity that is--
''(i) approved by the Secretary of the
Treasury;
''(ii) approved by the chief executive
officer of the State; and
''(iii) independent of any agency
administering activities or services funded
under this title.
''(2) Reimbursement.--
''(A) In general.--Not later than 30 days following
the completion of an audit under this subsection, a
State shall submit a copy of the audit to the State
legislature and to the Secretary of the Treasury.
''(B) Repayment.--Each State shall pay to the
United States amounts ultimately found by the approved
entity under paragraph (1)(A) not to have been expended
in accordance with this title plus 10 percent of such
amount as a penalty, or the Secretary of the Treasury
may offset such amounts plus the 10 percent penalty
against any other amount in any other year that the
State may be entitled to receive under this title.
''(b) Additional Accounting Requirements.--The provisions of
chapter 75 of title 31, United States Code, shall apply to the audit
requirements of this section.
''(c) Reporting Requirements; Form, Contents.--
''(1) Annual reports.--A State shall prepare comprehensive
annual reports on the activities carried out with amounts
received by the State under this title.
''(2) Content.--Reports prepared under this section--
''(A) shall be for the most recently completed
fiscal year;
''(B) shall be in accordance with generally
accepted accounting principles, including the
provisions of chapter 75 of title 31, United States
Code;
''(C) shall include the results of the most recent
audit conducted in accordance with the requirements of
paragraph (a) of this section; and
''(D) shall be in such form and contain such other
information as the State deems necessary--
''(i) to provided an accurate description
of such activities; and
''(ii) to secure a complete record of the
purposes for which amounts were expended in
accordance with this title.
''(3) Copies.--A State shall make copies of the reports
required under this section available for public inspection
within the State. Copies also shall be provided upon request to
any interested public agency, and each such agency may provide
its views on such reports to the Congress.
''(d) Administrative Supervision.--
''(1) Role of the secretary of the treasury.--
''(A) In general.--The Secretary of the Treasury
shall supervise the amounts received under this title
in accordance with subparagraph (B).
''(B) Limited supervision--The supervision by the
Secretary of the Treasury shall be limited to--
''(i) making quarterly payments to the
States in accordance with section 1902(b);
''(ii) approving the entities referred to
in subsection (a)(1)(B); and
''(iii) withholding payment to a State
based on the findings of such an entity in
accordance with subsection (a)(2)(B).
''(2) Other federal supervision.--No administrative officer
or agency of the United States, other than the Secretary of the
Treasury and, as provided for in section 1904, the Attorney
General, shall supervise the amounts received by the States
under this title or the use of such amounts by the States.
''(e) Limited Federal Oversight.--With the exception of the
Department of the Treasury as provided for in this section and section
1904 of this title, no Federal department or agency may promulgate
regulations or issue rules regarding the purpose of this title.

''nondiscrimination provisions

''Sec. 1904. (a) No Discrimination Against Individuals.--No
individual shall be excluded from participation in, denied the benefits
of, or subjected to discrimination under any program or activity funded
in whole or in part with amounts received under this title on the basis
of such individual's--
''(1) disability under section 504 of the Rehabilitation
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.--If the Secretary of the Treasury determines that
a State, or an entity that has received funds from amounts received by
the State under this title, has failed to comply with a provision of
law referred to in subsection (a), except as provided for in section
1905 of this title, the Secretary of the Treasury shall notify the
chief executive officer of the State and shall request the officer to
secure compliance with such provision of law. If, not later than 60
days after receiving such notification, the chief executive officer
fails or refuses to secure compliance, the Secretary of the Treasury
may--
''(1) refer the matter to the Attorney General with a
recommendation that an appropriate civil action be instituted;
''(2) exercise the powers and functions provided under
title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et
seq.), title IX of the Education Amendments of 1972 (20 U.S.C.
1681 et seq.); or section 505 of the Rehabilitation Act of 1973
(29 U.S.C. 794a), (as applicable); or
''(3) take such other action as may be provided by law.
''(c) Authority of Attorney General; Civil Actions.--When a matter
is referred to the Attorney General pursuant to subsection (b)(1), or
if the Attorney General has reason to believe that an entity is engaged
in a pattern or practice in violation of a provision of law referred to
in subsection (a), the Attorney General may bring a civil action in an
appropriate district court of the United States for such relief as may
be appropriate, including injunctive relief.

''nondiscrimination and institutional safeguards for religious
providers

''Sec. 1905. (a) Purpose.--The purpose of this section is to allow
the participation of religious and charitable organizations as
providers of health care services and assistance under this title
without impairing or diminishing the religious character or freedom of
such organizations.
''(b) Nondiscrimination.--Religious organizations are eligible as
providers of health care services and assistance as provided for under
this title. Neither the Federal Government nor a State receiving funds
under this title shall discriminate against an organization which is or
applies to be a provider of health care services and assistance on the
basis that the organization has a religious mission or purpose.
''(c) Religious Character and Freedom.--
''(1) In general.--Nothwithstanding any other provision of
law, any religious organization participating as a provider of
health care services and assistance funded under this title
shall retain its independence from Federal, State, and local
governments, including such organization's control over the
definition, development, practice, and expression of its
religious beliefs. Such
an organization may select, employ, promote, discipline, and
dismiss its clerics and other ecclesiastics, directors, officers,
employees, and volunteers on the basis of religion, a religious belief,
or a religious practice. However, a religious organization shall not
deny a needy individual health care services and assistance funded
under this title on the basis of religion, a religious belief, or
refusal to participate in a religious practice.
''(2) Additional safeguards.--Neither the Federal
Government nor a State shall require a religious provider of
health care services and assistance to--
''(A) alter its form of internal governance, or
form a separate, nonprofit corporation to receive and
administer the assistance funded under this title; or
''(B) alter real estate of facilities used to
provide such assistance, including but not limited to
the removal of religious art, icons, scripture, or
other symbols;
in order to be eligible to be a provider of health care
services and assistance funded under this title.
''(3) Fiscal accountability.--
''(A) In general.--Except as provided in
subparagraph (B), any religious organization providing
assistance funded under this title shall be subject to
the same regulations as other providers to account in
accord with generally accepted auditing principles for
the use of such funds provided under this title.
''(B) Limited audit.--Religious organizations may
segregate Federal funds provided under this title into
separate accounts, and then only the financial
assistance provided with those funds shall be subject
to audit.
''(d) Compliance.--A religious organization which has its rights
under this section violated may enforce its claim by asserting a civil
action for such relief as may be appropriate, including injunctive
relief or damages, in an appropriate district court of the United
States against the entity or agency that commits such violation.
''(e) Rights of Beneficiaries of Assistance.--
''(1) In general.--If a beneficiary has a bona fide
objection to the religious character of the organization or
institution from which the beneficiary is receiving health care
services and assistance funded under this title, each State
shall provide such beneficiary a certificate, redeemable with
any other provider of assistance funded under this title, for
services the value of which is no less than the value of the
funding received by the religious provider from a State to
provide assistance funded under this title for such individual.
''(2) Prohibition on providing cash in exchange for
certificates.--No provider of assistance funded under this
title shall provide a beneficiary a cash amount in exchange for
a certificate provided for under paragraph (1).

''emergency assistance

''Sec. 1906. (a) In General.--Health care services and assistance
funded under this title must be provided to a citizen, legal resident,
or an alien who is not lawfully admitted for permanent residence or
otherwise permanently residing in the United States under color of law,
if--
''(1) such services and assistance are necessary for the
treatment of an emergency medical condition;
''(2) such person otherwise meets the eligibility
requirements for health care services and assistance under the
State program funded under this title; and
''(3) such services and assistance are not related to an
organ transplant procedure.
''(b) Emergency Medical Condition.--For purposes of this section,
the term 'emergency medical condition' 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 jeopardy;
''(2) serious impairment to bodily functions; or
''(3) serious dysfunction of any bodily organ or part.''.

SEC 3. CONFORMING AMENDMENTS TO THE BUDGET ACT.

Section 255(h) of the Balanced Budget and Emergency Deficit Control
Act of 1985 (2 U.S.C. 905(h)) is amended by striking ''Grants to States
for Medicaid (75-0512-0-1-551);'' and inserting ''Block grants to
States for health care services to needy individuals;''.

SEC. 4. EFFECTIVE DATE.

The amendments made by this Act shall take effect on October 1,
1995.

SOLUTION:
Medicaid Flexibility Act of 1995 - Amends title XIX (Medicaid) of the Social Security Act to replace the Medicaid program with a program of block grants to States for health care services to needy individuals.