Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Accelerating Kids' Access to Care
Act''.

SEC. 2. STREAMLINED SCREENING AND ENROLLMENT PROCESS FOR ELIGIBLE OUT-
              OF-STATE MEDICAID PROVIDERS AND SUPPLIERS.

    (a) In General.--Section 1902(kk) of the Social Security Act (42
U.S.C. 1396a(kk)) is amended by adding at the end the following new
paragraph:
            ``(10) Streamlined screening and enrollment process for
        eligible out-of-state providers and suppliers.--
                    ``(A) In general.--Subject to subsection (a)(65),
                the State adopts a streamlined screening and enrollment
                process for eligible out-of-State providers and
                suppliers.
                    ``(B) Streamlined screening and enrollment
                process.--For purposes of subparagraph (A), the term
                `streamlined screening and enrollment process' means a
                process that enables an eligible out-of-State provider
                or supplier to enroll as a provider or supplier in the
                State plan on a simplified and streamlined basis in
                accordance with the requirements of subparagraph (D).
                    ``(C) Eligible out-of-state provider or supplier.--
                For purposes of subparagraph (A), the term `eligible
                out-of-State provider or supplier' means a provider or
                supplier of medical or other items or services
                furnished to a child for which payment is available
                under the State plan under this title that is located
                in another State and with respect to which the
                Secretary has determined there is a limited risk of
                fraud, waste, or abuse for purposes of determining the
                level of screening to be conducted under section
                1866(j)(2)(B).
                    ``(D) Requirements.--For purposes of subparagraph
                (B), the requirements of this subparagraph are the
                following:
                            ``(i) An eligible out-of-State provider or
                        supplier that elects to be and is enrolled in
                        the program established under this title in
                        accordance with the process established by the
                        Secretary under section 2(b) of the
                        Accelerating Kids' Access to Care Act is
                        enrolled in the State plan under this title
                        without being subject to any additional
                        screening and enrollment activities required by
                        the State.
                            ``(ii) An eligible out-of-State provider or
                        supplier that is enrolled in the State plan
                        through the streamlined screening and
                        enrollment process shall be enrolled for a
                        period of 5 years before being required to
                        obtain revalidation.
                            ``(iii) An eligible out-of-State provider
                        or supplier that is enrolled in the State plan
                        through the streamlined screening and
                        enrollment process shall be permitted to order
                        all clinically necessary follow-up care,
                        including with respect to the prescribing of
                        medications.''.
    (b) Coordination With Medicare.--The Secretary shall establish a
process for permitting a provider or a supplier, as the case may be,
the option when enrolling in the program established under the Medicare
program under title XVIII of the Social Security Act pursuant to
subpart P of part 424 of title 42, Code of Federal Regulations (or any
successor regulation), to elect, at the same time, to enroll in the
Medicaid program under title XIX of such Act for purposes of all State
plans under such title XIX. The Secretary may utilize the Medicare
Provider Enrollment, Chain and Ownership System (referred to as
``PECOS''), or another national, standardized, and widely accessible
platform to establish such process.
    (c) Conforming Amendments.--
            (1) Section 1902(a)(77) of the Social Security Act (42
        U.S.C. 1396a(a)(77)) is amended by inserting ``enrollment,''
        after ``screening,''.
            (2) Section 1902(kk) of such Act (42 U.S.C. 1396a(kk)), as
        amended by subsection (a), is further amended--
                    (A) in the subsection heading, by inserting
                ``Enrollment,'' after ``Screening,''; and
                    (B) in paragraph (9), by striking ``Nothing'' and
                inserting ``Except as provided in paragraph (10)(D)(i),
                nothing''.
            (3) Section 2107(e)(1)(G) of such Act (42 U.S.C.
        1397gg(e)(1)(G)) is amended by inserting ``enrollment,'' after
        ``screening,''.
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the
        amendments made by this section take effect on January 1, 2019.
            (2) Exception for state legislation.--In the case of a
        State plan for medical assistance under title XIX of the Social
        Security Act or a State child health plan under title XXI of
        such Act which the Secretary of Health and Human Services
        determines requires State legislation (other than legislation
        appropriating funds) in order for the plan to meet the
        additional requirements imposed by the amendments made by this
        section, such State plan shall not be regarded as failing to
        comply with the requirements of such title solely on the basis
        of its failure to meet these additional requirements before the
        first day of the first calendar quarter beginning after the
        close of the first regular session of the State legislature
        that begins after the date of the enactment of this Act. For
        purposes of the previous sentence, in the case of a State that
        has a 2-year legislative session, each year of such session
        shall be deemed to be a separate regular session of the State
        legislature.

Output: Accelerating Kids' Access to Care Act This bill requires: (1) state Medicaid programs to adopt a streamlined screening and enrollment process for eligible out-of-state providers and suppliers, and (2) the Centers for Medicare & Medicaid Services to establish a process for providers and suppliers to enroll simultaneously in the Medicare and Medicaid programs.


Input:
SECTION 1. RURAL COMMUNITY SERVICE.

    Title XI of the of the Higher Education Act of 1965 (20 U.S.C. 1136
et seq.) is amended by adding at the end the following new part:

                   ``PART C--RURAL COMMUNITY SERVICE

``SEC. 1171. FINDINGS; PURPOSE.

    ``(a) Findings.--The Congress finds that--
            ``(1) the Nation's rural centers are facing increasingly
        pressing problems and needs in the areas of economic
        development, community infrastructure and service, social
        policy, public health, housing, crime, education, environmental
        concerns, planning and work force preparation;
            ``(2) there are, in the Nation's rural institutions, people
        with underutilized skills, knowledge, and experience who are
        capable of providing a vast range of services towards the
        amelioration of the problems described in paragraph (1);
            ``(3) the skills, knowledge, and experience in these rural
        institutions, if applied in a systematic and sustained manner,
        can make a significant contribution to the solution of such
        problems; and
            ``(4) the application of such skills, knowledge, and
        experience is hindered by the limited funds available to
        redirect attention to solutions to such rural problems.
    ``(b) Purpose.--It is the purpose of this part to provide
incentives to rural academic institutions to enable such institutions
to work with private and civic organizations to devise and implement
solutions to pressing and severe problems in their communities.

``SEC. 1172. PROGRAM.

    ``The Secretary is authorized to carry out a program of providing
assistance to eligible institutions to enable such institutions to
carry out the authorized activities described in section 1174 in
accordance with the provisions of this part.

``SEC. 1173. APPLICATIONS FOR RURAL COMMUNITY SERVICE GRANTS.

    ``(a) Application.--
            ``(1) In general.--Each eligible institution desiring a
        grant under this part shall submit to the Secretary an
        application at such time, in such form, and containing or
        accompanied by such information and assurances, as the
        Secretary may require by regulation.
            ``(2) Contents.--Each application submitted pursuant to
        paragraph (1) shall--
                    ``(A) describe the activities and services for
                which assistance is sought; and
                    ``(B) contain assurances that the eligible
                institution will enter into a consortium to carry out
                the provisions of this part that includes, in addition
                to the eligible institution, one or more of the
                following entities:
                            ``(i) A community college.
                            ``(ii) A rural local educational agency.
                            ``(iii) A local government.
                            ``(iv) A business or other employer.
                            ``(v) A nonprofit institution.
            ``(3) Waiver.--The Secretary may waive the consortium
        requirements described in paragraph (2) for any applicant who
        can demonstrate to the satisfaction of the Secretary that the
        applicant has devised an integrated and coordinated plan which
        meets the purpose of this part.
    ``(b) Priority in Selection of Applications.--The Secretary shall
give priority to applications that propose to conduct joint projects
supported by other local, State, and Federal programs.
    ``(c) Selection Procedures.--The Secretary, by regulation, shall
develop a formal procedure for the submission of applications under
this part and shall publish in the Federal Register an announcement of
that procedure and the availability of funds under this part.

``SEC. 1174. AUTHORIZED ACTIVITIES.

    ``Grant funds made available under this part shall be used to
support planning, applied research, training, resource exchanges or
technology transfers, the delivery of services, or other activities the
purpose of which is to design and implement programs to assist rural
communities to meet and address their pressing and severe problems,
such as any of the following:
            ``(1) Work force preparation.
            ``(2) Rural poverty and the alleviation of such poverty.
            ``(3) Health care, including health care delivery and
        access as well as health education, prevention and wellness.
            ``(4) Underperforming school systems and students.
            ``(5) Problems faced by the elderly and individuals with
        disabilities in rural settings.
            ``(6) Problems faced by families and children.
            ``(7) Campus and community crime prevention, including
        enhanced security and safety awareness measures as well as
        coordinated programs addressing the root causes of crime.
            ``(8) Rural housing.
            ``(9) Rural infrastructure.
            ``(10) Economic development.
            ``(11) Rural farming and environmental concerns.
            ``(12) Other problem areas which participants in the
        consortium described in section 1173(a)(2)(B) concur are of
        high priority in rural areas.
            ``(13)(A) Problems faced by individuals with disabilities
        and economically disadvantaged individuals regarding
        accessibility to institutions of higher education and other
        public and private community facilities.
            ``(B) Amelioration of existing attitudinal barriers that
        prevent full inclusion of individuals with disabilities in
        their community.

``SEC. 1175. PEER REVIEW.

    ``The Secretary shall designate a peer review panel to review
applications submitted under this part and make recommendations for
funding to the Secretary. In selecting the peer review panel, the
Secretary may consult with other appropriate Cabinet-level Federal
officials and with non-Federal organizations, to ensure that the panel
will be geographically balanced and be composed of representatives from
public and private institutions of higher education, labor, business,
and State and local government, who have expertise in rural community
service or in education.

``SEC. 1176. DISBURSEMENT OF FUNDS.

    ``(a) Multiyear Availability.--Subject to the availability of
appropriations, grants under this part may be made on a multiyear
basis, except that no institution, individually or as a participant in
a consortium, may receive a grant for more than 5 years.
    ``(b) Equitable Geographic Distribution.--The Secretary shall award
grants under this part in a manner that achieves equitable geographic
distribution of such grants.
    ``(c) Matching Requirement.--An applicant under this part and the
local governments associated with its application shall contribute to
the conduct of the program supported by the grant an amount from non-
Federal funds equal to at least one-fourth of the amount grant, which
contribution may be in cash or in kind, fairly evaluated.

``SEC. 1177. DESIGNATION OF RURAL GRANT INSTITUTIONS.

    ``The Secretary shall publish a list of eligible institutions under
this part and shall designate such institutions of higher education as
`Rural Grant Institutions'. The Secretary shall establish a national
network of Rural Grant Institutions so that the results of individual
projects achieved in 1 rural area can be generalized, disseminated,
replicated and applied throughout the Nation.

``SEC. 1178. DEFINITIONS.

    ``As used in this part:
            ``(1) Rural area.--The term `rural area' means any area
        that is--
                    ``(A) outside an urbanized area, as such term is
                defined by the Bureau of the Census; and
                    ``(B) outside any place that--
                            ``(i) is incorporated or Bureau of the
                        Census designated; and
                            ``(ii) has a population of 75,000 or more.
            ``(2) Eligible institution.--The term `eligible
        institution' means an institution of higher education, or a
        consortium of such institutions any one of which meets all the
        requirements of this paragraph, which--
                    ``(A) is located in a rural area;
                    ``(B) draws a substantial portion of its
                undergraduate students from the rural area in which
                such institution is located, or from contiguous areas;
                    ``(C) carries out programs to make postsecondary
                educational opportunities more accessible to residents
                of such rural areas, or contiguous areas;
                    ``(D) has the present capacity to provide resources
                responsive to the needs and priorities of such rural
                areas and contiguous areas;
                    ``(E) offers a range of professional, technical, or
                graduate programs sufficient to sustain the capacity of
                such institution to provide such resources; and
                    ``(F) has demonstrated and sustained a sense of
                responsibility to such rural area and contiguous areas
                and the people of such areas.

``SEC. 1179. AUTHORIZATION OF APPROPRIATIONS; FUNDING RULE.

    ``(a) In General.--There are authorized to be appropriated such
sums as may be necessary in each fiscal year to carry out the
provisions of this part.
    ``(b) Funding Rule.--If in any fiscal year the amount appropriated
pursuant to the authority of subsection (a) is less than 50 percent of
the funds appropriated to carry out part A in such year, then the
Secretary shall make available in such year from funds appropriated to
carry out part A an amount equal to the difference between 50 percent
of the funds appropriated to carry out part A and the amount
appropriated pursuant to the authority of subsection (a).''.

Output:
Amends the Higher Education Act of 1965 to establish a rural community service program.
Authorizes appropriations.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Super-Efficient Appliance Incentives
and Market Transformation Act of 2007''.

SEC. 2. MODIFICATIONS OF ENERGY EFFICIENT APPLIANCE CREDIT FOR
              APPLIANCES PRODUCED AFTER 2007.

    (a) In General.--Section 45M of the Internal Revenue Code of 1986
is amended to read as follows:

``SEC. 45M. ENERGY EFFICIENT APPLIANCE CREDIT.

    ``(a) General Rule.--
            ``(1) In general.--For purposes of section 38, the energy
        efficient appliance credit determined under this section for
        any taxable year is an amount equal to the sum of the credit
        amounts determined under paragraph (2) for each type of
        qualified energy efficient appliance produced by the taxpayer
        during the calendar year ending with or within the taxable
        year.
            ``(2) Credit amounts.--The credit amount determined for any
        type of qualified energy efficient appliance is--
                    ``(A) the applicable amount determined under
                subsection (b) with respect to such type, multiplied by
                    ``(B) the eligible production for such type.
    ``(b) Applicable Amount.--For purposes of subsection (a)--
            ``(1) Dishwashers.--The applicable amount is--
                    ``(A) $45 in the case of a residential model
                dishwasher which--
                            ``(i) is manufactured in calendar year 2008
                        or 2009, and
                            ``(ii) uses not more than 324 kilowatt
                        hours per year and 5.8 gallons per cycle, and
                    ``(B) $75 in the case of a residential model
                dishwasher which--
                            ``(i) is manufactured in calendar year
                        2008, 2009, or 2010, and
                            ``(ii) uses not more than 307 kilowatt
                        hours per year and 5.0 gallons per cycle (5.5
                        gallons for dishwashers designed for greater
                        than 12 place settings).
            ``(2) Clothes washers.--The applicable amount is--
                    ``(A) $75 in the case of a residential model top-
                loading clothes washer which--
                            ``(i) is manufactured in calendar year
                        2008, and
                            ``(ii) meets or exceeds a 1.72 MEF and does
                        not exceed an 8.0 water consumption factor,
                    ``(B) $125 in the case of a residential model top-
                loading clothes washer which--
                            ``(i) is manufactured in calendar year 2008
                        or 2009, and
                            ``(ii) meets or exceeds a 1.8 MEF and does
                        not exceed a 7.5 water consumption factor,
                    ``(C) $150 in the case of a residential or
                commercial model clothes washer which--
                            ``(i) is manufactured in calendar year
                        2008, 2009, or 2010, and
                            ``(ii) meets or exceeds 2.0 MEF and does
                        not exceed a 6.0 water consumption factor, and
                    ``(D) $250 in the case of a residential or
                commercial model clothes washer which--
                            ``(i) is manufactured in calendar year
                        2008, 2009, or 2010, and
                            ``(ii) meets or exceeds 2.2 MEF and does
                        not exceed a 4.5 water consumption factor.
            ``(3) Refrigerators.--The applicable amount is--
                    ``(A) $50 in the case of a residential model
                refrigerator which--
                            ``(i) is manufactured in calendar year
                        2008, and
                            ``(ii) consumes at least 20 percent, but
                        not more than 22.9 percent, less kilowatt hours
                        per year than the 2001 energy conservation
                        standards,
                    ``(B) $75 in the case of a residential model
                refrigerator which--
                            ``(i) is manufactured in calendar year 2008
                        or 2009, and
                            ``(ii) consumes at least 23 percent, but
                        not more than 24.9 percent, less kilowatt hours
                        per year than the 2001 energy conservation
                        standards,
                    ``(C) $100 in the case of a residential model
                refrigerator which--
                            ``(i) is manufactured in calendar year
                        2008, 2009, or 2010, and
                            ``(ii) consumes at least 25 percent, but
                        not more than 29.9 percent, less kilowatt hours
                        per year than the 2001 energy conservation
                        standards, and
                    ``(D) $200 in the case of a residential model
                refrigerator which--
                            ``(i) is manufactured in calendar year
                        2008, 2009, or 2010, and
                            ``(ii) consumes at least 30 percent less
                        kilowatt hours per year than the 2001 energy
                        conservation standards.
            ``(4) Dehumidifiers.--The applicable amount is--
                    ``(A) $15 in the case of a dehumidifier which--
                            ``(i) is manufactured in calendar year
                        2008, and
                            ``(ii) has a capacity less than or equal to
                        45 pints per day and is 7.5 percent more
                        efficient than the applicable Department of
                        Energy energy conservation standard effective
                        October 2012, and
                    ``(B) $25 in the case of a dehumidifier which--
                            ``(i) is manufactured in calendar year
                        2008, and
                            ``(ii) has a capacity greater than 45 pints
                        per day and is 7.5 percent more efficient than
                        such conservation standard.
    ``(c) Eligible Production.--The eligible production in a calendar
year with respect to each type of qualified energy efficient appliance
is the excess of--
            ``(1) the number of appliances of such type which are
        produced by the taxpayer for sale within the United States
        during such calendar year, over
            ``(2) the average number of appliances of such type which
        were produced by the taxpayer (or any predecessor) for sale
        within the United States during the preceding 2-calendar year
        period.
    ``(d) Types of Qualified Energy Efficient Appliances.--For purposes
of this section, the types of qualified energy efficient appliances
are--
            ``(1) dishwashers described in subsection (b)(1),
            ``(2) clothes washers described in subsection (b)(2),
            ``(3) refrigerators described in subsection (b)(3), and
            ``(4) dehumidifiers described in subsection (b)(4).
    ``(e) Limitations.--
            ``(1) Aggregate credit amount allowed.--Except as provided
        in paragraph (2), the aggregate amount of credit allowed under
        subsection (a) with respect to a taxpayer for any taxable year
        shall not exceed $100,000,000 reduced by the amount of the
        credit allowed under subsection (a) to the taxpayer (or any
        predecessor) for all prior taxable years beginning after
        December 31, 2007.
            ``(2) Amount allowed for certain clothes washers and
        refrigerators.--For purposes of paragraph (1), clothes washers
        described in subsection (b)(2)(D) and refrigerators described
        in subsection (b)(3)(D) shall not be taken into account.
            ``(3) Limitation based on gross receipts.--The credit
        allowed under subsection (a) with respect to a taxpayer for the
        taxable year shall not exceed an amount equal to 2 percent of
        the average annual gross receipts of the taxpayer for the 3
        taxable years preceding the taxable year in which the credit is
        determined beginning after December 31, 2007.
            ``(4) Gross receipts.--For purposes of this subsection, the
        rules of paragraphs (2) and (3) of section 448(c) shall apply.
    ``(f) Definitions.--For purposes of this section:
            ``(1) Dishwasher.--The term `dishwasher' means a dishwasher
        subject to the energy conservation standards established by the
        Department of Energy.
            ``(2) Clothes washer.--The term `clothes washer' includes a
        clothes washer subject to the energy conservation standards
        established by the Department of Energy.
            ``(3) Top-loading clothes washer.--The term `top-loading
        clothes washer' means a clothes washer with the clothes
        container compartment access located on the top of the machine.
            ``(4) Refrigerator.--The term `refrigerator' means an
        automatic defrost refrigerator-freezer which has an internal
        volume of at least 16.5 cubic feet.
            ``(5) Dehumidifier.--The term `dehumidifier' means a self-
        contained, electrically operated, and mechanically refrigerated
        encased assembly consisting of--
                    ``(A) a refrigerated surface that condenses
                moisture from the atmosphere,
                    ``(B) a refrigerating system, including an electric
                motor,
                    ``(C) an air-circulating fan, and
                    ``(D) means for collecting or disposing of
                condensate.
            ``(6) Gallons per cycle.--The term `gallons per cycle'
        means the amount of water, expressed in gallons, required to
        complete a normal cycle of a dishwasher.
            ``(7) MEF.--The term `MEF' means the modified energy factor
        established by the Department of Energy for compliance with the
        Federal energy conservation standard.
            ``(8) Water consumption factor.--The term `water
        consumption factor' means the quotient of the total weighted
        per-cycle water consumption divided by the cubic foot capacity
        of the clothes washer.
            ``(9) 2001 energy conservation standard.--The term `2001
        energy conservation standard' means the energy conservation
        standards promulgated by the Department of Energy and effective
        July 1, 2001.
    ``(g) Special Rules.--For purposes of this section:
            ``(1) In general.--Rules similar to the rules of
        subsections (c), (d), and (e) of section 52 shall apply.
            ``(2) Controlled group.--
                    ``(A) In general.--All persons treated as a single
                employer under subsection (a) or (b) of section 52 or
                subsection (m) or (o) of section 414 shall be treated
                as a single producer.
                    ``(B) Inclusion of foreign corporations.--For
                purposes of subparagraph (A), in applying subsections
                (a) and (b) of section 52 to this section, section 1563
                shall be applied without regard to subsection (b)(2)(C)
                thereof.
            ``(3) Verification.--No amount shall be allowed as a credit
        under subsection (a) with respect to which the taxpayer has not
        submitted such information or certification as the Secretary,
        in consultation with the Secretary of Energy, determines
        necessary.''.
    (b) Credit Allowed Against the Alternative Minimum Tax.--Section
38(c)(4)(B) of the Internal Revenue Code of 1986 (relating to specified
credits) is amended--
            (1) by striking ``and'' at the end of clause (i),
            (2) by striking the period at the end of clause (ii)(II)
        and inserting ``, and'', and
            (3) by adding at the end the following new clause:
                            ``(iii) for taxable years beginning after
                        December 31, 2007, the credit determined under
                        section 45M.''.
    (c) Effective Date.--The amendments made by this section shall
apply to appliances produced after December 31, 2007.

Output: Super-Efficient Appliance Incentives and Market Transformation Act of 2007 - Amends the Internal Revenue Code to modify the applicable amount of the tax credit for energy efficient appliances (i.e., dishwashers, clothes washers, refrigerators, and dehumidifiers that restrict water and energy consumption) produced after 2007.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Primary Care Workforce Access
Improvement Act of 2011''.

SEC. 2. MEDICARE PRIMARY CARE GRADUATE MEDICAL EDUCATION PILOT PROJECT.

    (a) Establishment.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct a pilot
project under the Medicare program under title XVIII of the Social
Security Act, in accordance with the provisions of this section, to
test models for providing payment under such title for direct graduate
medical education and indirect medical education to medical education
entities, which entities are not otherwise eligible to receive such
payments under the Medicare program, for the costs of training primary
care residents.
    (b) Duration.--The Secretary shall conduct the pilot project under
this section over a 5-year period, which shall begin not later than 180
days after the date of the enactment of this Act.
    (c) Models.--
            (1) Required models.--Under the pilot project, the
        Secretary shall test two of each of the following models:
                    (A) A model in which the medical education entity
                receiving funds under the pilot project is a community-
                based independent corporate entity collaborating with
                two or more hospitals to operate one or more primary
                care graduate medical residency training programs.
                    (B) A model in which--
                            (i) the medical education entity receiving
                        funds under the pilot project is established by
                        two or more hospitals to operate one or more
                        primary care graduate medical residency
                        training programs; and
                            (ii) such hospitals may be the sole
                        corporate members of the entity but the
                        governing board of the entity shall include at
                        least one community representative.
                    (C) A model in which the medical education entity
                receiving funds under the pilot project is a hospital
                subsidiary or independent corporation that operates one
                or more primary care graduate medical residency
                training programs for a hospital with community
                participation in the governance of the subsidiary or
                corporation.
                    (D) A model in which--
                            (i) the medical education entity receiving
                        funds under the pilot project is independent of
                        any hospital but collaborates with a hospital
                        in operating one or more primary care graduate
                        medical residency training programs; and
                            (ii) the medical education entity may
                        include a university or school of medicine.
            (2) Additional models.--Under the pilot project, the
        Secretary may test models of medical education entities in
        addition to those described in paragraph (1).
    (d) Prioritization.--Under the pilot project, the Secretary of
Health and Human Services may give priority to testing models that
demonstrate the capability of improving the quality, quantity, and
distribution of primary care physicians, including the ability to
enhance primary care delivery in rural and underserved areas.
    (e) Payments.--
            (1) Payments to medical education entities.--Under the
        pilot project, the Secretary shall establish a process under
        which payments are made to each medical education entity
        participating under such project for direct graduate medical
        education and indirect medical education costs with respect to
        primary care residents enrolled under a primary care graduate
        medical residency training program operated pursuant to a model
        of such entity under subsection (c) instead of any payment or
        adjustment that would otherwise be made to a participant
        hospital (as defined in subsection (m)) of such entity for
        indirect and direct graduate medical education costs under
        subsections (d)(5)(B) and (h) of section 1886 of the Social
        Security Act (42 U.S.C. 1395ww) during the period of
        participation of such entity in such project.
            (2) Calculation of payments.--Payments to a medical
        education entity under the pilot project, with respect to a
        primary care graduate medical education residency program, for
        a cost reporting period during which the entity is
        participating in such pilot shall be, based on the most
        recently available data with respect to a previous cost
        reporting period, equal to the sum of the following:
                    (A) Direct gme.--The amount that, out of all of the
                payment amounts (determined on a per resident basis)
                received by hospitals under section 1886(h) of the
                Social Security Act (42 U.S.C. 1395ww(h)) for such
                previous cost reporting period, is equal to the 95th
                percentile of such payment amounts.
                    (B) Indirect gme.--The amount that, out of all of
                the additional payment amounts (determined on a per
                resident basis) received by hospitals under section
                1886(d)(5)(B) of the Social Security Act (42 U.S.C.
                1395ww(d)(5)(B)) for such previous cost reporting
                period, is equal to the 95th percentile of such payment
                amounts.
            (3) Additional payments for programs serving underserved
        areas.--Payments in addition to the payments described in
        paragraph (2) may be made under the pilot project for primary
        care graduate medical residency training programs that--
                    (A) operate in sites and areas that are underserved
                by primary care physicians; or
                    (B) change their training sites to include those
                areas.
            (4) Payments from medicare trust funds.--In providing for
        such payments under this subsection to medical education
        entities, the Secretary shall provide for an allocation of such
        payments between part A and part B (and the Federal Hospital
        Insurance Trust Fund under section 1817 of the Social Security
        Act (42 U.S.C. 1395i) and the Federal Supplementary Medical
        Insurance Trust Fund under section 1841 of such Act (42 U.S.C.
        1395t)) in the same manner as the Secretary provides for an
        allocation of payments under subsections (d)(5)(B) and (h),
        respectively, of section 1886 of such Act (42 U.S.C. 1395ww).
    (f) Uses of Payments.--
            (1) In general.--A medical education entity receiving
        payments under the pilot project shall use such payments for
        the training of primary care residents, including training
        activities in appropriate inpatient and outpatient settings in
        primary care graduate medical residency training programs
        accredited by the Accreditation Council for Graduate Medical
        Education or the American Osteopathic Association and for all
        relevant topics including patient care, care management,
        working in teams, supervision, and quality improvement.
            (2) Limitations.--Payments shall only be made for training
        primary care residents up to the initial board certification of
        such residents, except that with respect to training in
        geriatric medicine, payments may also be made for a fellowship
        after initial board certification.
    (g) Expansion During Pilot Project.--A medical education entity
receiving funds under the pilot project, with respect to a primary care
graduate medical residency training program, shall be allowed to
increase by up to 50 percent the number of full-time equivalent primary
care residents enrolled in the such program (determined in accordance
with the process under subsection (d)(2)(A)(ii)) during the duration of
the participation of such entity in such project.
    (h) Treatment After Project.--
            (1) In general.--Subject to paragraphs (2) and (3), after
        the last day of the pilot project, which may be extended at the
        discretion of the Secretary, any participant hospital of a
        medical education entity under the pilot project, shall receive
        payments under subsection (d)(5)(B) and (h) of section 1886 of
        the Social Security Act (42 U.S.C. 1395ww) in the same manner
        and to the same extent such hospital would receive such
        payments without application of this Act and such payments
        shall be calculated based on the number of full-time equivalent
        residents enrolled in such program without regard to any
        increase made pursuant to subsection (g).
            (2) Exception to ensure residents enrolled during pilot are
        able to complete training.--Subject to paragraph (3), a medical
        education entity receiving funds under the pilot project, with
        respect to a primary care graduate medical residency training
        program, shall continue to receive funding under this section
        (even after the last day of the project), with respect to each
        primary care resident who is enrolled under such program while
        the entity is participating in such project, to the extent and
        in such amounts necessary to allow for the full duration of
        training, subject to subsection (f)(2), of such primary care
        resident. Any such payments made pursuant to this subparagraph
        shall be deemed to be a payment made under the pilot project.
            (3) Limitation.--In no case may the total duration of the
        pilot project exceed seven years and in no case may payments be
        made under this section to a medical education entity for a
        period exceeding seven years.
    (i) Budget Neutrality.--For each year that the pilot project under
this section is being conducted (and for any subsequent year to the
extent subsection (h)(2) applies), the Secretary shall reduce payments
under subsections (d)(5)(B) and (h) of section 1886 of the Social
Security Act (42 U.S.C. 1395ww) by such amount as the Secretary
determines to be necessary to ensure that carrying out the pilot
project under this section during such year does not result in
expenditures under title XVIII of the Social Security Act for such year
that exceed the amount of such expenditures that would have been made
for such year without application of this section.
    (j) Waiver Authority.--The Secretary may waive such requirements of
titles XI and XVIII of the Social Security Act as may be necessary to
carry out the purpose of the pilot project under this section.
    (k) Report to Congress.--The Secretary is authorized to enter into
an agreement with the Institute of Medicine to conduct a study on the
results of the pilot project. Such agreement shall provide for the
Institute of Medicine to submit, not later than 1 year after the
completion of the pilot project under this section (or, if sooner,
January 1, 2019), to Congress a report on the results of such study,
including--
            (1) a detailed analysis of the effects of the pilot,
        including the quality, quantity, and distribution of primary
        care physicians during and after the pilot project compared to
        the quality, quantity, and distribution of such physicians
        before the pilot project; and the governance, administration
        and financial strength of the medical educational entities that
        participated in the pilot project;
            (2) recommendations on the extent to which the pilot
        project should be expanded to all primary care residents; and
            (3) recommendations for such legislation and administrative
        actions as needed.
    (l) Expansion.--If the Secretary determines that any of the models
tested under the pilot project under this section enhance the quality,
quantity, and distribution of primary care physicians for Medicare
beneficiaries, the Secretary may initiate comparable primary care
training projects.
    (m) Definitions.--For purposes of this section:
            (1) Direct graduate medical education costs; indirect
        graduate medical education costs.--The terms ``direct graduate
        medical education costs'' and ``indirect graduate medical
        education'' have the meanings given such terms for purposes of
        subsections (h) and (d)(5)(B), respectively, of section 1886 of
        the Social Security Act (42 U.S.C. 1395ww).
            (2) Medical education entity.--The term ``medical education
        entity'' means a corporate, nonprofit, or academic entity that
        has as its principal mission the education and training of
        primary care residents.
            (3) Medicare beneficiary.--The term ``Medicare
        beneficiary'' means an individual entitled to benefits under
        part A of title XVIII of the Social Security Act or enrolled
        under part B of such title.
            (4) Participant hospital.--The term ``participant
        hospital'' means, with respect to a medical education entity,
        any hospital that establishes, is collaborating with, a
        component of, or otherwise associated with, such entity to
        operate a primary care graduate medical residency training
        program under a model described in subsection (c).
            (5) Primary care graduate medical residency training
        program.--The term ``primary care graduate medical residency
        training program'' means an approved medical residency training
        program (as defined in section 1886(h)(5)(A) of the Social
        Security Act (42 U.S.C. 1395ww(h)(5)(A))) for training primary
        care residents.
            (6) Primary care resident.--The term ``primary care
        resident'' means a resident enrolled in an approved medical
        residency training program in family medicine, general internal
        medicine, general pediatrics, or geriatric medicine.

Output:
Primary Care Workforce Access Improvement Act of 2011 - Directs the Secretary of Health and Human Services (HHS) to conduct a pilot project under title XVIII (Medicare) of the Social Security Act to test models for providing payment for direct graduate medical education (GME) and indirect medical education (IME) to medical education entities (MEEs), not otherwise eligible to receive such payments, for the costs of training primary care residents.

Requires testing of two of the following model MEEs: (1) a community-based independent corporate entity collaborating with two or more hospitals to operate one or more primary care graduate medical residency training programs (training hospitals); (2) a MEE, with at least one community representative on its board, which is established by two or more training hospitals which may be the sole corporate members of the MEE; (3) a hospital subsidiary or independent corporation, with community participation in its governance, that operates one or more training programs for a hospital; or (4) a MEE (including a university or school of medicine) independent of any hospital but collaborating with one in operating one or more primary care graduate medical residency training programs.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Public Library Innovation Space
Act''.

SEC. 2. AUTHORIZATION OF APPROPRIATIONS.

    Subsection (a) of section 214 of the Museum and Library Services
Act (20 U.S.C. 9123(a)) is amended--
            (1) in paragraph (1), by striking ``and'' at the end;
            (2) in paragraph (2), by striking the period at the end and
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(3) to carry out chapter 5, $10,000,000 for each of
        fiscal years 2018 through 2022.''.

SEC. 3. PUBLIC LIBRARY MAKERSPACE GRANTS.

    Subtitle B of title II of the Museum and Library Services Act (20
U.S.C. 9101 et seq.) is amended by adding at the end the following:

          ``CHAPTER 5--PUBLIC LIBRARY MAKERSPACE GRANT PROGRAM

``SEC. 265. PUBLIC LIBRARY MAKERSPACE GRANT PROGRAM.

    ``(a) Program Authorized.--From the amounts provided under section
214(a)(3), the Director shall carry out a program under which the
Director makes grants, on a competitive basis, to eligible partnerships
to establish makerspaces at public libraries.
    ``(b) Applications.--To be considered for a grant under this
section, an eligible partnership shall submit an application to the
Director at such time, in such manner, and containing such information
and assurances as the Director may require.
    ``(c) Selection of Grantees.--In selecting eligible partnerships to
receive grants under this section, the Director shall consider--
            ``(1) the viability of the partnership making the
        application;
            ``(2) the ability of the partnership to meet the matching
        requirement described in subsection (d);
            ``(3) the potential of the project to provide social and
        economic benefits to the local community;
            ``(4) the support of local communities, government, and
        partners for the project;
            ``(5) the project's potential for strengthening the
        involvement of diverse and underserved communities in
        entrepreneurship and economic development; and
            ``(6) the ability of the project to continue after the end
        of the grant period.
    ``(d) Matching Requirement.--
            ``(1) In general.--Except as provided in paragraph (2), an
        eligible partnership shall contribute, for the activities for
        which the grant was awarded under this section, non-Federal
        matching funds in an amount equal to the amount of the grant.
            ``(2) Waiver.--The Director may waive the requirement of
        paragraph (1) for any eligible partnership that the Director
        determines does not have adequate resources to meet such
        requirement.
    ``(e) Reports.--Not less frequently than once annually, the
Director shall submit to Congress a report that includes--
            ``(1) a description of the activities carried out with
        grants under this section; and
            ``(2) an assessment of the effect of the grant program on
        community economic development.
    ``(f) Treatment of Makerspaces.--The use of a makerspace supported
by a grant under this section shall not be treated as a private
business use under section 141(b) of the Internal Revenue Code of 1986.
    ``(g) Prohibition on Construction Activities.--An eligible
partnership that receives a grant under this section may not use grant
funds, or matching funds contributed by the partnership under
subsection (d), for construction activities at a public library that
would provide extra square footage to house a makerspace.
    ``(h) Definitions.--In this section:
            ``(1) Eligible partnership.--The term `eligible
        partnership' means a partnership that includes a public library
        and--
                    ``(A) an economic development corporation;
                    ``(B) a local government;
                    ``(C) a State government;
                    ``(D) an elementary school or secondary school (as
                such terms are defined in section 8101 of the
                Elementary and Secondary Education Act of 1965 (20
                U.S.C. 7801));
                    ``(E) a museum;
                    ``(F) an institution of higher education (as such
                term is defined in section 102 of the Higher Education
                Act of 1965 (20 U.S.C. 1002));
                    ``(G) a nonprofit organization;
                    ``(H) a corporation;
                    ``(I) other entities identified by the Director; or
                    ``(J) a combination of entities described in any of
                subparagraphs (A) through (I).
            ``(2) Makerspace.--The term `makerspace' means a facility
        (which may be a facility at a fixed location or a mobile unit)
        that is open to the public and provides individuals with access
        to--
                    ``(A) tools, technology, and educational resources
                that are designed to enable such individuals to create
                physical goods, including prototypes; and
                    ``(B) educational opportunities, including
                vocational training and assistance with early-stage
                business ventures.''.

Output: Public Library Innovation Space Act This bill requires the National Museum and Library Services Board to carry out a program for making competitive grants to eligible partnerships (composed of a public library and an economic development corporation, a local government, a state government, an elementary or secondary school, a museum, an institution of higher education, a nonprofit organization, a corporation, and/or other entities identified by the Board) to establish makerspaces at public libraries.  A makerspace is a facility (which may be at a fixed location or a mobile unit) that is open to the public and provides individuals with access to: (1) tools, technology, and educational resources designed to enable such individuals to create physical goods, including prototypes; and (2) educational opportunities, including vocational training and assistance with early-stage business ventures.  A partnership must contribute, for the activities for which the grant was awarded, nonfederal matching funds equal to the grant amount.  Each eligible partnership that receives a grant may not use its grant funds, or the matching funds contributed by it, for construction activities at a public library that would provide extra square footage to house a makerspace.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``American Samoa Economic Development
Act of 1995''.

SEC. 2. FINDINGS.

    The Congress finds that--
            (1) funding for the United States territory of American
        Samoa has been based on the joint resolution entitled ``Joint
        Resolution to provide for accepting, ratifying, and confirming
        cessions of certain islands of the Samoan group to the United
        States, and for other purposes'', as amended (48 U.S.C. 1661),
        with commitments being made on a yearly basis;
            (2) American Samoa is locally self-governing with a
        constitution of its own adoption and the direct election of the
        Governor since 1977;
            (3) the territory of American Samoa has had difficulty in
        planning and implementing comprehensive and sustainable
        infrastructure based solely on annual ad hoc grants; and
            (4) the territory of American Samoa and the United States
        would benefit from a multiyear funding commitment which
        promotes economic development and self-sufficiency and requires
        compliance with financial management accounting standards, the
        establishment of semiautonomous public utility authorities
        utilizing cost-recovery principles, and the phaseout of Federal
        subsidies for Government operations.

SEC. 3. AUTHORIZATION OF FUNDING.

    (a) In General.--There are authorized to be appropriated to the
Secretary of the Interior for the Government of American Samoa
$34,500,000, backed by the full faith and credit of the United States,
for each of fiscal years 1996 through 2005. Such amounts shall, subject
to the limits specified in the table in subsection (b), be used for--
            (1) construction of capital assets of American Samoa;
            (2) maintenance and repair of such capital assets;
            (3) the operations of the Government of American Samoa; and
            (4) reduction of unbudgeted debt incurred by the Government
        of American Samoa in fiscal years prior to 1996.
    (b) Table of Multiyear Funding.--The table referred to in this
subsection is as follows:

----------------------------------------------------------------------------------------------------------------
                                                                            Deficit       Maintenance
            Fiscal year              Year #   Operations  Construction     reduction      and repair      Total
                                                                         (100% match)    (100% match)
----------------------------------------------------------------------------------------------------------------
1996...............................     1        23.0           5.5           3.0             3.0          34.5
1997...............................     2        23.0           5.5           3.0             3.0          34.5
1998...............................     3        23.0           5.5           3.0             3.0          34.5
1999...............................     4        21.0           7.5           3.0             3.0          34.5
2000...............................     5        18.0          10.5           3.0             3.0          34.5
2001...............................     6        15.0          16.5                           3.0          34.5
2002...............................     7        12.0          19.5                           3.0          34.5
2003...............................     8         9.0          22.5                           3.0          34.5
2004...............................     9         6.0          25.5                           3.0          34.5
2005...............................    10         3.0          28.5                           3.0          34.5
----------------------------------------------------------------------------------------------------------------

    (c) Multiyear Availability of Appropriations.--Amounts not expended
in the year appropriated shall remain available until expended.

SEC. 4. ESTABLISHMENT OF TRUST.

    (a) In General.--The Government of American Samoa shall establish a
trust into which the amounts appropriated pursuant to section 3 are
placed.
    (b) Trustee.--
            (1) In general.--A trustee to administer the trust
        established by this section shall be nominated by the Governor
        of American Samoa and passed by both Houses of the Legislature
        of American Samoa pursuant to local law and shall be a
        nongovernmental entity, bonded in an amount no less than 110
        percent of the maximum amount of funds which will be held in
        trust during any given fiscal year (hereafter in this Act
        referred to as the ``trustee''). The trustee shall not be the
        independent auditor required by section 7.
            (2) Replacement.--The trustee may be terminated only by
        mutual agreement, or at the end of its contract for services as
        trustee, or for good cause. Termination of a trustee for good
        cause must be recommended by the Governor of American Samoa and
        approved by both Houses of the Legislature of American Samoa.
            (3) Other terms and conditions.--The trustee shall be
        subject to such other conditions as the Government of American
        Samoa may provide under local law.
    (c) Trust Funds.--
            (1) Deposit; investment.--The trust funds shall be
        deposited in an account or accounts of a financial institution
        insured by the Federal Deposit Insurance Corporation, and may
        be invested by the Government of American Samoa, or the trustee
        if so designated, in only federally insured accounts or issues
        of bonds, notes or other redeemable instruments of the
        Government of the United States.
            (2) Use of interest and dividends.--Interest or dividends
        earned from investment of trust funds under paragraph (1) may
        be used for projects contained on the approved master plan of
        capital needs developed under section 5, or for the costs of
        managing the trust.
            (3) Availability and use of federal funds.--Federal funds
        made available for the purposes described in section 3(a)(1)
        may be used only on projects from the approved master plan of
capital needs.
    (d) Reports.--Within 90 days after the end of each fiscal year, the
trustee shall submit an annual report to the chairmen and ranking
minority members of the Committee on Energy and Natural Resources and
the Committee on Appropriations of the United States Senate, the
Committee on Resources and the Committee on Appropriations of the
United States House of Representatives, and the Government of American
Samoa. The report shall include at a minimum the financial statements
of the account or accounts in which it holds trust funds pursuant to
this Act.

SEC. 5. USES OF TRUST FUNDS.

    (a) Capital Needs.--
            (1) Master plan of capital needs.--For fiscal year 1997 and
        all following years, no funds appropriated pursuant to this Act
        shall be released by the trustee for construction of capital
        assets without the submission by the Government of American
        Samoa to the trustee of a master plan of capital needs that
        ranks projects in order of priority for at least five years.
        The master plan shall be approved by the Governor and passed by
        both Houses of the Legislature of American Samoa pursuant to
        such laws as the Government of American Samoa may enact. The
        master plan of capital needs may be amended at any time, but
        all amendments must be approved by the Governor and passed by
        both Houses of the Legislature of American Samoa. The plan
        shall include the capital needs of all the islands of American
        Samoa.
            (2) Funds for construction of capital assets.--Funds for
        the construction of capital assets shall be paid to the
        Government of American Samoa only after approval by the
        trustee. The trustee shall approve the release of funds only
        for construction projects for a public purpose in the areas of
        communications, electrical power, water, waste water, roads,
        schools, school transportation system, air, water and surface
        transportation, ports, harbors, storage and transportation
        facilities of fuels or other forms of energy, health, and
        construction of government-owned buildings. Funding made
        available pursuant to section 3(a)(1) for construction of
        capital assets may only be used for projects listed on the
        master plan of capital needs as set forth in this section. To
        the extent an appropriation is available, the projects
        contained on the master list with the highest priority are to
        be funded.
            (3) Requirement of semiautonomous agencies.--Beginning with
        fiscal year 1997, no funds for the construction of capital
        assets shall be released by the trustee in the areas of
        communications, electrical power, public health,
        transportation, water, and wastewater until there is
        established by local law semiautonomous government agencies of
        the Government of American Samoa.
            (4) Maintenance plan and funding.--For fiscal years 1997
        and all following years, no funds appropriated pursuant to this
        Act shall be released by the trustee for the construction of
        capital assets until the Government of American Samoa, or the
        appropriate semiautonomous government agency if required,
        submits to the trustee a maintenance plan covering the
        anticipated life of the project and the project is initially
        funded. The maintenance plan shall include the estimated cost
        of maintaining and repairing the project and identify a source
        to fund the estimated maintenance and repairs for the
        anticipated life of the project. The initial funding for this
        maintenance plan shall be in the amount of 10 percent of the
        cost of the project. Federal funds made available for the
        purposes described in section 3(a)(2) may be used for one-half
        of the initial funding. Other Federal funds made available
        pursuant to this Act may not be used for this purpose. Funds
        set aside pursuant to this paragraph may be used for the
        maintenance and repair of any capital asset within the purview
        of the government or the appropriate semiautonomous agency.
    (b) Debt Reduction.--Any funding made available pursuant to section
3(a)(4) used to reduce the unbudgeted debt of the Government of
American Samoa must be matched, on a dollar for dollar basis, by funds
provided by the Government of American Samoa from revenue raised from
non-Federal sources.
    (c) Maintenance and Repair.--Any funding made available pursuant to
section 3(a)(2) used for the maintenance or repair of the capital
assets of the Government of American Samoa must be matched, on a dollar
for dollar basis, by funds provided by the Government of American Samoa
from revenue raised from non-Federal sources.
    (d) Prohibited Uses of Funds.--Neither the funds appropriated
pursuant to this Act, nor any interest or dividends earned on those
funds may be transferred to other accounts, or loaned to other accounts
or agencies; nor may these funds, interest or dividends be used as
collateral for loans made by the local government.

SEC. 6. DISBURSEMENT OF TRUST FUNDS.

    (a) Operations.--Trust funds to be used for the operations of the
Government of American Samoa shall be disbursed in equal amounts on a
monthly basis, on the first business day of each month of the fiscal
year. An extra drawdown may be made once each fiscal year in an amount
not to exceed ten percent of the amounts appropriated for the fiscal
year for the purposes of section 3(a)(3), and only for purposes caused
by extreme or national emergencies deemed unforeseeable by the trustee.
    (b) Construction.--Trust funds to be used for the construction of
capital assets shall be released by the trustee--
            (1) to the Government of American Samoa, only upon
        completion of identifiable portions of the construction work if
        the work is performed by employees of the Government of
        American Samoa, or
            (2) a bona fide contractor of the Government of American
        Samoa pursuant to the terms of a construction contract, on an
        invoice presented to the Government of American Samoa and
        approved by an appropriate official of the Government of
        American Samoa.
    (c) Debt Reduction; Maintenance Repair.--Trust funds to be used for
unbudgeted debt reduction or maintenance and repair made available
under sections 3(a)(2) and 3(a)(4) shall be released by the trustee on
submission by the Government of American Samoa of proof of payment from
non-Federal sources for either debt reduction, maintenance, or repair,
and proof acceptable to the trustee of an obligation due and owing for
the appropriate category.

SEC. 7. AUDITS.

    (a) In General.--Beginning with fiscal year 1996, the Government of
American Samoa must obtain, at its own expense, a comprehensive
financial audit meeting the requirements of chapter 75 of title 31,
United States Code, and subtitle A of title 43, Code of Federal
Regulations, and upon which an independent auditor expresses an opinion
that the financial statements of the Government of American Samoa
present fairly, in all material respects, the financial position of the
Government of American Samoa, and were prepared in conformity with
generally accepted accounting principles. The audit shall include the
funds held in trust pursuant to this Act.
    (b) Submission of Audit Report to United States.--Reports of audits
required in this section shall be transmitted by the Governor of
American Samoa to the chairmen and ranking members of the Committee on
Energy and Natural Resources and the Committee on Appropriations of the
United States Senate, and the Committee on Resources and the Committee
on Appropriations of the United States House of Representatives within
180 days of the end of each fiscal year for which the United States
provides funding under this Act.
    (c) Failure To Obtain Audit.--In the event the Government of
American Samoa does not obtain the audit within the time required by
this section, the trustee shall not disburse additional funds pursuant
to section 3(a)(3) for the operations of the Government of American
Samoa until such time as a qualifying audit is received and the report
of that audit is forwarded as required by this section. Notwithstanding
the preceding sentence, one emergency disbursement may be made per year
under the provisions of section 6 of this Act, even if a qualifying
audit report is not obtained.

SEC. 8. AUTHORITY OF UNITED STATES TO AUDIT.

    The Comptroller General of the United States and the Inspector
General of the Department of the Interior shall have the authority to
conduct audits of all funds of all branches and semiautonomous
authorities of the Government of American Samoa. Nothing in this Act
shall be construed to restrict the authority of these or other Federal
agencies to audit government funds as authorized by Federal law.

SEC. 9. SETTLEMENT OF DISPUTES.

    The High Court of American Samoa is authorized to resolve disputes
which arise under this Act pursuant to its rules of procedure.

Output:
American Samoa Economic Development Act of 1995 - Authorizes appropriations to the Secretary of the Interior for the Government of American Samoa for FY 1996 through 2005 to be used for:  (1) construction, maintenance, and repair of American Samoa's capital assets; (2) operations of the Government of American Samoa; and (3) reduction of unbudgeted debt incurred by the Government of American Samoa in fiscal years prior to 1996.
Requires amounts appropriated to be placed in a trust administered by a nongovernmental entity.
Prohibits the release of funds for the construction of capital assets for FY 1997 and following years until:  (1) the Government of American Samoa submits to the trustee a master plan of capital needs that ranks projects in order of priority for at least five years; and (2) such Government submits to the trustee a maintenance plan covering the anticipated life of the project and the project is initially funded.  Approves the release of funds only for construction projects for specified public purposes.
Prohibits the release of such funds, beginning in FY 1997, in the areas of communications, electrical power, public health, transportation, water, and wastewater until semiautonomous government agencies of the Government of American Samoa are established by local law.
Requires funding provided to reduce the unbudgeted debt and for maintenance or repair of capital assets to be matched by non-Federal sources.
Prohibits funds appropriated pursuant to this Act from being transferred to other accounts, loaned to other accounts or agencies, or used as collateral for loans made by the local government.
Sets forth conditions on the release of trust funds to be used for construction of capital assets, debt reduction, and maintenance or repair.
Requires the Government of American Samoa to obtain and submit an annual audit of its financial position to specified congressional committees.  Withholds funds for government operations until a qualifying audit is received and reported.
Authorizes the Comptroller General and the Inspector General to conduct audits of all funds of branches and semiautonomous authorities of the Government of American Samoa.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Working Families Flexibility Act of
1996''.

SEC. 2. COMPENSATORY TIME.

    Subsection (o) of section 7 of the Fair Labor Standards Act of 1938
(29 U.S.C. 207) is amended--
            (1) by striking paragraphs (1) through (5) and inserting
        the following:
    ``(1) An employee may receive, in accordance with this subsection
and in lieu of monetary overtime compensation, compensatory time off at
a rate not less than one and one-half hours for each hour of employment
for which overtime compensation is required by this section.
    ``(2) An employer may provide compensatory time under paragraph (1)
only--
            ``(A) pursuant to--
                    ``(i) applicable provisions of a collective
                bargaining agreement, memorandum of understanding, or
                any other agreement between the employer and
                representatives of such employees, or
                    ``(ii) in the case of employees who are not
                represented by a collective bargaining agent or other
                representative designated by the employee, an agreement
                or understanding arrived at between the employer and
                employee before the performance of the work if such
                agreement or understanding was entered into knowingly
                and voluntarily by such employee;
            ``(B) in the case of an employee who is not an employee of
        a public agency, if such employee has affirmed, in a written or
        otherwise verifiable statement that is made, kept, and
        preserved in accordance with section 11(c), that the employee
        has chosen to receive compensatory time in lieu of overtime
        compensation; and
            ``(C) if the employee has not accrued compensatory time in
        excess of the limit applicable to the employee prescribed by
        paragraph (4) or (5).
In the case of employees described in subparagraph (A)(ii) who are
employees of a public agency and who were hired before April 15, 1986,
the regular practice in effect on such date with respect to
compensatory time off for such employees in lieu of the receipt of
overtime compensation, shall constitute an agreement or understanding
described in such subparagraph. Except as provided in the preceding
sentence, the provision of compensatory time off to employees of a
public agency for hours worked after April 14, 1986, shall be in
accordance with this subsection. An employer may provide compensatory
time under paragraph (1) to an employee who is not an employee of a
public agency only if such agreement or understanding was not a
condition of employment.
    ``(3) An employer which is not a public agency and which provides
compensatory time under paragraph (1) to employees shall not directly
or indirectly intimidate, threaten, or coerce or attempt to intimidate,
threaten, or coerce any employee for the purpose of--
            ``(A) interfering with such employee's rights under this
        subsection to request or not request compensatory time off in
        lieu of payment of overtime compensation for overtime hours; or
            ``(B) requiring any employee to use such compensatory time.
    ``(4)(A) An employee, who is not an employee of a public agency,
may accrue not more than 240 hours of compensatory time.
    ``(B)(i) Not later than January 31 of each calendar year, the
employee's employer shall provide monetary compensation for any
compensatory time off accrued during the preceding calendar year which
was not used prior to December 31 of the preceding year at the rate
prescribed by paragraph (6). An employer may designate and communicate
to the employer's employees a 12-month period other than the calendar
year, in which case such compensation shall be provided not later than
31 days after the end of such 12-month period.
    ``(ii) The employer may provide monetary compensation for an
employee's unused compensatory time in excess of 80 hours at any time
after giving the employee at least 30 days notice. Such compensation
shall be provided at the rate prescribed by paragraph (6).
    ``(iii) An employer which has adopted a policy offering
compensatory time to employees may discontinue such policy upon giving
employees 30 days notice. An employee who is not an employee of a
public agency may withdraw an agreement or understanding described in
paragraph (2)(A)(ii) at any time.
    ``(C) An employee may also request in writing that monetary
compensation be provided, at any time, for all compensatory time
accrued which has not yet been used. Within 30 days of receiving the
written request, the employer shall provide the employee the monetary
compensation due in accordance with paragraph (6).
    ``(5)(A) If the work of an employee of a public agency for which
compensatory time may be provided included work in a public safety
activity, an emergency response activity, or a seasonal activity, the
employee engaged in such work may accrue not more than 480 hours of
compensatory time for hours worked after April 15, 1986. If such work
was any other work, the employee engaged in such work may accrue not
more than 240 hours of compensatory time for hours worked after April
15, 1986. Any such employee who, after April 15, 1986, has accrued 480
or 240 hours, as the case may be, of compensatory time off shall, for
additional overtime hours of work, be paid overtime compensation.
    ``(B) If compensation is paid to an employee described in
subparagraph (A) for accrued compensatory time off, such compensation
shall be paid at the regular rate earned by the employee at the time
the employee receives such payment.
    ``(6)(A) An employee of an employer which is not a public agency
who has accrued compensatory time off authorized to be provided under
paragraph (1) shall, upon the voluntary or involuntary termination of
employment, be paid for the unused compensatory time at a rate of
compensation not less than--
            ``(i) the average regular rate received by such employee
        during the period during which the compensatory time was
        accrued, or
            ``(ii) the final regular rate received by such employee,
whichever is higher.
    ``(B) An employee of an employer which is a public agency who has
accrued compensatory time off authorized to be provided under paragraph
(1) shall, upon the voluntary or involuntary termination of employment,
be paid for the unused compensatory time at a rate of compensation not
less than--
            ``(i) the average regular rate received by such employee
        during the last 3 years of the employee's employment, or
            ``(ii) the final regular rate received by such employee,
whichever is higher.
    ``(C) Any payment owed to an employee under this subsection for
unused compensatory time shall be considered unpaid overtime
compensation.
    ``(7) An employee--
            ``(A) who has accrued compensatory time off authorized to
        be provided under paragraph (1), and
            ``(B) who has requested the use of such compensatory time,
shall be permitted by the employee's employer to use such time within a
reasonable period after making the request if the use of the
compensatory time does not unduly disrupt the operations of the
employer.''; and
            (2) by redesignating paragraphs (6) and (7) as paragraphs
        (8) and (9), respectively.

SEC. 3. REMEDIES.

    Section 16 of the Fair Labor Standards Act of 1938 (29 U.S.C. 216)
is amended--
            (1) in subsection (b), by striking ``(b) Any employer'' and
        inserting ``(b) Except as provided in subsection (f), any
        employer''; and
            (2) by adding at the end the following:
    ``(f) An employer which is not a public agency and which violates
section 7(o)(3) shall be liable to the employee affected in the amount
of the rate of compensation (determined in accordance with section
7(o)(6)(A)) for each hour of compensatory time accrued by the employee
and in an additional equal amount as liquidated damages reduced by the
amount of such rate of compensation for each hour of compensatory time
used by such employee.''.

SEC. 4. NOTICE TO EMPLOYEES.

    Not later than 30 days after the date of the enactment of this Act,
the Secretary of Labor shall revise the materials the Secretary
provides, under regulations published at 29 C.F.R. 516.4, to employers
for purposes of a notice explaining the Fair Labor Standards Act of
1938 to employees so that such notice reflects the amendments made to
such Act by this Act.

            Passed the House of Representatives July 30, 1996.

            Attest:

                                                ROBIN H. CARLE,

                                                                 Clerk.

Output: Working Families Flexibility Act of 1996 - Amends the Fair Labor Standards Act of 1938 (FLSA) to provide for compensatory time for all employees. Allows an employee to receive, in lieu of monetary overtime compensation, compensatory time off at a rate not less than one and one-half hours for each hour of employment for which overtime compensation is required under the Act. Allows an employer to provide such compensatory time only:  (1) pursuant to an agreement with employee representatives, or, where there are no designated representatives, with the employee if such agreement was entered into knowingly and voluntarily; (2) if a private employee has affirmed, in a verifiable statement, the choice of receiving compensatory time in lieu of overtime pay; and (3) if the employee has not accrued compensatory time in excess of applicable limits. Sets forth special rules relating to public employees. Prohibits employer coercion of employees for the purpose of:  (1) interfering with their right to choose whether to request compensatory time off in lieu of overtime pay; or (2) requiring them to use compensatory time. Limits to not more than 240 hours the amount of compensatory time an employee may accrue (with specified exceptions for public agency employees).  Requires payment of compensation at the prescribed regular rate for:  (1) compensatory time accrued but not used in a calendar year or other designated 12-month period; and (2) unused compensatory time upon termination of employment. Allows an employer to provide monetary compensation at any time after giving the employee at least 30 days notice, at the prescribed regular rate, for an employee's unused compensatory time in excess of 80 hours.  Allows an employee to request in writing that monetary compensation be provided at the prescribed regular rate, at any time, for all compensatory time accrued and not yet used. Requires employers to permit employees to use compensatory time within a reasonable period after employees request its use, if such use does not unduly disrupt employers' operations. Makes private employers who violate specified provisions of this Act liable to the employee affected in the amount of the rate of compensation for each hour of compensatory time accrued by the employee, and in an additional equal amount as liquidated damages reduced by the amount of such rate of compensation for each hour of compensatory time used by such employee. Directs the Secretary of Labor to revise materials provided to employers for notices explaining FLSA to employees to reflect amendments made by this Act.


Input:
SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Rural Equity
Payment Index Reform Act of 2003''.
    (b) Findings.--Congress makes the following findings:
            (1) Variations in the physician work adjustment factors
        under section 1848(e) of the Social Security Act (42 U.S.C.
        1395w-4w(e)) result in a physician work payment inequity
        between urban and rural localities under the medicare physician
        fee schedule.
            (2) The amount the medicare program spends on its
        beneficiaries varies substantially across the country, far more
        than can be accounted for by differences in the cost of living
        or differences in health status.
            (3) Since beneficiaries and others pay into the program on
        the basis of income and wages and beneficiaries pay the same
        premium for part B services, these payments result in
        substantial cross-subsidies from people living in low payment
        States with conservative practice styles or beneficiary
        preferences to people living in higher payment States with
        aggressive practice styles or beneficiary preferences.
            (4) Congress has been mindful of these variations when it
        comes to capitation payments made to managed care plans under
        the Medicare+Choice program and has put in place floors that
        increase monthly payments by more than one-third in some of the
        lowest payment counties over what would otherwise occur. But
        this change addresses only a very small fraction of medicare
        beneficiaries who are presently enrolled in Medicare+Choice
        plans operating in low payment counties.
            (5) Unfortunately, Congress has only begun to address the
        underlying problem of substantial geographic variations in fee-
        for-service spending under traditional medicare.
            (6) Improvements in rural hospital payment systems under
        the medicare program help to reduce aggregate per capita
        payment variation as rural hospitals are in large part located
        in low payment counties.
            (7) Many rural communities have great difficulty attracting
        and retaining physicians and other skilled health
        professionals.
            (8) Targeted efforts to provide relief to rural doctors in
        low payment localities would further reduce variation by
        improving access to primary and tertiary services along with
        more equitable payment.
            (9) Geographic adjustment factors in the medicare program's
        resource-based relative value scale unfairly suppress fee-for-
        service payments to rural providers.
            (10) Actual costs are not presently being measured
        accurately and payments do not reflect the costs of providing
        care.
            (11) Unless something is done about medicare payment in
        rural areas, as the baby boom cohort ages into medicare, the
        financial demands on rural communities to subsidize care for
        their aged and disabled medicare beneficiaries will progress
        from difficult to impossible in another 10 years.
            (12) The impact on rural health care infrastructure will be
        first felt in economically depressed rural areas where the
        ability to shift costs is already limited.

SEC. 2. PHYSICIAN FEE SCHEDULE WAGE INDEX REVISION.

    Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)) is amended--
            (1) in subparagraph (A), by striking ``subparagraphs (B)
        and (C)'' and inserting ``subparagraphs (B), (C), and (E)'';
        and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Floor for work geographic indices.--
                            ``(i) In general.--Notwithstanding the work
                        geographic index otherwise calculated under
                        subparagraph (A)(iii), in no case may the work
                        geographic index applied for payment under this
                        section be less than--
                                    ``(I) 0.976 for services furnished
                                during 2004;
                                    ``(II) 0.987 for services furnished
                                during 2005;
                                    ``(III) 0.995 for services
                                furnished during 2006; and
                                    ``(IV) 1.000 for services furnished
                                during 2007 and subsequent years.
                            ``(ii) Exemption from limitation on annual
                        adjustments.--The increase in expenditures
                        attributable to clause (i) shall not be taken
                        into account in applying subsection
                        (c)(2)(B)(ii)(II).''.

Output: Rural Equity Payment Index Reform Act of 2003 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a minimum geographic cost-of-practice index value for physicians' services furnished under the Medicare program.