workers in the job category employed by all the community or district boards, respectively, in its region to the number of residents in such region; and

(2) there is a community or district within its region which is a health worker shortage area (as defined in section 313 (c) (2)) with respect to the job category.

(f) An employee of the Organization may not receive any fee or prequiste from a patron of the Organization on account of duties performed by virtue of such employment, except as authorized by law.

SOLICITATION AND USE OF RECOMMENDATIONS

SEC. 322. (a) An area health board may solicit, accept, and consider, and any other indiivdual or organization may furnish or transmit to the board, any statement with respect to an individual who requests or is under consideration for appointment, promotion, assignment, or transfer by the board if—

(1) the statement is furnished pursuant to a request or requirement of the board and consists solely of an evaluation of the work performance, ability, aptitude, and general qualifications of such individual;

(2) the statement relates solely to the character and residence of such individual; or

(2) the statement is furnished by a former employer of such individual pursuant to a request of the board, and consists solely of an evaluation of the work performance, ability, aptitude, and general qualifications of such individual during the individual's employment with such former employer. (b) Except as provided in subsection (a), each appointment, promotion, assignment, or transfer, interim or otherwise, of an employee of the Organization (except individuals on the personal staffs of area health board members) shall be made without regard to any recommendation or statement, oral or written, with respect to any individual who requests or is under consideration for such appointment, promotion, assignment, or transfer, made by any individual or organization.

(c) Except as provided in subsection (a), individuals and organizations may not make or transmit to the Organization any recommendation or statement, oral or written, with respect to any individual who requests or is under consideration for any such appointment, promotion, assignment, or transfer. The Organization, subject to subsection (a) —

(1) shall not solicit, request, consider or accept any such recommendation or statement; and

(2) shall return any such written recommendation or statement received by it, appropriately marked as in violation of this section, to the person or organization making or transmitting such statement.

(d) An individual who requests or is under consideration for any such appointment, promotion, assignment, or transfer may not request or solicit any such recommendation or statement from any individual or organization except a statement of the type described in subsection (a) (2).

(e) The Organization shall take any action it determines necessary and proper, including but not limited to suspension, removal from office, or disqualification from employment by the Organization, to enforce the provisions of this section.

APPLICABILITY OF LAWS RELATING TO FEDERAL EMPLOYEES

SEC. 323. (a) The provisions of chapter 75 of title 5, United States Code (relating to adverse actions against employees) shall apply to employees of the Organization (other than employees serving on the personal staff of members of health boards), except to the extent of any inconsistency with

(1) the provisions of any collective-bargaining agreement negotiated on behalf of and applicable to them; or

(2) procedures established by the Organization and approved by the Civil Service Commission.

(b) Employees of the Organization shall be covered by subchapter I of chapter 81 of title 5, United States Code (relating to compensation for work injuries). (c) (1) Employees of the Organization shall be covered by chapter 83 of title 5, United States Code (relating to civil service retirement), to the extent not inconsistent with the provisions of any collective bargaining agreement negotiated on behalf of and applicable to them.

(2) The Organization shall withhold from pay and shall pay into the Civil Service Retirement and Disability Fund the amounts specified in chapter 83 of title 5, United State Code, as required under paragraph (1). The Organization, upon request of the Civil Service Commission, but not less frequently than annually, shall pay to the Commission the costs reasonably related to the administration of Fund activities for employees of the Organization.

(d) Sick and annual leave and compensatory time for employees of the Organization, whether accrued prior to or after the commencement of operations of the Organization, shall be obligations of the Organization.

(e) (1) Compensation, benefits, and other terms and conditions of employment in effect on the day before the effective date of health services for employees of the Federal Government performing functions that are provided under this Act by the Organization, shall apply to all employees of the Organization performing similar functions until changed by the Organization in accordance with this Act. Subject to the provisions of this Act, the provisions of subchapter I of chapter 85 and chapter 87 of title 5, United States Code (relating to unemployment compensation and life insurance) shall apply to employees of the Organization unless varied, added to, or substituted for in accordance with paragraph (2).

(2) No variation, addition, or substitution with respect to fringe benefits shall result in a program of fringe benefits which on the whole is less favorable to employees of the Organization than fringe benefits in effect for employees of the Federal Government on the effective date of health services. No variation, addition, or substitution with respect to fringe benefits of employees for whom there is a collective-bargaining representative shall be made except by agreement between such representative and the Organization.

APPLICABILITY OF FEDERAL LABOR-MANAGEMENT RELATIONS LAWS

SEC. 324. (a) The provisions of the National Labor Relations Act (42 U.S.C. 141 et seq.) shall apply to the Organization and its employees to the extent, not inconsistent with subsection (b), to which such provisions apply to employers (as defined in section 101 (2) of such Act).

(b) (1) Collective-bargaining agreements between area health boards and duly recognized bargaining representatives of employees of the Organization (A) shall be effective for not less than two years, and (B) may include procedures for resolution by the parties of grievances and adverse actions arising under the agreement, including procedures culminating in binding third-party arbitration.

(2) Area health boards and duly recognized bargaining representatives of employees of the Organization may by mutual agreement adopt procedures for the resolution by the parties (A) of grievances and adverse actions arising under collective-bargaining agreements, and (B) of disputes or impasses arising in the negotiation of such agreements.

(c) Sections 3(c) of the Labor-Management Reporting and Disclosure Act of 1959 (42 U.S.C. 402(c)) is amended by inserting "the United States Health Service Organization and" after "and includes".

TITLE IV-OTHER FUNCTIONS OF HEALTH BOARDS

PART A-ADVOCACY, GRIEVANCE PROCEDURES, AND TRUSTEESHIPS

ADVOCACY AND LEGAL SERVICES PROGRAM

SEC. 401. (a) Each area health board shall establish a program of health advocacy to ensure the full realization of the patient rights enumerated in part B of title II. Such a program shall include_

(1) the employment of individuals having basic legal knowledge and skills as health advocates;

(2) the presence of health advocates (A) in inpatient health care facilities at all times, and (B) in other health care facilities during the provision of health care services;

(3) provision for health advocates to (A) inform, on an ongoing basis, users and health workers of such patient rights and (B) report to the area health board any infraction of such rights which is not promptly corrected ; (4) provision for regular meetings between health workers and health

advocates, users, and any user representatives to discuss ways of ensuring the fulfillment of such rights through affirmative action of such workers and the area health board; and

(5) appropriate action by the area health board to ensure that infractions of such rights are promptly and sufficiently corrected.

(b) (1) The National Board shall establish a health rights legal services program and shall provide such program with sufficient legal and administrative personnel, funding, and facilities (A) to ensure that users and health workers receive, free of charge, high quality legal services (including representation in grievance proceedings commenced under section 402) for legal problems related to health rights and health care sservices, and (B) to improve, through litigation and other activities, the health care system and expand the rights of users and health workers.

(2) The health rights legal services program shall provide directly, by contract with the National Legal Services Corporation, or by contract with members of the private bar, for

(A) establishment of a legal services office in each region to provide representation (other than representation provided under subparagraph (B)) of users, health workers, and voluntary associations having a demonstrated interest in health care in proceedings and hearings under section 402; and

(B) establishment of legal services offices in such communities and districts as are determined, in accordance with guidelines established by the National Board, to have inadequate legal services to provide the legal services described in paragraph (1) (A).

(3) The National Board may carry out the functions described in paragraph (1) (B) directly, by contract, or otherwise.

GRIEVANCE PROCEDURES AND TRUSTEESHIPS

SEC. 402. (a) (1) Each regional and interim regional board shall provide, in accordance with this section, that any user health worker, or any voluntary association having a demonstrated interest in health care may commence a grievance proceeding before such board (or a person or committee designated by such board) with respect to an alleged violation of this Act by a district or community board within its region. Each regional and interim regional board may commence a grievance proceeding before itself (or a person or committee designated by such board) with respect to an alleged violation of this Act by a district or community board within its region.

(2) The appropriate National Board shall provide, in accordance with this section, that any user, health worker, or any voluntary association having a demonstrated interest in health care may commence a grievance proceeding before such Board (or a person or committee designated by such Board) with respect to an alleged violation of this Act, by a regional or interim regional board. The appropriate National Board may commence a grievance proceeding before itself (or a person or committee designed by such Board) with respect to an alleged violation of this Act by a regional or interim regional board.

(3) The Secretary of the Treasury (hereinafter in this section referred to as the "Secretary") shall provide, by regulation and in accordance with this section, that any user, health worker, or any voluntary association having a demonstrated interest in health care may commence a grievance proceeding before the Secretary (or a person or committee designated by the Secretary) with respect to an alleged violation of this Act by an appropriate National Board. The Secretary may commence a grievance proceeding before himself (or a person or committee designated by the Secretary) with respect to an alleged violation of this Act by an appropriate National Board.

(b) (1) The appropriate National Board shall provide, subject to paragraphs (3) and (4), for its review (or a review by a person or committee designated by the Board), by appeal to the Board by any party to a proceeding described in subsection (a) (1) or on its own initiative, of an adverse decision by a regional or interim regional board in the proceeding.

(2) The Secretary shall provide, subject to paragraphs (3) and (4), for the Secretary's review (or a review by a person or committee designated by the Secretary), by appeal to the Secretary by any party to a proceeding described in subsection (a) (2) or to a review proceeding under paragraph (1) or on his own initiative, of an adverse decision by the appropriate National Board in the proceeding.

(3) On and after the date a suit with respect to an adverse determination in a grievance proceeding or review proceeding is filed under subsection (e), no review proceeding respecting such proceeding or review proceeding may be commenced by appeal to the Board or the Secretary under paragraph (1) or (2), and any such review proceeding which was commenced by appeal to the Board or the Secretary under such paragraph before the date of filing of such suit and is pending on such date shall promptly be discontinued.

(4) No review of an adverse administrative decision may be made by appeal or by initiative under this subsection unless the appeal is filed or notice of the initiative is published (as the case may be) not later than 15 days after the publication of the decision.

(c) (1) Whenever a grievance proceeding is commenced under subsection (a), the entity before which the proceeding is held shall investigate the grievance. (2) An entity before which a proceeding or review proceeding is commenced under subsection (a) or (b)—

(A) shall conduct a full and open public hearing on the grievance as part of such proceeding

(i) if the grievance is supported by a petition signed by a minimal number of residents (as defined in paragraph (4)); or

(ii) before the entity (or the body which designated it) may set aside an election or transfer any functions of a health board under subsection (d); and

(B) may conduct such a hearing if the entity determines that such hearing is in the public interest.

(3) The entity that conducts a hearing under paragraph (2) shall provide for timely notice to, and opportunity to be heard by, any party with a direct interest in the grievance for which the hearing is conducted.

(4) As used in paragraph (1), the term "minimal number of residents" means, with respect to a grievance which concerns a health board which is—

(A) a community board, 100 individuals,

(B) a district board, 300 individuals,

(C) a regional or interim regional board, 1,000 individuals, and
(D) an approprate National Board, 250,000 individuals,

who are 18 years of age or older and who reside in the area served by the board. (d) (1) With respect to a grievance proceeding begun under subsection (a) relating to the conduct of an election of a community board, if the entity before which such proceeding is commenced under such subsection, or is reviewed under subsection (b), determines that the election (A) was not conducted substantially in compliance with this Act or (B) has revealed the systematic nonrepresentation of significant elements of the population of the community, whether by race, sex, national origin, income level, or otherwise, the entity shall set aside the election and, unless such determination is reviewed under subsection (b), the entity shall require that another election for members of the community board be conducted, in accordance with this Act, not later than 60 days after the date of such determination. If such election is conducted because of a determination under clause (B), the election shall be conducted (and subsequent elections may be conducted) in such a manner, including the use of geographic or other subdivisions for electoral purposes, as will facilitate the representation of the significant elements of the population of a community.

(2) With respect to a grievance proceeding begun under subsection (a) relating to a grievance other than the conduct of an election of a community board, if the entity before which such proceeding is commenced under such subsection, or is reviewed under subsection (b), determines that the grievance represents

(A) a failure by a health board to comply substantially and materially with this Act, the entity shall require that a new election or appointment, in accordance with this Act, of members of the health board be conducted or made within 60 days of the date of such determination; or

(B) a failure by a health board to comply, but not substantially and materially, with this Act, the entity may require that a new election or appointment, in accordance with this Act, of members of the health board be conducted or made if such failure is not corrected within a reasonable period of time (specified by the entity) of the date of such determination. (3) (A) If an entity determines under paragraph (1) or (2) that a community or district board has failed to comply with this Act, the entity shall transfer to the regional (or interim regional) board for such community or district such

functions of the community or district board as it determines necessary to carry out this Act until a new election or appointment is conducted or made.

(B) If an entity determines under paragraph (2) that a regional or interim regional board has failed to comply with this Act, the entity shall transfer to the appropriate National Board such functions of the regional or interim regional board as it determines necessary to carry out this Act until a new regional or interim regional board is appointed.

(C) If the Secretary determines under paragraph (2) that an appropriate National Board has failed to comply with this Act, the Secretary shall transfer to the Secretary such functions of the Board as the Secretary determines necessary to carry out this Act until a new National Board is appointed.

(D) If a health board or the Secretary is transferred the functions of another health board under this paragraph, until a new election or appointment of the other health board has been certified, (i) the health board or the Secretary, respectively, shall have the powers of the other health board to conduct such functions, (ii) the health board or the Secretary, respectively, may appoint a trustee (or trustee committee) to have such powers and carry out such functions, and (iii) any expenses that are certified by the health board or the Secretary, respectively (or by the trustee or trustee committee appointed by it) as having been incurred by it in discharging the functions transferred to it under this paragraph shall be paid from funds allocated to the other health board.

(e) Any party to a grievance proceeding or review proceeding commenced under this section may bring suit in the United States district court for the judicial district in which such proceeding, or review proceeding, was brought, for the review of an adverse determination in such proceeding or review proceeding. Such court shall affirm such determination unless if finds that such determination is not supported by substantial evidence or is arbitrary and capricious.

PART B-OCCUPATIONAL SAFETY AND HEALTH PROGRAMS

FUNCTIONS OF THE NATIONAL BOARD

SEC. 411. (a) On and after the effective date of health services, the National Board shall oversee occupational safety and health programs conducted at the regional level, and shall participate in the establishment and administration of occuptional safety and health standards under the Occuptional Safety and Health Act of 1970.

(b) In its participation in the establishment and administration of occupational safety and health standards under the Occupational Safety and Health Act of 1970, the National Board shall seek the advice and comments of regional occupational safety and health action councils established under section 413. (c) (1) To provide for participation of the National Board in the establish ment and administration of occupational safety and health standards, the Occupational Safety and Health Act of 1970 (29 U.S.C. 651 et seq.) is amended(A) by adding at the end of section 3 the following new paragraph: "(15) The term 'National Health Board' means the Board of Directors of the United States Health Services Organization.";

(B) by striking out "Secretary of Health, Education, and Welfare" each time it appears (other than in section 22(b)) and inserting in lieu thereof "National Health Board";

(C) by inserting "shall request the National Health Board and" in the first sentence of section 6(b) (1) before "may request";

(D) by inserting "the Board and" in the second sentence of section 6(b) (1) after "The Secretary shall provide";

(E) by striking out "An" in the third sentence of section 6(b) (1) and inserting in lieu thereof "The Board and an";

(F) by striking out "its" each time it appears in the third sentence of section 6(b) (1) and inserting in lieu thereof "their";

(G) by inserting "after consultation with the National Health Board and" in the fourth sentence of section 6(b) (6) (A) after "may be granted only";

(H) by inserting "after consultation with the National Health Board and" in the third sentence of section 6(d) before "after opportunity for";

(I) by striking out "The Secretary" and all that follows through "shall each" in section 8(g) (2) and inserting in lieu thereof "The Secretary shall"; (J) by striking out "their" in section 8(g) (2) and inserting in lieu thereof "his";