instruction:
In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.
question:
SECTION 1. SHORT TITLE.

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

SEC. 2. HEALTH PROFESSIONS TRAINING DEMONSTRATION PROJECT.

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


question:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Intermodal Safe Container 
Transportation Act Amendments of 1996''.

SEC. 2. REFERENCES TO TITLE 49.

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to, or repeal 
of, a section or other provision, the reference shall be considered to 
be made to a section or other provision of title 49, United States 
Code.

SEC. 3. DEFINITIONS.

    Section 5901 is amended--
            (1) by striking paragraph (1) and inserting the following:
            ``(1) except as otherwise provided in this chapter, the 
        definitions in sections 10102 and 13102 of this title apply.'';
            (2) by redesignating paragraphs (6) and (7) as paragraphs 
        (7) and (8), respectively; and
            (3) by inserting after paragraph (5) the following new 
        paragraph:
            ``(6) `gross cargo weight' means the weight of the cargo, 
        packaging materials (including ice), pallets, and dunnage.''.

SEC. 4. NOTIFICATIONS AND CERTIFICATIONS.

    Section 5902 is amended to read as follows:
``Sec. 5902. Notifications and certifications
    ``(a) Prior Notification.--
            ``(1) In general.--If the first carrier to which any loaded 
        container or trailer having a projected gross cargo weight of 
        more than 29,000 pounds is tendered for intermodal 
        transportation is a motor carrier, the person tendering the 
        container or trailer shall give the motor carrier a 
        notification of the projected gross cargo weight and a 
        reasonable description of the contents of the container or 
        trailer before the tendering of the container or trailer. The 
        notification may be transmitted electronically or by telephone.
            ``(2) Applicability.--This subsection applies to any person 
        within the United States who tenders a container or trailer 
        subject to this chapter for intermodal transportation if the 
        first carrier is a motor carrier.
    ``(b) Certification.--
            ``(1) In general.--A person who tenders a loaded container 
        or trailer with an actual gross cargo weight of more than 
        29,000 pounds, to a first carrier for intermodal transportation 
        shall provide a certification of the contents of the container 
        or trailer in writing, or electronically, before or when the 
        container or trailer is so tendered.
            ``(2) Contents of certification.--The certification 
        required by paragraph (1) shall include the following:
                    ``(A) The actual gross cargo weight.
                    ``(B) A reasonable description of the contents of 
                the container or trailer.
                    ``(C) The identity of the certifying party.
                    ``(D) The container or trailer number.
                    ``(E) The date of certification or transfer of data 
                to another document, as provided for in paragraph (3).
            ``(3) Transfer of certification data.--A carrier who 
        receives a certification may transfer the information contained 
        in the certification to another document or to electronic 
        format for forwarding to a subsequent carrier. The person 
        transferring the information shall state on the forwarded 
        document the date on which the data was transferred and the 
        identity of the party who performed the transfer.
            ``(4) Shipping documents.--For purposes of this chapter, a 
        shipping document, prepared by the person tendering a container 
        or trailer to a first carrier, that contains the information 
        required by paragraph (2) meets the requirements of paragraph 
        (1).
            ``(5) Use of `freight all kinds' term.--The term `Freight 
        All Kinds' or `FAK' may not be used for the purpose of 
        certification under this subsection after December 31, 2000, as 
        a description required under paragraph (2)(B) for a trailer or 
        container if the weight of any commodity in the trailer or 
        container equals or exceeds 20 percent of the total weight of 
the contents of the trailer or container. This subsection does not 
prohibit the use of such term after December 31, 2000, for rating 
purposes.
            ``(6) Separate document marking.--If a separate document is 
        used to meet the requirements of paragraph (1), it shall be 
        conspicuously marked `INTERMODAL CERTIFICATION'.
            ``(7) Applicability.--This subsection applies to any 
        person, domestic or foreign, who first tenders a container or 
        trailer subject to this chapter for intermodal transportation 
        within the United States.
    ``(c) Forwarding Certifications to Subsequent Carriers.--
            ``(1) General rule.--A carrier, agent of a carrier, broker, 
        customs broker, freight forwarder, warehouser, or terminal 
        operator shall forward the certification provided under 
        subsection (b) to a subsequent carrier transporting the 
        container or trailer in intermodal transportation before or 
        when the container or trailer is tendered to the subsequent 
        carrier.
            ``(2) Presumption of no certification required.--If no 
        certification is received by the subsequent carrier before or 
        when the container or trailer is being tendered to it, the 
        subsequent carrier may presume that no certification is 
        required.
            ``(3) Limitation on construction of forwarding.--The act of 
        forwarding the certification may not be construed as a 
        verification or affirmation of the accuracy or completeness of 
        the information in the certification.
            ``(4) Liability.--
                    ``(A) In general.--If a person inaccurately 
                transfers the information on the certification or fails 
                to forward the certification to a subsequent carrier, 
                then that person is liable to any person who incurs any 
                bond, fine, penalty, cost (including storage), or 
                interest charge incurred as a result of the inaccurate 
                transfer of information or failure to forward the 
                certification.
                    ``(B) Lien.--A subsequent carrier incurring a bond, 
                fine, penalty, or cost (including storage), or interest 
                charge as a result of the inaccurate transfer of the 
                information or the failure to forward the certification 
                shall have a lien against the contents of the container 
                or trailer under section 5905 in the amount of the 
                bond, fine, penalty, or cost (including storage), or 
                interest charge and all court costs and legal fees 
                incurred by the carrier as a result of such inaccurate 
                transfer or failure.
            ``(5) Notice to leased operators.--If a motor carrier knows 
        that the gross cargo weight of an intermodal container or 
        trailer subject to the certification requirements of subsection 
        (b) would result in a violation of applicable State gross 
        vehicle weight laws--
                    ``(A) a motor carrier must inform the operator of a 
                vehicle which is leased by the vehicle operator to a 
                motor carrier which transports an intermodal container 
                or trailer of the gross cargo weight of the container 
                or trailer as certified to the motor carrier pursuant 
                to subsection (b);
                    ``(B) the notice must be provided to the operator 
                prior to the operator being tendered the container or 
                trailer;
                    ``(C) the notice required by this subsection must 
                be in writing, but may be transmitted electronically;
                    ``(D) the motor carrier shall bear the burden of 
                proof to establish that it tendered the required notice 
                to the operator; and
                    ``(E) if the operator of a leased vehicle 
                transporting a container or trailer subject to this 
                chapter should receive a fine because of a violation of 
                a State's gross vehicle weight laws or regulations and 
                lessee motor carrier cannot establish that it tendered 
                to the operator the notice required by this section, 
                the operator shall be entitled to reimbursement from 
                the motor carrier of the amount of any fine and court 
                costs resulting from the failure of the motor carrier 
                to tender the notice to the operator.
    ``(d) Liability to Owner or Beneficial Owner.--If--
            ``(1) a person inaccurately transfers information on a 
        certification required by subsection (b)(1) or fails to forward 
        a certification to the subsequent carrier;
            ``(2) as a result of the inaccurate transfer of such 
        information or a failure to forward a certification, the 
        subsequent carrier incurs a bond, fine, penalty, or cost 
        (including storage), or interest charge; and
            ``(3) a subsequent carrier exercises its rights to a lien 
        under section 5905,
then that person is liable to the owner or beneficial owner or to any 
other person paying the amount of the lien to the subsequent carrier 
for the amount of the lien and all costs related to the imposition of 
the lien, including court costs and legal fees incurred in connection 
with imposition of the lien.
    ``(e) Nonapplicability.--
            ``(1) Consolidated shipments.--The notification and 
        certification requirements of subsections (a) and (b) do not 
        apply to any intermodal container or trailer containing 
        consolidated shipments loaded by a motor carrier if that motor 
        carrier--
                    ``(A) performs the highway portion of the 
                intermodal movement; or
                    ``(B) assumes the responsibility for any weight-
                related fine or penalty incurred by any other motor 
                carrier that performs a part of the highway 
                transportation.
            ``(2) Intermodal transportation of loaded containers.--
                    ``(A) In general.--Subsections (a) and (b) and 
                section 5903(c) do not apply to a carrier when the 
                carrier is transferring a loaded container or trailer 
                to another carrier during intermodal transportation, 
                unless the carrier is also the person tendering the 
                loaded container or trailer to the first carrier.
                    ``(B) Special rule.--A carrier, agent of a carrier, 
                broker, customs broker, freight forwarder, warehouser, 
                or terminal operator is deemed not to be a person 
                tendering a loaded container or trailer to a first 
                carrier under this section, unless the carrier, agent, 
                broker, customs broker, freight forwarder, warehouser, 
                or terminal operator assumes legal responsibility for 
                loading property into the container or trailer.''.

SEC. 5. PROHIBITIONS.

    (a) Providing Erroneous Information.--Section 5903(a) is amended by 
inserting ``, to whom section 5902(b) applies,'' after ``A person''.
    (b) Transporting Prior To Receiving Certification.--Section 5903(b) 
is amended to read as follows:
    ``(b) Transporting Prior To Receiving Certification.--
            ``(1) Presumption.--If no certification is received by a 
        motor carrier before or when a loaded intermodal container or 
        trailer is tendered to it, the motor carrier may presume that 
        the gross cargo weight of the container or trailer is less than 
        29,001 pounds.
            ``(2) Copy of certification not required to accompany 
        container or trailer.--Notwithstanding any other provision of 
        this chapter, if a certification is required by section 
        5902(b), a copy of the certification is not required to 
        accompany the intermodal container or trailer.''.
    (c) Unlawful Coercion.--Section 5903(c)(1) is amended by striking 
``10,000 pounds (including packing materials and pallets)'' and 
inserting ``29,000 pounds''.

SEC. 6. LIENS.

    (a) General Rule.--Section 5905(a) is amended to read as follows:
    ``(a) General Rule.--If a person involved in the intermodal 
transportation of a loaded container or trailer for which a 
certification is required by section 5902(b) of this title is required, 
because of a violation of a State's gross vehicle weight laws or 
regulations, to post a bond or pay a fine, penalty, cost (including 
storage), or interest charge resulting from--
            ``(1) erroneous information provided by the certifying 
        party in the certification to the first carrier in violation of 
        section 5903(a),
            ``(2) the failure of the party required to provide the 
        certification to the first carrier to provide it,
            ``(3) the failure of a person required under section 
        5902(c) to forward the certification to forward it, or
            ``(4) an error occurring in the transfer of information on 
        the certification to another document under section 5902(b)(3) 
        or 5902(c),
then the person posting the bond, or paying any fine, penalty, cost 
(including storage), or interest charge has a lien against the contents 
equal to the amount of the bond, fine, penalty, cost (including 
storage), or interest charge incurred, until the person receives a 
payment of that amount from the owner or beneficial owner of the 
contents or from the person responsible for making or forwarding the 
certification or transferring the information from the certification to 
another document.''.
    (b) Limitations.--Section 5905(b)(1) is amended--
            (1) by inserting after ``the first carrier'' the following: 
        ``or the owner or beneficial owner of the contents''; and
            (2) by striking ``cost, or interest.'' and inserting ``cost 
        (including storage), or interest charge. The lien shall remain 
        in effect until the lien holder has received payment for all 
        costs and expenses as described in subsection (a).''.

SEC. 7. PERISHABLE AGRICULTURAL COMMODITIES.

    Section 5906 is amended by striking ``Sections 5904(a)(2) and 5905 
of this title do'' and insert ``Section 5905 does''.

SEC. 8. EFFECTIVE DATE.

    Section 5907 is amended to read as follows:
``Sec. 5907. Effective date
    ``This chapter, as amended by the Intermodal Safe Container 
Transportation Act Amendments of 1996, is effective on the date of the 
enactment of such Act. The provisions of this chapter shall be 
implemented 180 days after such date of enactment.''.

SEC. 9. RELATIONSHIP TO OTHER LAWS.

    (a) In General.--Chapter 59 is amended by adding at the end the 
following new section:
``Sec. 5908. Relationship to other laws
    ``Nothing in this chapter affects--
            ``(1) chapter 51 (relating to transportation of hazardous 
        material) or the regulations issued under that chapter; or
            ``(2) any State highway weight or size law or regulation 
        applicable to tractor-trailer combinations.''.
    (b) Conforming Amendment.--The analysis for such chapter is amended 
by striking the item relating to section 5907 and inserting the 
following:

``5907. Effective date.
``5908. Relationship to other laws.''.

            Passed the House of Representatives September 18, 1996.

            Attest:

                                                ROBIN H. CARLE,

                                                                 Clerk.
answer:
Intermodal Safe Container Transportation Act Amendments of 1996 - Amends Federal transportation law to revise the prior notification requirements for intermodal freight transportation. 
Requires a person who tenders to a first carrier that is a motor carrier (currently, any carrier) a container or trailer with a gross cargo weight of more than 29,000 pounds (currently, 10,000 pounds, including packing material and pallets) for intermodal transportation to give prior notification of the cargo weight and a reasonable description of its contents to the motor carrier. 
Allows such notification to be made by telephone, and allows the required certification of the container or trailer contents to be electronic.  Sets forth administrative and civil penalties for persons who inaccurately transfer certification information.  Makes such a person liable to the owner or beneficial owner for any lien filed by a subsequent carrier that incurred a bond, fine, or other penalty as a result of an inaccurate information transfer or a failure to forward a certification. 
Requires a motor carrier that knows that the gross cargo weight of an intermodal container or trailer violates State vehicle weight laws to give notice to the operator of a leased vehicle that transports such items.  Requires the motor carrier to reimburse the operator of the leased vehicle that are fined because of a violation of a State's gross vehicle weight laws. 
Allows a motor carrier to presume that the gross cargo weight of a container or trailer is under 29,001 pounds if it receives no certification before or when a loaded intermodal container or trailer is tendered to it.  Declares that a copy of a certification is not required to accompany the intermodal container or trailer. 
Prohibits a person from coercing a person transporting a loaded container or trailer having a gross cargo weight of more than 29,000 pounds (currently, 10,000 pounds, including packing materials and pallets) before the required certification is provided. 
Adds to the circumstances giving certain persons a lien against the contents of the container or trailer as a result of a violation of a State's gross vehicle weight laws.  Includes among such circumstances:  (1) failure of the party required to provide certification off gross cargo weight to the first carrier to provide it; (2) failure of the party required to forward such certification to forward it; or (3) error in the transfer of information on the certification to another document.


question:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Iowa Medicare PPO Demonstration Act 
of 2003''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds the following:
            (1) When the reimbursement system under the Medicare 
        program, which evolved into the Prospective Payment System, was 
        created in 1965, Iowa had pioneered in cost containment 
        techniques and therefore received lower initial reimbursement 
        rates. As inflation adjustments occurred over the years, the 
        differential between reimbursement rates in the various states 
        widened even though many medical costs are themselves similar.
            (2) Despite the fact that Iowa ranks first among all states 
        in percent of citizens over 85, and fourth in citizens over 65, 
        Medicare beneficiaries in Iowa access the health care system 
        less frequently and experience shorter hospitalizations than 
        residents of many other States.
            (3) The inflation in general health care costs for which 
        Iowa has been relatively undercompensated coupled with the 
        unique problems of serving a disproportionately aging 
        population in a decentralized rural setting has created a 
        crisis for Iowa's health care providers and the Medicare 
        beneficiaries they serve.
            (4) The inequity inherent in the Medicare reimbursement 
        differential is symbolized by the fact that Medicare 
        reimbursements per beneficiary for Iowa is $3414, the lowest in 
        the nation, while the figure for Louisiana, the highest, is 
        $8033, or about two and one half times as great.
            (5) The average cost of living in the two states taken as a 
        percent of that in the entire United States, by contrast, is 
        almost the same, 92.5 for Iowa and 97.4 for Louisiana.
            (6) If the inequity in Medicare reimbursements did not 
        exist, the modest cost of living differential which exists 
        between Iowa and states such as Louisiana would be even closer 
        than indicated by the statistics described in paragraph (5) 
        because health care spending represents approximately 12 
        percent of the Gross Domestic Product (GDP), and when an 
        entitlement program of Federal government, such as the Medicare 
        program, provides disproportionately more resources to 
        individuals in one State over another State, generalized 
        economic, and specific health care cost, differentials occur.
            (7) Because of low Medicare rates, Iowa counties, 
        particularly but not exclusively the smaller ones, are 
        experiencing shortages of doctors and other health care 
        providers, which in the near future could cause a significant 
        access to health care crisis for many Iowa citizens.
            (8) All citizens pay into Social Security under a uniform 
        set of national standards.
            (9) Simple fairness and equity in the delivery of 
        government services dictate that the differences in Medicare 
        reimbursement received by each of the several States should not 
        fall far below the differences in the cost of living therein.
            (10) Low payment rates and a shortage of providers 
        discourage Medicare+Choice organizations from offering plans in 
        rural areas, and this unavailability of a Medicare+Choice 
        option in such areas is unfair to Medicare residents who would 
        like to take advantage of the additional services and other 
        benefits offered through Medicare+Choice plans.
            (11) In order to encourage the establishment of 
        Medicare+Choice plans in rural States, the Medicare program 
        needs to provide incentives to States, insurers, and other 
        entities interested in sponsoring Medicare+Choice plans in such 
        States. Given Iowa's low Medicare reimbursement rate, it is 
        unlikely that any new health care delivery model can attract 
        sufficient providers unless current Medicare fee-for-service 
        payment rates for those providers are exceeded.
            (12) Preferred provider organizations are uniquely 
        positioned to provide improved care management and clinical 
        outcomes in part due to the wide-ranging involvement of health 
        care professionals at each stage of a patient-oriented care 
        process.
            (13) State governments should be encouraged to support and, 
        where appropriate, oversee the establishment of organizations 
        which make available health care services to individuals 
        residing in underserved areas in the State.
    (b) Purpose.--In order to insure that Iowa's health care facilities 
and providers have access to the most innovative reimbursement options 
available under the Medicare program, the Secretary of Health and Human 
Services may approve a demonstration project to test ways in which 
cooperative efforts among insurers, institutional providers of 
services, and health care professionals may provide better access to 
health care services for Medicare beneficiaries. The demonstration 
project would be designed to improve access to health care services 
through the Medicare+Choice program.

SEC. 3. CONSIDERATION OF APPLICATIONS FOR THE PREFERRED PROVIDER 
              ORGANIZATION (PPO) DEMONSTRATION PROJECT UNDER THE 
              MEDICARE+CHOICE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services shall 
allow the receipt and approval of applications described in subsection 
(b) for a demonstration project conducted under section 402 of the 
Social Security Amendments of 1967 for participation of preferred 
provider organizations (PPOs) under the Medicare+Choice program under 
part C of title XVIII of the Social Security Act, with the 
understanding that the demonstration program could cause Medicare 
reimbursement in Iowa to rise to a level more in line with the average 
national Medicare reimbursement rate.
    (b) Application Described.--
            (1) In general.--An application described in this 
        subsection is an application by an appropriate insurer 
        domiciled and licensed to sell health insurance or health 
        benefits coverage in the State of Iowa (which for purposes of 
        this project shall include the Illinois, as well as the Iowa, 
        parts of the ``Quad Cities'') to offer a Medicare+Choice plan 
        in that State that meets the requirements described in 
        paragraph (2).
            (2) Annual plan requirements.--The requirements of a plan 
        for each contract year for which an application is granted 
        under paragraph (1) are as follows:
                    (A) All licensed physicians, hospitals, and 
                practitioners (as defined in section 1842(b)(18)(C) of 
                the Social Security Act) in the State are eligible to 
                be preferred providers under the insurer's network to 
                ensure that the health care needs of the Medicare 
                beneficiaries to be served by the network are met.
                    (B) Appropriate adjustments are made to the payment 
                rates to hospitals for indirect medical education costs 
                and for being a disproportionate share hospital in 
                manner similar to which such payment adjustments are 
                made under subparagraphs (B) and (F), respectively, of 
                section 1886(d)(5) of the Social Security Act.
                    (C) As a preferred provider, a provider of 
                services, physician, and health care practitioner shall 
                be reimbursed for services furnished to Medicare 
                beneficiaries at a rate no less than 110 percent of the 
                payment rate that would otherwise apply for the service 
                under part A or B, as the case may be.
                    (D) The Secretary provides partial underwriting of 
                the financial risk under the plan.
                    (E) The insurer should provide for health care 
                benefits in addition to those required under parts A 
                and B of such title (such as coverage of the costs of 
                some or all outpatient prescription drugs, hearing 
                aids, or eye glasses or reduced cost-sharing), after 
                taking into account costs of administration.
            (3) Additional payment for start up costs.--In addition to 
        payments made to the insurer under paragraph (2), the Secretary 
        may provide for a payment during the initial phase of the 
        project to reflect additional costs associated with the 
        establishment of preferred provider organizations under the 
        plan.
    (c) Period of Demonstration Project.--A demonstration project 
carried out under this section shall operate for a period of 5 years.
    (d) Advisory Board.--
            (1) Establishment.--As a part of the demonstration project 
        conducted under this section, the insurer shall provide for an 
        advisory board to review the appropriateness of proposed 
        payment rates and payment rate changes by the insurer for 
        services furnished by providers under the demonstration project 
        before such rates or changes take effect.
            (2) Composition.--The Board shall be composed of 7 members 
        with expertise in the field of health care as follows:
                    (A) The Attorney General of Iowa.
                    (B) 2 members appointed by the insurer upon the 
                recommendation of the Governor of Iowa.
                    (C) 2 members appointed by the insurer upon the 
                recommendation of the Iowa Hospital Association.
                    (D) 2 members appointed by the insurer upon the 
                recommendation of the Iowa Medical Society.
            (3) Terms of appointment.--The term of any appointment 
        under paragraph (2) shall be 5 years.
            (4) Meetings.--The advisory board shall meet at the call of 
        its chairman or a majority of its members.
            (5) Vacancies.--A vacancy on the advisory board shall be 
        filled in the same manner in which the original appointment was 
        made not later than 30 days after the advisory board is given 
        notice of the vacancy and shall not affect the power of the 
        remaining members to execute the duties of the advisory board .
            (6) Compensation.--Members of the advisory board shall 
        receive no additional pay, allowances, or benefits by reason of 
        their service.
answer:

Iowa Medicare PPO Demonstration Act of 2003 - Directs the Secretary of Health and Human Services to allow the receipt and approval of applications for a demonstration project conducted under the Social Security Amendments of 1967 for participation of preferred provider organizations under the Medicare+Choice program under part C of title XVIII of the Social Security Act, with the understanding that the demonstration program could cause Medicare reimbursement in Iowa to rise to a level more in line with the average national Medicare reimbursement rate.