.
Appropriations and Fund Transfers in the
Patient Protection and Affordable Care Act
(PPACA)
C. Stephen Redhead
Specialist in Health Policy
June 28October 14, 2010
Congressional Research Service
7-5700
www.crs.gov
R41301
CRS Report for Congress
Prepared for Members and Committees of Congress
c11173008
.
Appropriations and Fund Transfers in PPACA
Summary
On March 23, 2010, President Obama signed into law a comprehensive health care reform bill,
the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). The following week, on
March 30, 2010, the President signed the Health Care and Education Reconciliation Act of 2010
(HCERA; P.L. 111-152), which amended various health care and revenue provisions in PPACA.
Among its many provisions, PPACA (as amended by HCERA) restructures the private health
insurance market, sets minimum standards for health coverage, creates a mandate for most U.S.
residents to obtain health insurance, and provides for the establishment by 2014 of insurance
exchanges through which certain individuals and families will be able to receive federal subsidies
to reduce the cost of purchasing that coverage. In addition, theThe new law expands eligibility for
Medicaid; reduces
amends the Medicare program in ways that are intended to reduce the growth in Medicare
spending that had been projected under preexisting
law; imposes an excise tax on insurance plans
found to have high premiums; and makes other
changes to the federal tax code, Medicare, Medicaid, and
numerous other federal programs.
In addition, PPACA (as amended) appropriates or transfers from the some instances, PPACA mandates appropriations or requires the Secretary to transfer from the
Medicare Part A and Part B
trust funds billions of dollars to support new or existing grant
programs and other activities. This
report summarizes those mandated appropriations and fund
transfers. They include funding for a temporary
insurance program for individuals who have been
uninsured for several months and have a
preexisting condition, as well as funding for states to
plan and establish exchanges. PPACA also
provides funding for various Medicare and Medicaid
demonstration programs, for the creation of
a Center for Medicare and Medicaid Innovation to
test and implement innovative payment and
service delivery models, and for an independent
board to provide Congress with proposals for
reducing Medicare cost growth and improving
quality of care for Medicare beneficiaries.
Among other provisions, the new health reform law appropriates funding for health workforce
and maternal and child health programs, and establishes three multi-billion dollar funds. The first
fund will provide a total of $11 billion over five years in supplementary funding for community
health centers and the National Health Service Corps. (A separate appropriation provides $1.5
billion for health center construction and renovation.) The second fund will support comparative
effectiveness research through FY2019 with a mixture of appropriations and fund transfers. The
third fund, which is funded in perpetuity, is to support prevention, wellness, and other public
health-related programs and activities authorized under the Public Health Service Act (PHSA).
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA
authorizes new funding for numerous existing discretionary grant and other programs and
activities, primarily ones authorized under the PHSA. It also creates a number of new
discretionary grant programs and activities and provides for each an authorization of
appropriations. Funding for all of these discretionary programs and activities is subject to action
by congressional appropriators. A companion product, CRS Report R41390, Discretionary
Funding in the Patient Protection and Affordable Care Act (PPACA), summarizes all the
provisions in PPACA for which appropriations are authorized.
Congressional Research Service
.
Congressional Research Service
.
Appropriations and Fund Transfers in PPACA
Contents
Introduction ................................................................................................................................1
Mandated Appropriations and Fund Transfers........................................................................1
Discretionary Funding...........................................................................................................2
CRS Products........................................................................................................................2
Tables
Table 1. Appropriations and Fund Transfers in the Health Reform Law........................................3
Contacts
Author Contact Information ...................................................................................................... 1011
Acknowledgments .................................................................................................................... 1011
Congressional Research Service
.
Appropriations and Fund Transfers in PPACA
Introduction
On March 23, 2010, President Obama signed into law a comprehensive health care reform bill,
the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148).1 The following week, on
March 30, 2010, the President signed the Health Care and Education Reconciliation Act of 2010
(HCERA; P.L. 111-152), which amended various health care and revenue provisions in PPACA.2
Among its many provisions, PPACA (as amended) by HCERA) restructures the private health
insurance market, sets minimum standards for health coverage, creates a mandate for most U.S.
residents to
obtain health insurance, and provides for the establishment by 2014 of insurance
exchanges through which
certain individuals and families will be able to receive federal subsidies
to reduce the cost of
purchasing that coverage. In addition, theThe new law expands eligibility for Medicaid; reduces the
amends the Medicare program in ways that are intended to reduce the growth in Medicare
spending that had been projected under preexisting law; imposes an excise
tax on insurance plans determined
found to have high premiums; and makes other changes to the federal
tax code, Medicare, Medicaid, and numerous other programs.
In some instances, PPACA (as amended) appropriates funds or transfers amounts from the
numerous other federal programs.
Mandated Appropriations and Fund Transfers
In some instances, PPACA (as amended by HCERA) mandates appropriations or requires the
Secretary to transfer from the Medicare Part A and Part B trust funds billions of dollars to support
new or existing grant programs and other
activities. Table 1 summarizes all such appropriations
and fund transfers, which are grouped
under the following headings: (1) Private Health Insurance
Reforms; (2) Medicaid and the
Children’s Health Insurance Program (CHIP); (3) Medicare; (4)
Fraud and Abuse; (5) Health
Centers and the National Health Service Corps (NHSC); (6) Health
Workforce; (7) CommunityBasedCommunity-Based Prevention and Wellness; (8) Maternal and Child Health; (9)
Long-Term Care; (10)
Comparative Effectiveness Research; and (11) Biomedical Research; and (12)
PPACA Implementation.
Each table entry includes the following information: (1) the PPACA section number; an (2) an
indication of whether the provision
modifies an existing law or represents new standalone statutory authority; a brief description of
the program or activity; and details modifies the Public Health Service Act or another law either
by amending an existing section or by adding a new one, or whether the provision creates new
stand-alone statutory authority; (3) a brief description of the program or activity; and (4) details
of the appropriation or transfer of funds. In most cases, the
language specifies funding levels (or
transfer amounts) for one or more fiscal years. Two
provisions appropriate “such sums as may be
necessary” (SSAN) to carry out a program. Unless
otherwise stated, references in the table to “the Secretary”the
Secretary refer to the Secretary of Health and
Human Services (HHS).
The following laws are referred to in the table by their acronym:
•
Public Health Service Act (PHSA)
•
Social Security Act (SSA)
•
Internal Revenue Code (IRC)
•
Older Americans Act (OAA)
•
Deficit Reduction Act of 2005 (DRA)3
•
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)4
1
The full text of the Patient Protection and Affordable Care Act, as enacted, is at http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf.
2
The full text of the Health Care and Education Reconciliation Act of 2010, as enacted, is at
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h4872enr.txt.pdf.
3
P.L. 109-171
Congressional Research Service
1
.
Appropriations and Fund Transfers in PPACA
More information on the PPACA provisions summarized in the table may be found in the
following products:
Appropriations and Fund Transfers in PPACA
•
Internal Revenue Code (IRC)
•
Older Americans Act (OAA)
•
Deficit Reduction Act of 2005 (DRA)3
•
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)4
Discretionary Funding
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA (as
amended by HCERA) authorizes new funding for numerous existing discretionary grant and other
programs and activities. It also creates a number of new discretionary grant programs and
activities and provides for each an authorization of appropriations. Funding for all of these
discretionary programs and activities is subject to action by congressional appropriators. A
companion product, CRS Report R41390, Discretionary Funding in the Patient Protection and
Affordable Care Act (PPACA), summarizes all the provisions in PPACA for which appropriations
are authorized.
CRS Products
More information on the PPACA provisions summarized in Table 1 may be found in the
following CRS products:
3
4
•
CRS Report R40942, Private Health Insurance Provisions in the Patient
Protection and Affordable Care Act (PPACA), by Hinda Chaikind et al., Bernadette
Fernandez, and Mark Newsom
•
CRS Report R41210, Medicaid and the State Children’s Health Insurance
Program (CHIP) Provisions in PPACA: Summary and Timeline, coordinated by
Julie Stone
•
CRS Report R41196, Medicare Provisions in the Patient Protection and
Affordable Care Act (PPACA): Summary and Timeline, coordinated by Patricia A.
Davis
•
CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions
in the Patient Protection and Affordable Care Act (PPACA)PPACA: Summary and Timeline, coordinated by C.
Stephen Redhead and Erin
D. Williams
(...continued)
4P.L. 109-171.
P.L. 110-275.
Congressional Research Service
2
.
Table 1. Appropriations and Fund Transfers in the Health Reform Law
Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended by P.L. 111-152)
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Private Health Insurance Reforms
1002
New PHSA Sec.
2793
Health insurance consumer information. Requires the Secretary to award grants to states to
enable them (or the exchanges operating in such states) to establish, expand, or provide support for
offices of health insurance consumer assistance, or health insurance ombudsman programs. These
independent entities will assist consumers with filing complaints and appeals, educate consumers on
their rights and responsibilities, and collect, track, and quantify consumer problems and inquiries.
Appropriates $30 million for the first fiscal
year year
of the program, to remain available
without without
fiscal year limitation. [Note: the
section also
authorizes to be appropriated
SSAN for each
fiscal year thereafter.]
1003
New PHSA Sec.
2794
Review of health insurance premium rates. Requires the Secretary, in conjunction with the
states,
to establish a process for the annual review of unreasonable increases in health insurance premiums
premiums beginning in the 2010 plan year. Health insurance issuers must submit a justification for a premium
premium increase judged to be unreasonable prior to its implementation. Instructs the Secretary to
award grants
to states during the 5five-year period FY2010 through FY2014 for carrying out the
premium review. State
grantees are required to provide the Secretary with information about trends
in premium increases,
including recommendations as to whether particular issuers should be
excluded from participation in
the exchange due to a pattern of excessive or unjustified premium
increases.
Appropriates $250 million for the grant
program. Funds remaining unobligated at
the the
end of FY2014 shall remain available for
grants grants
to states for planning and
implementing implementing
PPACA’s individual and group
market reforms.
1101
New authority
High-risk pools for individuals with preexisting conditions. Requires the Secretary, within 90
days of enactment, to establish a temporary high-risk pool program to provide health insurance
coverage for eligible individuals who have been uninsured for 6six months and have a preexisting
condition. The program, which terminates on January 1, 2014, permits premium rates to vary on the
basis of age by a factor of up to 4:1 and places limits on out-of-pocket costs.
Appropriates $5 billion, to remain available
without fiscal year limitation, to pay claims
against (and administrative costs of) the
high-risk highrisk pool that are in excess of
premiums premiums
collected from enrollees.
1102
New authority
Reinsurance for early retirees. Requires the Secretary, within 90 days of enactment, to establish a
a temporary reinsurance program to provide reimbursement to participating employer-based plans for
for part of the cost of providing health benefits to early retirees age 55-64 and their families. The program
program reimburses participating plans for 80% of the costs of benefits provided per enrollee in
excess of
$15,000 and below $90,000. Funds must be used to lower costs for the plan; for example,
the funds
could be used to reduce premium costs or lower out-of-pocket costs for beneficiaries.
Appropriates $5 billion, to remain available
without fiscal year limitation, to carry out
the the
reinsurance program.
1311
New authority
Health insurance exchanges. Requires the Secretary, within 1one year of enactment, to award
grants to
states to plan and establish exchanges. By January 1, 2014, each state must have an
exchange to facilitate
access to insurers’ qualified health plans. The grants can be renewed to states
making progress in
establishing an exchange, implementing PPACA’s private health insurance market
reforms, and meeting
other benchmarks. However, no grant may be awarded after January 1, 2015.
Exchanges will have to be
self-sustaining by then, using assessments on insurers or some other way
to generate funds to support
their operations.
Appropriates amounts necessary for the
Secretary to award state grants. For each
fiscal fiscal
year, the Secretary must determine
the total
amount that will be made available
to each
state.
CRS-3
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
1322
New authority
Health insurance cooperatives. Requires the Secretary to establish the Consumer Operated and
Oriented Plan (CO-OP) program to provide funding until July 1, 2013, for the creation of nonprofit
member-run health insurance issuers that offer qualified health plans in the individual and small group
markets. Funds are to be provided as loans for start-up costs and as grants for meeting solvency
requirements. Loans must be repaid within 5 years; grants must be repaid within 15 years. Prohibits
health insurance issuers that existed on July 16, 2009, or governmental organizations from participating
participating in the CO-OP program.
Appropriates $6 billion to carry out the
CO-OP COOP program.
1323
New authority
Funding for territories. Provides funds for U.S. territories that elect to establish a health insurance
insurance exchange. Funds must be used to provide premium and cost-sharing assistance to territory residents
residents who obtain health insurance coverage through the exchange.
Appropriates $1 billion, to be available
during during
the period 2014 through 2019. Of
that total
amount, $925 million is for
Puerto Rico, and
the remaining $75 million
is for the other U.S.
territories in amounts
as specified by the
Secretary.
Medicaid and Children’s Health Insurance Program (CHIP)
2701
New SSA Sec.
1139B
Medicaid adult health quality measures. Requires the Secretary to develop and, not later than
January 1, 2012, publish an initial core set of quality measures for Medicaid-eligible adults. Not later than
than January 1, 2013, requires the Secretary to develop a standardized format for states to report
information about the quality of Medicaid care for adults based on those measures. The Secretary and
and the states must report on the development of and improvements to the quality measurement program
program on a regular basis.
Appropriates $60 million for each of
FY2010 FY2010
through FY2014. (Total amount =
$300
million.)
2707
New authority
Medicaid emergency psychiatric demonstration program. Directs the Secretary to establish a
3
a three-year Medicaid demonstration in which eligible states are required to reimburse certain
institutions for
mental disease (IMDs) for services provided to Medicaid beneficiaries aged 21
through 64 who are in
need of medical assistance to stabilize an emergency psychiatric condition.
Appropriates $75 million for FY2011, to
remain available for obligation through
December 131, 2015.
2801
Amends SSA
Sec.
1900
Medicaid and CHIP Payment and Access Commission (MACPAC). Clarifies and expands
MACPAC’s duties; for example, to include a review and assessment of payment policies under Medicaid
Medicaid and CHIP and how factors affecting expenditures and payment methodologies enable
beneficiaries to
obtain services, affect provider supply, and affect providers that serve a
disproportionate share of lowincomelow-income and other vulnerable populations. Additional duties include
reviewing and assessing policies
related to eligibility, enrollment and retention, benefits and coverage,
quality of care, and interactions
between Medicaid and Medicare and how those interactions affect
access to services, payments, and
dual eligibles. MACPAC is also required to report to Congress on
any Medicaid and CHIP regulations
that affect access, quality, and efficiency of health care.
Appropriates $9 million, and transfers from
CHIP funding an additional $2 million for
FY2010 for MACPAC activities. Funds are
to to
remain available until expended. (Total
amount amount
= $11 million.)
4108
New authority
Medicaid prevention and wellness incentives. Requires the Secretary to award state grants to
provide incentives for Medicaid beneficiaries to participate in evidence-based healthy lifestyle programs
programs to prevent or help manage chronic disease.
Appropriates $100 million for the 5five-year
period beginning January 1, 2011, to remain
available until expended.
CRS-4
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
4306
Amends SSA
Sec. 4306
Amends SSA Sec.
1139A(e)
CHIP childhood obesity demonstration program. Appropriates funding for a program authorized
authorized by the Children’s Health Insurance Program Reauthorization Act (CHIPRA; P.L. 111-3),
which requires
the Secretary to conduct a demonstration project to develop a model for reducing
childhood obesity.
Appropriates $25 million for the period
FY2010 through FY2014.
CRS-4
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer10203
Amends SSA
Secs. 2104 &
2113
CHIP annual appropriations, and outreach and enrollment grants. Appropriates funding for
for the CHIP program for FY2014 and FY2015 (the program previously had been funded through
FY2013).
Also, extends the time period for CHIP outreach and enrollment grants through FY2015
and increases
the existing appropriation for such grants from $100 million to $140 million.
Appropriates $19.147 billion for FY2014,
and a
total of $21.061 billion for FY2015 for
the the
CHIP program. Appropriates an
additional $40
million for the CHIP
outreach and enrollment
grants.
3014
Amends SSA
Sec.
1890(b). New
New SSA Sec.
1890A
Medicare quality measures. Expands the duties of the consensus-based entity under contract with
with CMS pursuant to SSA Sec. 1890 (currently the National Quality Forum). Requires the entity to convene
convene multi-stakeholder groups to provide input on the national priorities for health care quality improvement
improvement (developed under PPACA). In addition, the multi-stakeholder groups are required to
provide input on
the selection of quality measures for use in various specified Medicare payment
systems for hospitals
and other providers, as well as in other health care programs, and for use in
reporting performance
information to the public. Establishes a multi-step pre-rulemaking process
and timeline for the adoption,
dissemination, and review of measures by the Secretary.
Transfers from the Requires the Secretary to transfer from the
Medicare Part A and
Part B trust funds $20
million for each of
FY2010 through FY2014, to remain
remain available until expended.a (Total amount =
= $100 million.)
3021
New SSA Sec.
1115A
Center for Medicare and Medicaid Innovation (CMI). Requires the Secretary, no later than
January 1, 2011, to establish the CMI within the Centers for Medicare and Medicaid Services (CMS).
The purpose of CMI is to test and evaluate innovative payment and service delivery models to reduce
reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing
the quality of
care furnished under these programs. In selecting the models, the Secretary is also
required to give
preference to those that improve the coordination, quality, and efficiency of health
care services.
Appropriates (1) $5 million for FY2010 for
the the
selection, testing, and evaluation of new
payment and service delivery models; and
(2)
$10 billion for the period FY2011
through through
FY2019, plus $10 billion for each
subsequent subsequent
10-fiscal year period, to
continue such activities
and for the
expansion and nationwide implementation
implementation of successful models.b
Amounts are to
remain available until
expended.
3024
New SSA Sec.
1866D
Medicare independence at home demonstration program. Requires the Secretary to
conduct a
3 three-year Medicare demonstration program, beginning no later than January 1, 2012, to
test a payment
incentive and service delivery model aimed at reducing expenditures and improving
health outcomes
that uses physician- and nurse practitioner-directed primary care teams to provide
home-based services
to chronically ill patients. The Secretary must submit a plan, no later than
January 1, 2016, for expanding
the program if it is determined that such expansion would improve
the quality of care and reduce
spending.
Transfers from the Requires the Secretary to transfer from the
Medicare Part A and
Part B trust funds $5
million for each of
FY2010 through FY2015 for administering
administering and carrying out the
demonstration, to
remain available until
expended.a (Total
amount = $30 million.)
Medicare
CRS-5
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
3026
New authority
Community-based care transitions program. Requires the Secretary to establish a 5five-year
program, beginning January 1, 2011, to provide funding to eligible hospitals and community-based
organizations that provide evidence-based transition services to Medicare beneficiaries with multiple
chronic conditions who are high risk for hospital readmission.
Transfers from the Requires the Secretary to transfer from the
Medicare Part A and
Part B trust funds $500
million for the
period FY2011 through FY2015,
to remain
available until expended.a
3027
Amends DRA
Sec. 5007
Medicare gainsharing demonstration program. Under DRA Sec. 5007, CMS is supporting two
gainsharing projects to test and evaluate arrangements between hospitals and physicians that are
intended to improve the quality and efficiency of care provided to beneficiaries. The demonstration
allows hospitals to provide gainsharing payments to physicians that represent a share of the savings
incurred as a result of collaborative efforts to improve overall quality and efficiency.
Appropriates $1.6 million for FY2010, to
remain available through FY2014 or until
expended, for carrying out the
demonstration.
10203
Medicare
CRS-5
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
demonstration.
3306
Amends MIPPA
Sec. 119
Outreach and Assistanceassistance for Medicare Low-Income Programslow-income programs. Provides additional funding for
beneficiary outreach and education activities for Medicare low-income programs through the following
following entities: (1) State Health Insurance Counseling and Assistance Programs (SHIPs); (2) Area
Agencies on
Aging (AAAs); (3) Aging and Disability Resource Centers (ADRCs); and (4) the National
Center for
Benefits and Outreach Enrollment (NCBOE).
Appropriates a total of $45 million for the
period FY2010 through FY2012, to remain
available until expended, as follows: (1) $15
million for SHIPs; (2) $15 million for AAAs;
(3)
$10 million for ADRCs; and (4) $5
million for
the NCBOE.
3403
New SSA Sec.
1899A
Independent Payment Advisory Board. Creates an independent, 15-member Payment Advisory
Board tasked with presenting Congress with comprehensive proposals to reduce excess cost growth
and improve quality of care for Medicare beneficiaries. In years when Medicare costs are projected to
to exceed a target growth rate, the Boardboard’s proposals will take effect unless Congress passes an alternative
alternative measure that achieves the same level of savings. Congress would be allowed to consider
an alternative
provision on a fast-track basis. The Boardboard would be prohibited from making proposals
that ration care,
raise taxes, or increase Part B premiums, or change Medicare benefit, eligibility, or
cost-sharing
standards. Requires the Boardboard to make biannual recommendations to the President,
Congress, and
private entities on actions they can take to improve quality and constrain the rate of
cost growth in the
private sector. Requires the Boardboard to make non-binding Medicare
recommendations to Congress in
years in which Medicare growth is below the targeted growth
rate. Beginning in 2019, limits the Board’s
board’s binding recommendations to Congress to every other year
if the growth in overall health spending
exceeds growth in Medicare spending; such
recommendations would focus on slowing overall health
spending while maintaining or enhancing
beneficiary access to quality care under Medicare.
Appropriates $15 million for FY2012 to
support the Boardboard’s activities. For each
subsequent fiscal year, appropriates the
amount amount
from the previous fiscal year
adjusted for
inflation. Sixty percent of the
appropriation is to come from the Part A
trust fund and 40% is to come from the
to be derived by transfer from the Medicare
Part A trust fund, and 40% is to be derived by
transfer from the Medicare Part B trust fund.
4202(b)
New authority
Medicare prevention and wellness evaluation. Requires the Secretary to conduct an evaluation of
of community-based prevention and wellness programs and, based on the findings, develop a plan to
promote healthy lifestyles and chronic disease self-management among Medicare beneficiaries.
TransfersRequires the Secretary to transfer $50 million
from the Medicare
Part A and Part B trust
funds to fund the
evaluation.a
4204(e)
New authority
Medicare vaccine coverage. Requires the GAO to study and report to Congress on the impact of
of Medicare Part D vaccine coverage on access to those vaccines among beneficiaries.
Appropriates $1 million for FY2010 for the
GAO study.
10323
CRS-6
PPACA
Section
10323
New/Existing
Authority
New SSA Secs.
1881A & 2009
Program Summary
Appropriation/Transfer
Environmental health hazards. Provides Medicare coverage and medical screening services to
certain individuals exposed to environmental health hazards. Also, requires the Secretary to award
grants to state and local government agencies, health care facilities, and other entities to (1) provide
(1) provide screening for specified lung diseases and other environmental health conditions to
at-risk individuals;
and (2) disseminate public information about the availability of screening, the
detection and
treatment of environmental health conditions, and the availability of Medicare benefits to
certain certain
individuals diagnosed with such conditions.
Appropriates $23 million for the period
FY2010 through FY2014, and $20 million
for for
each 5five-fiscal year period thereafter, to
carry carry
out the screening and public
information information
dissemination program.
Health Care Fraud and Abuse Control (HCFAC) Account. Permanently applies an inflation
adjustment to the annual appropriation (provided under SSA Sec. 1817(k)) for the HCFAC Account,
which finances investigative and enforcement activities undertaken by the HHS Office of the Inspector
Inspector General, the Department of Justice, and the Federal Bureau of Investigation, as well as Medicare
Medicare Integrity Program activities undertaken by CMS contractors. In addition, provides
supplemental funds
through FY2020 for the HCFAC Account.
Appropriates $10 million for each of
FY2011 FY2011
through FY2020; plus an additional
$95 million
for FY2011, $55 million for
FY2012, $30
million for each of FY2013 and
FY2014, and
$20 million for each of FY2015
and FY2016.
Funds are to remain available
until expended.
(Total amount = $350
million.)
Fraud and Abuse
6402(i)
CRS-6
Amends SSA
Sec.
1817(k)
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer 1817(k)
Health Centers and the National Health Service Corps (NHSC)
4101(a)
New authority
School-based health centers. Requires the Secretary to establishcreate a grant program for the
establishment of school-based health centers. Funds may be used for facility construction, expansion,
and equipment.
Appropriates $50 million for each of
FY2010 FY2010
through FY2013, to remain
available until
expended. (Total amount =
$200 million.)
10503(b)
New authority
Community Health Center Fund (CHCF). Establishes a CHCF and appropriates a total of $11
billion over the 5five-year period FY2011 through FY2015 to the Fundfund, to be transferred by the Secretary
Secretary to HHS accounts to increase funding, over the FY2008 level, for (1) community health center
center operations; and (2) NHSC operations, scholarships, and loan repayments.
Over the period FY2011 through FY2015,
transfers from the CHCF a total of $9.5
billion for health center operations, and a
total of $1.5 billion for the NHSC, to
remain available until expended.Transfers from the CHCF to the Secretary the
following amounts, to remain available until
expended. (1) For health center operations:
FY2011 = $1 billion; FY2012 = $1.2 billion;
FY2013 = $1.5 billion; FY2014 = $2.2 billion;
and FY2015 = $3.6 billion. (Total amount =
$9.5 billion.) (2) For NHSC: FY2011 = $290
million; FY2012 = $295 million; FY2013 = $300
million; FY2014 = $305 million; and FY2015 =
$310 million. (Total amount = $1.5 billion.)
10503(c)
New authority
Health center construction and renovation. Provides funding for health center construction and
and renovation.
Appropriates $1.5 billion, to be available for
the period FY2011 through FY2015., and to
remain available until expended.
CRS-7
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Health Workforce
5507(a)
New SSA Sec.
2008
Health workforce demonstrationsdemonstration programs. Requires the Secretary to establish two demonstration
projects. The first is to
demonstration projects. The first is to award grants to states, Indian tribes, institutions of higher
education, and local workforce investment boards to provide low-income individuals with the
opportunity to obtain education and
training in health care jobs that pay well and are in high
demand; funds may be used to provide financial
aid and other supportive services. The second is to
provide states with grants to develop core training
competencies and certification programs for
personal and home care aides.
Appropriates $85 million for each of
FY2010 FY2010
through FY2014, of which $5
million in each of
FY2010 through FY2012 is
to be used for the
second project. (Total
amount = $425 million.)
5507(b)
Amends SSA
Sec.
501(c)
Family-to-family health information centers. Provides funding for the family-to-family information
information centers, which assist families of children with disabilities or special health care needs and the
the professionals who serve them.
Appropriates $5 million for each of FY2010
through FY2012. (Total amount = $15
million.)
5508(c)
New PHSA Sec.
340H
Teaching health centers. Requires the Secretary to make payments for direct and indirect graduate
graduate medical education costs to qualified teaching health centers for the expansion of existing, or
or establishment of new approved medical residency training programs.
Appropriates SSAN, not to exceed $230
million, for the period FY2011 through
FY2015.
5509
New authority
Medicare graduate nurse education demonstration program. Requires the Secretary to
establish a
Medicare demonstration program under which up to 5five eligible hospitals will receive
reimbursement for
providing advanced practice nurses with clinical training in primary care,
preventive care, transitional
care, and chronic care management.
Appropriates $50 million for each of
FY2012 FY2012
through FY2015, to remain
available until
expended. (Total amount =
$200 million.)
10502
New authority
Health care facility construction. Provides funding for debt service on, or construction or
renovation of, a hospital affiliated with a state’s sole public medical orand dental school.
Appropriates $100 million for FY2010, to
remain available for obligation until
September September
30, 2011.
Community-Based Prevention and Wellness
4002
CRS-7
New authority
Prevention and Public Health Fund (PPHF). Establishes a PPHF and appropriates amounts to the
Fund
the fund in perpetuity. Requires the Secretary to transfer amounts from the Fundfund to HHS accounts to
to increase funding, over the FY2008 level, for PHSA-authorized prevention, wellness, and public health
health activities, including prevention research and health screenings. Authorizes House and Senate
appropriators to transfer monies from the PPHF to eligible activities.
Appropriates the following amounts to the
PPHF: FY2010 = $500 million; FY2011 =
$750
million; FY2012 = $1 billion; FY2013 =
$1.25
billion; FY2014 = $1.5 billion; FY2015
and each
fiscal year thereafter = $2 billion.
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Maternal and Child Health
2951
New SSA Sec.
511
Maternal, infant, and early childhood home visitation programs. Requires the Secretary to
award grants to states, U.S. territories, and Indian tribes to develop and implement early childhood
home visiting programs that adhere to evidence-based models of service delivery. Programs must
establish benchmarks to measure improvements for the participating families in prenatal, maternal, and
and newborn health; child health and development; parenting skills; school readiness; juvenile
delinquency;
and family economic self-sufficiency.
Appropriates the following amounts for the
home visitation program: FY2010 = $100
million; FY2011 = $250 million, FY2012 =
$350
million; FY2013 = $400 million;
FY2015 = $400
million. (Total amount =
$1.5 billion.)
$1.5 billion.)
Maternal and Child Health
2951
New SSA Sec.
511
CRS-8
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
2953
New SSA Sec.
513
Personal responsibility education. Establishes a state formula grant program to support evidencebased
evidence-based Personal Responsibility Education programs designed to educate adolescents about
abstinence,
contraception, and adult preparation, including healthy life skills, educational and career
success, and
financial literacy. Also, requires the Secretary to award grants to implement innovative
youth pregnancy
prevention strategies and to target services at high-risk populations.
Appropriates $75 million for each of
FY2010 FY2010
through FY2014, of which $10
million each
year is to be reserved for the
youth pregnancy
prevention grants. (Total
amount = $375
million.)
2954
Amends SSA
Sec.
510
Abstinence education grants. Renews funding for the state formula grant program, authorized
under SSA Sec. 510, to support abstinence education programs. Funds are awarded to states based on
on the proportion of low-income children in each state compared to the national total, and may only be
be used for teaching abstinence.
Appropriates $50 million for each of
FY2010 FY2010
through FY2014. (Total amount =
$250
million.)
10211-10214
New authority
Pregnancy assistance grants. In collaboration with the Secretary of Education, requires the
Secretary to establish a Pregnancy Assistance Fund for the purpose of awarding grants to states to assist
assist pregnant and parenting teens and women. State grantees have the flexibility to make funds
available to
institutions of higher education, high schools and community service centers, and to the
state attorneys
general to improve services for pregnant women who are victims of domestic
violence, sexual assault,
or stalking.
Appropriates $25 million for each of
FY2010 FY2010
through FY2019. (Total amount =
$250
million.)
Long-Term Care
2405
New authority
State Aging and Disability Resource Centers (ADRCs). Provides funding for ADRCs
(authorized
under Sec. 202 of the OAA), which serve as a single, coordinated resource for
consumer information
on the range of long-term care options in community and institutional
settings. Some ADRCs also serve
as the entry point to publicly administered long-term care
programs (e.g., Medicaid, OAA services, state
assistance programs). As of 2009, ADRC funding had
expanded to include at least one site in each state,
DC, and 3 U.S. territories (Guam, Puerto Rico,
and Northern Mariana), with more than 200 sites
nationwide.
Appropriates $10 million for each of
FY2010 FY2010
through FY2014. (Total amount =
$50 million.)
6201
New authority
Background checks of long-term care providers. Requires the Secretary to establish a nationwide
nationwide program for background checks on direct patient access employees of long-term care
facilities or
providers, and to provide federal matching funds to states to conduct these activities.
Requires the Treasury Secretary to transfer
to to
HHS an amount, not to exceed $160
million,
that is specified by the HHS
Secretary as
necessary to carry out the
program for the period FY2010 through
FY2012.
CRS-8
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
period FY2010 through FY2012. Funds are to
remain available until expended.
CRS-9
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Comparative Effectiveness Research
6301(d)-(e)
New IRC Secs.
9511, 4375, &
4376. New SSA
Sec. 1183
Patient-Centered Outcomes Research Trust Fund (PCORTF). Establishes a PCORTF to fund
fund the new Patient-Centered Outcomes Research Institute and its comparative effectiveness research
research activities. The fund is to receive the following amounts: (1) specified annual appropriations
for each of
FY2010 through FY2019 (see amounts in the right-hand column); (2) additional annual appropriations
appropriations for each of FY2013 through FY2019 equal to the net revenue from a new fee levied
on health insurance
policies and self-insured plans;c and (3) transfers from the Medicare trust funds
for each of FY2013
through FY2019.d
Appropriates $10 million for FY2010, $50
million for FY2011, and $150 million for
each each
of FY2012 through FY2019, for a total
of $1.26
billion over that 10-year period.
For each of
FY2013 through FY2019, the
PCORTF is to
receive additional
appropriations based on the
revenue from
the health insurance policy/plan
fee, as well
as Medicare trust fund transfers.
Therapeutic research and development tax credits and grants. Creates a 2two-year
temporary tax
credit program, subject to an overall cap of $1 billion, for small companies (250 or
fewer employees)
that invest in new therapies to prevent, diagnose, and treat cancer and other
diseases. Companies may
apply for one or more tax credits, each covering up to 50% of the cost of
qualifying research
investments made in 2009 and 2010. However, the total amount of tax credits
any one company
receives for the two years may not exceed $5 million. Companies may elect to
receive one or more
grants in lieu of tax credits, subject to the same restrictions (i.e., grants may
cover up to 50% of the
cost of qualifying investments made in 2009 and 2010; the total amount of
grants any one company
receives for the two years may not exceed $5 million).
Appropriates SSAN to carry out the grant
program.
Comparative Effectiveness Research
6301(d)-(e)
New IRC Secs.
9511, 4375, &
4376. New SSA
Sec. 1183Health Insurance Reform Implementation Fund (HIRIF). Establishes an HIRIF for federal
administrative expenses to carry out PPACA and HCERA.
Appropriates $1 billion to the HIRIF.
Biomedical Research
9023(e)
New IRC Sec.
48D
PPACA Implementation
HCERA Sec.
1005
New authority
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), as amended
by the Health
Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
a.
Transfers from the two trust funds are in such proportion as the Secretary determines appropriate.
b.
Of the amounts appropriated for the period FY2011 through FY2019 and for each subsequent 10-fiscal year period, at least $25 million must be made available each
fiscal year for
the selection, testing, and evaluation of new payment and service delivery models.
c.
The health insurance fee is to equal $2 multiplied by the average number of covered lives in a policy/plan year ($1 in the case of a policy/plan year ending during
FY2013), updated
annually by the rate of medical inflation.
d.
The trust fund transfers are to equal $2 multiplied by the average number of individuals entitled to benefits under Part A or enrolled under Part B in a given fiscal year
($1 in
FY2013), updated annually by the rate of medical inflation.
CRS-9
.
10
Appropriations and Fund Transfers in PPACA
Author Contact Information
C. Stephen Redhead
Specialist in Health Policy
credhead@crs.loc.gov, 7-2261
Acknowledgments
Kirsten Colello, Patricia Davis, Gary Guenther, Elayne Heisler, Lisa Herz, Sarah Lister, Chris Peterson,
Amanda Sarata, Pam Smith, Julie Stone, and Susan Thaul provided comments on this report.
Congressional Research Service
1011