.
Appropriations and Fund Transfers in the
Patient Protection and Affordable Care Act
(PPACA)
C. Stephen Redhead
Specialist in Health Policy
October 1428, 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 PPACAthe Patient Protection and Affordable Care Act
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. The new law expands eligibility for Medicaid;
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 tax code, Medicare, Medicaid, and
numerous other federal programs.
In 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), coordinated by C. Stephen
Redhead, summarizes all the
provisions in PPACA for which appropriations are authorized.
Congressional Research Service
.
Appropriations and Fund Transfers in PPACAthe Patient Protection and Affordable Care Act
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 ...................................................................................................... 1115
Acknowledgments .................................................................................................................... 1115
Congressional Research Service
.
Appropriations and Fund Transfers in PPACAthe Patient Protection and Affordable Care Act
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. The new law expands eligibility for Medicaid;
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 tax code, Medicare, Medicaid, and
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) Community-Based Prevention and Wellness; (8) Maternal and Child Health; (9)
Long-Term Care; (10) Comparative Effectiveness Research; (11) Biomedical Research; and (12)
PPACA Implementation.
Each table entry includes the following information: (1) the PPACA section number; (2) an
indication of whether the provision 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. The table also includes web links to PPACA grant
opportunity announcements and grant awards. Unless otherwise stated, references in the table to the
the Secretary refer to the Secretary of Health and Human Services (HHS).
The following laws are referred to in the table by their acronymacronyms:
•
Public Health Service Act (PHSA)
•
Social Security Act (SSA)
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.
Congressional Research Service
1
.
Appropriations and Fund Transfers in PPACAthe Patient Protection and Affordable Care Act
•
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
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, 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 PPACA: Summary and Timeline, coordinated by C. Stephen Redhead and Erin
D. Williams
P.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
of the program, to remain
available without
fiscal year limitation. [Note: the section also
authorizes 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 beginning in the
2010 plan year. Health insurance issuers must submit a justification for a
premium increase judged to be unreasonable prior to its implementation.
Instructs the Secretary to
award grants to states during the five-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
end of FY2014 shall remain available for grants
to to
states for planning and implementing
PPACA’s individual and group market reforms.
1101
New authority
market reforms.
Private Health Insurance
1002
New PHSA Sec.
2793
1003
New PHSA Sec.
2794
1101
New authority
CRS-3
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 coverage
for eligible individuals who have been uninsured for six months and have a preexisting
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.
[Grant awards: http://www.hhs.gov/news/press/2010pres/10/
20101019a.html]
[Initial grant awards: http://www.hhs.gov/news/press/2010pres/08/
20100816a.html]
Appropriates $5 billion, to remain available
without fiscal year limitation,
to pay claims
against (and administrative costs of) the highriskhigh-risk pool that
are in excess of premiums
collected from enrollees.
1102
New authority
[Fact sheet with potential state-by-state allocations: http://www.hhs.gov/
ociio/initiative/hi_risk_pool_facts.html]
.
PPACA
Section
1102
New/Existing
Authority
New authority
1311
New authority
Program Summary
Appropriation/Transfer
Reinsurance for early retirees. Requires the Secretary, within 90 days
of enactment, to establish
a temporary reinsurance program to provide
reimbursement to participating employer-based plans
for part of the cost
of providing health benefits to early retirees age 55-64 and their families. The
The 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
reinsurance program.
1311
New authority
Health insurance exchanges. Requires the Secretary, within one 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
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 state.
[Participating employers, state-by-state: http://www.hhs.gov/news/press/
2010pres/10/20101004a.html]
[Initial grant awards: http://www.hhs.gov/news/press/2010pres/07/
20100729a.html]
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 health
insurance issuers that existed on July 16, 2009, or governmental
organizations from
participating in the CO-OP program.
Appropriates $6 billion to carry out the COOPCO-OP program.
1323
New authority
Funding for territories. Provides funds for U.S. territories that elect to
establish a health
insurance exchange. Funds must be used to provide
premium and cost-sharing assistance to territory
residents who obtain
health insurance coverage through the exchange.
Appropriates $1 billion, to be available during
the period 2014 through
2019. Of that total
amount, $925 million is for Puerto Rico, and
the the
remaining $75 million is for the other U.S.
territories in amounts as
specified by the
Secretary.
Secretary.
CRS-4
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
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 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 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
through FY2014. (Total
amount = $300
million.)
2707
New authority
Medicaid emergency psychiatric demonstration program. Directs
the Secretary to establish
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
through December 31, 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 and
CHIP and how factors affecting expenditures and payment methodologies enable
enable beneficiaries to obtain services, affect provider supply, and affect
providers that serve a
disproportionate share of low-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 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
remain available
until expended. (Total 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 to
prevent or help manage chronic disease.
Appropriates $100 million for the five-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. 1139A(e)
CHIP childhood obesity demonstration program. Appropriates
funding for a program
authorized by the Children’s Health Insurance
Appropriates $25 million for the period FY2010 through FY2014.
Program Reauthorization Act (CHIPRA; P.L. 111-3),
which requires
the Secretary to conduct a demonstration project to develop a model for reducing
reducing childhood obesity.
Appropriates $25 million for the period
FY2010 through FY2014.
10203CRS-5
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Amends SSA
Secs. 2104 &
2113
CHIP annual appropriations, and outreach and enrollment
grants. Appropriates funding
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
CHIP program. Appropriates an additional $40
million for
the CHIP outreach and enrollment
grants.
3014
Amends SSA
Sec. 1890(b).
New SSA Sec.
1890A
Medicare quality measures. Expands the duties of the consensus-basedconsensusbased entity under contract
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 (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
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.
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 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
selection, testing, and
evaluation of new
payment and service delivery models; and (2)
$10
billion for the period FY2011 through
FY2019, plus $10 billion for each subsequent
subsequent 10-fiscal year period, to continue such activities
and for the
expansion and nationwide
implementation of successful models.b
Amounts Amounts
are to remain available until
expended.
3024
New SSA Sec.
1866D
Medicare independence at home demonstration program.
Requires the Secretary to
conduct a 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
improving health outcomes that uses physician- and nurse practitioner-directedpractitionerdirected 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.
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 and carrying out the
demonstration, to remain available until
until expended.a (Total amount = $30 million.)
10203
Medicare
CRS-5
6
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
3026
New authority
Community-based care transitions program. Requires the
Secretary to establish a five-year
program, beginning January 1, 2011, to
provide funding to eligible hospitals and community-based
organizations organizations
that provide evidence-based transition services to Medicare beneficiaries
with multiple
chronic conditions who are at high risk for hospital
readmission.
Requires the Secretary to transfer from the
Medicare Part A and Part B
trust funds $500
million for the period FY2011 through FY2015,
to 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
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.
3306
Amends MIPPA
Sec. 119
Outreach and assistance for Medicare low-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.
the NCBOE.
CRS-7
[Grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100927a.html]
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
3403
New SSA Sec.
1899A
Independent Payment Advisory Board. Creates an independent, 15-member15member 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 exceed a target growth rate, the board’s proposals will
take effect unless Congress passes an
alternative measure that achieves
the same level of savings. Congress would be allowed to consider
an an
alternative provision on a fast-track basis. The board 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 board 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 board 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
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 board’s activities. For each
each subsequent fiscal year, appropriates the amount
from the previous
fiscal year adjusted for
inflation. Sixty percent of the appropriation is
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 community-based prevention and
wellness programs and, based on the findings, develop a plan to
promote promote
healthy lifestyles and chronic disease self-management among Medicare
beneficiaries.
Requires 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 Medicare Part D vaccine coverage on access
to those vaccines among beneficiaries.
Appropriates $1 million for FY2010 for the
GAO study.
CRS-6
PPACA
Section
10323
New/Existing
Authority
GAO study.
10323
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
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
individuals diagnosed with such
conditions.
Appropriates $23 million for the period
FY2010 through FY2014, and $20
million for
each five-fiscal year period thereafter, to carry
out the
screening and public information
dissemination program.
dissemination program.
CRS-8
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Fraud and Abuse
6402(i)
Amends SSA
Sec. 1817(k)
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 which
finances investigative and enforcement activities undertaken by the HHS
Office of the
Inspector General, the Department of Justice, and the
Federal Bureau of Investigation, as well as
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
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)
Amends SSA
Sec. 1817(k)
Health Centers and the National Health Service Corps (NHSC)
4101(a)
10503(b)
New authority
New authority
School-based health centers. Requires the Secretary to create 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
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 five-year period FY2011
through FY2015 to the fund, to be transferred by the
Secretary to HHS
accounts to increase funding, over the FY2008 level, for (1) community health
health center operations; and (2) NHSC operations, scholarships, and
loan repayments.
Transfers from the CHCF to the Secretary the
following amounts, to
remain available until
expended. (1) For health center operations:
FY2011 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.)
amount = $1.5 billion.)
[FY2010/FY2011 grant opportunity announcement: http://www.hrsa.gov/
about/news/pressreleases/101004schoolbasedhealthcenters.html]
[FY2011 grant opportunity announcements: (1) http://www.hhs.gov/news/
press/2010pres/08/20100809a.html; (2) http://www.hhs.gov/news/press/
2010pres/10/20101026a.html]
10503(c)
New authority
Health center construction and renovation. Provides funding for
health center construction
and renovation.
Appropriates $1.5 billion, to be available for
the period FY2011 through
FY2015, and to
remain available until expended.
CRS-7
[Initial grant awards: http://www.hhs.gov/news/press/2010pres/10/
20101008c.html]
CRS-9
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Health Workforce
5507(a)
New SSA Sec.
2008
Health workforce demonstration programs. Requires the Secretary
to establish two
demonstration projects. The first is to award health
profession opportunity grants to states, Indian tribes, institutions of higher
education, and local workforce investment boards to providehelp 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
through FY2014, of which
$5 million in each of
FY2010 through FY2012 is to be used for the
second 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 centers, which assist families of children
with disabilities or special health care needs and
the professionals who
serve them.
Appropriates $5 million for each of FY2010
through FY2012, to remain
available until expended. (Total amount = $15 million.)
Health Workforce
5507(a)
5507(b)
New SSA Sec.
2008
Amends SSA
Sec. 501(c)
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100927e.html]
[FY2011 grant opportunity announcement: http://www.hhs.gov/news/
press/2010pres/10/20101026f.html]. (Total amount = $15 million.)
5508(c)
New PHSA Sec.
340H
Teaching health centers. Requires the Secretary to make payments
for direct and indirect
graduate medical education costs to qualified
teaching health centers for the expansion of existing,
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 five 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
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 and dental school.
Appropriates $100 million for FY2010, to
remain available for obligation
until September
30, 2011.
Community-Based Prevention and Wellness
4002
New authority 30, 2011.
CRS-10
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Prevention and Public Health Fund (PPHF). Establishes a PPHF and
appropriates amounts to
the fund in perpetuity. Requires the Secretary to
transfer amounts from the fund to HHS accounts
to increase funding,
over the FY2008 level, for PHSA-authorized prevention, wellness, and public
public 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.
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 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; FY2015FY2014 = $400
million. (Total amount = $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
billion.)
Personal responsibility education programs. Establishes a state
formula grant program to support
evidence-based Personal Responsibility
Education programsPrograms 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
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 the
proportion of low-income children in each state compared to the national
total, and may only
be used for teaching abstinence.
Appropriates $50 million for each of 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 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
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
through FY2014. (Total amount = $50 million.)
6201
New authority
Background checks of long-term care providers. Requires the Secretary to establish a
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
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. 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 the new Patient-Centered Outcomes Research Institute and its comparative effectiveness
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 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
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 two-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.
Health 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).
million.)
Community-Based Prevention and Wellness
4002
New authority
[Grant opportunity announcements and awards for the FY2010 funds: (1)
http://www.hhs.gov/news/press/2010pres/09/20100927e.html (primary
care workforce grant awards: $253 million total); (2) http://www.hhs.gov/
news/press/2010pres/06/20100618g.html (grant opportunity
announcements for community/clinical prevention initiatives, and public
health infrastructure, systems, research, & training: approx. $250 million
total)c]
Maternal and Child Health
2951
New SSA Sec.
511
2953
New SSA Sec.
513
2954
Amends SSA
Sec. 510
CRS-11
[FY2010 grant awards: (1) http://www.hhs.gov/news/press/2010pres/07/
20100721a.html (states, territories); (2) http://www.acf.hhs.gov/news/
press/2010/hrsa_award_3m.html (Indian tribes, tribal organizations)]
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100930a.html]
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
teenpregnancy_abstinencegrants.html]
.
PPACA
Section
10211-10214
New/Existing
Authority
New authority
Program Summary
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 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.
Appropriation/Transfer
Appropriates $25 million for each of FY2010 through FY2019. (Total
amount = $250 million.)
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100928d.html]
Long-Term Care
2403
Amends DRA
Sec. 6071
2405
New authority
6201
New authority
CRS-12
Medicaid Money Follows the Person (MFP) demonstration
program. Appropriates funding through FY2016 for the MFP
demonstration, which authorizes the Secretary to award competitive
grants to states to reduce their reliance on institutional care for people
needing long-term care, and expand options for elderly people and
individuals with disabilities to receive home and community-based longterm care services.
Appropriates $450 million for each of FY2011 through FY2016, to remain
available through FY2016. (Total amount = $2.7 billion.)
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 through FY2014. (Total
amount = $50 million.)
Background checks of long-term care providers. Requires the
Secretary to establish a 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 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. Funds
are to remain available until expended.
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100927a.html]
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100927a.html]
[Initial grant awards: http://aging.senate.gov/record.cfm?id=328161]
.
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 the new Patient-Centered Outcomes
Research Institute and its comparative effectiveness 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 for each of
FY2013 through FY2019 equal to the net revenue from a new fee levied
on health insurance policies and self-insured plans;d and (3) transfers from
the Medicare trust funds for each of FY2013 through FY2019.e
Appropriates $10 million for FY2010, $50 million for FY2011, and $150
million for 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 two-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.
Health 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.
amended by the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
111-148), as
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.
cCRS-13
.
c.
Of the approx. $250 million for community/clinical prevention initiatives and public health infrastructure, systems, research, & training, HHS has announced grant
awards totaling $42.5 million to state, tribal, local and territorial health departments to improve their ability to provide public health services (http://www.hhs.gov/
news/press/2010pres/09/20100920a.html).
d.
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.
de.
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-10
14
.
Appropriations and Fund Transfers in PPACAthe Patient Protection and Affordable Care Act
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 SmithAmanda Sarata,
Pam Smith, Carmen Solomon-Fears, Emilie Stoltzfus, Julie Stone, and Susan Thaul provided comments on
this report.
Congressional Research Service
1115