.
Appropriations and Fund Transfers in the
Patient Protection and Affordable Care Act
(PPACA)
C. Stephen Redhead
Specialist in Health Policy
October 28, 2010February 10, 2011
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 the 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 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 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 numerous
other federal programs.
In some instances, PPACA mandates appropriations or requires the Secretary of Health and
Human Services 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).
This report will be updated periodically with information on recent PPACA funding
announcements. In addition to the mandated appropriations and fund transfers discussed in this report, PPACA
herein,
PPACA authorizes new funding for numerous existing discretionary grant and other programs and
activities, primarily ones authorized under the PHSA. ItThe law 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 the Patient Protection and Affordable Care Act
Contents
Introduction ................................................................................................................................1
PPACA Mandated Appropriations and Fund Transfers........................................................................1
1
PPACA Discretionary Funding ...........................................................................................................23
CRS Products........................................................................................................................23
Tables
Table 1. Description of Appropriations and Fund Transfers in the Health Reform Law........................................34
Table 2. Appropriations and Fund Transfers in the Health Reform Law, FY2010-FY2019.......... 16
Contacts
Author Contact Information ...................................................................................................... 1521
Acknowledgments .................................................................................................................... 1521
Congressional Research Service
.
Appropriations and Fund Transfers in the 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. 21
Among its many provisions, PPACA, (as amended by HCERA), restructures the private health
insurance 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 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 numerous
other federal programs.
PPACA Mandated Appropriations and Fund Transfers
In some instances, PPACA, (as amended by HCERA), mandates appropriations or requires the
Secretary Secretary of
Health and Human Services (HHS) 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)
new or existing grant programs and other activities. The new law
includes 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, PPACA 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).
Table 1 summarizes all such appropriations and fund transfers, grouped under the following
headings: (1) Private Health Insurance; (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;
1
A consolidated version of PPACA, incorporating the changes made by the health-related provisions in HCERA, is
available at http://statutes.legcoun.house.gov/PDF/ppacacon.PDF.
Congressional Research Service
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Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
(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 (with the name
of the administering HHS agency, if known); and (4) details
of the appropriation or transfer of
funds.
In most cases, the language specifies funding levels (or
or transfer amounts) for one or more fiscal
years. TwoHowever, three provisions appropriate or transfer “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 Secretary refer to the Secretary of Health and Human Services (HHS).
The following laws are referred to in the table by their acronyms:
•
Public Health Service Act (PHSA)
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 the 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
(SSAN) to carry out a program. Two other provisions (i.e., Secs. 1311 and 6201) specify that it is
for the HHS Secretary to determine, within certain parameters, the amount necessary for the
program. Table 1 entries also include information on, and web addresses for, official HHS
announcements on PPACA funding availability and/or grant awards.2
Table 2 shows the amounts appropriated or transferred in each provision by fiscal year, over the
10-year period FY2010 through FY2019. The information is organized and grouped under the
same headings used in Table 1. Unless otherwise stated, references to the Secretary in both tables
refer to the HHS Secretary.
The following laws and federal agencies are referred to in the tables by their acronym:
•
Administration on Aging (AoA)
•
Administration for Children and Families (ACF)
•
Agency for Healthcare Research and Quality (AHRQ)
•
Centers for Disease Control and Prevention (CDC)
•
Centers for Medicare & Medicaid Services (CMS)
•
Deficit Reduction Act of 2005 (DRA; P.L. 109-171)
•
Health Resources and Services Administration (HRSA)
•
HHS Office of the Secretary (OS)
•
Internal Revenue Code (IRC)
•
Internal Revenue Service (IRS)
•
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA; P.L.
110-275)
•
Older Americans Act (OAA)
•
Public Health Service Act (PHSA)
2
The information in the table on PPACA funding activities is largely drawn from HHS news releases
(http://www.hhs.gov/news/). It is not intended to be a complete summary of all such activities. Readers are encouraged
to visit other official federal websites that are tracking and providing information on PPACA implementation (e.g.,
http://www.healthcare.gov; http://www.hhs.gov/cciio/).
Congressional Research Service
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Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
•
Social Security Act (SSA)
PPACA Discretionary Funding
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA, as
amended, authorizes new funding for numerous existing discretionary grant and other programs
and activities, primarily ones authorized under the PHSA. While the authorization of
appropriations for most of these programs expired prior to PPACA’s enactment, many of them
continued to receive an annual appropriation. PPACA also authorizes a number of new
discretionary 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. However, it is often the case that new programs and activities face more of a
challenge in securing funding than do existing ones with an established appropriations history. 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 1the tables below 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
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3
Table 1. Description of 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 SummaryDescription
Appropriation/Transfer
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. [OS]
Appropriates $30 million for the first fiscal year of the program, to remain
available without fiscal year limitation. [Note: the section also authorizes
to be appropriated SSAN for each fiscal year thereafter.]
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 awardestablish a formula for awarding grants to states
during the five-year
period FY2010 through FY2014 for carrying out the
premium review.
No state shall receive less than $1 million or more than
$5 million in a grant year. 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. [OS]
Appropriates $250 million for the grant program. Funds remaining
unobligated at the end of FY2014 shall remain available for grants to
states for planning and implementing PPACA’s individual and group
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
for eligible individuals who have been uninsured for six months and have a
preexisting condition. The program, which is known as the Pre-Existing
Condition Insurance Plan (PCIP), terminates on Jan. 1, 2014. PCIP permits
terminates on January 1, 2014,
permits premium rates to vary on the basis of age by a factor of up to 4:1
and 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 high-risk pool that
are in excess of premiums collected from enrollees.
[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 [OS]
Appropriates $5 billion, to remain available without fiscal year limitation,
to pay claims against (and administrative costs of) the high-risk pool that
are in excess of premiums collected from enrollees.
Private Health Insurance
1002
New PHSA Sec.
2793
1003
New PHSA Sec.
2794
1101
New authority
CRS-4
[On Oct. 19, 2010, HHS announced Consumer Assistance Program
(CAP) grant awards totaling almost $30 million to 35 states, 4 territories,
and the District of Columbia (DC). See http://www.hhs.gov/news/press/
2010pres/10/20101019a.html.]
[On Aug. 16, 2010, HHS announced an initial round of grant awards
totaling $46 million to 45 states and DC. See http://www.hhs.gov/news/
press/2010pres/08/20100816a.html. Further, on Dec. 23, 2010, HHS
published a proposed rule that would establish a rate review program to
ensure that all rate increases that meet or exceed a threshold are
reviewed by a state or HHS to determine whether the increases are
unreasonable. See http://www.hhs.gov/news/press/2010pres/12/
20101221a.html.]
[For a fact sheet on the PCIP program including a list of the potential
allocation of funds, by state, see http://www.hhs.gov/ociio/initiative/
hi_risk_pool_facts.html. For more details about the PCIP program in each
state, see http://www.healthcare.gov/news/factsheets/preexisting_condition_insurance_enrollment.html.]
PPACA
Section
1102
New/Existing
Authority
New authority
1311
New authority
Program Description
Appropriation/Transfer
Reinsurance for early retirees. Requires the Secretary, within 90 days
of enactment, to establish a temporary reinsurance program, ending on
Jan. 1, 2014, 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 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-ofoutof-pocket costs for
beneficiaries. [OS]
Appropriates $5 billion, to remain available without fiscal year limitation,
to carry out the reinsurance program.
Health insurance exchanges. Requires the Secretary, within one year
of enactment, to award grants to states to plan and establish exchanges.
By JanuaryJan. 1, 2014, each state must have an exchange to facilitate access
to 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 JanuaryJan. 1, 2015. Exchanges will
have have
to be self-sustaining by then, using assessments on insurers or some
other other
way to generate funds to support their operations. [OS]
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.
[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.htmlFor more information on the early retiree reinsurance program,
including recent news and announcements, see http://www.errp.gov/.]
[On Sept. 30, 2010, HHS announced grant awards totaling $49 million to
48 states and DC for planning health insurance exchanges. See
http://www.healthcare.gov/news/factsheets/esthealthinsurexch.html. On
Jan. 20, 2011, HHS announced the availability of health insurance exchange
establishment grants and encouraged states to apply for funding. See
http://www.hhs.gov/news/press/2011pres/01/20110120b.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
insurance issuers that existed on July 16, 2009, or governmental
organizations from participating in the CO-OP program. [OS]
Appropriates $6 billion to carry out the CO-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
remaining $75 million is for the other U.S. territories in amounts as
specified by the Secretary.
CRS-4
.
5
PPACA
Section
New/Existing
Authority
Program SummaryDescription
Appropriation/Transfer
Medicaid and Children’s Health Insurance Program (CHIP)
2701
New SSA Sec.
1139B
2707
New authority
2801
Amends SSA
Sec. 1900
Medicaid adult health quality measures. Requires the Secretary to
develop and, not later than JanuaryJan. 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
on a regular basis. [CMS]
Appropriates $60 million for each of FY2010 through FY2014, to remain
available until expended. (Total . (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. [CMS]
Appropriates $75 million for FY2011, to remain available for obligation
through DecemberDec. 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 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
Medicaid and CHIP regulations that affect access, quality, and efficiency of
health care. [CMS]
Appropriates $9 million, and transfers from CHIP funding an additional $2
million for FY2010 for MACPAC activities. Funds Note: the section also
authorizes to be appropriated SSAN for each fiscal year thereafter. Funds
are to remain available
until expended. (Total amount = $11 million.)
until expended. (Total amount = $11 million.)
[On Dec. 30, 2010, HHS published a notice with comment period
identifying an initial core set of health quality measures recommended for
Medicaid-eligible adults. See http://edocket.access.gpo.gov/2010/pdf/201032978.pdf.]
[For more information on the demonstration, see http://www.samhsa.gov/
healthreform/docs/Medicaid_Emergency_Psychiatric_Demo_508.pdf.]
[For information on MACPAC, see http://www.macpac.gov/.]
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. [CMS]
Appropriates $100 million for the five-year period beginning January 1,
2011, Jan. 1, 2011,
to remain available until expended.
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 the
Secretary to conduct a demonstration project to develop a model for
reducing childhood obesity.
CRS-5
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Amends SSA
Secs. 2104 &
2113 [CDC]
Appropriates $25 million for the period FY2010 through FY2014.
CRS-6
PPACA
Section
10203(d)
New/Existing
Authority
Amends SSA
Secs. 2104 &
2113
Program Description
Appropriation/Transfer
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.
[For information on the CHIP outreach and enrollment grants, see
http://www.cms.gov/CHIPRA/11_outreachenrollmentgrants.asp.]
Medicare
3014
Amends SSA
Sec. 1890(b).
New SSA Sec.
1890A
Medicare quality and efficiency measures. Expands the duties of the consensusbased
consensus-based entity under contract with CMS pursuant to SSA Sec. 1890
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
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.
[CMS]
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
available until expended.a (Total amount = $100 million.)
3021(a)
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. [CMS]
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 10-fiscal year period, to continue such activities and for the
expansion and nationwide 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 three-year Medicare demonstration
program, beginning no later than JanuaryJan. 1, 2012, to test a payment
incentive incentive
and service delivery model aimed at reducing expenditures and
improving improving
health outcomes that uses physician- and nurse practitionerdirected 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. [CMS]
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 expended.a (Total amount = $30 million.)
10203
Medicare
CRS-6
.
3024
New SSA Sec.
1866E
CRS-7
[For information on CMI, see http://innovations.cms.gov/.]
[For a fact sheet on the independence at home demonstration, see
http://www.cms.gov/DemoProjectsEvalRpts/downloads/
IAH_FactSheet.pdf.]
PPACA
Section
New/Existing
Authority
Program SummaryDescription
Appropriation/Transfer
3026
New authority
Community-based care transitions program. Requires the
Secretary to establish a five-year program, beginning JanuaryJan. 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 at high risk for hospital
readmission. [CMS]
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(b)
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. [CMS]
Appropriates $1.6 million for FY2010, to remain available through FY2014
or until expended, for carrying out the demonstration.
3113
New authority
Diagnostic laboratory test demonstration program. Requires the
Secretary to conduct a 2-year demonstration program, with a subsequent
report to Congress, to test the impact of direct payments for certain
complex laboratory tests on Medicare costs and quality of care. [CMS]
Requires the Secretary to transfer from the Medicare Part B trust fund $5
million, to remain available until expended, for carrying out the
demonstration program and preparing the subsequent report.
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
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). [AoA, CMS]
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.
CRS-7
[Grant awards: http://www.hhs.gov/news/press/2010pres/09/
20100927a.html]
.
PPACA
Section
New/Existing
Authority
Program Summary8
[On Sept. 27, 2010, HHS announced grant awards totaling $45 million to
50 states, the territories, and 125 tribal organizations for Medicare
beneficiary outreach and assistance. Of this amount, $5 million was
awarded to NCBOE for technical assistance. See http://www.hhs.gov/
news/press/2010pres/09/20100927a.html.]
PPACA
Section
New/Existing
Authority
Program Description
Appropriation/Transfer
3403
New SSA Sec.
1899A
Independent Payment Advisory Board. Creates an independent, 15member 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
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 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
healthy lifestyles and chronic disease self-management among Medicare
beneficiaries. [CMS]
Requires the Secretary to transfer $50 million from the Medicare Part A
and Part B trust funds to fund the evaluation, to remain available until
expended.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.
10323(a)
New SSA SecsSec.
1881A & 2009
Environmental health hazards. Provides Medicare coverage and
medical screening services to certain individuals exposed to
environmental health hazards. Also, requiresExtends Medicare coverage to certain
individuals exposed to environmental health hazards. Requires the
Secretary to establish a pilot program, with appropriate reimbursement
methodologies, to provide comprehensive, coordinated, and cost-effective
care to certain exposed individuals residing in emergency declaration
areas. [CMS]
Requires the Secretary to transfer SSAN from the Medicare Part A and
Part B trust funds to carry out the pilot program.a
CRS-9
PPACA
Section
10323(b)
New/Existing
Authority
New SSA Sec.
2009
Program Description
Appropriation/Transfer
Environmental health hazards. 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., pursuant to new SSA Sec. 1881A (as added by PPACA Sec.
10323(a)). [CMS]
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.
CRS-8
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
Fraud and Abuse
6402(i)
Amends SSA
Sec. 1817(k) Funds are to
remain available until expended.
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 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 [CMS]
Appropriates from the Medicare Part A trust fund $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.)
$350 million.)
Fraud and Abuse
6402(i) &
HCERA Sec.
1303(a)
Amends SSA
Sec. 1817(k)
Health Centers and the National Health Service Corps (NHSC)
4101(a)
10503(b)(1)
CRS-10
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. [HRSA]
Appropriates $50 million for each of FY2010 through FY2013, to remain
available until expended. (Total amount = $200 million.)
Community Health Center Fund (CHCF). Establishes a CHCF and
appropriates to the fund 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
FY2011 through FY2015. Requires the Secretary to transfer $9.5 billion
from the CHCF to increase funding, over the FY2008 level, for (1) community
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
= $1 billion;
community health center operations. The remaining $1.5 billion is
discussed in the next table row. [HRSA]
Transfers from the CHCF the following amounts for health center
operations, to remain available until expended: 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.)
[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]
[On Oct. 4, 2010, HHS announced the availability of $100 million for
school-based health center construction and renovation. See
http://www.hrsa.gov/about/news/pressreleases/
101004schoolbasedhealthcenters.html.]
[For HHS/HRSA announcements on the FY2011 health center funds, see
(1) http://www.hhs.gov/news/press/2010pres/08/20100809a.html; (2)
http://www.hhs.gov/news/press/2010pres/10/20101026a.html; (3)
http://www.hhs.gov/news/press/2010pres/11/20101119b.html; and (4)
http://www.hrsa.gov/about/news/pressreleases/
110107healthcenterplanning.html.]
PPACA
Section
10503(b)(2)
New/Existing
Authority
New authority
Program Description
National Health Service Corps (NHSC). Requires the Secretary to
transfer from the CHCF a total of $1.5 billion to increase funding, over
the FY2008 level, for NHSC operations, scholarships, and loan
repayments. [HRSA]
Appropriation/Transfer
Transfers from the CHCF the following amounts for NHSC, to remain
available until expended: FY2011 = $290 million; FY2012 = $295 million;
FY2013 = $300 million; FY2014 = $305 million; and FY2015 = $310
million. (Total amount = $1.5 billion.)
[On Nov. 22, 2010, HHS announced the availability of the FY2011 NHSC
funds. See http://www.hhs.gov/news/press/2010pres/11/20101122b.html.]
10503(c)
New authority
Health center construction and renovation. Provides funding for
health center construction and renovation. [HRSA]
Appropriates $1.5 billion, to be available for the period FY2011 through
FY2015, and to remain available until expended.
[Initial grant awards:On Oct. 8, 2010, HHS announced awards totaling $727 million for CHC
construction and renovation. See http://www.hhs.gov/news/press/
2010pres/10/
20101008c.html.]
Health Workforce
5507(a)
5507(b)
5508(c)
CRS-11
New SSA Sec.
2008
Amends SSA
Sec. 501(c)
New PHSA Sec.
340H]
CRS-9
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/Transfer
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 help low-income
individuals 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. [ACF, HRSA]
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
project. (Total amount = $425 million.)
Family-to-family health information centers. ProvidesRenews 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. [HRSA]
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]
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
(GME) costs to
qualified teaching health centers (THCs) for the expansion of existing, or
establishment of
new approved medical residency training programs.
[HRSA]
Appropriates SSAN, not to exceed $230 million, for the period FY2011
through FY2015.
[On Sept. 27, 2010, HHS announced Health Profession Opportunity
Grant awards totaling $67 million. See http://www.hhs.gov/news/press/
2010pres/09/20100927e.html.]
[On Oct. 26, 2010, HHS announced the availability of $4 million to
support family-to-family information centers. See http://www.hhs.gov/
news/press/2010pres/10/20101026f.html.]
[On Jan. 25, 2011, HRSA announced the designation of 11 new THCs,
who will receive GME payments for their new residents. See
http://www.hrsa.gov/about/news/pressreleases/
110125teachinghealthcenters.html.]
PPACA
Section
New/Existing
Authority
Program Description
Appropriation/Transfer
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. [CMS]
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. [HRSA]
Appropriates $100 million for FY2010, to remain available for obligation
until September 30, 2011.
CRS-10
.
PPACA
Section
New/Existing
Authority
Program Summary
Appropriation/TransferSept. 30, 2011.
[On Dec. 29, 2010, HRSA announced a $100 million award to Ohio State
University. See http://www.hrsa.gov/about/news/pressreleases/2010/
101229ohiostate.html.]
Community-Based Prevention and Wellness
4002
New authority
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 health activities, including prevention research and health
screenings. Authorizes House and Senate appropriators to transfer
monies from the PPHF to eligible activities. [OS, CDC, HRSA]
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.
[For HHS’s announcements of FY2010 funding availability and grant
awards, see (1) http://www.hhs.gov/news/press/2010pres/09/
20100927e.html (primary care workforce grant awards: $253 million
total); and (2) http://www.hhs.gov/news/press/2010pres/06/
20100618g.html (funding opportunity announcements for
community/clinical prevention initiatives, and public health infrastructure,
systems, research, & training: approx. $250 million total). On Feb. 9,
2011, HHS announced the allocation of $750 million in FY2011 funds. See
http://www.hhs.gov/news/press/2011pres/02/20110209b.html.]
Maternal and Child Health
2951
New SSA Sec.
511
CRS-12
Maternal, infant, and early childhood home visiting program
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. [HRSA, ACF]
Appropriates the following amounts for the home visitationvisiting program:
FY2010 = $100 million; FY2011 = $250 million, FY2012 = $350 million;
FY2013 = $400 million; FY2014 = $400 million. (Total amount = $1.5
billion.)
[On July 21, 2010, HHS announced home visiting grant awards totaling
$87.5 million to all 50 states, DC, and the territories. See
http://www.hhs.gov/news/press/2010pres/07/20100721a.html. On Sept.
29, 2010, it announced grants totaling $3 million to 13 Indian tribes and
tribal organizations in 9 states. See http://www.acf.hhs.gov/news/press/
2010/hrsa_award_3m.html. On Feb. 8, 2011, HRSA issued guidance for
states to submit updated plans for their home visiting programs. See
http://www.hrsa.gov/grants/manage/homevisiting/sir02082011.pdf.]
PPACA
Section
2953
New/Existing
Authority
New SSA Sec.
513
2954
Amends SSA
Sec. 510
10211-10214
New authority
Program Description
Appropriation/Transfer
Personal responsibility education programs. Establishes a state
formula grant program to support evidence-based Personal Responsibility
Education Programs (PREPs) designed to educate adolescents about
abstinence,
contraception, and adult preparation, including healthy life
skills,
educational and career success, and financial literacy. Also, requires the
the Secretary to award grants to implement innovative youth pregnancy
prevention strategies and to target services at high-risk populations.
[ACF]
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. Funds are to remain available until expended. (Total
(Total amount = $375 million.)
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. [ACF]
Appropriates $50 million for each of FY2010 through FY2014. (Total
amount = $250 million.)
Appropriates $50 million for each of FY2010 through FY2014. (Total
amount = $250 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
[OS]
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. [CMS]
Appropriates $450 million for each of FY2011 through FY2016, to remain
available through FY2016. (Total amount = $2.7 billion.)
[On Sept. 30, 2010, HHS announced PREP grant awards totaling $55
million. See http://www.hhs.gov/news/press/2010pres/09/20100930a.html.]
[On Sept. 30, 2010, HHS announced abstinence education grants totaling
$33 million to 29 states and Puerto Rico. See http://www.hhs.gov/news/
press/2010pres/09/teenpregnancy_abstinencegrants.html.]
[On Sept. 28, 2010, HHS announced pregnancy assistance grant awards
totaling $24 million to 17 states and tribes. See http://www.hhs.gov/news/
press/2010pres/09/20100928d.html.]
Long-Term Care
2403
Amends DRA
Sec. 6071(h)
CRS-13
[On Sept. 27, 2010, HHS announced a round of MFP funding totaling $10
million to 23 states and DC. See http://www.hhs.gov/news/press/
2010pres/09/20100927a.html.]
PPACA
Section
2405
New/Existing
Authority
New authority
6201
New authority
8002(d)
Amends DRA
Sec. 6021(d)
Program Description
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.
[AoA]
Appropriation/Transfer
Appropriates $10 million for each of FY2010 through FY2014. (Total
amount = $50 million.)
[On Sept. 27, 2010, HHS announced ADRC grants totaling $10 million to
19 states and DC. See http://www.hhs.gov/news/press/2010pres/09/
20100927a.html.]
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. [CMS]
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)National Clearinghouse for Long-Term Care Information.
Extends funding for the National Clearinghouse for Long-Term Care
Information through FY2015, and requires the Clearinghouse to include
information on the Community Living Assistance Services and Supports
(CLASS) program, established under PPACA Sec. 8002(a). [CMS]
Appropriates $3 million for each of FY2011 through FY2015 for the
Clearinghouse. (Total amount = $15 million.)
[For information on an initial round of grant awards totaling $14 million
to 6 states, see http://aging.senate.gov/record.cfm?id=328161.]
Comparative Effectiveness Research
6301(d)-(e)
CRS-14
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;dc and (3) transfers from
the Medicare trust funds for each of FY2013 through FY2019.e
Appropriatesd [OS,
AHRQ]
Appropriates to the PCORTF $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
revenue from the health insurance policy/plan fee, as well as Medicare
trust fund
transfers. transfers. Each fiscal year, 20% of the funds in the PCORTF are
to be transferred to the Secretary.
PPACA
Section
New/Existing
Authority
Program Description
Appropriation/Transfer
Biomedical Research
9023
New IRC Sec.
48D
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 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 grants
any one company receives for the two years may not exceed $5
million).
[IRS]
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. [OS]
Appropriates $1 billion to the HIRIF.
Biomedical Research
9023(e)
New IRC Sec.
48D[For a list of all the companies and their research projects that the IRS has
approved, and the tax credit or grant award for each approved project,
see http://www.irs.gov/businesses/small/article/0,,id=228690,00.html.]
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 111-148), as 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.
CRS-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.
e.
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-14
.
Appropriations and Fund Transfers in the 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, Amanda Sarata,
Pam Smith, Carmen Solomon-Fears, Emilie Stoltzfus, Julie Stone, and Susan Thaul provided comments on
this report.
Congressional Research Service
15c.
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 beginning in FY2015.
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 beginning in FY2015.
CRS-15
Table 2. Appropriations and Fund Transfers in the Health Reform Law, FY2010-FY2019
Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended by P.L. 111-152)
PPACA
Section
Appropriation (or Fund Transfer) in $ millions
Program
FY2010
FY2011
FY2012
FY2013
FY2014
FY2015
FY2016
FY2017
FY2018
FY2019
Total
Private Health Insurance
1002
Health insurance consumer
information
30a
1003
Review of health insurance
premium rates
250
—
—
—
—
—
—
—
—
—
250
1101
Temporary high-risk health
insurance pools
5,000a
—
—
—
—
—
—
—
—
—
5,000
1102
Early retiree reinsurance
program
5,000a
—
—
—
—
—
—
—
—
—
5,000
1311
Health insurance exchange
planning and establishment
Appropriates necessary amounts for grants each fiscal year, as determined
by the Secretary; no grants may be awarded after Jan. 1, 2015
—
—
—
—
TBDb
1322
Consumer operated and
oriented plans (CO-OPs)
—
—
—
—
6,000
1323
Health insurance exchange
subsides (U.S. territories)
Authorizes to be appropriated SSAN for FY2011 and each fiscal year thereafter
6,000
—
—
—
—
—
—
—
—
—
30
1,000
$1 billion total for CY2014 through CY2109c
Medicaid and Children’s Health Insurance Program (CHIP)
2701
Medicaid adult health quality
measures
60
60
60
60
60
—
—
—
—
—
300d
2707
Medicaid emergency
psychiatric demonstration
—
75e
—
—
—
—
—
—
—
—
75
2801
Medicaid and CHIP Payment
and Access Commission
11f
4108
Medicaid prevention and
wellness incentives
—
4306
CHIP childhood obesity
demonstration
10203(d)
CHIP annual appropriationg
CRS-16
Authorizes to be appropriated SSAN for FY2011 and each fiscal year thereafter
—
—
—
—
—
100
—
—
—
—
—
25
21,061
—
—
—
—
40,208
$100 million total for CY2011 through CY2015d
$25 million total for FY2010 through FY2014
—
—
—
19,147
11
PPACA
Section
10203(d)
Appropriation (or Fund Transfer) in $ millions
Program
CHIP outreach and
enrollment grants
FY2010
FY2011
FY2012
FY2013
FY2014
FY2015
Increases total funding from $100 million to $140 million and extends
funding period through FY2015
FY2016
FY2017
FY2018
FY2019
Total
—
—
—
—
40
—
—
—
—
100
Medicare
3014
Medicare quality and
efficiency measures
3021(a)
Center for Medicare and
Medicaid Innovation
5
3024
Medicare independence at
home demonstration
5h
3026
Community-based care
transition services
—
3027(b)
Medicare gainsharing
demonstration
2
—
—
—
—
3113
Diagnostic laboratory test
demonstration
5i
—
—
—
3306
Outreach and assistance for
low-income beneficiaries
$45 million total for FY2010 through
FY2012
—
3403
Independent Payment
Advisory Board
4202(b)
20h
20
20
20
20
—
plus $10 billion total for FY2011 through FY2019, and $10 billion for each subsequent 10-fiscal year period
5
5
5
5
5
10,005d
—
—
—
—
30
—
—
—
—
500
—
—
—
—
—
2d
—
—
—
—
—
—
5
—
—
—
—
—
—
45d
$500 million total for FY2011 through FY2015h
For FY2013 and each subsequent fiscal year, appropriates previous year’s amount
adjusted for inflation; funds derived from the Medicare Part A and Part B trust funds.
—
—
15
Prevention and wellness
evaluation
50h
—
—
—
—
—
—
—
—
—
50
4204(e)
GAO study of Medicare
vaccine coverage
1
—
—
—
—
—
—
—
—
—
1
10323(a)
Environmental health pilot
program
10323(b)
Environmental health
screening and education
TBDb
TBDb
SSANh
$20 million total for FY2015 though FY2019, and for each 5fiscal year period thereafter
$23 million total for FY2010 through FY2014
43d
Fraud and Abuse
6402(i) &
HCERA
1303(a)
CRS-17
Health Care Fraud and
Abuse Control (HCFAC)
Account
—
105
65
40
40
30
30
10
10
10
350j
PPACA
Section
Appropriation (or Fund Transfer) in $ millions
Program
FY2010
FY2011
FY2012
FY2013
FY2014
FY2015
FY2016
FY2017
FY2018
FY2019
Total
Health Centers and the National Health Service Corps (NHSC)
4101(a)
School-based health center
establishment grants
50
50
50
50
—
—
—
—
—
—
200d
10503(b)(1)
Community Health Centers
Fund, patient services
—
1,000
1,200
1,500
2,200
3,600
—
—
—
—
9,500d
10503(b)(2)
Community Health Centers
Fund, NHSC
—
290
295
300
305
310
—
—
—
—
1,500d
10503(c)
Community health center
construction and renovation
—
—
—
—
—
1,500d
$1.5 billion total for FY2011 through FY2015
Health Workforce
5507(a)
Health workforce
demonstration grants
85
85
85
85
85
—
—
—
—
—
425
5507(b)
Family-to-family health
information centers
5
5
5
—
—
—
—
—
—
—
15d
5508(c)
Teaching health centers,
GME payments
—
—
—
—
—
≤230
5509
Medicare graduate nurse
education demonstration
—
—
50
50
50
50
—
—
—
—
200d
10502
Health care facility
construction
100
—
—
—
—
—
—
—
—
—
100k
500
750
1,000
1,250
1,500
2,000
2,000
2,000
2,000
2,000
15,000l
SSAN for FY2011 through FY2015, not to exceed $230
million
Community-Based Prevention and Wellness
4002
Prevention and Public Health
Fund
Maternal and Child Health
2951
Maternal, infant, and early
childhood home visitation
100
250
350
400
400
—
—
—
—
—
1,500
2953
Personal responsibility
education program grants
75
75
75
75
75
—
—
—
—
—
375d
2954
Abstinence education state
grants
50
50
50
50
50
—
—
—
—
—
250
CRS-18
Appropriation (or Fund Transfer) in $ millions
PPACA
Section
Program
10214
Pregnancy assistance grants
FY2010
FY2011
FY2012
FY2013
FY2014
FY2015
FY2016
FY2017
FY2018
FY2019
Total
25
25
25
25
25
25
25
25
25
25
250
Long-Term Care
2403
Medicaid money follows the
person demonstration
—
450
450
450
450
450
450
—
—
—
2,700
2405
State Aging and Disability
Resource Centers
10
10
10
10
10
—
—
—
—
—
50
6201
Background checks of longterm care providers
—
—
—
—
—
—
—
8002(d)
National Clearinghouse for
Long-Term Care Information
3
3
3
—
—
—
—
Up to $160 million total for
FY2010 through FY2012m
—
3
3
15
Comparative Effectiveness Research
6301(d)
Patient-Centered Outcomes
Research Trust Fund,
Medicare transfers
—
—
—
For each of FY2013 through FY2019, transfers amounts from the Medicare trust
funds as determined by a formulan
TBDb
6301(e)
Patient-Centered Outcomes
Research Trust Fund,
appropriations
10
50
150
For each of FY2013 through FY2019, appropriates $150 million plus an amount
equal to the net revenue from a fee levied on insurance policies and health planso
TBDb
SSAN
—
—
—
—
—
—
—
—
—
TBDp
1,000
—
—
—
—
—
—
—
—
—
1,000
Biomedical Research
9023(e)
Grants for investment in
new therapeutics
PPACA Implementation
HCERA
1005
Health Insurance Reform
Implementation Fund
Source: 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.
Notes: Funds are provided from the Treasury unless otherwise noted. A dash means that PPACA does not appropriate or transfer funds for the fiscal year(s) noted.
a.
Funds are to remain available without fiscal year limitation.
b.
To be determined.
c.
Of this 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.
CRS-19
d.
Funds are to remain available until expended.
e.
Funds are to remain available for obligation through Dec. 31, 2015.
f.
Of this total amount, $9 million is appropriated, and the remaining $2 million is a transfer from CHIP funding for FY2010. Funds are to remain available until expended.
g.
Prior to enactment of PPACA, the CHIP program was funded through FY2013.
h.
The Secretary is required to transfer amounts from the Medicare Part A and Part B trust funds in such proportion as the Secretary determines appropriate. Funds are
to remain available until expended,
i.
The Secretary is required to transfer the $5 million from the Medicare Part B trust fund, to remain available until expended.
j.
Funds are to be appropriated from the Medicare Part A trust fund. Note: the total amount appropriated (i.e., $350 million) includes a final appropriation of $10 million
for FY2020.
k.
Funds are to remain available for obligation until Sept. 30, 2011.
l.
PPACA Sec. 4002 provides annual appropriations for the Prevention and Public Health Fund in perpetuity; increasing from $500 million for FY2010 to $2 billion for
FY2015 and each fiscal year thereafter. Appropriations to the fund total $15 billion over the period FY2010 through FY2019.
m. PPACA Sec. 6201 requires the HHS Secretary to notify the Treasury Secretary of the amount necessary to carry out activities under this section for the period of
FY2010 through FY2012, but not to exceed $160 million. The Treasury Secretary must then transfer the amount specified from the Treasury to the HHS Secretary.
Funds are to remain available until expended.
n.
To be determined. PPACA Sec. 6301(d) provides a formula for the transfer of funds from the Medicare Part A and Part B trust funds to the Patient-Centered
Outcomes Research Trust Fund as follows: (1) for FY2013, an amount from each respective Medicare trust fund equal to $1 multiplied by the average number of
individuals entitled to Part A benefits, or enrolled in Part B during that period; and (2) for each of FY2014 through FY2019, an amount from each respective Medicare
trust fund equal to $2 multiplied by the average number of individuals entitled to Part A benefits, or enrolled in Part B during that fiscal year. Beginning in FY2015,
amounts are subject to adjustment for increases in health care spending.
o.
To be determined. In addition to the amounts transferred to the Patient-Centered Outcomes Research Trust Fund under PPACA Sec. 6301(d), described in the
preceding table note, PPACA Sec. 6301(e) appropriates to the Fund a specified amount for each of FY2010 through FY2019 plus an additional amount for each of
FY2013 through FY2019 equal to the net revenues received from a fee imposed on health insurance policies and self-insured plans. The fee equals $2 multiplied by the
average number of covered lives in a policy/plan year ($1 in the case of policy/plan years ending during FY2013). Beginning in FY2015, amounts are subject to
adjustment for increases in health care spending.
p.
To be determined. PPACA Sec. 9023(e) creates a two-year tax credit program, subject to an overall cap of $1 billion, for small companies that invest in new therapies
to prevent, diagnose and treat cancer and other diseases. The total amount of tax credits any one company can receive for the two years may not exceed $5 million.
Companies may elect to receive one or more grants—for which SSAN are appropriated—in lieu of tax credits. Grant applications must be received before Jan. 1,
2013.
CRS-20
Appropriations and Fund Transfers in the 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, Bernice Reyes,
Amanda Sarata, Pam Smith, Carmen Solomon-Fears, Emilie Stoltzfus, Julie Stone, and Susan Thaul
provided comments on this report.
Congressional Research Service
21