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