Appropriations and Fund Transfers in the
Patient Protection and Affordable Care Act
(PPACA)
C. Stephen Redhead
Specialist in Health Policy
October 14, 2010
Congressional Research Service
7-5700
www.crs.gov
R41301
CRS Report for Congress
P
repared for Members and Committees of Congress

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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. The new law expands eligibility for Medicaid;
amends the Medicare program in ways that are intended to reduce the growth in Medicare
spending that had been projected under preexisting law; imposes an excise tax on insurance plans
found to have high premiums; and makes other changes to the tax code, Medicare, Medicaid, and
numerous other federal programs.
In some instances, PPACA mandates appropriations or requires the Secretary to transfer from the
Medicare Part A and Part B trust funds billions of dollars to support new or existing grant
programs and other activities. This report summarizes those mandated appropriations and fund
transfers. They include funding for a temporary insurance program for individuals who have been
uninsured for several months and have a preexisting condition, as well as funding for states to
plan and establish exchanges. PPACA also provides funding for various Medicare and Medicaid
demonstration programs, for the creation of a Center for Medicare and Medicaid Innovation to
test and implement innovative payment and service delivery models, and for an independent
board to provide Congress with proposals for reducing Medicare cost growth and improving
quality of care for Medicare beneficiaries.
Among other provisions, the new health reform law appropriates funding for health workforce
and maternal and child health programs, and establishes three multi-billion dollar funds. The first
fund will provide a total of $11 billion over five years in supplementary funding for community
health centers and the National Health Service Corps. (A separate appropriation provides $1.5
billion for health center construction and renovation.) The second fund will support comparative
effectiveness research through FY2019 with a mixture of appropriations and fund transfers. The
third fund, which is funded in perpetuity, is to support prevention, wellness, and other public
health-related programs and activities authorized under the Public Health Service Act (PHSA).
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA
authorizes new funding for numerous existing discretionary grant and other programs and
activities, primarily ones authorized under the PHSA. It also creates a number of new
discretionary grant programs and activities and provides for each an authorization of
appropriations. Funding for all of these discretionary programs and activities is subject to action
by congressional appropriators. A companion product, CRS Report R41390, Discretionary
Funding in the Patient Protection and Affordable Care Act (PPACA), summarizes all the
provisions in PPACA for which appropriations are authorized.

Congressional Research Service

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Appropriations and Fund Transfers in PPACA

Contents
Introduction ................................................................................................................................ 1
Mandated Appropriations and Fund Transfers........................................................................ 1
Discretionary Funding........................................................................................................... 2
CRS Products........................................................................................................................ 2

Tables
Table 1. Appropriations and Fund Transfers in the Health Reform Law........................................ 3

Contacts
Author Contact Information ...................................................................................................... 11
Acknowledgments .................................................................................................................... 11

Congressional Research Service

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Appropriations and Fund Transfers in PPACA

Introduction
On March 23, 2010, President Obama signed into law a comprehensive health care reform bill,
the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148).1 The following week, on
March 30, 2010, the President signed the Health Care and Education Reconciliation Act of 2010
(HCERA; P.L. 111-152), which amended various health care and revenue provisions in PPACA.2
Among its many provisions, PPACA (as amended by HCERA) restructures the private health
insurance market, sets minimum standards for health coverage, creates a mandate for most U.S.
residents to obtain health insurance, and provides for the establishment by 2014 of insurance
exchanges through which certain individuals and families will be able to receive federal subsidies
to reduce the cost of purchasing that coverage. The new law expands eligibility for Medicaid;
amends the Medicare program in ways that are intended to reduce the growth in Medicare
spending that had been projected under preexisting law; imposes an excise tax on insurance plans
found to have high premiums; and makes other changes to the tax code, Medicare, Medicaid, and
numerous other federal programs.
Mandated Appropriations and Fund Transfers
In some instances, PPACA (as amended by HCERA) mandates appropriations or requires the
Secretary to transfer from the Medicare Part A and Part B trust funds billions of dollars to support
new or existing grant programs and other activities. Table 1 summarizes all such appropriations
and fund transfers, which are grouped under the following headings: (1) Private Health Insurance
Reforms; (2) Medicaid and the Children’s Health Insurance Program (CHIP); (3) Medicare; (4)
Fraud and Abuse; (5) Health Centers and the National Health Service Corps (NHSC); (6) Health
Workforce; (7) Community-Based Prevention and Wellness; (8) Maternal and Child Health; (9)
Long-Term Care; (10) Comparative Effectiveness Research; (11) Biomedical Research; and (12)
PPACA Implementation.
Each table entry includes the following information: (1) the PPACA section number; (2) an
indication of whether the provision modifies the Public Health Service Act or another law either
by amending an existing section or by adding a new one, or whether the provision creates new
stand-alone statutory authority; (3) a brief description of the program or activity; and (4) details
of the appropriation or transfer of funds. In most cases, the language specifies funding levels (or
transfer amounts) for one or more fiscal years. Two provisions appropriate “such sums as may be
necessary” (SSAN) to carry out a program. 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)

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.
Congressional Research Service
1

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Appropriations and Fund Transfers in PPACA

• Internal Revenue Code (IRC)
• Older Americans Act (OAA)
• Deficit Reduction Act of 2005 (DRA)3
• Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)4
Discretionary Funding
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA (as
amended by HCERA) authorizes new funding for numerous existing discretionary grant and other
programs and activities. It also creates a number of new discretionary grant programs and
activities and provides for each an authorization of appropriations. Funding for all of these
discretionary programs and activities is subject to action by congressional appropriators. A
companion product, CRS Report R41390, Discretionary Funding in the Patient Protection and
Affordable Care Act (PPACA), summarizes all the provisions in PPACA for which appropriations
are authorized.
CRS Products
More information on the PPACA provisions summarized in Table 1 may be found in the
following CRS products:
• 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

3 P.L. 109-171.
4 P.L. 110-275.
Congressional Research Service
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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 year
2793
enable them (or the exchanges operating in such states) to establish, expand, or provide support for
of the program, to remain available without
offices of health insurance consumer assistance, or health insurance ombudsman programs. These
fiscal year limitation. [Note: the section also
independent entities will assist consumers with filing complaints and appeals, educate consumers on
authorizes to be appropriated SSAN for each
their rights and responsibilities, and collect, track, and quantify consumer problems and inquiries.
fiscal year thereafter.]
1003
New PHSA Sec.
Review of health insurance premium rates. Requires the Secretary, in conjunction with the
Appropriates $250 million for the grant
2794
states, to establish a process for the annual review of unreasonable increases in health insurance
program. Funds remaining unobligated at the
premiums beginning in the 2010 plan year. Health insurance issuers must submit a justification for a
end of FY2014 shall remain available for grants
premium increase judged to be unreasonable prior to its implementation. Instructs the Secretary to
to states for planning and implementing
award grants to states during the five-year period FY2010 through FY2014 for carrying out the
PPACA’s individual and group market reforms.
premium review. State grantees are required to provide the Secretary with information about trends
in premium increases, including recommendations as to whether particular issuers should be
excluded from participation in the exchange due to a pattern of excessive or unjustified premium
increases.
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 six months and have a preexisting
against (and administrative costs of) the high-
condition. The program, which terminates on January 1, 2014, permits premium rates to vary on the
risk pool that are in excess of premiums
basis of age by a factor of up to 4:1 and places limits on out-of-pocket costs.
collected from enrollees.
1102 New
authority
Reinsurance for early retirees. Requires the Secretary, within 90 days of enactment, to establish
Appropriates $5 billion, to remain available
a temporary reinsurance program to provide reimbursement to participating employer-based plans
without fiscal year limitation, to carry out the
for part of the cost of providing health benefits to early retirees age 55-64 and their families. The
reinsurance program.
program reimburses participating plans for 80% of the costs of benefits provided per enrollee in
excess of $15,000 and below $90,000. Funds must be used to lower costs for the plan; for example,
the funds could be used to reduce premium costs or lower out-of-pocket costs for beneficiaries.
1311 New
authority
Health insurance exchanges. Requires the Secretary, within one year of enactment, to award
Appropriates amounts necessary for the
grants to states to plan and establish exchanges. By January 1, 2014, each state must have an
Secretary to award state grants. For each fiscal
exchange to facilitate access to insurers’ qualified health plans. The grants can be renewed to states
year, the Secretary must determine the total
making progress in establishing an exchange, implementing PPACA’s private health insurance market
amount that will be made available to each
reforms, and meeting other benchmarks. However, no grant may be awarded after January 1, 2015.
state.
Exchanges will have to be self-sustaining by then, using assessments on insurers or some other way
to generate funds to support their operations.
CRS-3

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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 CO-
Oriented Plan (CO-OP) program to provide funding until July 1, 2013, for the creation of nonprofit
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
Appropriates $1 billion, to be available during
insurance exchange. Funds must be used to provide premium and cost-sharing assistance to territory the period 2014 through 2019. Of that total
residents who obtain health insurance coverage through the exchange.
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 FY2010
1139B
January 1, 2012, publish an initial core set of quality measures for Medicaid-eligible adults. Not later
through FY2014. (Total amount = $300
than January 1, 2013, requires the Secretary to develop a standardized format for states to report
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
Appropriates $75 million for FY2011, to
a three-year Medicaid demonstration in which eligible states are required to reimburse certain
remain available for obligation through
institutions for mental disease (IMDs) for services provided to Medicaid beneficiaries aged 21
December 31, 2015.
through 64 who are in need of medical assistance to stabilize an emergency psychiatric condition.
2801 Amends
SSA
Medicaid and CHIP Payment and Access Commission (MACPAC). Clarifies and expands
Appropriates $9 million, and transfers from
Sec. 1900
MACPAC’s duties; for example, to include a review and assessment of payment policies under
CHIP funding an additional $2 million for
Medicaid and CHIP and how factors affecting expenditures and payment methodologies enable
FY2010 for MACPAC activities. Funds are to
beneficiaries to obtain services, affect provider supply, and affect providers that serve a
remain available until expended. (Total amount
disproportionate share of low-income and other vulnerable populations. Additional duties include
= $11 million.)
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.
4108 New
authority
Medicaid prevention and wellness incentives. Requires the Secretary to award state grants to
Appropriates $100 million for the five-year
provide incentives for Medicaid beneficiaries to participate in evidence-based healthy lifestyle
period beginning January 1, 2011, to remain
programs to prevent or help manage chronic disease.
available until expended.
CRS-4

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PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
4306 Amends
SSA
CHIP childhood obesity demonstration program. Appropriates funding for a program
Appropriates $25 million for the period
Sec. 1139A(e)
authorized by the Children’s Health Insurance Program Reauthorization Act (CHIPRA; P.L. 111-3),
FY2010 through FY2014.
which requires the Secretary to conduct a demonstration project to develop a model for reducing
childhood obesity.
10203 Amends
SSA
CHIP annual appropriations, and outreach and enrollment grants. Appropriates funding
Appropriates $19.147 billion for FY2014, and a
Secs. 2104 &
for the CHIP program for FY2014 and FY2015 (the program previously had been funded through
total of $21.061 billion for FY2015 for the
2113
FY2013). Also, extends the time period for CHIP outreach and enrol ment grants through FY2015
CHIP program. Appropriates an additional $40
and increases the existing appropriation for such grants from $100 million to $140 million.
million for the CHIP outreach and enrollment
grants.
Medicare
3014 Amends
SSA
Medicare quality measures. Expands the duties of the consensus-based entity under contract
Requires the Secretary to transfer from the
Sec. 1890(b).
with CMS pursuant to SSA Sec. 1890 (currently the National Quality Forum). Requires the entity to
Medicare Part A and Part B trust funds $20
New SSA Sec.
convene multi-stakeholder groups to provide input on the national priorities for health care quality
million for each of FY2010 through FY2014, to
1890A
improvement (developed under PPACA). In addition, the multi-stakeholder groups are required to
remain available until expended.a (Total amount
provide input on the selection of quality measures for use in various specified Medicare payment
= $100 million.)
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.
3021
New SSA Sec.
Center for Medicare and Medicaid Innovation (CMI). Requires the Secretary, no later than
Appropriates (1) $5 million for FY2010 for the
1115A
January 1, 2011, to establish the CMI within the Centers for Medicare and Medicaid Services (CMS).
selection, testing, and evaluation of new
The purpose of CMI is to test and evaluate innovative payment and service delivery models to
payment and service delivery models; and (2)
reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing
$10 billion for the period FY2011 through
the quality of care furnished under these programs. In selecting the models, the Secretary is also
FY2019, plus $10 billion for each subsequent
required to give preference to those that improve the coordination, quality, and efficiency of health
10-fiscal year period, to continue such activities
care services.
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
Requires the Secretary to transfer from the
1866D
conduct a three-year Medicare demonstration program, beginning no later than January 1, 2012, to
Medicare Part A and Part B trust funds $5
test a payment incentive and service delivery model aimed at reducing expenditures and improving
million for each of FY2010 through FY2015 for
health outcomes that uses physician- and nurse practitioner-directed primary care teams to provide
administering and carrying out the
home-based services to chronically ill patients. The Secretary must submit a plan, no later than
demonstration, to remain available until
January 1, 2016, for expanding the program if it is determined that such expansion would improve
expended.a (Total amount = $30 million.)
the quality of care and reduce spending.
CRS-5

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PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
3026 New
authority
Community-based care transitions program. Requires the Secretary to establish a five-year
Requires the Secretary to transfer from the
program, beginning January 1, 2011, to provide funding to eligible hospitals and community-based
Medicare Part A and Part B trust funds $500
organizations that provide evidence-based transition services to Medicare beneficiaries with multiple
million for the period FY2011 through FY2015,
chronic conditions who are high risk for hospital readmission.
to remain 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 demonstration.
al ows 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.
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
period FY2010 through FY2012, to remain
following entities: (1) State Health Insurance Counseling and Assistance Programs (SHIPs); (2) Area
available until expended, as follows: (1) $15
Agencies on Aging (AAAs); (3) Aging and Disability Resource Centers (ADRCs); and (4) the National million for SHIPs; (2) $15 million for AAAs; (3)
Center for Benefits and Outreach Enrollment (NCBOE).
$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
subsequent fiscal year, appropriates the amount
to exceed a target growth rate, the board’s proposals will take effect unless Congress passes an
from the previous fiscal year adjusted for
alternative measure that achieves the same level of savings. Congress would be al owed to consider
inflation. Sixty percent of the appropriation is
an alternative provision on a fast-track basis. The board would be prohibited from making proposals
to be derived by transfer from the Medicare
that ration care, raise taxes, or increase Part B premiums, or change Medicare benefit, eligibility, or
Part A trust fund, and 40% is to be derived by
cost-sharing standards. Requires the board to make biannual recommendations to the President,
transfer from the Medicare Part B trust fund.
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.
4202(b) New
authority
Medicare prevention and wellness evaluation. Requires the Secretary to conduct an evaluation Requires the Secretary to transfer $50 million
of community-based prevention and wel ness programs and, based on the findings, develop a plan to
from the Medicare Part A and Part B trust
promote healthy lifestyles and chronic disease self-management among Medicare beneficiaries.
funds to fund the evaluation.a
4204(e) New
authority
Medicare vaccine coverage. Requires the GAO to study and report to Congress on the impact
Appropriates $1 million for FY2010 for the
of Medicare Part D vaccine coverage on access to those vaccines among beneficiaries.
GAO study.
CRS-6

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PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
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 for
grants to state and local government agencies, health care facilities, and other entities to (1) provide
each five-fiscal year period thereafter, to carry
screening for specified lung diseases and other environmental health conditions to at-risk individuals;
out the screening and public information
and (2) disseminate public information about the availability of screening, the detection and
dissemination program.
treatment of environmental health conditions, and the availability of Medicare benefits to certain
individuals diagnosed with such conditions.
Fraud and Abuse
6402(i) Amends
SSA
Health Care Fraud and Abuse Control (HCFAC) Account. Permanently applies an inflation
Appropriates $10 million for each of FY2011
Sec. 1817(k)
adjustment to the annual appropriation (provided under SSA Sec. 1817(k)) for the HCFAC Account,
through FY2020; plus an additional $95 million
which finances investigative and enforcement activities undertaken by the HHS Office of the
for FY2011, $55 million for FY2012, $30
Inspector General, the Department of Justice, and the Federal Bureau of Investigation, as well as
million for each of FY2013 and FY2014, and
Medicare Integrity Program activities undertaken by CMS contractors. In addition, provides
$20 million for each of FY2015 and FY2016.
supplemental funds through FY2020 for the HCFAC Account.
Funds are to remain available until expended.
(Total amount = $350 million.)
Health Centers and the National Health Service Corps (NHSC)
4101(a) New
authority
School-based health centers. Requires the Secretary to create a grant program for the
Appropriates $50 million for each of FY2010
establishment of school-based health centers. Funds may be used for facility construction, expansion, through FY2013, to remain available until
and equipment.
expended. (Total amount = $200 million.)
10503(b) New
authority
Community Health Center Fund (CHCF). Establishes a CHCF and appropriates a total of $11
Transfers from the CHCF to the Secretary the
billion over the five-year period FY2011 through FY2015 to the fund, to be transferred by the
following amounts, to remain available until
Secretary to HHS accounts to increase funding, over the FY2008 level, for (1) community health
expended. (1) For health center operations:
center operations; and (2) NHSC operations, scholarships, and loan repayments.
FY2011 = $1 billion; FY2012 = $1.2 billion;
FY2013 = $1.5 billion; FY2014 = $2.2 billion;
and FY2015 = $3.6 billion. (Total amount =
$9.5 billion.) (2) For NHSC: FY2011 = $290
million; FY2012 = $295 million; FY2013 = $300
million; FY2014 = $305 million; and FY2015 =
$310 million. (Total amount = $1.5 billion.)
10503(c) New
authority
Health center construction and renovation. Provides funding for health center construction
Appropriates $1.5 billion, to be available for
and renovation.
the period FY2011 through FY2015, and to
remain available until expended.
CRS-7

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PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
Health Workforce
5507(a)
New SSA Sec.
Health workforce demonstration programs. Requires the Secretary to establish two
Appropriates $85 million for each of FY2010
2008
demonstration projects. The first is to award grants to states, Indian tribes, institutions of higher
through FY2014, of which $5 million in each of
education, and local workforce investment boards to provide low-income individuals with the
FY2010 through FY2012 is to be used for the
opportunity to obtain education and training in health care jobs that pay wel and are in high
second project. (Total amount = $425 million.)
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.
5507(b) Amends
SSA Family-to-family health information centers. Provides funding for the family-to-family
Appropriates $5 million for each of FY2010
Sec. 501(c)
information centers, which assist families of children with disabilities or special health care needs and through FY2012. (Total amount = $15 million.)
the professionals who serve them.
5508(c)
New PHSA Sec.
Teaching health centers. Requires the Secretary to make payments for direct and indirect
Appropriates SSAN, not to exceed $230
340H
graduate medical education costs to qualified teaching health centers for the expansion of existing,
million, for the period FY2011 through FY2015.
or establishment of new approved medical residency training programs.
5509 New
authority
Medicare graduate nurse education demonstration program. Requires the Secretary to
Appropriates $50 million for each of FY2012
establish a Medicare demonstration program under which up to five eligible hospitals will receive
through FY2015, to remain available until
reimbursement for providing advanced practice nurses with clinical training in primary care,
expended. (Total amount = $200 million.)
preventive care, transitional care, and chronic care management.
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 and 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
Appropriates the following amounts to the
the fund in perpetuity. Requires the Secretary to transfer amounts from the fund to HHS accounts
PPHF: FY2010 = $500 million; FY2011 = $750
to increase funding, over the FY2008 level, for PHSA-authorized prevention, wellness, and public
million; FY2012 = $1 billion; FY2013 = $1.25
health activities, including prevention research and health screenings. Authorizes House and Senate
billion; FY2014 = $1.5 billion; FY2015 and each
appropriators to transfer monies from the PPHF to eligible activities.
fiscal year thereafter = $2 billion.
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 = $350
establish benchmarks to measure improvements for the participating families in prenatal, maternal,
million; FY2013 = $400 million; FY2015 = $400
and newborn health; child health and development; parenting skills; school readiness; juvenile
million. (Total amount = $1.5 billion.)
delinquency; and family economic self-sufficiency.
CRS-8

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PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
2953
New SSA Sec.
Personal responsibility education. Establishes a state formula grant program to support
Appropriates $75 million for each of FY2010
513
evidence-based Personal Responsibility Education programs designed to educate adolescents about
through FY2014, of which $10 million each
abstinence, contraception, and adult preparation, including healthy life skills, educational and career
year is to be reserved for the youth pregnancy
success, and financial literacy. Also, requires the Secretary to award grants to implement innovative
prevention grants. (Total amount = $375
youth pregnancy prevention strategies and to target services at high-risk populations.
million.)
2954 Amends
SSA
Abstinence education grants. Renews funding for the state formula grant program, authorized
Appropriates $50 million for each of FY2010
Sec. 510
under SSA Sec. 510, to support abstinence education programs. Funds are awarded to states based
through FY2014. (Total amount = $250
on the proportion of low-income children in each state compared to the national total, and may only million.)
be used for teaching abstinence.
10211-10214 New
authority Pregnancy assistance grants. In collaboration with the Secretary of Education, requires the
Appropriates $25 million for each of FY2010
Secretary to establish a Pregnancy Assistance Fund for the purpose of awarding grants to states to
through FY2019. (Total amount = $250
assist pregnant and parenting teens and women. State grantees have the flexibility to make funds
million.)
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.
Long-Term Care
2405 New
authority
State Aging and Disability Resource Centers (ADRCs). Provides funding for ADRCs
Appropriates $10 million for each of FY2010
(authorized under Sec. 202 of the OAA), which serve as a single, coordinated resource for
through FY2014. (Total amount = $50 million.)
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.
6201 New
authority
Background checks of long-term care providers. Requires the Secretary to establish a
Requires the Treasury Secretary to transfer to
nationwide program for background checks on direct patient access employees of long-term care
HHS an amount, not to exceed $160 million,
facilities or providers, and to provide federal matching funds to states to conduct these activities.
that is specified by the HHS Secretary as
necessary to carry out the program for the
period FY2010 through FY2012. Funds are to
remain available until expended.
CRS-9

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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
Appropriates $10 million for FY2010, $50
9511, 4375, &
fund the new Patient-Centered Outcomes Research Institute and its comparative effectiveness
million for FY2011, and $150 million for each
4376. New SSA
research activities. The fund is to receive the fol owing amounts: (1) specified annual appropriations
of FY2012 through FY2019, for a total of $1.26
Sec. 1183
for each of FY2010 through FY2019 (see amounts in the right-hand column); (2) additional annual
billion over that 10-year period. For each of
appropriations for each of FY2013 through FY2019 equal to the net revenue from a new fee levied
FY2013 through FY2019, the PCORTF is to
on health insurance policies and self-insured plans;c and (3) transfers from the Medicare trust funds
receive additional appropriations based on the
for each of FY2013 through FY2019.d
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 two-year
Appropriates SSAN to carry out the grant
48D
temporary tax credit program, subject to an overall cap of $1 billion, for small companies (250 or
program.
fewer employees) that invest in new therapies to prevent, diagnose, and treat cancer and other
diseases. Companies may apply for one or more tax credits, each covering up to 50% of the cost of
qualifying research investments made in 2009 and 2010. However, the total amount of tax credits
any one company receives for the two years may not exceed $5 million. Companies may elect to
receive one or more grants in lieu of tax credits, subject to the same restrictions (i.e., grants may
cover up to 50% of the cost of qualifying investments made in 2009 and 2010; the total amount of
grants any one company receives for the two years may not exceed $5 million).
PPACA Implementation
HCERA Sec.
New authority
Health Insurance Reform Implementation Fund (HIRIF). Establishes an HIRIF for federal
Appropriates $1 billion to the HIRIF.
1005
administrative expenses to carry out PPACA and HCERA.
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-10

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Appropriations and Fund Transfers in PPACA


Author Contact Information

C. Stephen Redhead

Specialist in Health Policy
credhead@crs.loc.gov, 7-2261


Acknowledgments
Kirsten Colello, Patricia Davis, Gary Guenther, Elayne Heisler, Lisa Herz, Sarah Lister, Chris Peterson,
Amanda Sarata, Pam Smith, Julie Stone, and Susan Thaul provided comments on this report.

Congressional Research Service
11

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