.
Appropriations and Fund Transfers in the
Patient Protection and Affordable Care Act
(PPACA)
C. Stephen Redhead
Specialist in Health Policy
October 28, 2010
Congressional Research Service
7-5700
www.crs.gov
R41301
CRS Report for Congress
P
repared 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 market, sets minimum standards for health coverage, creates a mandate for most U.S.
residents to obtain health insurance, and provides for the establishment by 2014 of insurance
exchanges through which certain individuals and families will be able to receive federal subsidies
to reduce the cost of purchasing that coverage. The new law expands eligibility for Medicaid;
amends the Medicare program in ways that are intended to reduce the growth in Medicare
spending that had been projected under preexisting law; imposes an excise tax on insurance plans
found to have high premiums; and makes other changes to the tax code, Medicare, Medicaid, and
numerous other federal programs.
In some instances, PPACA mandates appropriations or requires the Secretary to transfer from the
Medicare Part A and Part B trust funds billions of dollars to support new or existing grant
programs and other activities. This report summarizes those mandated appropriations and fund
transfers. They include funding for a temporary insurance program for individuals who have been
uninsured for several months and have a preexisting condition, as well as funding for states to
plan and establish exchanges. PPACA also provides funding for various Medicare and Medicaid
demonstration programs, for the creation of a Center for Medicare and Medicaid Innovation to
test and implement innovative payment and service delivery models, and for an independent
board to provide Congress with proposals for reducing Medicare cost growth and improving
quality of care for Medicare beneficiaries.
Among other provisions, the new health reform law appropriates funding for health workforce
and maternal and child health programs, and establishes three multi-billion dollar funds. The first
fund will provide a total of $11 billion over five years in supplementary funding for community
health centers and the National Health Service Corps. (A separate appropriation provides $1.5
billion for health center construction and renovation.) The second fund will support comparative
effectiveness research through FY2019 with a mixture of appropriations and fund transfers. The
third fund, which is funded in perpetuity, is to support prevention, wellness, and other public
health-related programs and activities authorized under the Public Health Service Act (PHSA).
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA
authorizes new funding for numerous existing discretionary grant and other programs and
activities, primarily ones authorized under the PHSA. It also creates a number of new
discretionary grant programs and activities and provides for each an authorization of
appropriations. Funding for all of these discretionary programs and activities is subject to action
by congressional appropriators. A companion product, CRS Report R41390, Discretionary
Funding in the Patient Protection and Affordable Care Act (PPACA), coordinated by C. Stephen
Redhead, summarizes all the provisions in PPACA for which appropriations are authorized.
Congressional Research Service
.
Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
Contents
Introduction ................................................................................................................................ 1
Mandated Appropriations and Fund Transfers........................................................................ 1
Discretionary Funding........................................................................................................... 2
CRS Products........................................................................................................................ 2
Tables
Table 1. Appropriations and Fund Transfers in the Health Reform Law........................................ 3
Contacts
Author Contact Information ...................................................................................................... 15
Acknowledgments .................................................................................................................... 15
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.2
Among its many provisions, PPACA (as amended by HCERA) restructures the private health
insurance market, sets minimum standards for health coverage, creates a mandate for most U.S.
residents to obtain health insurance, and provides for the establishment by 2014 of insurance
exchanges through which certain individuals and families will be able to receive federal subsidies
to reduce the cost of purchasing that coverage. The new law expands eligibility for Medicaid;
amends the Medicare program in ways that are intended to reduce the growth in Medicare
spending that had been projected under preexisting law; imposes an excise tax on insurance plans
found to have high premiums; and makes other changes to the tax code, Medicare, Medicaid, and
numerous other federal programs.
Mandated Appropriations and Fund Transfers
In some instances, PPACA (as amended by HCERA) mandates appropriations or requires the
Secretary to transfer from the Medicare Part A and Part B trust funds billions of dollars to support
new or existing grant programs and other activities. Table 1 summarizes all such appropriations
and fund transfers, which are grouped under the following headings: (1) Private Health Insurance
Reforms; (2) Medicaid and the Children’s Health Insurance Program (CHIP); (3) Medicare; (4)
Fraud and Abuse; (5) Health Centers and the National Health Service Corps (NHSC); (6) Health
Workforce; (7) Community-Based Prevention and Wellness; (8) Maternal and Child Health; (9)
Long-Term Care; (10) Comparative Effectiveness Research; (11) Biomedical Research; and (12)
PPACA Implementation.
Each table entry includes the following information: (1) the PPACA section number; (2) an
indication of whether the provision modifies the Public Health Service Act or another law either
by amending an existing section or by adding a new one, or whether the provision creates new
stand-alone statutory authority; (3) a brief description of the program or activity; and (4) details
of the appropriation or transfer of funds. In most cases, the language specifies funding levels (or
transfer amounts) for one or more fiscal years. Two provisions appropriate “such sums as may be
necessary” (SSAN) to carry out a program. The table also includes web links to PPACA grant
opportunity announcements and grant awards. Unless otherwise stated, references in the table to
the 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/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
.
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. 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
2
.
Table 1. Appropriations and Fund Transfers in the Health Reform Law
Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended by P.L. 111-152)
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
Private Health Insurance
1002
New PHSA Sec.
Health insurance consumer information. Requires the Secretary to
Appropriates $30 million for the first fiscal year of the program, to remain
2793
award grants to states to enable them (or the exchanges operating in such available without fiscal year limitation. [Note: the section also authorizes
states) to establish, expand, or provide support for offices of health
to be appropriated SSAN for each fiscal year thereafter.]
insurance consumer assistance, or health insurance ombudsman
programs. These independent entities will assist consumers with filing
[Grant awards: http://www.hhs.gov/news/press/2010pres/10/
complaints and appeals, educate consumers on their rights and
20101019a.html]
responsibilities, and collect, track, and quantify consumer problems and
inquiries.
1003
New PHSA Sec.
Review of health insurance premium rates. Requires the Secretary,
Appropriates $250 million for the grant program. Funds remaining
2794
in conjunction with the states, to establish a process for the annual review unobligated at the end of FY2014 shall remain available for grants to
of unreasonable increases in health insurance premiums beginning in the
states for planning and implementing PPACA’s individual and group
2010 plan year. Health insurance issuers must submit a justification for a
market reforms.
premium increase judged to be unreasonable prior to its implementation.
Instructs the Secretary to award grants to states during the five-year
[Initial grant awards: http://www.hhs.gov/news/press/2010pres/08/
period FY2010 through FY2014 for carrying out the premium review.
20100816a.html]
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.
Appropriates $5 billion, to remain available without fiscal year limitation,
Requires the Secretary, within 90 days of enactment, to establish a
to pay claims against (and administrative costs of) the high-risk pool that
temporary high-risk pool program to provide health insurance coverage
are in excess of premiums collected from enrollees.
for eligible individuals who have been uninsured for six months and have a
preexisting condition. The program, which terminates on January 1, 2014,
[Fact sheet with potential state-by-state allocations: http://www.hhs.gov/
permits premium rates to vary on the basis of age by a factor of up to 4:1
ociio/initiative/hi_risk_pool_facts.html]
and places limits on out-of-pocket costs.
CRS-3
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
1102 New
authority
Reinsurance for early retirees. Requires the Secretary, within 90 days
Appropriates $5 billion, to remain available without fiscal year limitation,
of enactment, to establish a temporary reinsurance program to provide
to carry out the reinsurance program.
reimbursement to participating employer-based plans for part of the cost
of providing health benefits to early retirees age 55-64 and their families.
[Participating employers, state-by-state: http://www.hhs.gov/news/press/
The program reimburses participating plans for 80% of the costs of
2010pres/10/20101004a.html]
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
Appropriates amounts necessary for the Secretary to award state grants.
of enactment, to award grants to states to plan and establish exchanges.
For each fiscal year, the Secretary must determine the total amount that
By January 1, 2014, each state must have an exchange to facilitate access
will be made available to each state.
to insurers’ qualified health plans. The grants can be renewed to states
making progress in establishing an exchange, implementing PPACA’s
[Initial grant awards: http://www.hhs.gov/news/press/2010pres/07/
private health insurance market reforms, and meeting other benchmarks.
20100729a.html]
However, no grant may be awarded after January 1, 2015. Exchanges will
have to be self-sustaining by then, using assessments on insurers or some
other way to generate funds to support their operations.
1322 New
authority
Health insurance cooperatives. Requires the Secretary to establish
Appropriates $6 billion to carry out the CO-OP program.
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.
1323 New
authority
Funding for territories. Provides funds for U.S. territories that elect to Appropriates $1 billion, to be available during the period 2014 through
establish a health insurance exchange. Funds must be used to provide
2019. Of that total amount, $925 million is for Puerto Rico, and the
premium and cost-sharing assistance to territory residents who obtain
remaining $75 million is for the other U.S. territories in amounts as
health insurance coverage through the exchange.
specified by the Secretary.
CRS-4
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
Medicaid and Children’s Health Insurance Program (CHIP)
2701
New SSA Sec.
Medicaid adult health quality measures. Requires the Secretary to
Appropriates $60 million for each of FY2010 through FY2014. (Total
1139B
develop and, not later than January 1, 2012, publish an initial core set of
amount = $300 million.)
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.
2707 New
authority
Medicaid emergency psychiatric demonstration program. Directs Appropriates $75 million for FY2011, to remain available for obligation
the Secretary to establish a three-year Medicaid demonstration in which
through December 31, 2015.
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.
2801 Amends
SSA
Medicaid and CHIP Payment and Access Commission
Appropriates $9 million, and transfers from CHIP funding an additional $2
Sec. 1900
(MACPAC). Clarifies and expands MACPAC’s duties; for example, to
million for FY2010 for MACPAC activities. Funds are to remain available
include a review and assessment of payment policies under Medicaid and
until expended. (Total amount = $11 million.)
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.
4108 New
authority
Medicaid prevention and wellness incentives. Requires the
Appropriates $100 million for the five-year period beginning January 1,
Secretary to award state grants to provide incentives for Medicaid
2011, to remain available until expended.
beneficiaries to participate in evidence-based healthy lifestyle programs to
prevent or help manage chronic disease.
4306 Amends
SSA
CHIP childhood obesity demonstration program. Appropriates
Appropriates $25 million for the period FY2010 through FY2014.
Sec. 1139A(e)
funding for a program authorized by the Children’s Health Insurance
Program Reauthorization Act (CHIPRA; P.L. 111-3), which requires
the Secretary to conduct a demonstration project to develop a model for
reducing childhood obesity.
CRS-5
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
10203 Amends
SSA
CHIP annual appropriations, and outreach and enrollment
Appropriates $19.147 billion for FY2014, and a total of $21.061 billion for
Secs. 2104 &
grants. Appropriates funding for the CHIP program for FY2014 and
FY2015 for the CHIP program. Appropriates an additional $40 mil ion for
2113
FY2015 (the program previously had been funded through FY2013). Also,
the CHIP outreach and enrollment grants.
extends the time period for CHIP outreach and enrol ment grants
through FY2015 and increases the existing appropriation for such grants
from $100 million to $140 million.
Medicare
3014 Amends
SSA
Medicare quality measures. Expands the duties of the consensus-
Requires the Secretary to transfer from the Medicare Part A and Part B
Sec. 1890(b).
based entity under contract with CMS pursuant to SSA Sec. 1890
trust funds $20 million for each of FY2010 through FY2014, to remain
New SSA Sec.
(currently the National Quality Forum). Requires the entity to convene
available until expended.a (Total amount = $100 million.)
1890A
multi-stakeholder groups to provide input on the national priorities for
health care quality improvement (developed under PPACA). In addition,
the multi-stakeholder groups are required to provide input on the
selection of quality measures for use in various specified Medicare
payment 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
Appropriates (1) $5 million for FY2010 for the selection, testing, and
1115A
Secretary, no later than January 1, 2011, to establish the CMI within the
evaluation of new payment and service delivery models; and (2) $10
Centers for Medicare and Medicaid Services (CMS). The purpose of CMI
billion for the period FY2011 through FY2019, plus $10 billion for each
is to test and evaluate innovative payment and service delivery models to
subsequent 10-fiscal year period, to continue such activities and for the
reduce program expenditures under Medicare, Medicaid, and CHIP while
expansion and nationwide implementation of successful models.b Amounts
preserving or enhancing the quality of care furnished under these
are to remain available until expended.
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.
3024
New SSA Sec.
Medicare independence at home demonstration program.
Requires the Secretary to transfer from the Medicare Part A and Part B
1866D
Requires the Secretary to conduct a three-year Medicare demonstration
trust funds $5 million for each of FY2010 through FY2015 for
program, beginning no later than January 1, 2012, to test a payment
administering and carrying out the demonstration, to remain available
incentive and service delivery model aimed at reducing expenditures and
until expended.a (Total amount = $30 million.)
improving health outcomes that uses physician- and nurse practitioner-
directed primary care teams to provide home-based services to
chronically ill patients. The Secretary must submit a plan, no later than
January 1, 2016, for expanding the program if it is determined that such
expansion would improve the quality of care and reduce spending.
CRS-6
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
3026 New
authority
Community-based care transitions program. Requires the
Requires the Secretary to transfer from the Medicare Part A and Part B
Secretary to establish a five-year program, beginning January 1, 2011, to
trust funds $500 million for the period FY2011 through FY2015, to
provide funding to eligible hospitals and community-based organizations
remain available until expended.a
that provide evidence-based transition services to Medicare beneficiaries
with multiple chronic conditions who are at high risk for hospital
readmission.
3027
Amends DRA
Medicare gainsharing demonstration program. Under DRA Sec.
Appropriates $1.6 million for FY2010, to remain available through FY2014
Sec. 5007
5007, CMS is supporting two gainsharing projects to test and evaluate
or until expended, for carrying out the demonstration.
arrangements between hospitals and physicians that are intended to
improve the quality and efficiency of care provided to beneficiaries. 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.
Appropriates a total of $45 million for the period FY2010 through
Sec. 119
Provides additional funding for beneficiary outreach and education
FY2012, to remain available until expended, as follows: (1) $15 million for
activities for Medicare low-income programs through the following
SHIPs; (2) $15 million for AAAs; (3) $10 million for ADRCs; and (4) $5
entities: (1) State Health Insurance Counseling and Assistance Programs
million for the NCBOE.
(SHIPs); (2) Area Agencies on Aging (AAAs); (3) Aging and Disability
Resource Centers (ADRCs); and (4) the National Center for Benefits and
[Grant awards: http://www.hhs.gov/news/press/2010pres/09/
Outreach Enrollment (NCBOE).
20100927a.html]
CRS-7
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
3403
New SSA Sec.
Independent Payment Advisory Board. Creates an independent, 15-
Appropriates $15 million for FY2012 to support the board’s activities. For
1899A
member Payment Advisory Board tasked with presenting Congress with
each subsequent fiscal year, appropriates the amount from the previous
comprehensive proposals to reduce excess cost growth and improve
fiscal year adjusted for inflation. Sixty percent of the appropriation is to be
quality of care for Medicare beneficiaries. In years when Medicare costs
derived by transfer from the Medicare Part A trust fund, and 40% is to be
are projected to exceed a target growth rate, the board’s proposals will
derived by transfer from the Medicare Part B trust fund.
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.
4202(b) New
authority
Medicare prevention and wellness evaluation. Requires the
Requires the Secretary to transfer $50 million from the Medicare Part A
Secretary to conduct an evaluation of community-based prevention and
and Part B trust funds to fund the evaluation.a
wel ness programs and, based on the findings, develop a plan to promote
healthy lifestyles and chronic disease self-management among Medicare
beneficiaries.
4204(e) New
authority
Medicare vaccine coverage. Requires the GAO to study and report to Appropriates $1 million for FY2010 for the GAO study.
Congress on the impact of Medicare Part D vaccine coverage on access
to those vaccines among beneficiaries.
10323
New SSA Secs.
Environmental health hazards. Provides Medicare coverage and
Appropriates $23 million for the period FY2010 through FY2014, and $20
1881A & 2009
medical screening services to certain individuals exposed to
million for each five-fiscal year period thereafter, to carry out the
environmental health hazards. Also, requires the Secretary to award
screening and public information dissemination program.
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.
CRS-8
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
Fraud and Abuse
6402(i) Amends
SSA
Health Care Fraud and Abuse Control (HCFAC) Account.
Appropriates $10 million for each of FY2011 through FY2020; plus an
Sec. 1817(k)
Permanently applies an inflation adjustment to the annual appropriation
additional $95 million for FY2011, $55 million for FY2012, $30 million for
(provided under SSA Sec. 1817(k)) for the HCFAC Account, which
each of FY2013 and FY2014, and $20 million for each of FY2015 and
finances investigative and enforcement activities undertaken by the HHS
FY2016. Funds are to remain available until expended. (Total amount =
Office of the Inspector General, the Department of Justice, and the
$350 million.)
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.
Health Centers and the National Health Service Corps (NHSC)
4101(a) New
authority
School-based health centers. Requires the Secretary to create a grant
Appropriates $50 million for each of FY2010 through FY2013, to remain
program for the establishment of school-based health centers. Funds may
available until expended. (Total amount = $200 million.)
be used for facility construction, expansion, and equipment.
[FY2010/FY2011 grant opportunity announcement: http://www.hrsa.gov/
about/news/pressreleases/101004schoolbasedhealthcenters.html]
10503(b) New
authority
Community Health Center Fund (CHCF). Establishes a CHCF and
Transfers from the CHCF to the Secretary the fol owing amounts, to
appropriates a total of $11 billion over the five-year period FY2011
remain available until expended. (1) For health center operations: FY2011
through FY2015 to the fund, to be transferred by the Secretary to HHS
= $1 billion; FY2012 = $1.2 billion; FY2013 = $1.5 billion; FY2014 = $2.2
accounts to increase funding, over the FY2008 level, for (1) community
billion; and FY2015 = $3.6 billion. (Total amount = $9.5 billion.) (2) For
health center operations; and (2) NHSC operations, scholarships, and
NHSC: FY2011 = $290 million; FY2012 = $295 million; FY2013 = $300
loan repayments.
million; FY2014 = $305 million; and FY2015 = $310 million. (Total
amount = $1.5 billion.)
[FY2011 grant opportunity announcements: (1) http://www.hhs.gov/news/
press/2010pres/08/20100809a.html; (2) http://www.hhs.gov/news/press/
2010pres/10/20101026a.html]
10503(c) New
authority
Health center construction and renovation. Provides funding for
Appropriates $1.5 billion, to be available for the period FY2011 through
health center construction and renovation.
FY2015, and to remain available until expended.
[Initial grant awards: http://www.hhs.gov/news/press/2010pres/10/
20101008c.html]
CRS-9
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
Health Workforce
5507(a)
New SSA Sec.
Health workforce demonstration programs. Requires the Secretary Appropriates $85 million for each of FY2010 through FY2014, of which
2008
to establish two demonstration projects. The first is to award health
$5 million in each of FY2010 through FY2012 is to be used for the second
profession opportunity grants to states, Indian tribes, institutions of higher project. (Total amount = $425 million.)
education, and local workforce investment boards to help low-income
individuals obtain education and training in health care jobs that pay well
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
and are in high demand; funds may be used to provide financial aid and
20100927e.html]
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
Appropriates $5 million for each of FY2010 through FY2012, to remain
Sec. 501(c)
the family-to-family information centers, which assist families of children
available until expended. (Total amount = $15 million.)
with disabilities or special health care needs and the professionals who
serve them.
[FY2011 grant opportunity announcement: http://www.hhs.gov/news/
press/2010pres/10/20101026f.html]
5508(c)
New PHSA Sec.
Teaching health centers. Requires the Secretary to make payments
Appropriates SSAN, not to exceed $230 million, for the period FY2011
340H
for direct and indirect graduate medical education costs to qualified
through FY2015.
teaching health centers for the expansion of existing, or establishment of
new approved medical residency training programs.
5509 New
authority
Medicare graduate nurse education demonstration program.
Appropriates $50 million for each of FY2012 through FY2015, to remain
Requires the Secretary to establish a Medicare demonstration program
available until expended. (Total amount = $200 million.)
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.
10502 New
authority
Health care facility construction. Provides funding for debt service
Appropriates $100 million for FY2010, to remain available for obligation
on, or construction or renovation of, a hospital affiliated with a state’s
until September 30, 2011.
sole public medical and dental school.
CRS-10
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
Community-Based Prevention and Wellness
4002 New
authority
Prevention and Public Health Fund (PPHF). Establishes a PPHF and
Appropriates the following amounts to the PPHF: FY2010 = $500 million;
appropriates amounts to the fund in perpetuity. Requires the Secretary to FY2011 = $750 million; FY2012 = $1 billion; FY2013 = $1.25 billion;
transfer amounts from the fund to HHS accounts to increase funding,
FY2014 = $1.5 billion; FY2015 and each fiscal year thereafter = $2 billion.
over the FY2008 level, for PHSA-authorized prevention, wellness, and
public health activities, including prevention research and health
[Grant opportunity announcements and awards for the FY2010 funds: (1)
screenings. Authorizes House and Senate appropriators to transfer
http://www.hhs.gov/news/press/2010pres/09/20100927e.html (primary
monies from the PPHF to eligible activities.
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.
Maternal, infant, and early childhood home visitation programs.
Appropriates the fol owing amounts for the home visitation program:
511
Requires the Secretary to award grants to states, U.S. territories, and
FY2010 = $100 million; FY2011 = $250 million, FY2012 = $350 million;
Indian tribes to develop and implement early childhood home visiting
FY2013 = $400 million; FY2014 = $400 million. (Total amount = $1.5
programs that adhere to evidence-based models of service delivery.
billion.)
Programs must establish benchmarks to measure improvements for the
participating families in prenatal, maternal, and newborn health; child
[FY2010 grant awards: (1) http://www.hhs.gov/news/press/2010pres/07/
health and development; parenting skills; school readiness; juvenile
20100721a.html (states, territories); (2) http://www.acf.hhs.gov/news/
delinquency; and family economic self-sufficiency.
press/2010/hrsa_award_3m.html (Indian tribes, tribal organizations)]
2953
New SSA Sec.
Personal responsibility education programs. Establishes a state
Appropriates $75 million for each of FY2010 through FY2014, of which
513
formula grant program to support evidence-based Personal Responsibility
$10 million each year is to be reserved for the youth pregnancy
Education Programs designed to educate adolescents about abstinence,
prevention grants. (Total amount = $375 million.)
contraception, and adult preparation, including healthy life skills,
educational and career success, and financial literacy. Also, requires the
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
Secretary to award grants to implement innovative youth pregnancy
20100930a.html]
prevention strategies and to target services at high-risk populations.
2954 Amends
SSA
Abstinence education grants. Renews funding for the state formula
Appropriates $50 million for each of FY2010 through FY2014. (Total
Sec. 510
grant program, authorized under SSA Sec. 510, to support abstinence
amount = $250 million.)
education programs. Funds are awarded to states based on the
proportion of low-income children in each state compared to the national [FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
total, and may only be used for teaching abstinence.
teenpregnancy_abstinencegrants.html]
CRS-11
.
PPACA
New/Existing
Section
Authority
Program Summary
Appropriation/Transfer
10211-10214 New
authority Pregnancy assistance grants. In col aboration with the Secretary of
Appropriates $25 million for each of FY2010 through FY2019. (Total
Education, requires the Secretary to establish a Pregnancy Assistance
amount = $250 million.)
Fund for the purpose of awarding grants to states to assist pregnant and
parenting teens and women. State grantees have the flexibility to make
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
funds available to institutions of higher education, high schools and
20100928d.html]
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
2403 Amends
DRA
Medicaid Money Follows the Person (MFP) demonstration
Appropriates $450 million for each of FY2011 through FY2016, to remain
Sec. 6071
program. Appropriates funding through FY2016 for the MFP
available through FY2016. (Total amount = $2.7 billion.)
demonstration, which authorizes the Secretary to award competitive
grants to states to reduce their reliance on institutional care for people
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
needing long-term care, and expand options for elderly people and
20100927a.html]
individuals with disabilities to receive home and community-based long-
term care services.
2405 New
authority
State Aging and Disability Resource Centers (ADRCs). Provides
Appropriates $10 million for each of FY2010 through FY2014. (Total
funding for ADRCs (authorized under Sec. 202 of the OAA), which serve
amount = $50 million.)
as a single, coordinated resource for consumer information on the range
of long-term care options in community and institutional settings. Some
[FY2010 grant awards: http://www.hhs.gov/news/press/2010pres/09/
ADRCs also serve as the entry point to publicly administered long-term
20100927a.html]
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
Requires the Treasury Secretary to transfer to HHS an amount, not to
Secretary to establish a nationwide program for background checks on
exceed $160 million, that is specified by the HHS Secretary as necessary
direct patient access employees of long-term care facilities or providers,
to carry out the program for the period FY2010 through FY2012. Funds
and to provide federal matching funds to states to conduct these
are to remain available until expended.
activities.
[Initial grant awards: http://aging.senate.gov/record.cfm?id=328161]
CRS-12
.
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).
Appropriates $10 million for FY2010, $50 million for FY2011, and $150
9511, 4375, &
Establishes a PCORTF to fund the new Patient-Centered Outcomes
million for each of FY2012 through FY2019, for a total of $1.26 billion
4376. New SSA
Research Institute and its comparative effectiveness research activities.
over that 10-year period. For each of FY2013 through FY2019, the
Sec. 1183
The fund is to receive the following amounts: (1) specified annual
PCORTF is to receive additional appropriations based on the revenue
appropriations for each of FY2010 through FY2019 (see amounts in the
from the health insurance policy/plan fee, as well as Medicare trust fund
right-hand column); (2) additional annual appropriations for each of
transfers.
FY2013 through FY2019 equal to the net revenue from a new fee levied
on health insurance policies and self-insured plans;d and (3) transfers from
the Medicare trust funds for each of FY2013 through FY2019.e
Biomedical Research
9023(e) New
IRC
Sec.
Therapeutic research and development tax credits and grants.
Appropriates SSAN to carry out the grant program.
48D
Creates a two-year temporary tax credit program, subject to an overal
cap of $1 billion, for small companies (250 or fewer employees) that
invest in new therapies to prevent, diagnose, and treat cancer and other
diseases. Companies may apply for one or more tax credits, each
covering up to 50% of the cost of qualifying research investments made in
2009 and 2010. However, the total amount of tax credits any one
company receives for the two years may not exceed $5 million.
Companies may elect to receive one or more grants in lieu of tax credits,
subject to the same restrictions (i.e., grants may cover up to 50% of the
cost of qualifying investments made in 2009 and 2010; the total amount of
grants any one company receives for the two years may not exceed $5
million).
PPACA Implementation
HCERA Sec.
New authority
Health Insurance Reform Implementation Fund (HIRIF).
Appropriates $1 billion to the HIRIF.
1005
Establishes an HIRIF for federal 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.
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 annual y 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 annual y 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
15