Appropriations and Fund Transfers in the
Patient Protection and Affordable Care Act
(PPACA)
C. Stephen Redhead
Specialist in Health Policy
February 10, 2011
Congressional Research Service
7-5700
www.crs.gov
R41301
CRS Report for Congress
P
repared for Members and Committees of Congress
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, 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 of Health and
Human Services to transfer from the Medicare Part A and Part B trust funds billions of dollars to
support new or existing grant programs and other activities. This report summarizes those
mandated appropriations and fund transfers. They include funding for a temporary insurance
program for individuals who have been uninsured for several months and have a preexisting
condition, as well as funding for states to plan and establish exchanges. PPACA also provides
funding for various Medicare and Medicaid demonstration programs, for the creation of a Center
for Medicare and Medicaid Innovation to test and implement innovative payment and service
delivery models, and for an independent board to provide Congress with proposals for reducing
Medicare cost growth and improving quality of care for Medicare beneficiaries.
Among other provisions, the new health reform law appropriates funding for health workforce
and maternal and child health programs, and establishes three multi-billion dollar funds. The first
fund will provide a total of $11 billion over five years in supplementary funding for community
health centers and the National Health Service Corps. (A separate appropriation provides $1.5
billion for health center construction and renovation.) The second fund will support comparative
effectiveness research through FY2019 with a mixture of appropriations and fund transfers. The
third fund, which is funded in perpetuity, is to support prevention, wellness, and other public
health-related programs and activities authorized under the Public Health Service Act (PHSA).
This report will be updated periodically with information on recent PPACA funding
announcements. In addition to the mandated appropriations and fund transfers discussed herein,
PPACA authorizes new funding for numerous existing discretionary grant and other programs and
activities, primarily ones authorized under the PHSA. The law also creates a number of new
discretionary grant programs and activities and provides for each an authorization of
appropriations. Funding for all of these discretionary programs and activities is subject to action
by congressional appropriators. A companion product, CRS Report R41390, Discretionary
Funding in the Patient Protection and Affordable Care Act (PPACA), coordinated by C. Stephen
Redhead, summarizes all the provisions in PPACA for which appropriations are authorized.
Congressional Research Service
Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
Contents
Introduction ................................................................................................................................ 1
PPACA Mandated Appropriations and Fund Transfers........................................................... 1
PPACA Discretionary Funding .............................................................................................. 3
CRS Products........................................................................................................................ 3
Tables
Table 1. Description of Appropriations and Fund Transfers in the Health Reform Law................. 4
Table 2. Appropriations and Fund Transfers in the Health Reform Law, FY2010-FY2019.......... 16
Contacts
Author Contact Information ...................................................................................................... 21
Acknowledgments .................................................................................................................... 21
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). 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.1
Among its many provisions, PPACA, as amended, 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.
PPACA Mandated Appropriations and Fund Transfers
In some instances, PPACA, as amended, mandates appropriations or requires the Secretary of
Health and Human Services (HHS) to transfer from the Medicare Part A and Part B trust funds
billions of dollars to support new or existing grant programs and other activities. The new law
includes funding for a temporary insurance program for individuals who have been uninsured for
several months and have a preexisting condition, as well as funding for states to plan and
establish exchanges. PPACA also provides funding for various Medicare and Medicaid
demonstration programs, for the creation of a Center for Medicare and Medicaid Innovation to
test and implement innovative payment and service delivery models, and for an independent
board to provide Congress with proposals for reducing Medicare cost growth and improving
quality of care for Medicare beneficiaries.
Among other provisions, PPACA appropriates funding for health workforce and maternal and
child health programs, and establishes three multi-billion dollar funds. The first fund will provide
a total of $11 billion over five years in supplementary funding for community health centers and
the National Health Service Corps. (A separate appropriation provides $1.5 billion for health
center construction and renovation.) The second fund will support comparative effectiveness
research through FY2019 with a mixture of appropriations and fund transfers. The third fund,
which is funded in perpetuity, is to support prevention, wellness, and other public health-related
programs and activities authorized under the Public Health Service Act (PHSA).
Table 1 summarizes all such appropriations and fund transfers, grouped under the following
headings: (1) Private Health Insurance; (2) Medicaid and the Children’s Health Insurance
Program (CHIP); (3) Medicare; (4) Fraud and Abuse; (5) Health Centers and the National Health
Service Corps (NHSC); (6) Health Workforce; (7) Community-Based Prevention and Wellness;
1 A consolidated version of PPACA, incorporating the changes made by the health-related provisions in HCERA, is
available at http://statutes.legcoun.house.gov/PDF/ppacacon.PDF.
Congressional Research Service
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Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
(8) Maternal and Child Health; (9) Long-Term Care; (10) Comparative Effectiveness Research;
(11) Biomedical Research; and (12) PPACA Implementation.
Each table entry includes the following information: (1) the PPACA section number; (2) an
indication of whether the provision modifies the Public Health Service Act or another law either
by amending an existing section or by adding a new one, or whether the provision creates new
stand-alone statutory authority; (3) a brief description of the program or activity (with the name
of the administering HHS agency, if known); and (4) details of the appropriation or transfer of
funds.
In most cases, the language specifies funding levels or transfer amounts for one or more fiscal
years. However, three provisions appropriate or transfer “such sums as may be necessary”
(SSAN) to carry out a program. Two other provisions (i.e., Secs. 1311 and 6201) specify that it is
for the HHS Secretary to determine, within certain parameters, the amount necessary for the
program. Table 1 entries also include information on, and web addresses for, official HHS
announcements on PPACA funding availability and/or grant awards.2
Table 2 shows the amounts appropriated or transferred in each provision by fiscal year, over the
10-year period FY2010 through FY2019. The information is organized and grouped under the
same headings used in Table 1. Unless otherwise stated, references to the Secretary in both tables
refer to the HHS Secretary.
The following laws and federal agencies are referred to in the tables by their acronym:
• Administration on Aging (AoA)
• Administration for Children and Families (ACF)
• Agency for Healthcare Research and Quality (AHRQ)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• Deficit Reduction Act of 2005 (DRA; P.L. 109-171)
• Health Resources and Services Administration (HRSA)
• HHS Office of the Secretary (OS)
• Internal Revenue Code (IRC)
• Internal Revenue Service (IRS)
• Medicare Improvements for Patients and Providers Act of 2008 (MIPPA; P.L.
110-275)
• Older Americans Act (OAA)
• Public Health Service Act (PHSA)
2 The information in the table on PPACA funding activities is largely drawn from HHS news releases
(http://www.hhs.gov/news/). It is not intended to be a complete summary of all such activities. Readers are encouraged
to visit other official federal websites that are tracking and providing information on PPACA implementation (e.g.,
http://www.healthcare.gov; http://www.hhs.gov/cciio/).
Congressional Research Service
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Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
• Social Security Act (SSA)
PPACA Discretionary Funding
In addition to the mandated appropriations and fund transfers discussed in this report, PPACA, as
amended, authorizes new funding for numerous existing discretionary grant and other programs
and activities, primarily ones authorized under the PHSA. While the authorization of
appropriations for most of these programs expired prior to PPACA’s enactment, many of them
continued to receive an annual appropriation. PPACA also authorizes a number of new
discretionary programs and activities and provides for each an authorization of appropriations.
Funding for all of these discretionary programs and activities is subject to action by congressional
appropriators. However, it is often the case that new programs and activities face more of a
challenge in securing funding than do existing ones with an established appropriations history. A
companion product, CRS Report R41390, Discretionary Funding in the Patient Protection and
Affordable Care Act (PPACA), summarizes all the provisions in PPACA for which appropriations
are authorized.
CRS Products
More information on the PPACA provisions summarized in the tables below may be found in the
following CRS products:
• CRS Report R40942, Private Health Insurance Provisions in the Patient
Protection and Affordable Care Act (PPACA)
• CRS Report R41210, Medicaid and the State Children’s Health Insurance
Program (CHIP) Provisions in PPACA: Summary and Timeline
• CRS Report R41196, Medicare Provisions in the Patient Protection and
Affordable Care Act (PPACA): Summary and Timeline
• CRS Report R41278, Public Health, Workforce, Quality, and Related Provisions
in PPACA: Summary and Timeline
Congressional Research Service
3
Table 1. Description of Appropriations and Fund Transfers in the Health Reform Law
Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended by P.L. 111-152)
PPACA
New/Existing
Section
Authority
Program Description
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
[On Oct. 19, 2010, HHS announced Consumer Assistance Program
complaints and appeals, educate consumers on their rights and
(CAP) grant awards totaling almost $30 million to 35 states, 4 territories,
responsibilities, and collect, track, and quantify consumer problems and
and the District of Columbia (DC). See http://www.hhs.gov/news/press/
inquiries. [OS]
2010pres/10/20101019a.html.]
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 establish a formula for awarding grants to states [On Aug. 16, 2010, HHS announced an initial round of grant awards
during the five-year period FY2010 through FY2014 for carrying out the
totaling $46 million to 45 states and DC. See http://www.hhs.gov/news/
premium review. No state shall receive less than $1 million or more than
press/2010pres/08/20100816a.html. Further, on Dec. 23, 2010, HHS
$5 million in a grant year. State grantees are required to provide the
published a proposed rule that would establish a rate review program to
Secretary with information about trends in premium increases, including
ensure that all rate increases that meet or exceed a threshold are
recommendations as to whether particular issuers should be excluded
reviewed by a state or HHS to determine whether the increases are
from participation in the exchange due to a pattern of excessive or
unreasonable. See http://www.hhs.gov/news/press/2010pres/12/
unjustified premium increases. [OS]
20101221a.html.]
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 is known as the Pre-Existing
[For a fact sheet on the PCIP program including a list of the potential
Condition Insurance Plan (PCIP), terminates on Jan. 1, 2014. PCIP permits allocation of funds, by state, see http://www.hhs.gov/ociio/initiative/
premium rates to vary on the basis of age by a factor of up to 4:1 and
hi_risk_pool_facts.html. For more details about the PCIP program in each
places limits on out-of-pocket costs. [OS]
state, see http://www.healthcare.gov/news/factsheets/pre-
existing_condition_insurance_enrollment.html.]
CRS-4
PPACA
New/Existing
Section
Authority
Program Description
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, ending on
to carry out the reinsurance program.
Jan. 1, 2014, to provide reimbursement to participating employer-based
plans for part of the cost of providing health benefits to early retirees age
[For more information on the early retiree reinsurance program,
55-64 and their families. The program reimburses participating plans for
including recent news and announcements, see http://www.errp.gov/.]
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. [OS]
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 Jan. 1, 2014, each state must have an exchange to facilitate access to
will be made available to each state.
insurers’ qualified health plans. The grants can be renewed to states
making progress in establishing an exchange, implementing PPACA’s
[On Sept. 30, 2010, HHS announced grant awards totaling $49 mil ion to
private health insurance market reforms, and meeting other benchmarks.
48 states and DC for planning health insurance exchanges. See
However, no grant may be awarded after Jan. 1, 2015. Exchanges will have http://www.healthcare.gov/news/factsheets/esthealthinsurexch.html. On
to be self-sustaining by then, using assessments on insurers or some other Jan. 20, 2011, HHS announced the availability of health insurance exchange
way to generate funds to support their operations. [OS]
establishment grants and encouraged states to apply for funding. See
http://www.hhs.gov/news/press/2011pres/01/20110120b.html.]
1322 New
authority
Health insurance cooperatives. Requires the Secretary to establish
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. [OS]
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-5
PPACA
New/Existing
Section
Authority
Program Description
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, to remain
1139B
develop and, not later than Jan. 1, 2012, publish an initial core set of
available until expended. (Total 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
[On Dec. 30, 2010, HHS published a notice with comment period
to report information about the quality of Medicaid care for adults based
identifying an initial core set of health quality measures recommended for
on those measures. The Secretary and the states must report on the
Medicaid-eligible adults. See http://edocket.access.gpo.gov/2010/pdf/2010-
development of and improvements to the quality measurement program
32978.pdf.]
on a regular basis. [CMS]
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 Dec. 31, 2015.
eligible states are required to reimburse certain institutions for mental
disease (IMDs) for services provided to Medicaid beneficiaries aged 21
[For more information on the demonstration, see http://www.samhsa.gov/
through 64 who are in need of medical assistance to stabilize an
healthreform/docs/Medicaid_Emergency_Psychiatric_Demo_508.pdf.]
emergency psychiatric condition. [CMS]
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. Note: the section also
include a review and assessment of payment policies under Medicaid and
authorizes to be appropriated SSAN for each fiscal year thereafter. Funds
CHIP and how factors affecting expenditures and payment methodologies
are to remain available until expended. (Total amount = $11 million.)
enable beneficiaries to obtain services, affect provider supply, and affect
providers that serve a disproportionate share of low-income and other
[For information on MACPAC, see http://www.macpac.gov/.]
vulnerable populations. Additional duties include reviewing and assessing
policies related to eligibility, enrollment and retention, benefits and
coverage, quality of care, and interactions between Medicaid and
Medicare and how those interactions affect access to services, payments,
and dual eligibles. MACPAC is also required to report to Congress on any
Medicaid and CHIP regulations that affect access, quality, and efficiency of
health care. [CMS]
4108 New
authority
Medicaid prevention and wellness incentives. Requires the
Appropriates $100 million for the five-year period beginning Jan. 1, 2011,
Secretary to award state grants to provide incentives for Medicaid
to remain available until expended.
beneficiaries to participate in evidence-based healthy lifestyle programs to
prevent or help manage chronic disease. [CMS]
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. [CDC]
CRS-6
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
10203(d) 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
[For information on the CHIP outreach and enrollment grants, see
from $100 million to $140 million.
http://www.cms.gov/CHIPRA/11_outreachenrollmentgrants.asp.]
Medicare
3014 Amends
SSA
Medicare quality and efficiency measures. Expands the duties of the
Requires the Secretary to transfer from the Medicare Part A and Part B
Sec. 1890(b).
consensus-based entity under contract with CMS pursuant to SSA Sec.
trust funds $20 million for each of FY2010 through FY2014, to remain
New SSA Sec.
1890 (currently the National Quality Forum). Requires the entity to
available until expended.a (Total amount = $100 million.)
1890A
convene multi-stakeholder groups to provide input on the national
priorities for health care quality improvement (developed under PPACA).
In addition, the multi-stakeholder groups are required to provide input on
the selection of quality measures for use in various specified Medicare
payment systems for hospitals and other providers, as well as in other
health care programs, and for use in reporting performance information
to the public. Establishes a multi-step pre-rulemaking process and timeline
for the adoption, dissemination, and review of measures by the Secretary.
[CMS]
3021(a)
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
[For information on CMI, see http://innovations.cms.gov/.]
of health care services. [CMS]
3024
New SSA Sec.
Medicare independence at home demonstration program.
Requires the Secretary to transfer from the Medicare Part A and Part B
1866E
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 Jan. 1, 2012, to test a payment incentive
administering and carrying out the demonstration, to remain available
and service delivery model aimed at reducing expenditures and improving
until expended.a (Total amount = $30 million.)
health outcomes that uses physician- and nurse practitioner-directed
primary care teams to provide home-based services to chronically ill
[For a fact sheet on the independence at home demonstration, see
patients. The Secretary must submit a plan, no later than January 1, 2016,
http://www.cms.gov/DemoProjectsEvalRpts/downloads/
for expanding the program if it is determined that such expansion would
IAH_FactSheet.pdf.]
improve the quality of care and reduce spending. [CMS]
CRS-7
PPACA
New/Existing
Section
Authority
Program Description
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 Jan. 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. [CMS]
3027(b)
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. [CMS]
3113 New
authority
Diagnostic laboratory test demonstration program. Requires the
Requires the Secretary to transfer from the Medicare Part B trust fund $5
Secretary to conduct a 2-year demonstration program, with a subsequent
million, to remain available until expended, for carrying out the
report to Congress, to test the impact of direct payments for certain
demonstration program and preparing the subsequent report.
complex laboratory tests on Medicare costs and quality of care. [CMS]
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
[On Sept. 27, 2010, HHS announced grant awards totaling $45 mil ion to
Outreach Enrollment (NCBOE). [AoA, CMS]
50 states, the territories, and 125 tribal organizations for Medicare
beneficiary outreach and assistance. Of this amount, $5 million was
awarded to NCBOE for technical assistance. See http://www.hhs.gov/
news/press/2010pres/09/20100927a.html.]
CRS-8
PPACA
New/Existing
Section
Authority
Program Description
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, to remain available until
wel ness programs and, based on the findings, develop a plan to promote
expended.a
healthy lifestyles and chronic disease self-management among Medicare
beneficiaries. [CMS]
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(a)
New SSA Sec.
Environmental health hazards. Extends Medicare coverage to certain
Requires the Secretary to transfer SSAN from the Medicare Part A and
1881A
individuals exposed to environmental health hazards. Requires the
Part B trust funds to carry out the pilot program.a
Secretary to establish a pilot program, with appropriate reimbursement
methodologies, to provide comprehensive, coordinated, and cost-effective
care to certain exposed individuals residing in emergency declaration
areas. [CMS]
CRS-9
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
10323(b)
New SSA Sec.
Environmental health hazards. Requires the Secretary to award
Appropriates $23 million for the period FY2010 through FY2014, and $20
2009
grants to state and local government agencies, health care facilities, and
million for each five-fiscal year period thereafter, to carry out the
other entities to (1) provide screening for specified lung diseases and
screening and public information dissemination program. Funds are to
other environmental health conditions to at-risk individuals; and (2)
remain available until expended.
disseminate public information about the availability of screening, the
detection and treatment of environmental health conditions, and the
availability of Medicare benefits to certain individuals diagnosed with such
conditions, pursuant to new SSA Sec. 1881A (as added by PPACA Sec.
10323(a)). [CMS]
Fraud and Abuse
6402(i) &
Amends SSA
Health Care Fraud and Abuse Control (HCFAC) Account.
Appropriates from the Medicare Part A trust fund $10 million for each of
HCERA Sec.
Sec. 1817(k)
Permanently applies an inflation adjustment to the annual appropriation
FY2011 through FY2020; plus an additional $95 million for FY2011, $55
1303(a)
(provided under SSA Sec. 1817(k)) for the HCFAC Account, which
million for FY2012, $30 million for each of FY2013 and FY2014, and $20
finances investigative and enforcement activities undertaken by the HHS
million for each of FY2015 and FY2016. Funds are to remain available until
Office of the Inspector General, the Department of Justice, and the
expended. (Total amount = $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. [CMS]
Health Centers and the National Health Service Corps
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. [HRSA]
[On Oct. 4, 2010, HHS announced the availability of $100 million for
school-based health center construction and renovation. See
http://www.hrsa.gov/about/news/pressreleases/
101004schoolbasedhealthcenters.html.]
10503(b)(1) New
authority Community Health Center Fund (CHCF). Establishes a CHCF and
Transfers from the CHCF the following amounts for health center
appropriates to the fund a total of $11 billion over the five-year period
operations, to remain available until expended: FY2011 = $1 billion;
FY2011 through FY2015. Requires the Secretary to transfer $9.5 billion
FY2012 = $1.2 billion; FY2013 = $1.5 billion; FY2014 = $2.2 billion; and
from the CHCF to increase funding, over the FY2008 level, for
FY2015 = $3.6 billion. (Total amount = $9.5 billion.)
community health center operations. The remaining $1.5 billion is
discussed in the next table row. [HRSA]
[For HHS/HRSA announcements on the FY2011 health center funds, see
(1) http://www.hhs.gov/news/press/2010pres/08/20100809a.html; (2)
http://www.hhs.gov/news/press/2010pres/10/20101026a.html; (3)
http://www.hhs.gov/news/press/2010pres/11/20101119b.html; and (4)
http://www.hrsa.gov/about/news/pressreleases/
110107healthcenterplanning.html.]
CRS-10
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
10503(b)(2) New
authority National Health Service Corps (NHSC). Requires the Secretary to
Transfers from the CHCF the following amounts for NHSC, to remain
transfer from the CHCF a total of $1.5 billion to increase funding, over
available until expended: FY2011 = $290 million; FY2012 = $295 million;
the FY2008 level, for NHSC operations, scholarships, and loan
FY2013 = $300 million; FY2014 = $305 million; and FY2015 = $310
repayments. [HRSA]
million. (Total amount = $1.5 billion.)
[On Nov. 22, 2010, HHS announced the availability of the FY2011 NHSC
funds. See http://www.hhs.gov/news/press/2010pres/11/20101122b.html.]
10503(c) New
authority
Health center construction and renovation. Provides funding for
Appropriates $1.5 billion, to be available for the period FY2011 through
health center construction and renovation. [HRSA]
FY2015, and to remain available until expended.
[On Oct. 8, 2010, HHS announced awards totaling $727 million for CHC
construction and renovation. See http://www.hhs.gov/news/press/
2010pres/10/20101008c.html.]
Health Workforce
5507(a)
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
[On Sept. 27, 2010, HHS announced Health Profession Opportunity
and are in high demand; funds may be used to provide financial aid and
Grant awards totaling $67 million. See http://www.hhs.gov/news/press/
other supportive services. The second is to provide states with grants to
2010pres/09/20100927e.html.]
develop core training competencies and certification programs for
personal and home care aides. [ACF, HRSA]
5507(b) Amends
SSA Family-to-family health information centers. Renews 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. [HRSA]
[On Oct. 26, 2010, HHS announced the availability of $4 million to
support family-to-family information centers. See http://www.hhs.gov/
news/press/2010pres/10/20101026f.html.]
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 (GME) costs to
through FY2015.
qualified teaching health centers (THCs) for the expansion of existing, or
establishment of new approved medical residency training programs.
[On Jan. 25, 2011, HRSA announced the designation of 11 new THCs,
[HRSA]
who will receive GME payments for their new residents. See
http://www.hrsa.gov/about/news/pressreleases/
110125teachinghealthcenters.html.]
CRS-11
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
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. [CMS]
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 Sept. 30, 2011.
sole public medical and dental school. [HRSA]
[On Dec. 29, 2010, HRSA announced a $100 million award to Ohio State
University. See http://www.hrsa.gov/about/news/pressreleases/2010/
101229ohiostate.html.]
Community-Based Prevention and Wellness
4002 New
authority
Prevention and Public Health Fund (PPHF). Establishes a PPHF and
Appropriates 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
[For HHS’s announcements of FY2010 funding availability and grant
screenings. Authorizes House and Senate appropriators to transfer
awards, see (1) http://www.hhs.gov/news/press/2010pres/09/
monies from the PPHF to eligible activities. [OS, CDC, HRSA]
20100927e.html (primary care workforce grant awards: $253 million
total); and (2) http://www.hhs.gov/news/press/2010pres/06/
20100618g.html (funding opportunity announcements for
community/clinical prevention initiatives, and public health infrastructure,
systems, research, & training: approx. $250 million total). On Feb. 9,
2011, HHS announced the allocation of $750 million in FY2011 funds. See
http://www.hhs.gov/news/press/2011pres/02/20110209b.html.]
Maternal and Child Health
2951
New SSA Sec.
Maternal, infant, and early childhood home visiting program.
Appropriates the fol owing amounts for the home visiting 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
[On July 21, 2010, HHS announced home visiting grant awards totaling
health and development; parenting skills; school readiness; juvenile
$87.5 million to all 50 states, DC, and the territories. See
delinquency; and family economic self-sufficiency. [HRSA, ACF]
http://www.hhs.gov/news/press/2010pres/07/20100721a.html. On Sept.
29, 2010, it announced grants totaling $3 million to 13 Indian tribes and
tribal organizations in 9 states. See http://www.acf.hhs.gov/news/press/
2010/hrsa_award_3m.html. On Feb. 8, 2011, HRSA issued guidance for
states to submit updated plans for their home visiting programs. See
http://www.hrsa.gov/grants/manage/homevisiting/sir02082011.pdf.]
CRS-12
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
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 (PREPs) designed to educate adolescents about
prevention grants. Funds are to remain available until expended. (Total
abstinence, contraception, and adult preparation, including healthy life
amount = $375 million.)
skills, educational and career success, and financial literacy. Also, requires
the Secretary to award grants to implement innovative youth pregnancy
[On Sept. 30, 2010, HHS announced PREP grant awards totaling $55
prevention strategies and to target services at high-risk populations.
million. See http://www.hhs.gov/news/press/2010pres/09/20100930a.html.]
[ACF]
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 [On Sept. 30, 2010, HHS announced abstinence education grants totaling
total, and may only be used for teaching abstinence. [ACF]
$33 million to 29 states and Puerto Rico. See http://www.hhs.gov/news/
press/2010pres/09/teenpregnancy_abstinencegrants.html.]
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
[On Sept. 28, 2010, HHS announced pregnancy assistance grant awards
funds available to institutions of higher education, high schools and
totaling $24 million to 17 states and tribes. See http://www.hhs.gov/news/
community service centers, and to the state attorneys general to improve
press/2010pres/09/20100928d.html.]
services for pregnant women who are victims of domestic violence, sexual
assault, or stalking. [OS]
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(h)
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
[On Sept. 27, 2010, HHS announced a round of MFP funding totaling $10
needing long-term care, and expand options for elderly people and
million to 23 states and DC. See http://www.hhs.gov/news/press/
individuals with disabilities to receive home and community-based long-
2010pres/09/20100927a.html.]
term care services. [CMS]
CRS-13
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
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
[On Sept. 27, 2010, HHS announced ADRC grants totaling $10 million to
ADRCs also serve as the entry point to publicly administered long-term
19 states and DC. See http://www.hhs.gov/news/press/2010pres/09/
care programs (e.g., Medicaid, OAA services, state assistance programs).
20100927a.html.]
As of 2009, ADRC funding had expanded to include at least one site in
each state, DC, and 3 U.S. territories (Guam, Puerto Rico, and Northern
Mariana), with more than 200 sites nationwide. [AoA]
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. [CMS]
[For information on an initial round of grant awards totaling $14 million
to 6 states, see http://aging.senate.gov/record.cfm?id=328161.]
8002(d) Amends
DRA
National Clearinghouse for Long-Term Care Information.
Appropriates $3 million for each of FY2011 through FY2015 for the
Sec. 6021(d)
Extends funding for the National Clearinghouse for Long-Term Care
Clearinghouse. (Total amount = $15 million.)
Information through FY2015, and requires the Clearinghouse to include
information on the Community Living Assistance Services and Supports
(CLASS) program, established under PPACA Sec. 8002(a). [CMS]
Comparative Effectiveness Research
6301(d)-(e) New
IRC
Secs. Patient-Centered Outcomes Research Trust Fund (PCORTF).
Appropriates to the PCORTF $10 million for FY2010, $50 million for
9511, 4375, &
Establishes a PCORTF to fund the new Patient-Centered Outcomes
FY2011, and $150 million for each of FY2012 through FY2019, for a total
4376. New SSA
Research Institute and its comparative effectiveness research activities.
of $1.26 billion over that 10-year period. For each of FY2013 through
Sec. 1183
The fund is to receive the following amounts: (1) specified annual
FY2019, the PCORTF is to receive additional appropriations based on the
appropriations for each of FY2010 through FY2019 (see amounts in the
revenue from the health insurance policy/plan fee, as well as Medicare
right-hand column); (2) additional annual appropriations for each of
trust fund transfers. Each fiscal year, 20% of the funds in the PCORTF are
FY2013 through FY2019 equal to the net revenue from a new fee levied
to be transferred to the Secretary.
on health insurance policies and self-insured plans;c and (3) transfers from
the Medicare trust funds for each of FY2013 through FY2019.d [OS,
AHRQ]
CRS-14
PPACA
New/Existing
Section
Authority
Program Description
Appropriation/Transfer
Biomedical Research
9023 New
IRC
Sec.
Therapeutic research and development tax credits and grants.
Appropriates SSAN to carry out the grant program.
48D
Creates a two-year tax credit program, subject to an overal cap of $1
billion, for small companies (250 or fewer employees) that invest in new
[For a list of al the companies and their research projects that the IRS has
therapies to prevent, diagnose, and treat cancer and other diseases.
approved, and the tax credit or grant award for each approved project,
Companies may apply for one or more tax credits, each covering up to
see http://www.irs.gov/businesses/small/article/0,,id=228690,00.html.]
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).
[IRS]
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. [OS]
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 beginning in FY2015.
d. The trust fund transfers are to equal $2 multiplied by the average number of individuals entitled to benefits under Part A or enrolled under Part B in a given fiscal year
($1 in FY2013), updated annual y by the rate of medical inflation beginning in FY2015.
CRS-15
Table 2. Appropriations and Fund Transfers in the Health Reform Law, FY2010-FY2019
Patient Protection and Affordable Care Act (PPACA; P.L. 111-148, as amended by P.L. 111-152)
Appropriation (or Fund Transfer) in $ millions
PPACA
Section
Program
FY2010
FY2011
FY2012
FY2013 FY2014 FY2015 FY2016 FY2017 FY2018
FY2019
Total
Private Health Insurance
1002 Health
insurance
consumer
information
30a Authorizes to be appropriated SSAN for FY2011 and each fiscal year thereafter
30
1003
Review of health insurance
premium rates
250 — — — — — — — — —
250
1101
Temporary high-risk health
insurance pools
5,000a — — — — — — — — —
5,000
1102
Early retiree reinsurance
program
5,000a — — — — — — — — —
5,000
1311
Health insurance exchange
Appropriates necessary amounts for grants each fiscal year, as determined
planning and establishment
by the Secretary; no grants may be awarded after Jan. 1, 2015
— — — —
TBDb
1322
Consumer operated and
oriented plans (CO-OPs)
6,000 — — — — — — — — —
6,000
1323
Health insurance exchange
subsides (U.S. territories)
— — — —
$1 billion total for CY2014 through CY2109c 1,000
Medicaid and Children’s Health Insurance Program (CHIP)
2701
Medicaid adult health quality
measures
60 60 60 60 60 — — — — —
300d
2707 Medicaid
emergency
psychiatric demonstration
— 75e — — — — — — — — 75
2801
Medicaid and CHIP Payment
and Access Commission
11f Authorizes to be appropriated SSAN for FY2011 and each fiscal year thereafter 11
4108 Medicaid
prevention
and
wellness incentives
—
$100 million total for CY2011 through CY2015d —
—
—
—
100
4306 CHIP
childhood
obesity
demonstration
$25 million total for FY2010 through FY2014
— — — — — 25
10203(d)
CHIP annual appropriationg — — — —
19,147
21,061 — — — —
40,208
CRS-16
Appropriation (or Fund Transfer) in $ millions
PPACA
Section
Program
FY2010
FY2011
FY2012
FY2013 FY2014 FY2015 FY2016 FY2017 FY2018
FY2019
Total
10203(d) CHIP
outreach
and
Increases total funding from $100 million to $140 million and extends
enrollment grants
funding period through FY2015
— — — — 40
Medicare
3014
Medicare quality and
efficiency measures
20h 20 20 20 20 — — — — —
100
3021(a)
Center for Medicare and
Medicaid Innovation
5
plus $10 billion total for FY2011 through FY2019, and $10 billion for each subsequent 10-fiscal year period
10,005d
3024
Medicare independence at
home demonstration
5h 5 5 5 5 5 — — — —
30
3026 Community-based
care
transition services
—
$500 million total for FY2011 through FY2015h —
—
—
—
500
3027(b) Medicare
gainsharing
demonstration
2 — — — — — — — — — 2d
3113
Diagnostic laboratory test
demonstration
5i — — — — — — — — — 5
3306
Outreach and assistance for
$45 million total for FY2010 through
low-income beneficiaries
FY2012
— — — — — — —
45d
3403 Independent
Payment
Advisory Board
— — 15
For FY2013 and each subsequent fiscal year, appropriates previous year’s amount
adjusted for inflation; funds derived from the Medicare Part A and Part B trust funds.
TBDb
4202(b)
Prevention and wel ness
evaluation
50h — — — — — — — — — 50
4204(e)
GAO study of Medicare
vaccine coverage
1 — — — — — — — — — 1
10323(a) Environmental
health
pilot
program
SSANh
TBDb
10323(b) Environmental
health
screening and education
$23 million total for FY2010 through FY2014
$20 million total for FY2015 though FY2019, and for each 5-
fiscal year period thereafter
43d
Fraud and Abuse
6402(i) &
Health Care Fraud and
HCERA
Abuse Control (HCFAC)
— 105 65 40 40 30 30 10 10 10
350j
1303(a)
Account
CRS-17
Appropriation (or Fund Transfer) in $ millions
PPACA
Section
Program
FY2010
FY2011
FY2012
FY2013 FY2014 FY2015 FY2016 FY2017 FY2018
FY2019
Total
Health Centers and the National Health Service Corps (NHSC)
4101(a) School-based
health
center
establishment grants
50 50 50 50 — — — — — —
200d
10503(b)(1) Community
Health
Centers
Fund, patient services
— 1,000 1,200 1,500 2,200 3,600
—
—
—
—
9,500d
10503(b)(2) Community
Health
Centers
Fund, NHSC
— 290 295 300 305 310 — — — —
1,500d
10503(c) Community
health
center
construction and renovation
—
$1.5 billion total for FY2011 through FY2015
— — — —
1,500d
Health Workforce
5507(a) Health
workforce
demonstration grants
85 85 85 85 85 — — — — —
425
5507(b) Family-to-family
health
information centers
5 5 5 — — — — — — —
15d
5508(c) Teaching
health
centers,
GME payments
—
SSAN for FY2011 through FY2015, not to exceed $230
million
— — — —
≤230
5509
Medicare graduate nurse
education demonstration
— — 50 50 50 50 — — — —
200d
10502 Health
care facility
construction
100 — — — — — — — — —
100k
Community-Based Prevention and Wellness
4002
Prevention and Public Health
Fund
500 750 1,000 1,250 1,500 2,000 2,000 2,000 2,000 2,000
15,000l
Maternal and Child Health
2951
Maternal, infant, and early
childhood home visitation
100 250 350 400 400 — — — — —
1,500
2953 Personal
responsibility
education program grants
75 75 75 75 75 — — — — —
375d
2954 Abstinence
education
state
grants
50 50 50 50 50 — — — — —
250
CRS-18
Appropriation (or Fund Transfer) in $ millions
PPACA
Section
Program
FY2010
FY2011
FY2012
FY2013 FY2014 FY2015 FY2016 FY2017 FY2018
FY2019
Total
10214 Pregnancy
assistance
grants 25 25 25 25 25 25 25 25 25 25
250
Long-Term Care
2403
Medicaid money fol ows the
person demonstration
— 450 450 450 450 450 450 — — —
2,700
2405 State
Aging
and Disability
Resource Centers
10 10 10 10 10 — — — — — 50
6201
Background checks of long-
Up to $160 million total for
term care providers
FY2010 through FY2012m
— — — — — — —
8002(d) National
Clearinghouse
for
Long-Term Care Information
— 3 3 3 3 3 — — — —
15
Comparative Effectiveness Research
6301(d) Patient-Centered
Outcomes
Research Trust Fund,
— — —
For each of FY2013 through FY2019, transfers amounts from the Medicare trust
Medicare transfers
funds as determined by a formulan
TBDb
6301(e) Patient-Centered
Outcomes
Research Trust Fund,
10 50 150
For each of FY2013 through FY2019, appropriates $150 million plus an amount
appropriations
equal to the net revenue from a fee levied on insurance policies and health planso
TBDb
Biomedical Research
9023(e)
Grants for investment in
new therapeutics
SSAN — — — — — — — — —
TBDp
PPACA Implementation
HCERA
Health Insurance Reform
1005
Implementation Fund
1,000 — — — — — — — — —
1,000
Source: Prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (PPACA), P.L. 111-148, as amended by the
Health Care and Education Reconciliation Act of 2010 (HCERA), P.L. 111-152.
Notes: Funds are provided from the Treasury unless otherwise noted. A dash means that PPACA does not appropriate or transfer funds for the fiscal year(s) noted.
a. Funds are to remain available without fiscal year limitation.
b. To be determined.
c. Of this total amount, $925 million is for Puerto Rico, and the remaining $75 million is for the other U.S. territories in amounts as specified by the Secretary.
CRS-19
d. Funds are to remain available until expended.
e. Funds are to remain available for obligation through Dec. 31, 2015.
f.
Of this total amount, $9 million is appropriated, and the remaining $2 million is a transfer from CHIP funding for FY2010. Funds are to remain available until expended.
g. Prior to enactment of PPACA, the CHIP program was funded through FY2013.
h. The Secretary is required to transfer amounts from the Medicare Part A and Part B trust funds in such proportion as the Secretary determines appropriate. Funds are
to remain available until expended,
i.
The Secretary is required to transfer the $5 million from the Medicare Part B trust fund, to remain available until expended.
j.
Funds are to be appropriated from the Medicare Part A trust fund. Note: the total amount appropriated (i.e., $350 million) includes a final appropriation of $10 million
for FY2020.
k. Funds are to remain available for obligation until Sept. 30, 2011.
l.
PPACA Sec. 4002 provides annual appropriations for the Prevention and Public Health Fund in perpetuity; increasing from $500 million for FY2010 to $2 billion for
FY2015 and each fiscal year thereafter. Appropriations to the fund total $15 billion over the period FY2010 through FY2019.
m. PPACA Sec. 6201 requires the HHS Secretary to notify the Treasury Secretary of the amount necessary to carry out activities under this section for the period of
FY2010 through FY2012, but not to exceed $160 million. The Treasury Secretary must then transfer the amount specified from the Treasury to the HHS Secretary.
Funds are to remain available until expended.
n. To be determined. PPACA Sec. 6301(d) provides a formula for the transfer of funds from the Medicare Part A and Part B trust funds to the Patient-Centered
Outcomes Research Trust Fund as fol ows: (1) for FY2013, an amount from each respective Medicare trust fund equal to $1 multiplied by the average number of
individuals entitled to Part A benefits, or enrolled in Part B during that period; and (2) for each of FY2014 through FY2019, an amount from each respective Medicare
trust fund equal to $2 multiplied by the average number of individuals entitled to Part A benefits, or enrolled in Part B during that fiscal year. Beginning in FY2015,
amounts are subject to adjustment for increases in health care spending.
o. To be determined. In addition to the amounts transferred to the Patient-Centered Outcomes Research Trust Fund under PPACA Sec. 6301(d), described in the
preceding table note, PPACA Sec. 6301(e) appropriates to the Fund a specified amount for each of FY2010 through FY2019 plus an additional amount for each of
FY2013 through FY2019 equal to the net revenues received from a fee imposed on health insurance policies and self-insured plans. The fee equals $2 multiplied by the
average number of covered lives in a policy/plan year ($1 in the case of policy/plan years ending during FY2013). Beginning in FY2015, amounts are subject to
adjustment for increases in health care spending.
p. To be determined. PPACA Sec. 9023(e) creates a two-year tax credit program, subject to an overall cap of $1 billion, for small companies that invest in new therapies
to prevent, diagnose and treat cancer and other diseases. The total amount of tax credits any one company can receive for the two years may not exceed $5 million.
Companies may elect to receive one or more grants—for which SSAN are appropriated—in lieu of tax credits. Grant applications must be received before Jan. 1,
2013.
CRS-20
Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act
Author Contact Information
C. Stephen Redhead
Specialist in Health Policy
credhead@crs.loc.gov, 7-2261
Acknowledgments
Kirsten Colello, Patricia Davis, Gary Guenther, Elayne Heisler, Lisa Herz, Sarah Lister, Bernice Reyes,
Amanda Sarata, Pam Smith, Carmen Solomon-Fears, Emilie Stoltzfus, Julie Stone, and Susan Thaul
provided comments on this report.
Congressional Research Service
21