Discretionary Funding in the Patient
Protection and Affordable Care Act (ACA)
C. Stephen Redhead, Coordinator
Specialist in Health Policy
Kirsten J. Colello
Specialist in Health and Aging Policy
Elayne J. Heisler
Analyst in Health Services
Sarah A. Lister
Specialist in Public Health and Epidemiology
Amanda K. Sarata
Specialist in Health Policy
December 16, 2011
Congressional Research Service
7-5700
www.crs.gov
R41390
CRS Report for Congress
Pr
epared for Members and Committees of Congress

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Summary
The Patient Protection and Affordable Care Act (ACA) reauthorized new funding for numerous
existing discretionary grant and other programs and activities. ACA also created multiple new
discretionary grant programs and activities and provided for each an authorization of
appropriations. Funding for all of these programs and activities is subject to action by
congressional appropriators. This report summarizes all the discretionary spending provisions in
ACA that authorized appropriations for grant programs and other activities. A companion product,
CRS Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable
Care Act (PPACA), summarizes all the mandatory appropriations and Medicare trust fund
transfers in the new law.
Among the provisions that are intended to strengthen the nation’s health care safety net and
improve access to care, ACA permanently reauthorized the federal health centers program and the
National Health Service Corps (NHSC). The NHSC provides scholarships and student loan
repayments to individuals who agree to a period of service as a primary care provider in a
federally designated Health Professional Shortage Area. In addition, the new law addressed
concerns about the current size, specialty mix, and geographic distribution of the health care
workforce. It reauthorized and expanded existing health workforce education and training
programs under Titles VII and VIII of the Public Health Service Act (PHSA). Title VII supports
the education and training of physicians, dentists, physician assistants, and public health workers
through grants, scholarships, and loan repayment. ACA created several new programs to increase
training experiences in primary care, in rural areas, and in community-based settings, and
provided training opportunities to increase the supply of pediatric subspecialists and geriatricians.
It also expanded the nursing workforce development programs authorized under PHSA Title VIII
to bolster undergraduate and graduate nursing education and training.
As part of a comprehensive framework for federal community-based (i.e., public health)
prevention activities, including a national strategy and a national education and outreach
campaign, ACA authorized several new grant programs with a focus on preventable or modifiable
risk factors for disease (e.g., sedentary lifestyle, tobacco use). The new law also leveraged a
number of mechanisms to improve the quality of health care, including new requirements for
quality measure development, collection, analysis, and public reporting; programs to develop and
disseminate innovative strategies for improving the quality of health care delivery; and support
for care coordination programs such as medical homes, patient navigators, and the co-location of
primary health care and mental health services.
Additionally, ACA authorized funding for programs to prevent elder abuse, neglect, and
exploitation; grants to expand trauma care services and improve regional coordination of
emergency services; and demonstration projects to implement alternatives to current tort litigation
for resolving medical malpractice claims, among other provisions.
The Congressional Budget Office estimated that ACA’s discretionary spending provisions, if fully
funded by future appropriations acts, would result in appropriations of approximately $106 billion
over the 10-year period FY2010-FY2019. Most of that funding would be for programs that
existed prior to, and whose funding was reauthorized by, ACA. Few new programs created by
ACA received funding in FY2010 or FY2011.

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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Contents
Introduction...................................................................................................................................... 1
Discretionary Funding in ACA ........................................................................................................ 2
Potential Impact of Automatic Spending Reductions on Discretionary Spending .................... 4
Appropriations and Trust Fund Transfers in ACA........................................................................... 5

Tables
Table 1. ACA Discretionary Funding: Health Centers and Clinics.................................................. 6
Table 2. ACA Discretionary Funding: Health Care Workforce ....................................................... 7
Table 3. ACA Discretionary Funding: Prevention and Wellness ................................................... 17
Table 4. ACA Discretionary Funding: Maternal and Child Health................................................ 21
Table 5. ACA Discretionary Funding: Health Care Quality .......................................................... 21
Table 6. ACA Discretionary Funding: Nursing Homes ................................................................. 25
Table 7. ACA Discretionary Funding: Health Disparities Data Collection ................................... 26
Table 8. ACA Discretionary Funding: Emergency Care................................................................ 27
Table 9. ACA Discretionary Funding: Elder Justice...................................................................... 28
Table 10. ACA Discretionary Funding: Biomedical Research ...................................................... 30
Table 11. ACA Discretionary Funding: Biologics ......................................................................... 30
Table 12. ACA Discretionary Funding: 340B Drug Pricing .......................................................... 31
Table 13. ACA Discretionary Funding: Medical Malpractice ....................................................... 31
Table 14. ACA Discretionary Funding: Pain Care Management ................................................... 32
Table 15. ACA Discretionary Funding: Medicaid Demonstrations ............................................... 32
Table 16. ACA Discretionary Funding: Medicare ......................................................................... 33
Table 17. ACA Discretionary Funding: Private Health Insurance ................................................. 33

Contacts
Author Contact Information........................................................................................................... 34
Acknowledgments ......................................................................................................................... 34
Key Policy Staff............................................................................................................................. 34

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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Introduction
The Patient Protection and Affordable Care Act (ACA)1 restructured the private health insurance
market, set minimum standards for health coverage, created a mandate for most U.S. residents to
obtain health insurance coverage, and provided for the establishment by 2014 of state-based
insurance exchanges for the purchase of private health insurance. Qualifying individuals and
families will be able to receive federal subsidies to reduce the cost of purchasing coverage
through the exchanges. The new law also expanded eligibility for Medicaid; amended the
Medicare program in an effort to reduce the rate of its projected growth; imposed an excise tax on
insurance plans found to have high premiums; and made numerous other changes to the tax code,
Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and many other federal
programs.
ACA implementation is projected to have a significant impact on federal revenues and direct (also
referred to as mandatory) spending.2 The law included direct spending to subsidize the purchase
of health insurance coverage through the exchanges, as well as increased outlays for the
expansion of the Medicaid program. ACA also included numerous mandatory appropriations to
fund temporary programs to increase access and funding for targeted groups, provide funding to
states to plan and establish exchanges, and support many other research and demonstration
programs and activities. The costs of expanding public and private health insurance coverage and
other mandatory spending are offset by revenues from new taxes and fees, and by savings from
payment and health care delivery system reforms designed to slow the growth in spending on
Medicare and other federal health care programs.
Implementation of ACA is also likely to affect discretionary spending that is subject to the annual
appropriations process.3 The law reauthorized appropriations for numerous existing discretionary
grant programs and activities, primarily ones authorized under the Public Health Service Act
(PHSA). While the authorizations of appropriations for most of these programs expired prior to
their reauthorization by ACA, almost all of them continued to receive an annual appropriation.
ACA also created multiple new grant programs and provided for each an authorization of
appropriations.
Funding for all ACA’s discretionary programs depends on actions taken by congressional
appropriators, a process that may lead to greater or smaller amounts than the sums authorized by
the law. With Congress now operating under discretionary spending limits set by the Budget
Control Act, it may prove difficult to secure funding for new programs and activities.4 Even

1 ACA was signed into law on March 23, 2010 (P.L. 111-148, 124 Stat. 119). A week later, on March 30, 2010, the
President signed the Health Care and Education Reconciliation Act (HCERA; P.L. 111-152, 124 Stat. 1029), which
amended multiple health care and revenue provisions in ACA. Several other bills that were subsequently enacted
during the 111th Congress made more targeted changes to specific ACA provisions. All references to ACA in this
report refer to the law as amended. Note that previous CRS reports on the Patient Protection and Affordable Care Act
used the acronym PPACA to refer to the law. CRS is now using the more common acronym ACA.
2 Mandatory, or direct, spending generally refers to budget authority (i.e., the authority to incur financial obligations
that result in government expenditures, such as purchasing services or awarding grants) that is provided in laws other
than the annual appropriations acts. Mandatory spending includes entitlement authority (e.g., Medicare, Social
Security).
3 Discretionary spending refers to outlays from budget authority that is provided in and controlled by annual
appropriations acts.
4 For a detailed examination of all the provisions in the Budget Control Act, see CRS Report R41965, The Budget
(continued...)
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maintaining current funding levels for existing programs with an established appropriations
history may prove a challenge under growing pressure to reduce federal discretionary spending.
This report summarizes all the discretionary spending provisions in ACA that authorize (or
reauthorize) appropriations for grant programs and other activities. It will be updated to reflect
important legislative and other developments.
Discretionary Funding in ACA
The law’s discretionary funding provisions are grouped by general topic in a series of tables with
the following headings: Health Centers and Clinics (Table 1); Health Care Workforce (Table 2);
Prevention and Wellness (Table 3); Maternal and Child Health (Table 4); Health Care Quality
(Table 5); Nursing Homes (Table 6); Health Data Collection (Table 7); Emergency Care (Table
8); Elder Justice (Table 9); Biomedical Research (Table 10); Biologics (Table 11); 340B Drug
Pricing (Table 12); Medical Malpractice (Table 13); Pain Care Management (Table 14);
Medicaid Demonstrations (Table 15); Medicare (Table 16); and Private Health Insurance (Table
17).
Each table row includes the following information: (1) the ACA section number; (2) an indication
of whether the provision modifies the PHSA or another law either by amending an existing
section or subsection or by adding a new one, or whether it creates new stand-alone statutory
authority, as well as the name (if known) of the administering agency or office within the
Department of Health and Human Services (HHS); (3) a brief description of the program or
activity, including the FY2010 and FY2011 funding amounts for new and existing programs and
activities that received an appropriation;5 (4) where applicable, the types of entities and/or
individuals eligible for funding;6 and (5) details of the authorization of appropriations. Where
available, the table entry includes the Catalog of Federal Domestic Assistance (CFDA) number
for the grant program.7 Unless otherwise stated, all references in the tables to the Secretary refer
to the HHS Secretary.
Many of the discretionary spending provisions summarized in the tables authorize annual
appropriations of specified amounts for one or more fiscal years to carry out the program or
activity. Other provisions authorize the appropriation of specified amounts for FY2010 or
FY2011 and unspecified amounts—such sums as may be necessary, or SSAN—for later years. A

(...continued)
Control Act of 2011, by Bill Heniff Jr., Elizabeth Rybicki, and Shannon M. Mahan.
5 The FY2010 and FY2011 funding amounts that appear in the tables in this report are taken from the HHS agency
FY2011 operating plans, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency
congressional budget justification documents, available at http://www.hhs.gov/about/hhsbudget.html. FY2012 funding
amounts will be incorporated in the tables once the HHS FY2012 annual appropriations are enacted and figures become
available. For more information on funding for the Public Health Service agencies within HHS, see CRS Report
R41737, Public Health Service (PHS) Agencies: Overview and Funding, FY2010-FY2012, coordinated by C. Stephen
Redhead and Pamela W. Smith.
6 Not applicable if the funding is to support programs and activities carried out by a federal agency.
7 CFDA is a government-wide compendium of federal grant and other assistance programs. Each program is assigned a
unique five-digit number, XX.XXX, where the first two digits represent the funding agency and the second three digits
represent the program. Programs funded by the Department of Health and Human Services begin with the number 93.
For more information, see https://www.cfda.gov.
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few provisions authorize multi-year appropriations, available for obligation for a period in excess
of one fiscal year (e.g., for the period FY2011 through FY2014). Numerous other provisions
simply authorize the appropriation of SSAN, in a few cases without specifying any fiscal years.
ACA also reauthorized the Indian Health Care
Acronyms Used in the Tables in
Improvement Act (IHCIA), which authorizes
This Report
many programs and services provided by the
Agency for Healthcare Research and Quality (AHRQ)
Indian Health Service (IHS). It also extended
Centers for Disease Control and Prevention (CDC)
indefinitely the authorization of
appropriations for IHCIA programs. For more
Centers for Medicare and Medicaid Services (CMS)
information on ACA’ s Indian health
Community Health Center Fund (CHCF)
provisions, which are not included in this
Federal Food, Drug, and Cosmetic Act (FFDCA)
report, see CRS Report R41630, The Indian
Health Care Improvement Act Reauthorization
Food and Drug Administration (FDA)
and Extension as Enacted by the ACA:
Health Resources and Services Administration (HRSA)
Detailed Summary and Timeline, by Elayne J.
Indian Health Service (IHS)
Heisler.
National Institutes of Health (NIH)
The Congressional Budget Office (CBO)
Office of Personnel Management (OPM)
estimated that ACA’s discretionary spending
Office of the Secretary (OS)
provisions, if fully funded by future
Prevention and Public Health Fund (PPHF)
appropriations acts, would result in
appropriations of approximately $106 billion
Public Health Service Act (PHSA)
over the period FY2010-FY2019.8 However,
Substance Abuse and Mental Health Services
much of that funding—about $82 billion—is
Administration (SAMHSA)
for three programs that were in existence prior
Social Security Act (SSA)
to, and whose funding was reauthorized by,
ACA; namely, the National Health Service
Corps, the federal health centers program, and the IHS.
In addition, CBO projected that both the Department of Health and Human Services (HHS) and
the Internal Revenue Service (IRS) will incur substantial costs to implement the policies and
programs established by ACA. Most of these costs will have to be funded through the annual
appropriations process. CBO estimated that the costs to the IRS of implementing the eligibility
determination, documentation, and verification processes for the health insurance subsidies will
probably total between $5 billion and $10 billion over 10 years. It further estimated that the costs
to HHS of implementing the changes in Medicare, Medicaid, and CHIP, as well as some of the
reforms to the private insurance market, will require similar amounts over 10 years.9

8 U.S. Congressional Budget Office, letter to the Honorable Jerry Lewis about the potential effects of the Patient
Protection and Affordable Care Act on discretionary spending, May 11, 2010, available at http://www.cbo.gov/ftpdocs/
114xx/doc11490/LewisLtr_HR3590.pdf. CBO’s estimate of discretionary spending includes (1) amounts specified in
ACA, plus estimated amounts for subsequent years (adjusted for anticipated inflation) where ACA specifies an amount
for the first year (FY2010 or FY2011) and authorizes SSAN for subsequent years; and (2) estimated amounts for
subsequent years (adjusted for anticipated inflation) where there is an appropriation under prior law for FY2010 and
ACA authorizes the appropriation of SSAN for later years. The CBO estimate does not include new ACA programs for
which the law provided only an authorization for the appropriation of SSAN.
9 Ibid. Section 1105 of the Health Care and Education Reconciliation Act established a Health Insurance Reform
Implementation Fund (HIRIF) within HHS and appropriated $1 billion to the Fund to implement ACA. CBO’s
estimates of the amount of discretionary funding necessary to implement ACA are in addition to the funding provided
(continued...)
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For FY2010 and FY2011, it appears that none of the new discretionary programs authorized
under ACA received funding through the regular appropriations process. However, three new
programs received mandatory funds from ACA’s Prevention and Public Health Fund (see
discussion below under “Appropriations and Trust Fund Transfers in ACA”).10
Potential Impact of Automatic Spending Reductions on
Discretionary Spending
The Budget Control Act of 2011 (BCA)11 established new budgetary enforcement mechanisms for
reducing the federal deficit by at least $2.1 trillion over the 10-year period FY2012-FY2021. The
BCA placed statutory limits, or caps, on discretionary spending for each of those 10 fiscal years,
which will save an estimated $0.9 trillion during that period. In addition, it created a Joint Select
Committee on Deficit Reduction (Joint Committee) with instructions to develop legislation to
reduce the budget deficit by at least another $1.5 trillion through FY2021. The Joint Committee
had until November 23, 2011, to approve a legislative proposal and have it considered by the
House and Senate under special procedures that would prevent amendments and limit debate in
both chambers. If a Joint Committee bill reducing the deficit by at least $1.2 billion over the
period FY2012-FY2021 is not signed into law by January 15, 2012, then automatic spending
reductions will be triggered beginning in FY2013.
On November 21, 2010, the Joint Committee announced that the group had been unable to reach
agreement on a legislative proposal to cut the deficit, raising the likelihood that automatic
spending reductions will occur.12 Under the BCA, the spending reductions would take the form of
equal cuts (in dollar terms) in defense and nondefense spending for each fiscal year over the
period FY2013-FY2021. The annual amount of spending cuts required in each of these two
categories would be divided proportionately between direct and discretionary spending. Cuts in
nonexempt direct spending programs—both defense and nondefense—would be executed
through sequestration (i.e., an across-the-board cancellation of budgetary resources).
Discretionary spending reductions in FY2013 also would be achieved through a sequestration of
nonexempt discretionary appropriations, with any reduction in funding for health centers and the
IHS capped at 2%. For each of the remaining fiscal years (i.e., FY2014-FY2021) discretionary
spending reductions would be achieved through a downward adjustment of the statutory limits for
defense and nondefense spending. In contrast to the automatic spending reductions achieved
through sequestration, lowering the annual discretionary spending limits allows Congress and the
President to determine through the annual appropriations process which accounts are to be
reduced, and by how much, in order to meet those limits. Lowering the annual spending limits
also would make it that much more of a challenge to maintain funding levels for existing
programs, let alone secure funding for new ones. For more information, see CRS Report R42051,

(...continued)
to the HIRIF.
10 The three programs are (1) Sec. 5208, Nurse-Managed Health Clinics, see Table 1; (2) Sec. 5102, State Health Care
Workforce Development Grants, see Table 2; and (3) Sec. 4201, Community Transformation Grants, see Table 3.
11 P.L. 112-25, 125 Stat. 240.
12 The Joint Committee’s statement is at http://www.deficitreduction.gov/public/index.cfm/2011/11/statement-from-co-
chairs-of-the-joint-select-committee-on-deficit-reduction.
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Budget Control Act: Potential Impact of Automatic Spending Reduction Procedures on Health
Reform Spending, by C. Stephen Redhead.
Appropriations and Trust Fund Transfers in ACA
Separate from the discretionary funding authorities discussed in this report, ACA included
numerous provisions that appropriate billions of dollars to fund new and existing grant programs
and other activities. Several other provisions require the HHS Secretary to transfer amounts from
the Medicare Part A and Part B trust funds to support various specified activities. All these
mandatory spending provisions are summarized in a companion product, CRS Report R41301,
Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA),
by C. Stephen Redhead.
Of particular note, ACA established and appropriated billions of dollars for two new funds to help
support HHS programs and activities. First, the Community Health Center Fund (CHCF) will
provide a total of $11 billion in supplemental funding over the period FY2011-FY2015 for the
federal health centers program and the National Health Service Corps (see Table 1 and Table
2).13 A separate ACA appropriation provided $1.5 billion for health center construction and
renovation (see Table 1). Second, the Prevention and Public Health Fund (PPHF), for which ACA
provided an annual appropriation in perpetuity,14 is intended to fund prevention, wellness, and
other public health-related programs and activities authorized under the PHSA. In addition to
funding three of ACA’s new discretionary programs, PPHF funds for FY2010 and/or FY2011
were used to supplement regular appropriations for a number of other longstanding programs that
were reauthorized by the law (see Table 2 and Table 3).15

13 The CHCF will provide the following amounts to supplement regular appropriations for health center operating
grants: FY2011 = $1 billion; FY2012 = $1.2 billion; FY2013 = $1.5 billion; FY2014 = $2.2 billion; and FY2015 = $3.6
billion. It also will provide the following amounts to supplement regular appropriations for the National Health Service
Corps: FY2011 = $290 million; FY2012 = $295 million; FY2013 = $300 million; FY2014 = $305 million; and FY2015
= $310 million.
14 ACA appropriated the following amounts to the PPHF: FY2010 = $500 million; FY2011 = $750 million; FY2012 =
$1 billion; FY2013 = $1.25 billion; FY2014 = $1.5 billion; and FY2015 and each fiscal year thereafter = $2 billion.
15 For more information on the allocation of PPHF funds in FY2010 and FY2011, see CRS Report R41737, Public
Health Service (PHS) Agencies: Overview and Funding, FY2010-FY2012, coordinated by C. Stephen Redhead and
Pamela W. Smith.
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 1. ACA Discretionary Funding: Health Centers and Clinics
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5601 Permanently Health centers program. Provides operating grants to health
Community, migrant, public housing, and
$3.0 billion for FY2010, $3.9
reauthorizes PHSA centers serving federally designated medically underserved
homeless health centers that meet the
billion for FY2011, $5.0
Sec. 330 (HRSA)
populations and furnishing comprehensive primary care services,
statutory requirements of PHSA Sec. 330.
billion for FY2012, $6.5
referrals, and other services needed to facilitate access to such care,
billion for FY2013, $7.3
regardless of ability to pay.
billion for FY2014, and $8.3
billion for FY2015; amounts
FY2010 funding = $2.19 billion; FY2011 funding = $2.58 billion.
in subsequent years based
[Note: FY2011 funding = $1.58 billion in regular appropriations +
on previous year’s funding,
$1 billion from the CHCF. In addition, ACA appropriated $1.5
subject to adjustment.
billion for the period FY2011 through FY2015 for health center
construction and renovation; see CRS Report R41301.]
4101(b)
New PHSA Sec.
School-based health centers (SBHCs). Requires the Secretary
SBHCs that meet certain specified criteria and
SSAN for each of FY2010
399Z-1 (HRSA)
to award grants to fund the management and operation of SBHCs
match 20% of the grant amount with non-
through FY2014.
that provide comprehensive physical and behavioral health services
federal funds (unless waived). Preference may
to children and adolescents, subject to parental consent.
be given to SBHCs serving children and
adolescents who have limited access to or
[Note: ACA Sec. 4101(a) appropriated a total of $200 million for
difficulty accessing health care.
SBHC construction and renovation; see CRS Report R41301.]
5208
New PHSA Sec.
Nurse-managed health clinics (NMHCs). Requires the
NMHCs that provide care regardless of
$50 million for FY2010, and
330A-1 (HRSA)
Secretary to award grants to fund the operation of NMHCs—
income or insurance status and in which
SSAN for each of FY2011
associated with schools, colleges, federally qualified health centers
nurses provide the majority of the services. At through FY2014.
(FQHCs), or nonprofit health/social services agencies—that provide least one advanced practice nurse must hold
comprehensive primary health care and wellness services to
an executive management position in the
vulnerable or underserved populations.
NMHC.
FY2010 funding = $15 million from the PPHF; FY2011 funding =
$0. [CFDA 93.515]
10504 New
authority Access to affordable care demonstration program. Within
State-based, nonprofit, public-private
SSAN (no years specified).
(HRSA)
six months of enactment, requires the Secretary to establish a
partnerships that provide access to
three-year demonstration project in up to 10 states—each state
comprehensive health care services to the
may receive up to $2 million—to provide access to comprehensive
uninsured at reduced fees.
health care services to the uninsured.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). FY2010 and FY2011 funding amounts are taken from HRSA’s
FY2011 operating plan, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency’s FY2012 congressional budget justification document,
available at http://www.hhs.gov/about/hhsbudget.html.
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 2. ACA Discretionary Funding: Health Care Workforce
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
National Health Service Corps (NHSC)
5207 Permanently NHSC scholarships and loan repayments. In exchange for a
(1) Scholarships: students accepted to or
$320 million for FY2010,
reauthorizes
commitment to work in a federally designated Health Professional
enrolled in a training program for medicine,
$414 million for FY2011,
PHSA Title III,
Shortage Area (HPSA), provides (1) scholarships to students
dentistry, family nurse practitioner, nurse
$535 million for FY2012,
Part D, Subpart III
training in a primary care discipline to cover tuition, fees, other
midwife, or physician assistant who agree to
$691 million for FY2013,
(HRSA)
educational costs, and a stipend; and (2) student loan repayments of two to four years of service in an NHSC-
$893 million for FY2014,
up to $50,000 a year to primary care and mental health clinicians.
approved site in a HPSA. (2) Loan
and $1.155 billion for
repayments: primary care, dental, and mental
FY2015; amounts in
FY2010 funding = $141 million; FY2011 funding = $315 million.
health clinicians who agree to at least two
subsequent years based on
[Note: FY2011 funding = $25 million in regular appropriations +
years of service in an NHSC-approved site in
previous year’s funding,
$290 million from the CHCF; see CRS Report R41301. CFDA
a HPSA.
subject to adjustment.
93.162, 93.288]
Physicians
5301 Amends
and Primary care training programs. (1) Authorizes five-year
(1) Training grants: public and nonprofit
For both grant programs,
reauthorizes
grants to support training programs in primary care. Funds are to
private hospitals, medical schools,
$125 million for FY2010,
PHSA Sec. 747
be used to plan, develop and operate accredited training programs,
academically affiliated physician assistant
and SSAN for each of
(HRSA)
including residency and internship programs, in family medicine,
training programs, and other public and
FY2011 through FY2014. A
general internal medicine, and general pediatrics and to provide
nonprofit private entities. (2) Capacity
separate authorization of
financial assistance (e.g., traineeships). (2) Authorizes five-year
building grants: medical schools; priority given $750,000 for each of
grants for primary care capacity building. Funds are to be used to
to entities proposing innovative approaches
FY2010 through FY2014 is
create academic units or programs that improve clinical teaching in
to primary care training and with a record of
provided for capacity
the primary care fields, and (in a separate authorization) to
training primary care providers, among other
building grants to integrate
integrate academic units to enhance interdisciplinary recruitment,
things.
academic units.
training, and faculty development.
FY2010 funding = $237 million; FY2011 funding = $39 million.
[Note: FY2010 funding = $39 million in regular appropriations +
$198 million from the PPHF; see CRS Report R41301. CFDA
93.510, 93.514, 93.884]
5203
New PHSA Sec.
Pediatric specialist loan repayment program. Requires the
Practicing or in-training pediatric specialists
$30 million for each of
775 (HRSA)
Secretary to implement a loan repayment program that pays up to
and surgeons, and child and adolescent
FY2010 through FY2014 for
$35,000 for each year of service (for a maximum of three years) to
mental health specialists, who agree to at
loan repayments to
eligible individuals in exchange for a commitment to work in a
least 2 years of full-time service in a HPSA.
pediatric specialists and
pediatric medical specialty, in pediatric surgery, or in child and
surgeons; $20 million for
adolescent mental and behavioral health care in a medically
each of FY2010 through
underserved area.
FY2013 for loan repayments
to mental health providers.
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5508(a)
New PHSA Sec.
Teaching health centers development grants. Authorizes
FQHCs, rural health clinics, Indian health
$25 million for FY2010, $50
749A (HRSA)
three-year grants of up to $500,000 to community-based,
centers, and entities receiving PHSA Title X
million for each of FY2011
ambulatory care centers that establish or expand a primary care
(family planning) funds.
and FY2012, and SSAN for
residency training program.
each fiscal year thereafter.
10501(l)
New PHSA Sec.
Rural physician training grants. Requires the Secretary to (1)
Medical schools; priority given to entities that $4 million for each of
749B (HRSA)
award grants for recruiting medical students most likely to practice
train students to practice in rural
FY2010 through FY2013.
in underserved rural communities and for providing rural-focused
communities, that have established
training and experience; and (2) within 60 days of enactment, by
partnerships with rural community health
regulation, define underserved rural communities. [Note: HRSA
centers, or who submit a long-term plan for
published an interim final rule on May 26, 2010 (75 Federal Register
tracking where graduates practice.
29447).]
Dentistry
5303
New PHSA Sec.
General, pediatric, and public health dentistry training.
Dental or dental hygiene schools; approved
$30 million for FY2010, and
748; authority
Authorizes grants or contracts for dental training activities including residency or advanced education programs in
SSAN for each of FY2011
previously part of
faculty development, financial assistance, faculty loan repayment
general, pediatric, or public health dentistry.
through FY2015; permits
Sec. 747 (HRSA)
programs, technical assistance for pediatric dental programs, and
Eligible entities may partner with schools of
grantees to carry over funds
pre- and post-doctoral training programs in dental primary care.
public health so that dental residents and
for up to three fiscal years.
Gives priority to entities that train individuals from disadvantaged
dental hygiene students may receive masters-
backgrounds, who have a record of placing graduates in facilities
level training in public health.

that provide care to the underserved, or whose programs focus on
providing care to the underserved through demonstrated
partnerships with FQHCs, rural health clinics, or through having
programs focused on specific topics, such as HIV/AIDs.
FY2010 funding = $15 million; FY2011 funding = $15 million.
[CFDA 93.884]
5304
New PHSA Sec.
Alternative dental health care provider demonstration
Institutions of higher education; public-
SSAN (no years specified).
340G-1 (HRSA)
program. Authorizes the Secretary to award 15 five-year grants of private entities; FQHCs; facilities operated by
not less than $4 million to train or employ alternative dental health
the IHS or by Indian tribes or organizations;
care providers (e.g., community dental health coordinators, dental
state or county public health clinics; public
health aides) to increase access to dental health care services in
hospitals or health systems; or accredited
rural and other underserved communities.
dental education programs.
CRS-8

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
Nursing
5309(a) Amends
and Nurse education, practice, and quality grants. Authorizes
Schools of nursing, health care facilities
SSAN for each of FY2010
reauthorizes
grants or contracts to expand enrollment in baccalaureate nursing
(including NMHCs), or partnerships of the
through FY2014. See also
PHSA Sec. 831
programs; provide training in new technologies; develop cultural
two.
ACA Sec. 5312 below.
(HRSA)
competencies; expand nursing practice arrangements in non-
institutional settings; and support nurse retention programs that
offer career advancement for nursing personnel, enhance
collaboration among nurses and other health professionals, and
promote nurse involvement in clinical decision making.
FY2010 funding = $40 million; FY2011 funding = $40 million.
[CFDA 93.359, 93.503]
5309(b)
New PHSA Sec.
Nurse retention grants. New authority that largely duplicates
Schools of nursing, health care facilities
SSAN for each of FY2010
831A (HRSA)
the nurse retention grant program authorized under PHSA Sec. 831 (including NMHCs), or partnerships of the
through FY2012. See also
(see ACA Sec. 5309(a) above).
two.
ACA Sec. 5312 below.
5311(a) Amends
and Nursing faculty loan program. Authorizes loans to nursing
Accredited schools of nursing may operate
SSAN for each of FY2010
reauthorizes
school students pursuing advanced degrees to become qualified
the student loan programs.
through FY2014.
PHSA Sec. 846A
nursing faculty. Sets the annual loan limit at $35,500 for FY2010 and
(HRSA)
FY2011; for subsequent fiscal years, the loan limit is subject to a
cost-of-attendance adjustment. Students who go on to serve as
nursing school faculty may have up to 85% of their loan repayment
cancelled.
FY2010 funding = $25 million; FY2011 funding = $25 million.
[CFDA 93.264]
5311(b)
New PHSA Sec.
Nursing faculty loan repayment program. Authorizes a loan
U.S. citizens, nationals, or lawful permanent
SSAN for each of FY2010
847 (HRSA)
repayment program for qualified nursing students or graduates who residents who are registered nurses and have through FY2014.
agree to serve as nursing faculty for four to six years. Sets the
either already completed a master’s or
annual loan limit for FY2010 and FY2011 at $10,000 for individuals
doctorate nursing program at an accredited
with a master’s or equivalent degree in nursing ($20,000 for those
school of nursing or are currently enrolled
with a doctorate or equivalent degree in nursing), and an aggregate
on a full-time or part-time basis in such a
loan limit of $40,000 for individuals with a master’s or equivalent
program.
degree in nursing ($80,000 for those with a doctorate or equivalent
degree in nursing). Thereafter, the annual and aggregate loan limits
are subject to a cost-of-attendance adjustment.
CRS-9

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5312 Amends
PHSA
Authorization of appropriations. Reauthorizes funding for the
(1) Sec. 811: accredited programs for
$338 million for FY2010,
Sec. 871;
following PHSA Title VIII programs:
advanced nurse education including combined and SSAN for each of
previously Sec.
registered nurse masters degree programs,
FY2011 through FY2016.
841 (HRSA)
•
Sec. 811 (grants for the support of advanced education nurses,
authorized nurse practitioner programs,
[Note: ACA did not
i.e., nurse practitioners): FY2010 funding = $96 million;
accredited nurse midwifery programs,
reauthorize funding for the
FY2011 funding = $64 million. [Note: FY2010 funding = $64
accredited nurse anesthesia programs, and
Sec. 846 nursing education
million in regular appropriations + $31 million from the PPHF.
other programs approved by the Secretary.
loan repayment and
CFDA 93.124, 93.247, 93.358, 93.513]
(2) Sec. 821: schools of nursing, nursing
scholarship programs.]a
•
Sec. 821 (grants for nursing workforce diversity): FY2010
centers, academic health centers, state or
funding = $16 million, FY2011 funding = $16 million.
local governments, and other appropriate
[CFDA 93.178]
public or private nonprofit entities as
determined appropriate by the Secretary. (3)
•
Sec. 831 (nurse education, practice, and quality grants) and
Secs. 831 and 831A: schools of nursing,
new Sec. 831A (nurse retention grants); see ACA Secs.
health care facilities, or partnerships of the
5309(a)&(b) above for funding amounts.
two.
5316 New
authority
Family nurse practitioner demonstration program. Requires FQHCs, NMHCs.
SSAN for each of FY2011
the Secretary to award three-year demonstration grants, not to
through FY2014.
exceed $600,000 a year, for programs to train nurse practitioners
as primary care providers in FQHCs and NMHCs (as defined in
ACA Sec. 5208). Preference given to bilingual individuals.
Geriatrics and Long-Term Care (LTC)
5302
New PHSA Sec.
Direct care worker training. Requires the Secretary to establish Accredited institutions of higher education
$10 million for the period
747A (HRSA)
a grant program to provide new training opportunities, such as
that have established a partnership with a
FY2011 through FY2013.
tuition and fee assistance, for direct care workers employed in LTC
long-term care setting (e.g., nursing home,
settings. Individuals who receive assistance are required to work in
home and community based service
the field of geriatrics, disability services, LTC services and supports,
provider), as specified.
or chronic care management for a minimum of two years.
CRS-10

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5305(a) Amends
PHSA Geriatric workforce development; geriatric career
(1) Accredited schools of allied health,
(1) $10.8 million for the
Sec. 753 by adding incentive awards. (1) Requires the Secretary to award no more
medicine, nursing, dentistry, osteopathic
period FY2011 through
new subsections
than 24 grants or contracts for $150,000 to eligible entities that
medicine, optometry, podiatric medicine,
FY2014. (2) $10 million for
(d)&(e) (HRSA)
operate geriatric education centers to support short-term intensive
veterinary medicine, public health, or
the period FY2011 through
courses on geriatrics and LTC, and support training for family
chiropractic care; accredited graduate
FY2013.
caregivers and direct care workers. (2) Requires the Secretary to
programs in clinical psychology, clinical social
award grants or contracts to eligible individuals pursuing an
work, health administration, marriage and
advanced degree in geriatrics or a related field, in return for
family therapy, and counseling; and physician
agreeing to teach or practice in the field of geriatrics, LTC, or
assistant programs. (2) Advanced practice
chronic care management for a minimum of five years upon
nurse, clinical social worker, pharmacist, or
completion of the degree.
psychology student.
FY2010 funding = $34 million; FY2011 funding = $34 million.
[CFDA 93.156, 93.250, 93.969]
5305(c) Amends
and Geriatric nursing education and training. Provides
A school of nursing, a health care facility, a
SSAN for each of FY2010
reauthorizes
traineeships for individuals preparing for advanced degrees in
program leading to certification as a certified
through FY2014.
PHSA Sec. 865;
geriatric nursing or other nursing areas that specialize in elder care.
nurse assistant, or a partnership of a health
previously Sec.
care facility and one of the other two
855 (HRSA)
FY2010 funding = $5 million; FY2011 funding = $5 million.
entities.
[CFDA 93.265]

Pain Care
4305(c)
New PHSA Sec.
Education and training in pain care. Authorizes a grant
Health professions schools, hospices, and
SSAN for each of FY2010
759 (HRSA)
program to train health professionals in pain care. [See also Table
other public and private entities. Applicants
through FY2012, to remain
14.]
must agree to include training and education
available until expended.
on recognizing the signs and symptoms of
pain; applicable laws and policies on
controlled substances; interdisciplinary
approaches to pain care delivery; barriers to
care in underserved populations; and recent
developments in pain care.
Public Health
5204
New PHSA Sec.
Public health workforce loan repayment program. Requires
Public health or health professionals who
$195 million for FY2010,
776 (HRSA)
the Secretary to establish a student loan repayment program that
agree to work for at least three years in a
and SSAN for each of
pays up to $35,000 a year, or one-third of total debt, whichever is
public health agency or related training
FY2011 through FY2015.
less, to increase the supply of public health professionals.
fellowship.
CRS-11

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5206(b)
New PHSA Sec.
Public health and allied health scholarship program.
Accredited institutions that offer training
$60 million for FY2010, and
777 (HRSA)
Authorizes grants to eligible educational entities to award
programs in public health and allied health.
SSAN for each of FY2011
scholarships for the training of mid-career professionals in public
through FY2015.
health and allied health. Available grant funds are to be divided
50:50 between supporting public health and allied health
professionals.
5313
New PHSA Sec.
Community health worker (CHW) program. Requires CDC
States and subdivisions, health departments,
SSAN for each of FY2010
399V (CDC)
to award grants to promote healthy behaviors and outcomes for
free clinics, hospitals, and FQHCs; priority
through FY2014.
populations in medically underserved communities through
given to applicants that target areas with a
programs of training and supervision of CHWs.
high proportion of uninsured or
underinsured individuals, or with high rates of
chronic illness or infant mortality.
5314
New PHSA Sec.
CDC training fellowships. Authorizes the Secretary to expand
Participants may be placed in state and local
$39.5 million for each of
778 (CDC)
existing CDC training fellowships in epidemiology, laboratory
health agencies, and states can receive federal FY2010 through FY2013
science, and informatics; the Epidemic Intelligence Service (EIS); and
assistance for loan repayment programs for
($24.5 million for EIS, and
other training programs that meet similar objectives. [CFDA
such participants.
$5 million each for
93.065]
epidemiology, laboratory
science, and informatics).
5315
New PHSA Title
United States Public Health Sciences Track. Authorizes the
Assistance to academic institutions for
Requires the Secretary to
II, Part D – Secs.
establishment of a science track at academic sites selected by the
program development; tuition and stipends
transfer SSAN from the
271-274 (U.S.
Secretary to award degrees that emphasize team-based service,
for students who meet a service obligation,
Public Health and Social
Surgeon General)
public health, epidemiology, and emergency preparedness and
including in the United States Public Health
Services Emergency Fund
response.
Service (USPHS) Commissioned Corps.
for FY2010 and each fiscal
Preference to students from rural
year thereafter. [Note: P.L.
communities, and minorities.
112-10 prohibits any such
transfer of funds.]b
10501(m)(2) Amends
PHSA
Public health workforce programs. Reauthorizes funding for
Eligible entities for each program are
$43 million for FY2011, and
Sec. 770 (HRSA)
existing public health workforce programs (PHSA Secs. 765-769).
stipulated and generally include accredited
SSAN for each of FY2012
They include grants for public health training centers; tuition, fees,
academic institutions, but may also include
through FY2015.
and stipends for traineeships in public health and in health
state, local and tribal public health
administration; and residency programs in preventive medicine and
departments and/or other private nonprofit
dental public health. Several programs mention preference for
entities.
underserved communities or underrepresented minorities.
FY2010 funding = $25 million; FY2011 funding = $30 million.
[Note: Funding for FY2010 and FY2011 included $15 million and
$20 million from the PPHF, respectively. CFDA 93.117, 93.236,
93.249, 93.516, 93.964]
CRS-12

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5210 Amends
PHSA
USPHS Commissioned Corps. Establishes a Ready Reserve
Not applicable.
$17.5 million for each of
Sec. 203 (U.S.
Corps of officers who are subject to involuntary call to active duty
FY2010 through FY2014 ($5
Surgeon General)
(including for training) by the Surgeon General, in order to bolster
million for recruitment and
the available workforce for both routine and emergency public
training, $12.5 million for
health missions.
the Ready Reserve Corps).
Workforce Diversity/Health Disparities
5307(a) Amends
and Cultural competency, prevention, public health,
Health professions schools, academic health
SSAN for each of FY2010
reauthorizes
disparities, and individuals with disability training.
centers, state or local governments, or other
through FY2015.
PHSA Sec. 741
Authorizes grants, contracts, or cooperative agreements under
appropriate public or private nonprofit
(HRSA)
PHSA Title VII (Health Professions Education) for the development
entities (or consortia of such entities).
and evaluation of research, demonstration projects, and model
curricula that provide training in cultural competency, prevention,
public health proficiency, reducing health disparities, and aptitude
for working with individuals with disabilities.
5307(b) Amends
and Cultural competency, prevention, public health,
Nursing schools, academic health centers,
SSAN for each of FY2010
reauthorizes
disparities, and individuals with disability training.
state or local governments, or other
through FY2015.
PHSA Sec. 807
Authorizes grants, contracts, or cooperative agreements under
appropriate public or private nonprofit
(HRSA)
PHSA Title VIII (Nursing Workforce Development) for the
entities.
development and evaluation of research, demonstration projects,
and model curricula that provide training in cultural competency,
prevention, public health proficiency, reducing health disparities,
and aptitude for working with individuals with disabilities. The
Secretary is required to coordinate this program with the one
authorized under PHSA Sec. 741.
5401 Amends
and Centers of excellence (COE). Requires the Secretary to fund
Health professions schools that recruit,
$50 million for each of
reauthorizes
COE; i.e., centers that sponsor programs related to the
enroll, and graduate underrepresented
FY2010 through FY2015,
PHSA Sec. 736
recruitment, training and retention of underrepresented minorities
minorities or who have increased the
and SSAN for each
(HRSA)
in the health professions.
recruitment of underrepresented minorities
subsequent fiscal year.
serving in faculty or administrative positions.
FY2010 funding = $25 million; FY2011 funding = $24 million.
[CFDA 93.157]
CRS-13

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
Mental and Behavioral Health
5306 Redesignates
Mental and behavioral health education and training
Historically black colleges and universities
$35 million for the period of
PHSA Sec. 756 as
grants. Authorizes grants for the recruitment and education of
(HBCUs) or other minority-serving
FY2010 through FY2013 ($8
Sec. 757, and adds students in social work, interdisciplinary psychology training, and
institutions. Institutions of higher education
million for training in social
a new Sec. 756
internships or other field placement programs related to child and
that have knowledge, understanding and
work, $12 million for
(HRSA)
adolescent mental health. Priority for social work grants given to
participation of individuals and groups from
training in graduate
schools of social work meeting certain criteria such as recruiting
different racial, ethnic, cultural, geographic,
psychology, $10 million for
from and placing graduates into areas with a high-need and high-
religious, linguistic, and class backgrounds,
training in professional child
demand population. Priority for psychology grants given to
and different genders and sexual orientations; and adolescent mental
institutions that focus on the needs of specified vulnerable groups.
and that have internship or other field
health, and $5 million for
Priority for grants to train professional and paraprofessional child
placement programs that prioritize cultural
training in paraprofessional
and adolescent mental health workers given to applicants that can,
and linguistic competency. State-licensed
child and adolescent mental
among other things, assess workforce needs and that have
mental health organizations to train
health).
programs designed to increase the number of child and adolescent
paraprofessional child and adolescent mental
mental health workers serving high-priority populations.
health workers.
FY2010 funding = $3 million, FY2011 funding = $3 million.
[CFDA 93.189]
Policy and Planning
5101 New
authority
National Health Care Workforce Commission. Establishes a
Not applicable.
SSAN (no years specified).
15-member commission focused on evaluating and meeting the
need for health care workers in the United States. The commission
is required to conduct studies, produce annual reports beginning in
2011, and make recommendations on high-priority topics related to
the health care workforce.
5102 New
authority
State health care workforce development grants. Establishes A state workforce investment board that
For planning grants, $8
(HRSA)
a matching grants program for state partnerships to plan and
includes certain specified members.
million for FY2010, and
implement activities leading to coherent and comprehensive health
SSAN for each subsequent
care workforce development strategies at the state and local levels.
fiscal year. For
Planning grants of up to $150,000 are for up to one year and
implementation grants, $150
require a 15% match. Implementation grants are for up to two
million for FY2010, and
years (with up to one additional year of funding) and require a 25%
SSAN for each subsequent
match.
fiscal year.
FY2010 funding = $6 million from the PPHF; FY2011 funding =
$0. [CFDA 93.509]
CRS-15

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
5103 Amends
and Health care workforce program assessment. Requires the
State and regional centers for health
For the National Center,
reauthorizes
Secretary to establish a National Center for Health Care
workforce analysis: states, state workforce
$7.5 million for each of
PHSA Sec. 761
Workforce Analysis, award grants to support state and regional
investment boards, public health or health
FY2010 through FY2014; for
(HRSA)
centers for health workforce analysis, and increase funding for
professions schools, academic health centers,
state and regional centers,
longitudinal evaluations of specified individuals who have received
or appropriate public or private nonprofit
$4.5 million for each of
education, training, or financial assistance from programs under
entities.
FY2010 through FY2014;
PHSA Title VII.
and for longitudinal
evaluations, SSAN for
FY2010 funding = $3 million; FY2011 funding = $3 million.
FY2010 through FY2014.
[Includes funding for Sec. 792 (health professions data) and Sec. 806
(nursing grant program data). CFDA 93.300]
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). FY2010 and FY2011 funding amounts are taken from HRSA’s
FY2011 operating plan, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency’s FY2012 congressional budget justification document,
available at http://www.hhs.gov/about/hhsbudget.html.
a. The nursing education loan repayment program repays 60% of a registered nurse’s educational loans in return for a two-year commitment to work in a health care
facility with a critical shortage of nurses. Participants may have an additional 25% of their loan repaid in exchange for one more year of service. The nurse scholarship
program offer scholarships to individuals attending nursing school in exchange for at least two years working in a health care facility with a critical shortage of nurses.
Together the two programs, authorized under PHSA Sec. 846, received $94 million in FY2010 and $93 million in FY2011. The authorization of appropriations for Sec.
846 expired at the end of FY2007 and was not reauthorized by ACA.
b. The Department of Defense and Full-Year Continuing Appropriations Act, 2011 (P.L. 112-10, Div. B, Sec. 1828) prohibited the transfer of funds from the Public Health
and Social Services Emergency Fund (PHSSEF) to support the U.S. Public Health Sciences Track. The PHSSEF is an HHS account administered by the Secretary.
Congress has historically used the PHSSEF to provide one-time funding for non-routine activities. Each fiscal year, Congress appropriates amounts to the PHSSEF for
specified purposes. ACA did not authorize or appropriate funds to the PHSSEF.
CRS-16

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 3. ACA Discretionary Funding: Prevention and Wellness
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
Community-Based Prevention
3509/3511 New
PHSA Offices of Women’s Health. Establishes or reauthorizes offices
OS grants, agreements, and contracts may be
For most offices, SSAN for
Secs. 229 (OS),
of women’s health in OS, CDC, AHRQ, HRSA, FDA, NIH, and
awarded to public and private entities,
each of FY2010 through
310A (CDC),
SAMHSA. Grants, agreements, or contracts may be awarded for
agencies, and organizations.
FY2014. For NIH and
925 (AHRQ);
activities of the OS office to establish an information center and
SAMHSA offices, SSAN (no
new SSA Sec.
coordinating committee. Activities of other offices include
years specified).
713 (HRSA);
recommendations regarding grant-making through other agency
and new
accounts, not direct grant-making.
FFDCA Sec.
1011 (FDA).
Funding for the OS Office on Women’s Health = $43 million
Reauthorizes
for FY2010 and for FY2011. Funding for the NIH Office of
PHSA Secs.
Research on Women’s Health = $34 million for FY2010 and for
486(a) (NIH)
FY2011.
and 501(f)
(SAMHSA).
4003 Amends
PHSA
Clinical and community preventive services task forces.
Not applicable.
SSAN for each fiscal year to
Sec. 915(a)
Reauthorizes and expands the authority for the U.S. Preventive
carry out the activities of the
(AHRQ). New
Services Task Force (USPSTF) to review and recommend effective
USPSTF and the TFCPS.
PHSA Sec. 399U clinical preventive services. Provides explicit statutory authority for
(CDC).
the existing Task Force on Community Preventive Services (TFCPS)
to review and recommend effective community-based interventions.
4004 New
authority
Education and outreach regarding prevention. Requires the
Mentions awarding contracts, but does not
SSAN for each fiscal year; no
Secretary to carry out various specified communications activities
specify eligibility criteria.
more than $500 million
regarding health promotion and disease prevention, for common
total.
and serious chronic health problems. They include establishing,
within one year of enactment, a national media campaign on health
promotion and disease prevention.
4102(a) New
PHSA Oral health activities. Requires CDC, subject to appropriations,
Community-based providers of dental
SSAN (no years specified).
Secs. 399LL,
to fund a five-year national oral health education campaign, and
services, including public or private entities.
399LL-1, and
award grants for dental caries disease management programs,
399LL-2 (CDC)
among other things.
CRS-17

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
4102(b) Amends
PHSA
School-based dental sealant program. Amends the existing
Grants must be awarded to each of the 50
Authority expired at end of
Sec. 317M(c)
school-based dental sealant grant program, which was discretionary, states and territories, and to Indians, Indian
FY2005; ACA does not
(CDC, HRSA)
by requiring the Secretary to award grants to the 50 states and to
tribes, tribal organizations, and urban Indian
authorize new funding.
Indian tribes for school-based dental sealant programs.
organizations. Preference given to urban
districts with high participation rates in school
Funding for all CDC’s oral health programs under Sec. 317M:
meals programs, and rural districts with high
FY2010 = $15 million; FY2011 = $15 million.
poverty levels (as defined).
4102(c) Amends
PHSA
Oral health infrastructure. Requires the Secretary to enter into
States, territories, and tribal entities.
SSAN for FY2010 through
Sec. 317M by
cooperative agreements to establish oral health leadership and
FY2014.
adding a new
programs to improve oral health.
subsection (d)
(CDC)
4102(d) New
authority
Oral health surveillance. Requires the Secretary to expand the
Not applicable.
SSAN (no years specified)
(CDC, AHRQ)
following surveillance systems to include more information on oral
for PRAMS; SSAN for each
health: Pregnancy Risk Assessment Monitoring System (PRAMS);
of FY2010 through FY2014
National Health and Nutrition Examination Survey (NHANES);
for NOHSS; no explicit
National Oral Health Surveillance System (NOHSS); and Medical
authorization of
Expenditure Panel Survey (MEPS).
appropriations for
NHANES/MEPS expansion.
4201 New
authority
Community transformation grants. Requires CDC to fund
State or local government agencies or
SSAN for each of FY2010
(CDC)
competitive grants for the implementation, evaluation, and
nonprofit organizations, networks of
through FY2014.
dissemination of evidence-based community preventive health
community-based organizations, and Indian
activities.
tribes.
FY2011 funding = $145 million from the PPHF. [CFDA 93.531]
4202(a) New
authority
Community wellness pilot program. Requires CDC to award
State or local health departments, and Indian
SSAN for each of FY2010
(CDC)
grants for five-year pilot programs to provide community
tribes.
through FY2014.
prevention interventions, screenings, and clinical referrals for
individuals between 55 and 64 years of age.
4204 Amends
PHSA
Immunization programs. Provides explicit authority for states
States, political subdivisions, and other public
SSAN for each of FY2010
Sec. 317 and
to purchase vaccines at prices negotiated by Secretary. Permanently
entities.
through FY2014 for
adds a new
reauthorizes state immunization grants. Requires new immunization
demonstration grants; SSAN
subsection (m)
demonstration grants.
(no years specified) for
(CDC)
other authorities.
Funding for the Sec. 317 vaccination program: FY2010 = $561
million; FY2011 = $589 million. [Note: FY2011 funding = $489
million in regular appropriations + $100 million from the PPHF.
CFDA 93.268]
CRS-18

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
4206 Amends
PHSA
Individualized wellness plan demonstration program.
Community health centers.
SSAN (no years specified).
Sec. 330 by
Requires the Secretary to establish a pilot program in not more
adding a new
than 10 community health centers to test the impact of providing
subsection (s)
at-risk individuals who use the centers with individualized wellness
plans.
4304
New PHSA Sec.
Epidemiology and laboratory capacity grants. Codifies
State, local, or tribal health departments,
$190 million for each of
2821 (CDC)
existing grant program to strengthen national epidemiology,
tribal jurisdictions, or academic centers that
FY2010 through FY2013 (at
laboratory, and information management capacity for the response
meet CDC-specified criteria.
least $95 million for
to infectious diseases and other conditions of public health
epidemiology, $60 million
importance.
for information management,
and $32 million for
laboratories).
10334 Amends
PHSA
Offices of Minority Health. Elevates the existing OS Office of
For OS office: public and nonprofit private
SSAN for each of FY2011
Sec. 1707 (OS)
Minority Health and NIH National Center on Minority Health and
entities, federal agencies, and organizations
through FY2016 for OS
and PHSA Title
Health Disparities (NCMHD); instructs the OS office to award
that are indigenous human resource providers office.
IV (NIH)
grants and undertake other activities to improve minority health
in communities of color. For the NIH
status; and gives the new NIH National Institute on Minority Health
Institute, grantee eligibility criteria are not
and Health Disparities (NIMHD) responsibility for minority health
stipulated.
disparities research and other health disparities research at NIH.
Funding for the NIMHD = $211 million for FY2010, and $210
million for FY2011. Funding for the OS Office of Minority
Health = $56 million for FY2010 and for FY2011.
10407 New
authority
Diabetes activities. Requires CDC to conduct several diabetes
Not applicable.
SSAN (no years specified).
(CDC)
prevention activities including state assessments, vital statistics,
physician education, and funding of an Institute of Medicine (IOM)
report.
10411 New
PHSA
Congenital heart disease programs. Authorizes CDC to
NCHDSS grantee must be a public or private
SSAN for each of FY2011
Secs. 399V-2
establish a National Congenital Heart Disease Surveillance System
nonprofit entity with experience in congenital
through FY2015 for both the
(CDC) and 425
(NCHDSS), or to award one grant to establish such a system.
heart disease. NIH must consider the
surveillance system and the
(NIH)
Authorizes NIH to expand and coordinate research on congenital
application of research to minority and
expanded research program.
heart disease.
medically underserved populations.
10412 Reauthorizes
Public access defibrillation programs. Reauthorizes a program
States and political subdivisions, Indian tribes,
$25 million for each of
PHSA Sec. 312
of grants for public access defibrillation programs, including
and tribal organizations.
FY2003 through FY2014.
(HRSA)
equipment purchase and training.
FY2010 funding = $2.5 million; FY2011 funding = $236,000.
CRS-19

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 4. ACA Discretionary Funding: Maternal and Child Health
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
2952(b)
New SSA Sec.
Services to individuals with a postpartum condition.
Public or nonprofit private entities, state or
$3 million for FY2010, and
512 (HRSA)
Authorizes grants to establish, operate and coordinate effective and
local government public-private partnerships,
SSAN for each of FY2011
cost-efficient systems for the delivery of essential services to
recipients of Healthy Start grants, public or
and FY2012.
individuals with, or at risk of, postpartum depression and their
nonprofit private hospitals, community-based
families.
organizations, hospices, ambulatory care
facilities, community health centers, migrant
health centers, public housing, primary care
centers, and homeless health centers.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).

Table 5. ACA Discretionary Funding: Health Care Quality
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
Quality Measure Development, Analysis, and Public Reporting
3013(a)&(c)
New PHSA 931
Quality measure development. Requires the Secretary, in
Entities with demonstrated expertise in
$75 million for each of
(AHRQ)
consultation with AHRQ and CMS, to (1) identify gaps where no
measure development and evaluation, which
FY2010 through FY2014, to
quality measures exist or where existing measures need
have adopted processes that incorporate the
remain available until
improvement, updating or expansion consistent with the National
views of measure users, as well as those
expended. At least 50% of
Strategy for Quality Improvement; and (2) fund or enter into
assessed by the measures, into the
the amounts appropriated
agreements with eligible entities for purposes of developing,
development process.
must be used pursuant to
improving, updating, or expanding quality measures in areas
SSA Sec. 1890A(e), as added
identified as gap areas.
by ACA Sec. 3013(b). See
below.
3013(b) Amends
new
Quality and efficiency measures development. Requires CMS, Not specified.
See ACA Sec. 3013(a)&(c)
SSA Sec. 1890A, in consultation with AHRQ, through contracts, to develop quality
above.
as added by
and efficiency measures as determined appropriate for use under
ACA Sec.
the SSA.
3014(b), by
adding a new
subsection (e)
(CMS)
CRS-21

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
3015
New PHSA Sec.
Collection and analysis of data for quality and resource use
Multi-stakeholder entities that coordinate
SSAN for each of FY2010
399II
measures. Requires the Secretary to establish and implement an
methods and plans for the consistent
through FY2014.
overall strategic framework to carry out the public reporting of
reporting of summary quality and cost
performance information. Requires the Secretary to collect and
information and that are capable of submitting
aggregate consistent data on quality and resource use measures, and such summary data for a particular population
authorizes the Secretary to award grants or contracts for this
and providers. Awards may only be made to
purpose. Authorizes the Secretary to award grants or contracts to
entities that enable summary data that can be
eligible entities to support new, or improve existing, efforts to
integrated and compared across multiple
collect and aggregate quality and resource use measures.
sources.
3015
New PHSA Sec.
Public reporting of performance information. Requires the
Not applicable.
SSAN for each of FY2010
399JJ
Secretary to make available to the public, through standardized
through FY2014.
websites, performance information summarizing data on quality
measures. The information must include clinical conditions to the
extent such data is available and, where appropriate, be provider-
specific and sufficiently disaggregated and specific to meet the needs
of patients with different clinical conditions.
Quality Improvement Research, Training, and Implementation
3501
New PHSA Sec.
Health care delivery system research. Requires AHRQ to (1)
Not specified.
$20 million for FY2010
933 (AHRQ)
identify, develop, evaluate, and disseminate innovative strategies for
through FY2014.
quality improvement practices in the delivery of health care services
that represent best practice; (2) support research on health care
delivery improvement and facilitate adoption of best practices; and
(3) make the research findings available to the public; among other
specified functions.
3501/3511
New PHSA Sec.
Quality improvement technical assistance and
May be a health care provider, professional
SSAN (no years specified).
934 (AHRQ)
implementation. Requires AHRQ to award technical assistance
society, health care worker organization,
grants (with a matching requirement) to entities that deliver health
Indian health organization, quality
care to help them understand, adapt, and implement the models and improvement organization, patient safety
practices identified by the research conducted by the agency.
organization, local quality improvement
collaborative, the Joint Commission, academic
health center, university, physician-based
research network, primary care extension
program, or an IHS program; and must have
demonstrated expertise in providing
information and technical support and
assistance to health care providers regarding
quality improvement.
CRS-22

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
3508/3511 New
authority Quality and patient safety training. Authorizes the Secretary
Health professional schools; schools of public
SSAN (no years specified).
to award demonstration grants (with a matching requirement) to
health, social work, nursing, pharmacy or
eligible entities or consortia to develop and implement academic
health care administration; institutions with a
curricula that integrate quality improvement and patient safety into
graduate medical education program.
clinical education of health professionals.
Health Care Coordination
3502/3511 New
authority Community health team grants to support medical homes.
States or state-designated entities; Indian
SSAN (no years specified).
Requires the Secretary to award grants to or enter into contracts
tribes or tribal organizations.
with eligible entities to support community-based interdisciplinary,
interprofessional health teams in assisting primary care practices.
Funding must be used to establish the health teams and to provide
capitated payments to the providers.
3503/3511
New PHSA Sec.
Medication therapy management (MTM) grants. Requires
Entities that provide a setting appropriate for
SSAN (no years specified).
935 (AHRQ)
the Secretary, not later than May 1, 2010, to provide grants to
MTM services and that submit a plan for
support MTM services provided by licensed pharmacists that are
achieving long-term financial sustainability.
targeted at patients who take four or more prescribed medications,
take high-risk medications, have two or more chronic diseases, or
have undergone a transition of care or other factors that are likely
to create a high risk for medication-related problems.
3506
New PHSA Sec.
Program to facilitate shared decision making. Requires the
The standards and certification contract is to
SSAN for FY2010 and each
936 (AHRQ)
Secretary, through a contract, to develop and identify standards for
be awarded to the entity that holds the
subsequent fiscal year.
patient decision aids, to review patient decision aids, and develop a
contract under SSA Sec. 1890 (currently the
certification process for determining whether patient decision aids
National Quality Forum). Eligible grantees are
meet those standards. Further requires the Secretary to (1) award
not specified.
grants or contracts to develop, update, and produce patient
decision aids, to test such materials to ensure they are balanced and
evidence-based, and to educate providers on their use; and (2) to
award grants for establishing Shared Decision Making Resource
Centers to develop and disseminate best practices to speed
adoption and effective use of patient decision aids and shared
decision making. Also requires the Secretary to award grants to
providers for the development and implementation of shared
decision-making techniques.
CRS-23

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
3510 Amends
and
Patient navigator program. Prohibits the Secretary from
A public or nonprofit private health center
$3.5 million for FY2010, and
reauthorizes
awarding a grant to an entity under this section unless the entity
(including an FQHC), IHS facility, hospital,
SSAN for each of FY2011
PHSA Sec. 340A provides assurances that patient navigators recruited, assigned,
cancer center, rural health clinic, academic
through FY2015.
(HRSA)
trained, or employed using these grant funds meet certain minimum
health center, or a nonprofit entity that
core proficiencies.
partners or coordinates referrals with such a
facility to provide patient navigator services.
FY2010 funding = $5 million; FY2011 funding = $5 million.
[CFDA 93.191]
5405
New PHSA Sec.
Primary care extension program. Requires the Secretary to
States or multistate entities.
$120 million for each of
399V-1 (AHRQ) establish a Primary Care Extension Program to award state planning
FY2011 and FY2012, and
and implementation grants for Primary Care Extension Program
SSAN for each of FY2013
State Hubs, consisting of the state health department and other
and FY2014.
specified entities. State hubs must contract with and provide grant
funds to county and local entities to serve as Primary Care
Extension Agencies that assist primary care providers in
implementing patient-centered medical homes and develop and
support primary care learning communities, among other functions.
5604
New PHSA Sec.
Co-locating primary and specialty care in community-
Qualified community mental health programs.
$50 million for FY2010, and
520K
based mental health settings. Requires the Secretary to fund
SSAN for each of FY2011
(SAMHSA)
demonstration projects for providing coordinated and integrated
through FY2014.
services to individuals with mental illness and co-occurring chronic
diseases through the co-location of primary and specialty care
services in community-based mental and behavioral health settings.
10333
New PHSA Sec.
Community-based collaborative care network program.
An eligible CCN is a consortium of health
SSAN for each of FY2011
340H
Authorizes the Secretary to award grants to eligible entities to
care providers with a joint governance
through FY2015.
support community-based collaborative care networks (CCN).
structure that provides comprehensive
coordinated and integrated health care
services (as defined by the Secretary) for low-
income populations. CCNs must include a
safety net hospital and all FQHCs in the
community, as specified.
CRS-24

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
10410
New PHSA Sec.
Centers of excellence for depression. Requires SAMHSA to
Institutions of higher education; public or
$100 million for each of
520B
award five-year grants (with a matching requirement) on a
private nonprofit research institutions.
FY2011 through FY2015,
(SAMHSA)
competitive basis to eligible entities to establish national centers of
and $150 million for each of
excellence for depression. One grantee is to be designated as the
FY2016 through FY2020.
coordinating center and required to establish and maintain a
national database. Centers of excellence may receive a grant of up
to $5 million; the coordinating center may receive a grant of up to
$10 million.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). FY2010 and FY2011 funding amounts are taken from HRSA’s
FY2011 operating plan, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency’s FY2012 congressional budget justification document,
available at http://www.hhs.gov/about/hhsbudget.html.

Table 6. ACA Discretionary Funding: Nursing Homes
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
6112 New
authority
National independent monitor demonstration program.
Duties of the independent monitor are
SSAN (no years specified); a
Requires the Secretary, within one year of enactment, to implement stipulated, but eligibility criteria are not.
monitored chain must
a two-year demonstration to develop, test, and implement an
contribute a portion of costs
independent monitoring program to oversee interstate and large
of the demonstration, as
intrastate chains of skilled nursing facilities (SNFs) and nursing
determined by the Secretary.
facilities (NFs).
6114 New
authority
Culture change and information technology demonstration
Facility-based settings.
SSAN (no years specified).
programs. Requires the Secretary, within one year of enactment,
to award one or more competitive grants to support each of the
following two three-year demonstration projects for SNFs and NFs:
(1) develop best practices for culture change (i.e., patient-centric
models of care); and (2) develop best practices for the use of health
information technology.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
CRS-25

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 7. ACA Discretionary Funding: Health Disparities Data Collection
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
4302(a) New
PHSA Health disparities data collection and analysis. Not later than
Not applicable.
SSAN for each of FY2010
Title XXXI and
two years after enactment, requires federally conducted and
through FY2014; however,
Sec. 3101
supported health programs and surveys, to the extent practicable,
data may not be collected
to collect and report data on race, ethnicity, sex, primary language,
unless funds are directly
and disability status, as well as other demographic data on health
appropriated for such
disparities as deemed appropriate by the Secretary. Requires the
purpose.
Secretary to adopt standards for the measurement and collection of
such data. Requires the Secretary to analyze the data collected on
health disparities; provide for the public reporting and dissemination
of the data and analyses; and safeguard the privacy of the
information. [Note: On June 29, 2011, HHS announced new draft
standards for collecting and reporting health disparities data, and
announced plans to begin collecting health data on lesbian, gay,
bisexual, and transgender (LGBT) populations. See
http://www.hhs.gov/news/press/2011pres/06/20110629a.html.]
5605 New
authority
Key national indicators. Establishes a Commission on Key
National Academy of Sciences.
$10 million for FY2010, and
National Indicators composed of eight members appointed by
$7.5 million for each of
Congress. [Note: The Commission members were appointed in
FY2011 through FY2018,
Dec. 2010. See http://www.stateoftheusa.org/content/commission-
with amounts appropriated
on-key-national-ind.php.] Requires the commission to contract with
to remain available until
the National Academy of Sciences to review available public and
expended.
private sector research on key national indicator set selection and
determine how best to establish a key national indicator system,
among other things. Mandates a Government Accountability Office
(GAO) study of previous efforts by public, private, or foreign
entities to develop best practices for a key national indicator
system. [Note: GAO released its study in March 2011. See
http://www.gao.gov/new.items/d11396.pdf.]
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
CRS-26

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 8. ACA Discretionary Funding: Emergency Care
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
3504(a)
New PHSA Sec.
Regional systems for emergency care. Requires the Assistant
States (or a partnership of one or more
$24 million for each of
1204 (OS)
Secretary for Preparedness and Response to award at least four
states and one or more localities) and Indian
FY2010 through FY2014 for
multi-year contracts or grants (with matching requirement) for pilot tribes (or a partnership of one or more
PHSA Title XII Parts A and B
projects to improve regional coordination of emergency services.
tribes). Priority given to entities that serve a
(i.e., Secs. 1201-1222).
medically underserved population.
3504(b)
New PHSA Sec.
Emergency medicine research. Requires the Secretary to
Not specified.
SSAN for each of FY2010
498D (NIH,
expand and accelerate basic, translational, and service delivery
through FY2014.
AHRQ, HRSA,
research on emergency medical care systems and emergency
CDC)
medicine, including pediatric emergency medical care. Also requires
the Secretary to support research on the economic impact of
coordinated emergency care systems.
3505(a) Amends
and
Trauma care centers. Requires the Secretary to establish
Qualified public nonprofit IHS, Indian tribal,
$100 million for FY2009, and
reauthorizes
separate grant programs for trauma care centers to (1) help defray
and urban Indian trauma centers.
SSAN for each of FY2010
PHSA Secs.
substantial uncompensated care costs, (2) further the core missions
through FY2015.
1241-1245
of trauma care centers, and (3) provide emergency relief to ensure
(HRSA)
the continued availability of trauma services.
3505(b) New
PHSA Trauma service availability grants. Requires the Secretary to
Grants are awarded to states to fund (1) a
$100 million for each of
Secs. 1281-1282
award grants to states for the purpose of supporting trauma-related
public or nonprofit trauma center, (2) a safety FY2010 through FY2015.
(HRSA)
physician specialties and broadening access to and availability of
net public or nonprofit trauma center, or (3)
trauma care services.
a hospital in an underserved area (as defined
by the state) that seeks to establish new
trauma services. States must use at least 40%
of the amount awarded in a fiscal year for
grants to safety net trauma centers.
5603 Amends
and
Children’s emergency medical services demonstration
States or accredited schools of medicine.
$25 million for FY2010,
reauthorizes
grants. Expands emergency services for children who need
$26.3 million for FY2011,
PHSA Sec. 1910
treatment for trauma or critical care by lengthening the period for
$27.6 million for FY2012,
(HRSA)
demonstration grants to four years (with an optional fifth year).
$28.9 million for FY2013,
and $30.4 million for
FY2010 funding = $22 million; FY2011 funding = $22 million.
FY2014.
[CFDA 93.127]
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). FY2010 and FY2011 funding amounts are taken from HRSA’s
FY2011 operating plan, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency’s FY2012 congressional budget justification document,
available at http://www.hhs.gov/about/hhsbudget.html.
CRS-27

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 9. ACA Discretionary Funding: Elder Justice
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
6703(a)
New SSA Sec.
Elder Justice Coordinating Council. Establishes an Elder Justice
Not applicable.
SSAN (no years specified).
2021 (OS)
Coordinating Council to include the Secretary as chair and the U.S.
See also new SSA Sec. 2024
Attorney General, as well as the head of each federal department or
below.
agency, identified by the chair, as having administrative responsibility
or administering programs related to elder abuse, neglect, and
exploitation.
6703(a)
New SSA Sec.
Advisory Board on Elder Abuse, Neglect, and Exploitation.
Not applicable.
SSAN (no years specified).
2022
Establishes an advisory board to create a short- and long-term
See also new SSA Sec. 2024
multidisciplinary plan for development of the field of elder justice
below.
and to make recommendations to the Elder Justice Coordinating
Council.
6703(a)
New SSA Sec.
Authorization of appropriations. Authorizes funding for new
Not applicable.
$6.5 million for FY2011, and
2024
SSA Secs. 2021 (Coordinating Council), 2022 (Advisory Board), and
$7.0 million for each of
2023 (human subject protection guidelines for researchers).
FY2012 through FY2014.
6703(a)
New SSA Sec.
Forensic centers and expertise. Requires the Secretary to
(1) Stationary forensic centers: four of the
$4 million for FY2011, $6
2031
award grants to eligible entities to establish and operate stationary
grants to institutions of higher education with
million for FY2012, and $8
and mobile forensic centers and to develop forensic expertise
demonstrated expertise in forensics or
million for each of FY2013
pertaining to elder abuse, neglect, and exploitation.
commitment to preventing or treating elder
and FY2014.
abuse. (2) Mobile forensic centers: six of the
grants to appropriate entities.
6703(a)
New SSA Sec.
Incentives for LTC staffing. Requires the Secretary to award
LTC facilities or community-based LTC
For new SSA Sec. 2041: $20
2041(a)
grants to carry out activities for individuals to train for, seek, and
entities as defined by the Secretary.
million for FY2011, $17.5
maintain employment providing direct care in LTC facilities; and to

million for FY2012, and $15
award grants to conduct programs that offer direct care employees
million for each of FY2013
continuing training and varying levels of certification.
and FY2014.
6703(a)
New SSA Sec.
Certified EHR technology grant program. Authorizes grants
LTC facilities.
See above authorization of
2041(b)
to LTC facilities for specified activities that would assist such
appropriations for SSA Sec.
entities in offsetting costs related to purchasing, leasing, developing,
2041.
and implementing certified electronic health record technology.
6703(a)
New SSA Sec.
Standards for transactions involving clinical data by LTC
Not applicable.
See above authorization of
2041(c)
facilities. Requires the Secretary to adopt electronic standards for
appropriations for SSA Sec.
the exchange of clinical data by LTC facilities and, within 10 years,
2041.
to have in place procedures to accept the optional electronic
submission of clinical data by LTC facilities pursuant to such
standards.
CRS-28

Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
6703(a)
New SSA Sec.
Adult protective service functions. Requires the Secretary to
Not applicable.
$3 million for FY2011, and
2042(a)
undertake various activities with respect to adult protective
$4 million for each of
services, including providing funding, collecting and disseminating
FY2012 through FY2014.
data on elder abuse, disseminating information on best practices and
training, conducting research, and providing technical assistance to
states and other entities.
6703(a)
New SSA Sec.
Grants to enhance provision of adult protective services.
States and U.S. territories.
$100 million for each of
2042(b)
Requires the Secretary to award formula grants to enhance adult
FY2011 through FY2014.
protective services programs provided by states and local
governments.
6703(a)
New SSA Sec.
Adult protective services demonstration grants. Requires
States.
$25 million for each of
2042(c)
the Secretary to fund state demonstration programs for adult
FY2011 through FY2014.
protective services that test methods to prevent and detect elder
abuse.
6703(a)
New SSA Sec.
Long-term care ombudsman program grants. Requires the
Eligible entities with relevant expertise and
$5 million for FY2011, $7.5
2043(a)
Secretary to award grants to improve the capacity of state LTC
experience in abuse and neglect in LTC
million for FY2012, and $10
ombudsman programs to address abuse and neglect complaints,
facilities, or state LTC ombudsman programs.
million for each of FY2013
conduct pilot programs, and provide support for such programs.
and FY2014.
6703(a)
New SSA Sec.
Ombudsman training programs. Requires the Secretary to
Not specified.
$10 million for each of
2043(b)
establish programs to provide and improve ombudsman training
FY2011 through FY2014.
with respect to elder abuse, neglect, and exploitation for national
organizations and state LTC ombudsman programs.
6703(b) New
authority
National Training Institute for Surveyors. Requires that the
Not specified.
$12 million for the period of
Secretary enter into a contract with an entity to establish and
FY2011 through FY2014.
operate a National Training Institute for Federal and State
Surveyors to provide and improve training of surveyors investigating
allegations of abuse in programs and LTC facilities that receive
payments under Medicare or Medicaid.
6703(b) New
authority
Grants to state survey agencies. Requires the Secretary to
State agencies that perform surveys of nursing $5 million for each of
award grants to state survey agencies that perform surveys of
facilities.
FY2011 through FY2014.
Medicare or Medicaid participating nursing facilities to design and
implement complaint investigation systems.
6703(c) New
authority
National nurse aide registry study and report. Requires the
Not applicable.
SSAN (no years specified) to
Secretary, in consultation with appropriate government agencies
carry out these activities,
and private sector organizations, to conduct a study on establishing
with funding not to exceed
a national nurse aide registry and report on its findings.
$500,000.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 10. ACA Discretionary Funding: Biomedical Research
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
10409 Amends
PHSA
Cures Acceleration Network (CAN). Establishes a CAN
Public or private entity, which may include a
$500 million for FY2010, and
Secs. 402(b) and program within the Office of the NIH Director to award grants,
private or public research institution, an
SSAN for subsequent fiscal
499(c); new
contracts, or cooperative agreements to support the development
institution of higher education, a medical
years. Other funds
PHSA Sec. 402C of treatments for diseases or conditions that are rare, and for which center, a biotechnology company, a
appropriated under the
(NIH)
market incentives are inadequate.
pharmaceutical company, a disease advocacy
PHSA may not be allocated
organization, a patient advocacy organization,
to CAN.
or an academic research institution.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).

Table 11. ACA Discretionary Funding: Biologics
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
7002 Amends
PHSA
FDA approval of follow-on biologics. Creates a regulatory
Not applicable.
SSAN for each of FY2010
Sec. 351 (FDA)
pathway for approving biosimilar or interchangeable biological
through FY2012.
drugs. Provides for the collection of user fees, subject to
congressional authorization, to cover regulatory costs beginning in
FY2013.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 12. ACA Discretionary Funding: 340B Drug Pricing
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
7102 Amends
PHSA
Improvements to 340B program integrity. Requires the
Not applicable.
SSAN for FY2010 and each
Sec. 340B(d)
Secretary to develop systems to improve compliance and program
succeeding fiscal year.
(HRSA)
integrity to (1) increase transparency and strengthen monitoring,
oversight, and investigation of the prices that manufacturers charge
covered entities; and (2) ensure covered entities do not divert
drugs or obtain multiple discounts. Further requires the Secretary
to establish a new administrative dispute resolution process to
mediate and resolve covered entity overpayment claims and
manufacturer claims against covered entities for drug diversion or
multiple discounts.
FY2010 funding = $2 million; FY2011 funding = $4 million.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). FY2010 and FY2011 funding amounts are taken from HRSA’s
FY2011 operating plan, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency’s FY2012 congressional budget justification document,
available at http://www.hhs.gov/about/hhsbudget.html.

Table 13. ACA Discretionary Funding: Medical Malpractice
New/Existing
ACA
Authority
Authorization of
Section
(Agent)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
10607
New PHSA Sec.
Liability reform demonstration program. Authorizes five-year To receive a grant, a state must develop an
$50 million for the period
399V-4 (HRSA)
demonstration grants to states for the implementation and
alternative system that allows for the
FY2011 through FY2015.
evaluation of alternatives to current tort litigation for resolving
resolution of disputes caused by health care
disputes over injuries allegedly caused by health care providers or
providers or organizations, and reduces
organizations. Planning grants of up to $500,000 may be awarded to
medical errors by encouraging the collection
states for the development of demonstration project applications.
and analysis of patient safety data related to
the resolved disputes.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 14. ACA Discretionary Funding: Pain Care Management
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
4305(a) New
authority
Conference on pain. Requires the Secretary, within one year of
IOM or another appropriate entity if the IOM
SSAN for each of FY2010
appropriating funds, to contract with the IOM to convene a
declines.
and FY2011.
Conference on Pain for the purpose of assessing the public health
impact of pain, reviewing pain research, care, and education, and
identifying barriers to improved pain care. A report summarizing
the Conference’s findings must be submitted to Congress by June
30, 2011. [Note: IOM released its report on June 29, 2011. See
http://painconsortium.nih.gov/.]
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).

Table 15. ACA Discretionary Funding: Medicaid Demonstrations
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
2705 New
authority
Global payment system demonstration program. Requires
Large safety net hospital systems or
SSAN (no years specified).
(CMS)
the Secretary, in coordination with the Center for Medicare and
networks.
Medicaid Innovation, to fund up to five demonstrations during the
period FY2010 through FY2012 under which a participating state
will adjust payments made to an eligible hospital system or network
from a fee-for-service model to a global capitated payment model.
2706 New
authority
Pediatric accountable care organization demonstration
Eligible pediatric providers must meet certain
SSAN (no years specified).
(CMS)
program. Requires the Secretary to conduct a five-year
performance guidelines established by the
demonstration (Jan. 1, 2012 through Dec. 31, 2016) under which a
Secretary to be recognized as an ACO, and
participating state is allowed to recognize pediatric providers as an
must achieve a specified minimum level of
accountable care organization (ACO) for the purpose of receiving
Medicaid savings to receive an incentive
incentive payments.
payment.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).
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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Table 16. ACA Discretionary Funding: Medicare
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
3129 Amends
and
Rural hospital flexibility grant program. Extends authorization
States; small rural hospitals.
SSAN for each of FY2011
reauthorizes
of appropriations for the rural hospital flexibility (FLEX) grants that
and FY2012, to remain
SSA Sec. 1820
support a range of performance and quality improvement activities
available until expended.
(HRSA)
at small rural hospitals. Permits the funding to be used to help rural
hospitals participate in delivery system reform programs authorized
under ACA.
FY2010 funding = $41 million; FY2011 funding = $41 million.
Sources: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152). FY2010 and FY2011 funding amounts are taken from HRSA’s
FY2011 operating plan, available at http://www.hhs.gov/asfr/ob/docbudget/2011operatingplan.html, and the agency’s FY2012 congressional budget justification document,
available at http://www.hhs.gov/about/hhsbudget.html.

Table 17. ACA Discretionary Funding: Private Health Insurance
New/Existing
ACA
Authority
Authorization of
Section
(Agency)
Summary of Provision and Funding (FY2010-FY2011)
Eligibility
Appropriations
1334 New
authority
Multi-state health plans. Requires OPM to contract with health
Health insurance issuers that agree to offer
SSAN (no years specified).
(OPM)
insurers to offer at least two multi-state health plans (at least one
multi-state qualified health plans and meet
nonprofit) through exchanges in each state. Authorizes OPM to
other specified requirements.
prohibit multi-state plans that do not meet standards for medical
loss ratios, profit margins, and premiums. Requires multi-state plans
to cover essential health benefits and meet all the requirements of a
qualified health plan.
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148), as amended by
the health provisions in the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152).

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Discretionary Funding in the Patient Protection and Affordable Care Act (ACA)

Author Contact Information

C. Stephen Redhead, Coordinator
Sarah A. Lister
Specialist in Health Policy
Specialist in Public Health and Epidemiology
credhead@crs.loc.gov, 7-2261
slister@crs.loc.gov, 7-7320
Kirsten J. Colello
Amanda K. Sarata
Specialist in Health and Aging Policy
Specialist in Health Policy
kcolello@crs.loc.gov, 7-7839
asarata@crs.loc.gov, 7-7641
Elayne J. Heisler

Analyst in Health Services
eheisler@crs.loc.gov, 7-4453

Acknowledgments
Pamela W. Smith, Analyst in Biomedical Policy, provided extensive comments on the initial version of this
report.
Key Policy Staff
Area of Expertise
Name
Phone
E-mail
Health Centers and Clinics
Elayne J. Heisler
7-4453
eheisler@crs.loc.gov
C. Stephen Redhead
7-2261
credhead@crs.loc.gov
Health Care Workforce
Elayne J. Heisler
7-4453
eheisler@crs.loc.gov
Bernice Reyes-Akinbileje
7-2260
breyes@crs.loc.gov
Long-Term Care
Kirsten J. Colello
7-7839
kcolello@crs.loc.gov
Prevention and Wellness
Sarah A. Lister
7-7320
slister@crs.loc.gov
Maternal and Child Health
Emilie Stoltzfus
7-2324
estoltzfus@crs.loc.gov
Amalia Corby-Edwards
7-0423
acorbyedwards@crs.loc.gov
Health Care Quality
Amanda K. Sarata
7-7641
asarata@crs.loc.gov
Nursing Homes
Cliff Binder
7-7965
cbinder@crs.loc.gov
Health Disparities
Amalia Corby-Edwards
7-0423
acorbyedwards@crs.loc.gov
Emergency Care
Elayne J. Heisler
7-4453
eheisler@crs.loc.gov
Elder Justice
Kirsten J. Colello
7-7839
kcolello@crs.loc.gov
Biomedical Research
Pamela W. Smith
7-7048
psmith@crs.loc.gov
Biologics
Judith A. Johnson
7-7077
jajohnson@crs.loc.gov
340B Drug Pricing
Cliff Binder
7-7965
cbinder@crs.loc.gov
Medical Malpractice
Vivian S. Chu
7-4576
vchu@crs.loc.gov
Pain Care Management
Kirsten J. Colello
7-7839
kcolello@crs.loc.gov
Medicaid Cliff
Binder
7-7965
cbinder@crs.loc.gov
Medicare Sibyl
Tilson
7-7368
stilson@crs.loc.gov
Private Health Insurance
Bernadette Fernandez
7-0322
bfernandez@crs.loc.gov

Congressional Research Service
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