This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA), including the Maternal and Child Health Services Block Grant (Title V), General Provisions, Peer Review, and Administrative Simplification (Title XI), Medicare (Title XVIII), Medicaid (Title XIX), and the State Children’s Health Insurance Program (CHIP; Title XXI); the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); as well as selected provisions from the Public Health Service Act (PHSA) that are scheduled to terminate during the first session of the 114th Congress (i.e., by December 31, 2015). This report includes only those health care-related expiring provisions for which congressional action would be needed to extend the application of a provision once the expiration date is reached, and it does not include demonstration projects or pilot programs. Although the Congressional Research Service (CRS) has attempted to be comprehensive, CRS cannot guarantee that every relevant provision is included here.
The report defines what constitutes an expiring provision, clarifies which issues do not meet the definition of an expiring provision, lists the legislative history of each of the programs and policies that are due to expire before the end of the first session of the 114th Congress, and includes future deadlines, when applicable, for those programs and policies. The historical legislative actions that created, modified, or extended the expiring provisions covered in this report are also summarized.
Expiring provisions are organized by SSA section, ACA section, or PHSA title and section, as appropriate. The last part of the report includes provisions with expiration dates in 2013 that were not extended in any subsequent legislation. The main body of the text also includes a number of provisions that expired in 2014.
This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA), including the Maternal and Child Health Services Block Grant (Title V), General Provisions, Peer Review, and Administrative Simplification (Title XI), Medicare (Title XVIII), Medicaid (Title XIX), and the State Children's Health Insurance Program (CHIP; Title XXI); the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); as well as selected provisions from the Public Health Service Act (PHSA) that are scheduled to terminate during the first session of the 114th Congress (i.e., by December 31, 2015). This report includes only those health care-related expiring provisions for which congressional action would be needed to extend the application of a provision once the expiration date is reached, and it does not include demonstration projects or pilot programs. Although the Congressional Research Service (CRS) has attempted to be comprehensive, CRS cannot guarantee that every relevant provision is included here.
The report defines what constitutes an expiring provision, clarifies which issues do not meet the definition of an expiring provision, lists the legislative history of each of the programs and policies that are due to expire before the end of the first session of the 114th Congress, and includes future deadlines, when applicable, for those programs and policies. The historical legislative actions that created, modified, or extended the expiring provisions covered in this report are also summarized.
Expiring provisions are organized by SSA section, ACA section, or PHSA title and section, as appropriate. The last part of the report includes provisions with expiration dates in 2013 that were not extended in any subsequent legislation. The main body of the text also includes a number of provisions that expired in 2014.
This report provides a list of selected health-related programs and activities under specified titles of the Social Security Act (SSA), including the Maternal and Child Health Services Block Grant (Title V), General Provisions, Peer Review, and Administrative Simplification (Title XI), Medicare (Title XVIII), Medicaid (Title XIX), and the State Children's Health Insurance Program (CHIP; Title XXI); the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); as well as selected provisions from the Public Health Service Act (PHSA) that are scheduled to terminate during the first session of the 114th Congress (i.e., by December 31, 2015).1 This report includes only those health care-related expiring provisions for which congressional action would be needed to extend the application of a provision once the expiration date is reached, and it does not include demonstration projects or pilot programs. Although the Congressional Research Service (CRS) has attempted to be comprehensive, CRS cannot guarantee that every relevant provision is included here. The report focuses specifically on health care-related expiring provisions and, in that context, it defines what constitutes an expiring provision, clarifies which issues do not meet the definition of an expiring provision, lists the legislative history of each of the programs and policies that are due to expire before the end of the first session of the 114th Congress, and includes future deadlines, when applicable, for those programs and policies. The report will be updated as needed.
Some health care-related statutes in current law include provisions that (1) are time limited and (2) will expire absent further congressional action. Most expiring provisions provide temporary increases or decreases in funding or special protections that may result in greater funding.2 For example, one Medicare provision provided increased payments for certain Medicare mental health services provided during a certain time period; when the provision was not extended, the bonus payments ended.3 Examples of funding protections include those Medicare funding provisions that establish a floor (e.g., for a geographic adjustment index under the physician fee schedule) or a "hold harmless." Generally, the list covers provisions that have or will expire before the end of the first session of the 114th Congress (i.e., by December 31, 2015).
While Medicare payments are reviewed for modification and updates each year, not every provision that changes Medicare payments is considered an expiring provision. Services for which payments are automatically updated each year are not considered expiring provisions and are not included in this report. For example, the physician fee schedule update is not considered an expiring provision because the statute prescribes the update process (the sustainable growth rate, or SGR, system) that applies each year, even though Congress has regularly chosen to supersede those updates in almost all recent years.4 Similarly, a recent change in Medicare payment policy included in the ACA requires the payment updates for many Medicare entities be adjusted by a productivity adjustment (similar to the payment adjustment for physicians).5 In general, the ACA provisions specify that the adjustment may result in a negative payment update allowing the payment rate for a year to be less than the rate for the preceding year. Just as the Medicare physician payment update is not considered an expiring provision, negative payment updates resulting from the productivity adjustment would not be considered expiring provisions because the updates are not time limited and do not expire absent congressional action, though, as with physician payments, Congress may choose to modify those updates.6
This report includes only those health care-related expiring provisions for which congressional action would be needed to extend the application of a provision once the expiration date is reached. Demonstration projects and pilot programs are not included. Provisions that expired or were repealed in 2013 are collected in the last section of the report.
The expiring provisions are summarized below, organized by SSA or PHSA title and section, as appropriate. The last part of the report includes provisions with expiration dates in 2013 that were not extended in any subsequent legislation. Because these programs and provisions are diverse, the provisions identified herein are not perfectly consistent, including with regard to the style of citations. The legislative actions that created, modified, or extended the expiring provisions covered in this report are the following:
Table 1. Legislative Acts That Created, Modified, or Extended Current Health Care-Related Expiring Provisions
|
P.L. # |
Acronym |
Act Title |
|
PRWORA |
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 |
|
|
BBA97 |
Balanced Budget Act of 1997 |
|
|
— |
District of Columbia Appropriations Act, Fiscal Year 1998 |
|
|
— |
Omnibus Consolidated and Emergency Supplemental Appropriation Act of FY1999 |
|
|
BBRA 99 |
Balanced Budget Refinement Act of 1999 |
|
|
BIPA 2000 |
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 |
|
|
WREA |
Welfare Reform Extension Act of 2003 |
|
|
— |
State Children's Health Insurance Program Allotments Extension Act |
|
|
— |
Technical Corrections with Respect to the Definition of Qualifying State |
|
|
MMA |
Medicare Prescription Drug, Improvement, and Modernization Act of 2003a |
|
|
DRA |
Deficit Reduction Act of 2005 |
|
|
TRHCA |
Tax Relief and Health Care Act of 2006 |
|
|
— |
National Institutes of Health Reform Act of 2006 |
|
|
— |
U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 |
|
|
— |
An Act to Provide for the Extension of Transitional Medical Assistance, and Other Provisions |
|
|
— |
Making Continuing Appropriations for the Fiscal Year 2008, and for Other Purposes |
|
|
— |
Department of Defense Appropriations Act of 2008 |
|
|
— |
Making Further Continuing Appropriations for the Fiscal Year 2008, and for Other Purposes. |
|
|
— |
Making Further Continuing Appropriations for the Fiscal Year 2008, and for Other Purposes. |
|
|
MMSEA |
Medicare, Medicaid, and SCHIP Extension Act of 2007b |
|
|
MIPPA |
Medicare Improvements for Patients and Providers Act of 2008c |
|
|
CHIPRA |
Children's Health Insurance Program Reauthorization Act of 2009d |
|
|
ARRA |
American Recovery and Reinvestment Act of 2009e |
|
|
ACA |
Patient Protection and Affordable Care Act of 2010f |
|
|
HCERA |
Health Care and Education Reconciliation Act of 2010g |
|
|
MMEA |
Medicare and Medicaid Extenders Act of 2010 |
|
|
IACTA |
Improving Access to Clinical Trials Act of 2009 |
|
|
TPTCCA |
Temporary Payroll Tax Cut Continuation Act of 2011 |
|
|
MCTRJCA |
Middle Class Tax Relief and Job Creation Act of 2012 |
|
|
ATRA |
American Taxpayer Relief Act of 2012h |
|
|
— |
Continuing Appropriations Resolution of 2014, which includes the Bipartisan Budget Act of 2013 and the Pathway for SGR Reform Act of 2013 |
|
|
PAMA |
Protecting Access to Medicare Act of 2014 |
Source: The Congressional Research Service (CRS).
a. See CRS Report RL31966, Overview of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and CRS Report RL32005, Medicare Fee-for-Service Modifications and Medicaid Provisions of H.R. 1 as Enacted.
b. See CRS Report RL34360, P.L. 110-173: Provisions in the Medicare, Medicaid, and SCHIP Extension Act of 2007.
c. See CRS Report RL34592, P.L. 110-275: The Medicare Improvements for Patients and Providers Act of 2008.
d. See CRS Report R40226, P.L. 111-3: The Children's Health Insurance Program Reauthorization Act of 2009.
e. The Health Information Technology for Economic and Clinical Health Act was incorporated into ARRA. A description of the Medicare provisions in that bill can be found in CRS Report R40161, The Health Information Technology for Economic and Clinical Health (HITECH) Act.
f. See CRS Report R41196, Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline, and CRS Report R41210, Medicaid and the State Children's Health Insurance Program (CHIP) Provisions in ACA: Summary and Timeline.
g. See CRS Report R41124, Medicare: Changes Made by the Reconciliation Act of 2010 to the Patient Protection and Affordable Care Act (P.L. 111-148).
h. See CRS Report R42944, Medicare, Medicaid, and Other Health Provisions in the American Taxpayer Relief Act of 2012.
DRA Section 6064 established the Family-to-Family Health Information Centers program in SSA Section 501(c). The program, administered by the Health Resources and Services Administration (HRSA), provides grants to family-staffed organizations that provide health care information and resources to families of children with special health care needs.
Current status: The funding designated for Family-to-Family Health Information Centers expires March 31, 2015.
PRWORA Section 912 authorized abstinence education formula grants in SSA Section 510.7 To receive these formula grants, states must request funding when applying for Maternal and Child Health Block Grant funds8 authorized in SSA Section 501. Funds provided must be used exclusively for teaching abstinence from sexual activity outside of marriage. PRWORA authorized and appropriated $250 million ($50 million for each of FY1998 through FY2002) for abstinence education. Subsequently, funding for this program was extended through June 30, 2009, by a series of legislation detailed below. ACA Section 2954 appropriated $50 million for each of FY2010 through FY2014 for this program. Most recently, PAMA extended funding for the program through FY2015. In addition, for FY2012 (P.L. 112-74) and FY2013 (P.L. 113-6), $5 million was added to this program to be used to award competitive grants. This program is administered by the Administration for Children and Families (ACF).
Current status: The funding designated for abstinence education grants expires September 30, 2015.
ACA Section 2951 established the Maternal, Infant, and Early Childhood Home Visiting Program in SSA Section 511. This program provides grants to states, territories, and tribes for the support of evidence-based early childhood home visiting programs. These programs support in-home visits by health or social service professionals with at-risk families. The ACA appropriated a total of $1.5 billion for FY2010 through FY2014 for the home visitation grant program. PAMA extended this funding through March 31, 2015. Of the amount appropriated for this program, 3% annually is reserved for research and evaluation and 3% annually is reserved to make grants to tribal entities for home visitation services to Indian families. This program is administered collaboratively by the Maternal and Child Health Bureau at HRSA and ACF.
Current status: The funding designated for Maternal, Infant, and Early Childhood Home Visiting Program expires March 31, 2015.
ACA Section 2953 established the Personal Responsibility Education Program (PREP) in Section 513 of the SSA. PREP is a state formula grant program to support evidence-based programs designed to educate adolescents about abstinence, contraception, and adulthood. The ACA also required the Secretary of Health and Human Services (the Secretary) to award grants to implement innovative youth pregnancy prevention strategies and to target services to high-risk populations. The ACA appropriated a total of $375 million, with $75 million appropriated for each of FY2010 through FY2014. The ACA required that $10 million each year be reserved for the youth pregnancy prevention grants. PAMA extended funding for the program through FY2015. The funds are available until expended. The program is administered by ACF.
Current status: The funding designated for PREP expires September 30, 2015. The funds are available until expended.
See SSA Section 1871.
Current status: The appropriation in Section 1139A(i) for funding to carry out SSA Section 1139A expired in FY2013; the funding designated to carry out SSA Section 1139A(b) expired in FY2014.
Current status: The appropriation in SSA Section 1139B(e) for funding to carry out SSA Section 1139B and SSA Section 1139A(b) expired in FY2014.
Current Status: The Medicare therapy cap exceptions process and the associated mandated medical review expire March 31, 2015.
Current Status: Increased Medicare ambulance payments in low population density areas apply through March 31, 2015.
Current Status: The MIPAA Medicare rural and urban add-on payments expire on March 31, 2015.
Current Status: The Medicare PQRS incentive payments expired on December 31, 2014, with a penalty imposed beginning in 2015 and in subsequent years for professionals who do not successfully report. There is no expiration for this penalty.
Current Status: The 1.0 floor for the Medicare physician fee schedule work geographic index will expire on March 31, 2015.
Current Status: No Medicare EHR payment incentives will be provided after December 31, 2016, regardless of what year the physician first receives an incentive payment.
Current Status: Enrollment in SNPs will no longer be limited to special needs individuals after December 31, 2016.
Current Status: MDH special payment status expires for discharges starting April 1, 2015.
Current status: The low-volume adjustment will revert to original standards starting for discharges on April 1, 2015. These standards are set in statute at more than 25 road miles and less than 800 discharges. As directed, CMS examined the empirical cost relationship and set the standards at fewer than 200 total discharges established at Title 42, Section 412.101, of the Code of Federal Regulations.
Current Status: Funding for low-income Medicare beneficiary outreach and education is available for obligation through March 31, 2015.
Current Status: Medicare cost contracts can be extended or renewed indefinitely, except that beginning on or after January 1, 2016, these contracts may not be extended or renewed in areas that during the entire previous year had two or more MA regional plans or two or more MA local plans offered by different organizations, with a minimum enrollment. This means that such plans will not be renewed at the end of 2016, based on minimum enrollment data for the 2015 contract year, and will cease to operate at the end of 2016.
Current Status: Incentive payments to hospitals for the meaningful use of EHRs were authorized from FY2011 through FY2014.
Current Status: Funding to carry out the quality measure selection activities under SSA Section 1890A(a)-(d) will expire on March 31, 2015. The funding will remain available until expended.
Current Status: Funding for the contract with the consensus-based entity (NQF) will expire on March 31, 2015. Funds transferred will remain available until expended.
Current Status: The Medicare HH PPS rural add-on will expire on December 31, 2015.
Current Status: The QI program authorization expires on March 31, 2015, and $1.035 billion has been appropriated through the second quarter of FY2015 (March 31, 2015).
Under Medicaid, for the most part, states establish their own payment rates for Medicaid providers. Federal statute requires that these rates be sufficient to enlist enough providers so that covered benefits will be available to Medicaid enrollees at least to the same extent they are available to the general population in the same geographic area.
Current Status: The requirement for states to provide Medicaid primary care payments at parity with Medicare and the full federal financing of the increased primary care rates expired December 31, 2014.
Under federal law, states are required to continue Medicaid benefits for certain low-income families that would otherwise lose coverage because of changes in their income. This continuation, called transitional medical assistance (TMA), requires four months of TMA for families that lose Medicaid eligibility due to increased spousal support collections, as well as those who lose eligibility due to an increase in earned income or hours of employment. Section 303(a)(1) of the Family Support Act of 1988 (P.L. 100-485) expanded work-related TMA and requires states to provide at least 6, and up to 12, months of coverage. Since 1996, these work-related TMA requirements have been funded by short-term extensions.
Current status: Medicaid work-related TMA will expire after March 31, 2015.
CHIPRA created a state plan option for "Express Lane" eligibility, through September 30, 2013, whereby states are permitted to rely on a finding from specified "Express Lane" agencies (e.g., those that administer programs such as Temporary Assistance for Needy Families, Medicaid, CHIP, and Food Stamps) for (1) determinations of whether a child has met one or more of the eligibility requirements necessary to determine his or her initial eligibility, (2) eligibility redeterminations, or (3) renewal of eligibility for medical assistance under Medicaid or CHIP.
Current status: Authority for "Express Lane" eligibility determinations will expire after September 30, 2015.
Current Status: Authority for individuals to exclude certain earnings from participation in a clinical trial for rare diseases or conditions when determining Medicaid income eligibility will expire five years after the date of enactment (i.e., October 5, 2015).
Medicaid is jointly financed by the federal government and the states. The federal government's share of a state's expenditures for most Medicaid services is called the federal medical assistance percentage (FMAP), which varies by state and is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national average (and vice versa for states with higher per capita incomes). Exceptions to the regular FMAP rate have been made for certain states, situations, populations, providers, and services.
Current Status: The additional Medicaid FMAP increase for certain expansion states expires on December 31, 2015.
The Balancing Incentive Payments (BIP) Program authorizes CMS to provide incentive payment grants to qualifying state Medicaid programs for increasing their share of long-term services and supports (LTSS) spending on home and community-based services while reducing their share of spending on institutional long-term care. To be eligible to receive incentive payments, states must have spent less than 50% of total Medicaid medical assistance spending on non-institutionally based LTSS for FY2009, among other requirements. Participating states will receive an FMAP rate increase for eligible medical assistance payments.
Current status: Authority for Medicaid BIP Program payments to states will expire after September 30, 2015.
ACA Section 5507(a) required the Secretary to establish a demonstration project in SSA Section 2008 that awarded funds to states, Indian tribes, institutions of higher education, and local workforce investment boards for health profession opportunity grants (HPOG). These grants were used to help low-income individuals—including individuals receiving assistance from the State Temporary Assistance for Needy Families (TANF) program—to obtain education and training in health care jobs that pay well and are in high demand. Funds also were used to provide financial aid and other supportive services. The section appropriated $85 million for each of FY2010 through FY2014 ($425 million total) but reserved a total of $15 million for a demonstration project for personal and home care aides from FY2010 through FY2012. PAMA extended funding for the HPOG program through FY2015. This program is administered jointly by HRSA and ACF.
Current status: Health Professions Opportunity Grants are funded through September 30, 2015.
Federal funding for CHIP is provided through FY2015 with appropriation amounts in statute that are the overall annual ceiling on federal CHIP spending to the states, the District of Columbia, and the territories. CHIP was established as part of the Balanced Budget Act of 1997 (P.L. 105-33). Since that time, other federal laws have provided additional years of appropriation amounts.
Current Status: FY2015 is the last year for which a CHIP appropriation amount is provided.
State allotments are the federal funds allocated to each state for the federal share of their CHIP expenditures. State CHIP allotment funds are provided annually, and the funds are available to states for two years. There are two formulas for determining state allotments: an even year formula and an odd year formula. In even years, such as FY2014, state CHIP allotments are each state's previous year allotment plus any Child Enrollment Contingency Fund (described below) payments from the previous year adjusted for health care inflation and child population growth in the state. For even years, the allotment amount can be adjusted to reflect CHIP eligibility or benefit expansions. In odd years, state CHIP allotments are each state's previous year spending (including federal CHIP payments from the state CHIP allotment, Child Enrollment Contingency Funds, and redistribution funds) adjusted using the same growth factor as the even year formula (i.e., health care inflation and child population growth in the state). Since the odd year formula is based on states' actual use of CHIP funds, it is called the "re-basing year" because a state's CHIP allotment can either increase or decrease depending on each state's CHIP expenditures in the previous year.
Current Status: CHIP allotments are authorized through FY2015.
If a state's CHIP allotment for the current year, in addition to any allotment funds carried over from the prior year, is insufficient to cover the projected CHIP expenditures for the current year, a few different shortfall funding sources are potentially available. These include Child Enrollment Contingency Fund payments, redistribution funds, and Medicaid funds. For FY2009 through FY2015, Child Enrollment Contingency Fund payments have been available to states with both a funding shortfall (i.e., current year CHIP allotment plus any unused CHIP allotment funds from the previous year are insufficient to cover the federal share of the state's CHIP program) and CHIP enrollment for children exceeding a target level. As a result, not all states with funding shortfalls are eligible for Child Enrollment Contingency Fund payments. The contingency fund payments are based on a state's growth in CHIP enrollment and per capita spending. This means that a state may receive a payment from the fund that does not equal its actual shortfall in CHIP funding.
Current Status: CHIP Child Enrollment Contingency Fund payments are authorized through September 30, 2015.
In a few situations, federal CHIP funding is used to finance Medicaid expenditures. For instance, certain states significantly expanded Medicaid eligibility for children prior to the enactment of CHIP in 1997. These states are allowed to use their CHIP allotment funds to fund the difference between the Medicaid and CHIP matching rates (i.e., federal medical assistance percentage [FMAP] and enhanced federal medical assistance percentage [E-FMAP] rates, respectively) to finance the cost for children in Medicaid above 133% FPL. The following 11 states meet the definition: Connecticut, Hawaii, Maryland, Minnesota, New Hampshire, New Mexico, Rhode Island, Tennessee, Vermont, Washington, and Wisconsin. This is referred to as the "qualifying state" option, and FY2015 is the last year the qualifying state option is authorized.
Current Status: The qualifying state option is authorized through September 30, 2015.
CHIPRA authorized $100 million in outreach and enrollment grants in addition to the regular CHIP allotments for fiscal years 2009 through 2013. Ten percent of the allocation is directed to a national enrollment campaign, and 10% is targeted to outreach for Native American children. The remaining 80% is distributed among state and local governments and to community-based organizations for purposes of conducting outreach campaigns with a particular focus on rural areas and underserved populations. Grant funds are also targeted to proposals that address cultural and linguistic barriers to enrollment.
Current status: Authority for CHIP outreach and enrollment grants will expire after September 30, 2015.
See "Adult Quality Measures (SSA Section 1139B(e))" and "CHIPRA Children's Health Care Quality Measures (SSA Section 1139A(i))," above.
The ACA created the Community Health Center Fund (CHCF) that provided mandatory funding for federal health centers authorized in PHSA Section 330.15 These centers are located in medically underserved areas and provide primary care, dental care, and other health and supportive services to individuals regardless of their ability to pay.
Current Status: Funding for the Community Health Center Fund is appropriated through FY2015. Funds transferred will remain available until expended.
The BBA97 authorized two diabetes-related programs within the PHSA. The first, authorized in Section 330B, provides funding for the National Institutes of Health16 to award grants for research into the prevention and cure of Type I diabetes. The second, authorized in Section 330C, provided funding for the Indian Health Service (IHS)17 to award grants for services related to the prevention and treatment of diabetes for American Indians and Alaska Natives who receive services at IHS-funded facilities.18
Current Status: Funding for the two PHSA diabetes-related programs will expire on September 30, 2015.
The ACA created the Community Health Center Fund that provided mandatory funding for the National Health Service Corps (NHSC), authorized in Title III of the PHSA, which provides scholarships and loan repayments to certain health professionals in exchange for providing care in a health professional shortage area for a period of time that varies based on the length of the scholarship or the number of years of loan repayment received.
Current Status: Funding for the National Health Service Corp is appropriated through FY2015. Funds transferred will remain available until expended.
The ACA Section 5508(c) created PHSA Section 340H, which required the Secretary to make direct and indirect Graduate Medical Education payments to qualified teaching health centers.
Current Status: Funding for direct and indirect Graduate Medical Education payments to teaching health centers has been provided through September 30, 2015.
The ACA authorizes grants to states for the planning and establishment of health insurance exchanges. Exchanges are marketplaces where individuals and small businesses can "shop" for health insurance sold by private insurance companies. The ACA provides an indefinite appropriation for the exchange grants. For each fiscal year, the HHS Secretary is to determine the total amount that will be made available to each state for exchange grants.
Current status: Authority for the exchange grants terminated after December 31, 2014. However, states may continue to use the grant funding they previously received for exchange design and implementation in 2015 and beyond.
The following provisions have expiration dates on or before December 31, 2013, and were not addressed in any subsequent legislation.
The ACA included maintenance of effort (MOE) provisions under which states were required to maintain their Medicaid programs for adults with no more restrictive eligibility standards, methodologies, and procedures until the exchanges were operational (i.e., through December 31, 2013), and for Medicaid-eligible children up to the age of 19 until September 30, 2019. Failure to comply with the ACA MOE requirements means a state loses all of its federal Medicaid matching funds.
Current Status: The ACA adult MOE requirement expired December 31, 2013.
The Medicaid statute requires that states make disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. While most federal Medicaid funding is provided on an open-ended basis, federal DSH funding is capped. Each state receives an annual DSH allotment, which is the maximum amount of federal matching funds a state is permitted to claim for Medicaid DSH payments. States' Medicaid DSH allotments are based on each state's prior year DSH allotment, but Hawaii and Tennessee have special statutory arrangements for the determination of their respective DSH allotments provided through multiple laws. Most recently, the ACA provided Hawaii a Medicaid DSH allotment for FY2012 and subsequent years, and the Tennessee provision provided an allotment for FY2012 and FY2013.
Current Status: For FY2014 and subsequent years, Tennessee is the only state without a Medicaid DSH allotment.
CHIPRA established performance bonus payments for states that increase their Medicaid (not CHIP) enrollment among low-income children above a defined baseline. From FY2009 through FY2013, performance bonus payments were available to states. To qualify for bonus payments, states had to have (1) implemented five out of eight specified enrollment and retention provisions and (2) achieved state-specific targets for increasing Medicaid enrollment among children. There were two tiers of bonus payments depending on how much the state's enrollment exceeded the baseline. From FY2009 through FY2013, 27 states received CHIPRA performance bonus payments totaling $1.1 billion over the five years. Some states received payments in more than one year.
Current Status: CHIPRA performance bonus payments were authorized through FY2013.
In the early years of the CHIP program, states were permitted and encouraged to extend CHIP coverage to uninsured pregnant women, parents, and childless adults aged 19 and older generally through the use of the Section 1115 waiver authority. However, Congress acted to largely limit this practice through a series of laws. The DRA prohibited the use of CHIP funds from coverage of non-pregnant childless adults in any new waivers approved after February 8, 2006. CHIPRA terminated CHIP coverage of non-pregnant childless adults by the end of calendar year 2009, prohibited new states from obtaining waivers to extend CHIP coverage to uninsured parents, and phased out coverage of parents altogether by FY2014.
Current Status: The authority for states to use CHIP federal matching funds for parent coverage waivers expired September 30, 2013.
ACA directly appropriated funding to support construction and renovation of school-based health centers. The ACA appropriated $50 million for each of FY2010 through FY2013 for a total of $200 million.
Current status: No funding was appropriated in FY2014 or in F2015 as of the publication date of this report.
Author Contact Information
Acknowledgments
Elizabeth Crowe, research assistant, assisted in the formatting and organization of this report.
| 1. |
The Congressional Research Service (CRS) does not determine committee jurisdiction. The programs included in this report are generally those that the Senate Finance Committee; the Senate Committee on Health, Education, Labor, and Pensions; the House Committee on Energy and Commerce; and the House Committee on Ways and Means typically have exercised jurisdiction over. However, there may be some programs for which jurisdiction has not been explicitly established. |
| 2. |
A less common type of expiring provision is one that temporarily delays the implementation of a regulation, requirement, or deadline. For example, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) delayed the implementation of the revised case-mix classification methodology for payments to skilled nursing facilities (Resource Utilization Group–Version Four; RUG-IV) until October 1, 2011. There are currently no health care–related provisions of this type expiring in 2015. |
| 3. |
The 5% bonus for certain Medicare mental health services was in place from July 1, 2008, to February 29, 2012. |
| 4. |
CRS Report R40907, Medicare Physician Payment Updates and the Sustainable Growth Rate (SGR) System. |
| 5. |
CRS Report R41196, Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline. |
| 6. |
CRS Report RL30526, Medicare Payment Updates and Payment Rates. |
| 7. |
For more information on abstinence education programs in Title V of the Social Security Act (SSA), see CRS Report RS20301, Teenage Pregnancy Prevention: Statistics and Programs. |
| 8. |
For more information on the Maternal and Child Health Block Grant, see CRS Report R42428, The Maternal and Child Health Services Block Grant: Background and Funding. |
| 9. |
Funding for the Abstinence Education Program was $37.5 million in FY2009 (i.e., rate of $50 million per year for three-quarters of the fiscal year). |
| 10. |
For FY2012, Division F, Title II of the Consolidated Appropriations Act, 2012 (P.L. 112-74) provided an additional $5 million for competitive abstinence education grants to supplement the formula grants under SSA §510. |
| 11. |
MCTRJCA added the following requirements: (1) Any request for such an exception, for services furnished on or after October 1, 2012, would be subject to a manual medical review process "that is similar to the manual medical review process used for certain exceptions under this paragraph in 2006"; (2) claims are to include a modifier specifying that "the services are medically necessary as justified by appropriate documentation in the medical record involved"; (3) beginning October 1, 2012, the national provider identifier (NPI) of the physician who reviews the therapy plan be included in each request for payment, or bill submitted, for therapy services; (4) not later than June 15, 2013, the Medicare Payment Advisory Commission (MedPAC) is to submit a report making recommendations on how to improve the outpatient therapy benefit under Medicare Part B that is to include recommendations on how to reform the payment system for outpatient therapy services so that the benefit is better designed to reflect individual acuity, condition, and therapy needs of the patient, as well as an examination of private sector initiatives relating to outpatient therapy benefits; (5) to assist in reforming the Medicare payment system for outpatient therapy services, beginning on January 1, 2013, the Secretary is to collect claims-based data on patient function during the course of therapy services in order to better understand patient condition and outcomes; and (6) not later than May 1, 2013, the Comptroller General is to submit a report on the implementation of the manual medical review process that will include aggregate data on the number of individuals and claims affected, the number of reviews conducted, and the outcome of such reviews. |
| 12. |
Generally, Medicare physician fee schedule payment rates are established by rule on a calendar year basis. |
| 13. |
In 2011, CMS changed the name from the Physician Quality Reporting Initiative (PQRI) to the Physician Quality Reporting System (PQRS). See http://www.cms.gov/PQRS/. |
| 14. |
For details, see CRS Report R42944, Medicare, Medicaid, and Other Health Provisions in the American Taxpayer Relief Act of 2012. |
| 15. |
For more information on health centers, see CRS Report R42433, Federal Health Centers. |
| 16. |
For more information on the National Institutes of Health, see CRS Report R41705, The National Institutes of Health (NIH): Background and Congressional Issues. |
| 17. |
For more information on the Indian Health Service, see CRS Report R43330, The Indian Health Service (IHS): An Overview. |
| 18. |
IHS-funded facilities refer to facilities operated directly by the IHS, by an Indian Tribe, a Tribal Organization, or an Urban Indian Organization as these terms are defined in §4 of the Indian Health Care Improvement Act (25 U.S.C. §1604). |