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Thursday, September 9, 2010

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

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

The Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), as amended by the Health Care and Education Reconciliation Act (HCERA; P.L. 111-152), authorizes new funding for numerous existing discretionary grant and other programs and activities. PPACA, as amended, also creates a number of new discretionary grant programs and activities and provides 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 provisions in PPACA for which appropriations are authorized. A companion product, CRS Report R41301, Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA), summarizes all the mandated 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, PPACA permanently reauthorizes 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 seeks to address concerns about the current size, specialty mix, and geographic distribution of the health care workforce. It reauthorizes and expands 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. PPACA creates several new programs to increase training experiences in primary care, in rural areas, and in community-based settings, and provides training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also expands 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, PPACA authorizes 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 leverages 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, PPACA authorizes 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 new law also reauthorizes the Indian Health Care Improvement Act (IHCIA), which sets out the national policy for Indian health care and authorizes programs and services provided by the Indian Health Service. For more information on PPACA' s Indian health provisions, which are not discussed in this report, see CRS Report R41152, Indian Health Care Improvement Act Provisions in the Patient Protection and Affordable Care Act (PPACA)

Date of Report: September 2, 2010
Number of Pages: 32
Order Number: R41390
Price: $29.95

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