Community Living Assistance Services and Supports (CLASS) Provisions in the Patient Protection and Affordable Care Act (PPACA)

Janemarie Mulvey
Specialist in Aging and Income Security

Kirsten J. Colello
Specialist in Health and Aging Policy

Under current law, the majority of paid long-term care (LTC) services are funded by public programs, such as Medicaid and Medicare. However, these programs are limited in scope and continue to face increased financial pressures. Although private LTC insurance is available to provide some financial protection against an individual's risk of the potentially high cost of LTC, fewer than 10% of individuals aged 50 and older own such a policy. Thus, for the majority of older Americans, the out-of-pocket cost of obtaining paid help for these services may far exceed their financial resources. To address gaps in LTC coverage and assist individuals and families in paying for such services, the recently enacted Patient Protection and Affordable Care Act (PPACA; P.L. 111-148) establishes a federally administered voluntary LTC insurance program entitled the Community Living Assistance Services and Supports (CLASS) program. PPACA creates a new Title XXXII of the Public Health Service Act (PHSA) titled Community Living Assistance Services and Supports.

Once established, employed individuals aged 18 and older can voluntarily enroll in the CLASS program. PPACA specifies two processes for enrollment into the CLASS program. The first is an automatic enrollment process. This is a voluntary program and employers would have the option of participating. Within the automatic enrollment process, employers who choose to participate would be responsible for withholding CLASS premiums through payroll deductions. Employees would then have the opportunity to "opt-out" if they do not want to participate. These enrollment procedures for employers in the CLASS program are intended to be similar to those currently established for 401(k) and other similar retirement plans by the Internal Revenue Service. An alternative enrollment process would also be developed for self-employed individuals, those with more than one employer, and those who have an employer that does not elect to participate in the automatic enrollment process.

Premiums for the CLASS program are to be determined by the Secretary based on 75-year actuarial estimates of expected future use and expenditures. Premiums would vary by age at enrollment. PPACA also includes premium subsidies for workers with incomes below the federal poverty level and full-time students aged 18 to 21 who currently are working. To be eligible to receive benefits an individual must be an active enrollee who meets the five-year vesting and minimum earnings requirements. In addition, an eligible individual must have a functional limitation, as certified by a licensed health care practitioner, that is expected to last for 90 days. Benefits to eligible recipients include a cash benefit of at least an average of $50 a day (based on the reasonably expected distribution of beneficiaries receiving benefits at various levels). Other benefits include advocacy services, and advice and assistance counseling on accessing and coordinating LTC services.

This report first discusses the cost and financing for LTC services as well as the current market for private LTC insurance. It then details those CLASS program requirements for enrollment, premiums, eligibility, benefits, administration and oversight as specified in PPACA. This report then discusses the federal budget implications of the CLASS program, as estimated by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services (CMS). Finally, the report provides a timeline of CLASS program provisions enacted under PPACA. .


Date of Report: July 20, 2010
Number of Pages: 18
Order Number: R40842
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The Americans with Disabilities Act: Application to the Internet

Nancy Lee Jones
Legislative Attorney

The Americans with Disabilities Act (ADA) provides broad nondiscrimination protection in employment, public services, public accommodations, and services operated by private entities, transportation, and telecommunications for individuals with disabilities. As stated in the act, its purpose is "to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities."

However, the ADA, enacted on July 26, 1990, prior to widespread use of the Internet, does not specifically cover the Internet, and the issue of coverage has not been definitively resolved. The Supreme Court has not addressed this issue, although there are some lower court decisions. The cases that directly discuss the ADA's application to the Internet vary in their conclusions about coverage.

The American Recovery and Reinvestment Act (ARRA) did not specifically mention Internet accessibility, but did include the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of P.L. 111-5, and also directed the Federal Communications Commission (FCC) to develop a national broadband plan. The FCC released its plan on March 16, 2010.


Date of Report: July 22, 2010
Number of Pages: 14
Order Number: R40462
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Medicaid: The Federal Medical Assistance Percentage (FMAP)

April Grady
Specialist in Health Care Financing

Medicaid is a health insurance program jointly funded by the federal government and the states. Historically, eligibility for Medicaid was generally limited to low-income children, pregnant women, parents of dependent children, the elderly, and people with disabilities; however, recent changes will soon require coverage for childless adults as well. The federal government's share of a state's expenditures for most Medicaid services is called the federal medical assistance percentage (FMAP). The remainder is referred to as the nonfederal share, or state share. 

Generally determined annually, the FMAP is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita income relative to the national average (and vice versa for states with higher per capita incomes). For FY2011, regular FMAPs—that is, excluding the impact of the temporary FMAP increase included in the American Recovery and Reinvestment Act of 2009 (ARRA, P.L. 111-5)—range from 50.00% to 74.73%. 

The temporary FMAP increase in ARRA is available for nine quarters, subject to certain requirements. The Administration has estimated that the provision will increase federal Medicaid payments to states by more than $90 billion. The ARRA FMAPs end December 31, 2010, but many states assumed that a six-month extension would be provided when they planned their SFY2011 budgets (most of which began on July 1). 

Although H.R. 4213 had been the recent vehicle for a six-month extension of ARRA FMAPs, the House and Senate ultimately agreed to a version of the bill that excluded it. Future congressional action on an extension is uncertain. 

The recently enacted Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended by P.L. 111-152) also contains a number of provisions that affect FMAPs. Most notably, it provides FMAPs of up to 100% for certain newly eligible individuals. It also provides—subject to various requirements—increased FMAPs for certain disaster-affected states, primary care payment rate increases, specified preventive services and immunizations, smoking cessation services for pregnant women, specified home and community-based services, and health home services for certain people with chronic conditions.

Date of Report: June 23, 2010
Number of Pages: 23
Order Number: RL32950
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Coal Mine Safety and Health

Linda Levine
Specialist in Labor Economics

Fatal injuries associated with coal mine accidents fell almost continually between 1925 and 2005. In 2006, however, the number of fatalities more than doubled to 47, which prompted the 109th Congress to enact the Mine Improvement and New Emergency Response Act (MINER, P.L. 109- 236). Fatalities declined in subsequent years and dropped to a low of 18 in 2009. After the deaths of 29 coal miners at Massey Energy's Upper Big Branch (UBB) mine in West Virginia on April 5, 2010, the 111th Congress turned its attention to the issue of mine safety.

In the wake of the methane explosion at Sago mine in West Virginia in January 2006, the Mine Safety and Health Administration (MSHA) was criticized for its slow pace of rulemaking earlier in the decade. MSHA standard-setting activity quickened after enactment of the MINER act in June 2006. The amendment of the 1977 Mine act emphasized factors thought to have played a role at Sago and other recent incidents, and imposed several rulemaking deadlines on MSHA. The agency published all the requisite final standards except one: the MINER act required that, by June 15, 2009, two-way wireless communications systems and electronic tracking systems be part of emergency response plans (ERPs). In January 2009, MSHA issued a letter stating that "because fully wireless communications technology is not sufficiently developed at this time, nor is it likely to be technologically feasible by June 15, 2009 ... [n]ew ERPs and revisions to existing ERPs should provide for alternatives to fully wireless communication systems."

Some Members characterized passage of the MINER act as a first step. In 2008, the House passed the Supplemental Mine Improvement and New Emergency Response Act (S-MINER) as amended. Some of the bill's provisions addressed issues that arose from the Crandall Canyon Mine incident in Utah in August 2007. S-MINER was opposed by the Bush Administration.

In 2010, one issue policymakers have focused on is the greatly increased number of citations for violations being contested by mine operators. The UBB mine incident brought to public attention the potential implications for miner safety of operators appealing to the Federal Mine Safety and Health Review Commission (FMSHRC) penalty assessments proposed by MSHA. Through publication of an interim rule and a notice of proposed rulemaking in spring 2010, FMSHRC intends to speed its civil penalty proceedings and thereby more quickly issue final orders that MSHA can include when determining whether a mine should be placed in pattern of violations (POV) status. The Miner Safety and Health Act of 2010 (H.R. 5663), introduced on July 1, includes provisions changing POV criteria as well as withdrawing all persons from coal or other mines in POV status and doubling the number of mandated inspections at those mines. The bill also defines in statute significant and substantial mine safety and health violations, strengthens whistleblower protections for miners and other workers covered by the Occupational Safety and Health Act (OSH Act), and amends civil and criminal penalty provisions in the Mine act and the OSH Act. H.R. 5663's amendment of the OSH Act is similar to provisions in the Protecting America's Workers Act (H.R. 2067, S. 1580). The Committee on Education and Labor held a hearing on the bill on July 13, 2010.


Date of Report: June 15, 2010
Number of Pages: 18
Order Number: RL34429
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Individual Mandate and Related Information Requirements under PPACA

Hinda Chaikind
Specialist in Health Care Financing

Chris L. Peterson
Acting Section Research Manager

This report describes the individual mandate under §1501 and §10106 of the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), as amended by §1002 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). Hereafter, "PPACA" will refer to PPACA as amended by the reconciliation act and other laws. In addition, PPACA includes several reporting requirements designed, in part, to assist individuals in providing evidence of having met the mandate, as well as other related information about their health insurance. These requirements are also described in this report.

Beginning in 2014, PPACA requires individuals to maintain health insurance, with some exceptions. Most individuals will be required to maintain minimum essential coverage, which includes eligible employer coverage, individual coverage, grandfathered plans, and federal programs such as Medicare and Medicaid, among others. Those who do not maintain minimum essential coverage, and who are not exempt from the mandate, will be required to pay a penalty for noncompliance.


Date of Report: July 20, 2010
Number of Pages: 16
Order Number: R41331
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New Entities Created Pursuant to the Patient Protection and Affordable Care Act

Curtis W. Copeland
Specialist in American National Government

The Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, March 23, 2010) creates, requires others to create, or authorizes dozens of new entities to implement the legislation. Some of these new entities are offices within existing cabinet departments and agencies, and are assigned certain administrative or representational duties related to the legislation. Other entities are new boards and commissions with particular planning and reporting responsibilities. Still others are advisory bodies that were created to study particular issues, offer recommendations, or both. Although PPACA describes some of these new organizations and advisory bodies in detail, in many cases it is currently impossible to know how much influence they will ultimately have over the implementation of the legislation.

This report describes dozens of new governmental organizations or advisory bodies that are mentioned in PPACA, but does not include other types of entities that were created by the legislation (e.g., various demonstration projects, grants, trust funds, programs, systems, formulas, guidelines, risk pools, websites, ratings areas, model agreements, or protocols). A table in the Appendix is organized in terms of entities (1) that were created by PPACA itself (e.g., through statutory language stating that an organization is "established" or "created"); (2) that PPACA requires the President to establish (e.g., "the President shall establish"); (3) that PPACA requires the Secretary of the Department of Health and Human Services (HHS) to establish (e.g., "the Secretary shall establish"); (4) that PPACA requires some other organization to establish; and (5) that PPACA authorizes to be established. For each entity listed, the table identifies (to the extent provided in the legislation) the relevant section of PPACA, the name of the entity, the date that the entity is required to be created and its location, the composition of the entity and its leadership, and the purpose and duties of the entity.

The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable, for the number of entities created by some sections is contingent upon other factors, and some new entities may satisfy more than one requirement in the legislation. Although PPACA states that certain entities were "established" by the legislation, in practical terms, these entities will not be able to function until members are appointed and appropriations are provided or made available. The legislation sometimes indicates when and where certain entities are to be established, how members are to be appointed, the amount and timing of appropriations, whether certain general management laws are applicable, and when the entities will cease to exist. In other cases, however, PPACA is silent with regard to these and other issues. The degree of specificity in these provisions may have implications for congressional control and, conversely, the amount of discretion that agencies will have in the implementation of the legislation. PPACA significantly increased the appointment responsibilities of the Comptroller General of the United States, and it is unclear how the Government Accountability Office (GAO) will be able to independently audit entities whose members are appointed by the head of GAO.


Date of Report: July 8, 2010
Number of Pages: 42
Order Number: R41315
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The Genetic Information Nondiscrimination Act of 2008 and the Patient Protection and Affordable Care Act of 2010: Overview and Legal Analysis of Potential Interactions

Amanda K. Sarata, Coordinator
Specialist in Health Policy

Nancy Lee Jones
Legislative Attorney

Jennifer Staman
Legislative Attorney

Upon the enactment of the Patient Protection and Affordable Care Act (PPACA), as amended, certain questions have been raised about how PPACA might affect existing law. One such existing law, the Genetic Information Nondiscrimination Act (GINA), is a civil rights statute and has as its purpose the prohibition of discrimination against individuals on the basis of genetic information. In order to effectuate this prohibition, GINA not only contains certain requirements for health insurance and a general prohibition of employment discrimination provisions, but also has strong privacy protections. On the other hand, PPACA is comprehensive health care legislation that is intended to, among other things, enhance consumer protections in the private health insurance market. Both GINA and PPACA contain provisions affecting certain elements of health insurance, as well as employment-based wellness programs. PPACA, the more recent statute, does not specifically amend GINA and also does not reference GINA's requirements. The two laws serve different but complementary purposes, and there is no explicit conflict or contradiction in their terms. Still, the interaction of these two acts may be analyzed.

This report provides a brief overview of GINA, an overview of relevant PPACA and GINA provisions relating to the provision of health insurance through the private market and the implementation of employer wellness programs, and statutory analysis of the potential interactions between the related provisions in both laws.


Date of Report: July 8, 2010
Number of Pages: 14
Order Number: R41314
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The Americans with Disabilities Act (ADA): Statutory Language and Recent Issues

Nancy Lee Jones
Legislative Attorney

The Americans with Disabilities Act (ADA) provides broad nondiscrimination protection in employment, public services, public accommodations, services operated by public entities, transportation, and telecommunications for individuals with disabilities. This report summarizes the major provisions of the ADA and analyzes selected recent issues, including the Supreme Court cases and the ADA Amendments Act of 2008.


Date of Report: July 8, 2010
Number of Pages: 38
Order Number: 98-921
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Health Insurance: State High Risk Pools

Bernadette Fernandez
Analyst in Health Care Financing

In an effort to expand the options for health coverage, 35 states have established high risk health insurance pools. These programs target individuals who cannot obtain or afford health insurance in the private market, primarily because of preexisting health conditions. Also, many states use their high risk pools to comply with the portability and guaranteed availability provisions of the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).

In general, state high risk pools tend to be small and enroll a small percentage of the uninsured. In 2008, a total of 199,418 individuals were enrolled in the 34 high risk pools in operation that year. State-established nonprofit organizations typically run these pools, with private insurance companies handling day-to-day operations. Although benefit packages vary across states and plans, they generally reflect health benefits that are available in the private insurance market. The majority of high risk pools cap premiums between 150% to 200% of market rates, and pools are subsidized through insurer assessments and other funding mechanisms.

The Trade Act of 2002 (P.L. 107-210) appropriated a total of $100 million for FY2003-FY2004. With the expiration of authorizing legislation for federal funding of state pools, the 109th Congress took up this issue. The House passed H.R. 4519, the State High Risk Pool Funding Extension Act of 2006, which reauthorized federal grants to state high risk pools through FY2010, and changed the funding formula used for such grants. The Act authorized $15 million for seed grants and $75 million for operational and bonus grants for FY2006. The Senate passed H.R. 4519 without amendment, and it was signed into law (P.L. 109-172) on February 10, 2006.

As part of the budget reconciliation process, the Senate passed S. 1932, the Deficit Reduction Act of 2005 (DRA) conference agreement, which provided appropriations for the grants authorized under H.R. 4519. The measure also included conforming language on enactment of H.R. 4519. The House agreed to the Senate-amended DRA bill, and it was signed it into law (P.L. 109-171) on February 8, 2006. The Centers for Medicare and Medicaid Services (CMS) awarded grants to 31 states that experienced operational losses in 2005. Of those 31 states, 25 also received bonus grants. In 2006, CMS awarded seed grants to five states, and to another five states in 2007.

The 110th Congress took up the issue of extending the federal grant program by making funding available pursuant to the Consolidated Appropriations Act of 2008 (P.L. 110-161). The grant funding totaled $49,127,000. In July 2008, CMS announced that 30 states received operational and bonus grants totaling $49,126,500.

The 111th Congress provided $75,000,000 in appropriations for grants to state high risk pools under the Omnibus Appropriations Act of 2009 (P.L. 111-8). In May of 2009, CMS announced the availability of these grants. To date, the grant awards have not been posted by CMS.

The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA) was signed into law on March 23, 2010. On March 30, 2010, PPACA was amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). PPACA requires the Secretary of Health and Human Services to establish a temporary high risk pool program, no later than 90 days after enactment, to provide health insurance coverage to eligible individuals. To date, the Secretary has issued letters to governors and insurance commissioners to survey state interest in participating in this new high risk pool program.


Date of Report: June 23, 2010
Number of Pages: 15
Order Number: RL31745
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Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act (PPACA)

C. Stephen Redhead
Specialist in Health Policy

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). The following week, on March 30, 2010, the President signed the Health Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152), which amended various health care and revenue provisions in PPACA.

Among its many provisions, PPACA (as amended by HCERA) restructures the private health insurance market, sets minimum standards for health coverage, creates a mandate for most U.S. residents to obtain health insurance, and provides for the establishment by 2014 of insurance exchanges through which certain individuals and families will be able to receive federal subsidies to reduce the cost of purchasing that coverage. In addition, the new law expands eligibility for Medicaid; reduces the growth in Medicare spending that had been projected under preexisting law; imposes an excise tax on insurance plans found to have high premiums; and makes other changes to the federal tax code, Medicare, Medicaid, and numerous other programs.

In addition, PPACA (as amended) appropriates or transfers from the Medicare Part A and Part B trust funds billions of dollars to support new or existing grant programs and other activities. This report summarizes those appropriations and fund transfers. They include funding for a temporary insurance program for individuals who have been uninsured for several months and have a preexisting condition, as well as funding for states to plan and establish exchanges. PPACA also provides funding for various Medicare and Medicaid demonstration programs, for the creation of a Center for Medicare and Medicaid Innovation to test and implement innovative payment and service delivery models, and for an independent board to provide Congress with proposals for reducing Medicare cost growth and improving quality of care for Medicare beneficiaries.

Among other provisions, the new health reform law appropriates funding for health workforce and maternal and child health programs, and establishes three multi-billion dollar funds. The first fund will provide a total of $11 billion over five years in supplementary funding for community health centers and the National Health Service Corps. (A separate appropriation provides $1.5 billion for health center construction and renovation.) The second fund will support comparative effectiveness research through FY2019 with a mixture of appropriations and fund transfers. The third fund, which is funded in perpetuity, is to support prevention, wellness, and other public health-related programs and activities authorized under the Public Health Service Act.


Date of Report: June 28, 2010
Number of Pages: 13
Order Number: R41301
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Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline

Patricia A. Davis, Coordinator
Specialist in Health Care Financing

Jim Hahn
Analyst in Health Care Financing

Geoffrey J. Hoffman
Analyst in Health Care Financing

Paulette C. Morgan
Specialist in Health Care Financing

Julie Stone
Specialist in Health Care Financing

Sibyl Tilson
Specialist in Health Care Financing

Medicare is a federal program that pays for covered health services for most persons 65 years old and older and for most permanently disabled individuals under the age of 65. The rising cost of health care, the impact of the aging baby boomer generation, and declining revenues in a weakened economy continue to challenge the program's ability to provide quality and effective health services to its 45 million beneficiaries in a financially sustainable manner.

On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148), as passed by the Senate on December 24, 2009, and the House on March 21, 2010. The new law will, among other things, make numerous statutory changes to the Medicare program. On March 30, 2010, the President signed into law H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (the "Reconciliation Act," or HCERA; P.L. 111-152), which modifies a number of Medicare provisions in PPACA and adds several new provisions.

This report, one of a series of CRS products on PPACA and the Reconciliation Act, examines the Medicare related provisions in these Acts. Estimates from CBO on PPACA and the Reconciliation Act indicate that net reductions in Medicare direct spending will reach approximately $390 billion from FY2010 to FY2019. Major savings are expected from constraining Medicare's annual payment increases for certain providers, tying maximum Medicare Advantage payments near or below spending in fee-for-service Medicare, reducing payments to hospitals that serve a large number of low-income patients, creating an Independent Payment Advisory Board to make changes in Medicare payment rates, and modifying the high-income threshold adjustment for Part B premiums. A new Hospital Insurance tax for high-wage earners will also raise approximately $87 billion over 10 years, and a new Medicare tax on net investment income, added by the Reconciliation Act, is expected to raise an additional $123 billion over 10 years.

Other provisions in PPACA address more systemic issues, such as increasing the efficiency and quality of Medicare services and strengthening program integrity. For example, PPACA requires the establishment of a national, voluntary pilot program that will bundle payments for physician, hospital, and post-acute care services with the goal of improving patient care and reducing spending. Another provision adjusts payments to hospitals for readmissions related to certain potentially preventable conditions. In addition, PPACA subjects providers and suppliers to enhanced screening before allowing them to participate in the Medicare program, and both PPACA and the Reconciliation Act increase funding for anti-fraud activities.

PPACA also improves some benefits provided to Medicare beneficiaries. For instance, Medicare prescription drug program enrollees will receive a 50% discount off the price of brand-name drugs during the coverage gap (the "doughnut hole") starting in 2011, and the coverage gap will be phased out by 2020. Other provisions expand assistance for some low-income beneficiaries enrolled in the Medicare drug program, and eliminate beneficiary copayments for certain preventive care services.


Date of Report: June 30, 2010
Number of Pages: 140
Order Number: R41196
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The Americans with Disabilities Act and Emergency Preparedness and Response

Nancy Lee Jones
Legislative Attorney

The Americans with Disabilities Act (ADA) provides broad nondiscrimination protection for individuals with disabilities in employment, public services, and public accommodations and services operated by private entities. Although the ADA does not include provisions specifically discussing its application to disasters, its nondiscrimination provisions are applicable to emergency preparedness and responses to disasters. In order to further the ADA's goals, President Bush issued an Executive Order on July 22, 2004, relating to emergency preparedness for individuals with disabilities and establishing the Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities. The Department of Homeland Security (DHS) issued its Nationwide Plan Review Phase 2 Report, which includes a discussion of people with disabilities and emergency planning and readiness. The National Council on Disability has also issued recommendations on emergency preparation and disaster relief relating to individuals with disabilities. The Post-Katrina Emergency Management Reform Act of 2006 added the position of Disability Coordinator to FEMA.


Date of Report: June 30, 2010
Number of Pages: 10
Order Number: RS22254
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Medicare Primer

Patricia A. Davis, Coordinator
Specialist in Health Care Financing

Medicare is a federal insurance program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act as a federal entitlement program to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services.

Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person with a permanent disability, have End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease).

In FY2010, the program will cover an estimated 47 million persons (39 million aged and 8 million disabled) at an estimated total cost of about $521 billion, accounting for approximately 3.6% of GDP. Medicare is an entitlement program, which means that it is required to pay for services provided to eligible persons so long as specific criteria are met.

Since 1965, the Medicare program has undergone considerable changes. Most recently, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152), signed into law on March 23, 2010, and March 30, 2010, respectively, made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits.

Having passed health reform legislation in March 2010, the remaining months of the 111th Congress may be partly spent working on addressing Medicare physician payment issues and on identifying and making any necessary technical fixes to the March legislation. Over the long term, Congress' focus will include monitoring the implementation and effects of payment and program changes made by the new health care reform laws.


Date of Report: July 1, 2010
Number of Pages: 27
Order Number: R40425
Price: $29.95

Document available via e-mail as a pdf file or in paper form.
To order, e-mail Penny Hill Press or call us at 301-253-0881. Provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.

EMTALA: Access to Emergency Medical Care

Edward C. Liu
Legislative Attorney

The Emergency Medical Treatment and Active Labor Act (EMTALA) ensures universal access to emergency medical care at all Medicare participating hospitals with emergency departments. Under EMTALA, any person who seeks emergency medical care at a covered facility, regardless of ability to pay, immigration status, or any other characteristic, is guaranteed an appropriate screening exam and stabilization treatment before transfer or discharge. Failure to abide by these requirements can subject hospitals or physicians to civil monetary sanctions or exclusion from Medicare. Hospitals may also be subject to civil liability under the statute for personal injuries resulting from the violation.


Date of Report: July 1, 2010
Number of Pages: 11
Order Number: R40227
Price: $29.95

Document available via e-mail as a pdf file or in paper form.
To order, e-mail Penny Hill Press or call us at 301-253-0881. Provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.