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R44100 – Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2017) – 10/7/2016

R44100 – Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2017) – 10/7/2016 published on

Author: C. Stephen Redhead, Specialist in Health Policy; Ada S. Cornell, Information Research Specialist
Pages: 22

Congress remains deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA), the health reform law enacted in March 2010. Since the ACA’s enactment, lawmakers opposed to specific provisions in the ACA or the entire law have repeatedly debated its implementation and considered bills to repeal, defund, delay, or otherwise amend the law. In addition to considering ACA repeal or amendment in authorizing legislation, some lawmakers have used the annual appropriations process in an effort to eliminate funding for the ACA’s implementation and address other aspects of the law. ACA-related provisions have been included in enacted appropriations acts each year since the ACA became law. In October 2013, disagreement between the Republican-led House and Democratic-controlled Senate over the inclusion of ACA language in a temporary spending bill for the new fiscal year (i.e., FY2014) resulted in a partial shutdown of government operations that lasted 16 days. Bills: H.R. 1473, H.R. 1, H.R. 3070, H.R. 2434, H.R. 6020, H.R. 2786, H.R. 5016, H.R. 2995, H.R. 3020, H.R. 940, S. 3686, S. 1599, S. 1573, S. 3295, S. 3301, S. 1284, S. 1371

An Introduction to Child Nutrition Reauthorization – IF10266

An Introduction to Child Nutrition Reauthorization – IF10266 published on

The “child nutrition programs” (National School Lunch Program and certain other institutional food service programs) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs are up for reauthorization during the 114th Congress.  Some of the authorities created or extended in the last reauthorization law (Healthy, Hunger-Free Kids Act of 2010 (P.L. 111- 296)) expire on September 30, 2015.

Date of Report: July 28, 2015
Pages: 2
Order Number: IF10266
Price: $5.95

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Medicare, Observation Care, and the Two-Midnight Rule – IF10264

Medicare, Observation Care, and the Two-Midnight Rule – IF10264 published on

Medicare cost sharing and post hospital coverage can depend on whether a beneficiary was admitted to the hospital and received treatment as an inpatient or received treatment as an outpatient. Some beneficiaries are surprised to learn that despite having received treatment overnight in a hospital bed during their hospital stay they were never formally admitted but instead were under observation as an outpatient. The Two-Midnight Rule implemented by the Centers for Medicare & Medicaid Services (CMS) is intended to clarify when an inpatient admission is considered medically necessary.

Date of Report: July 23, 2015
Pages: 2
Order Number: IF10264
Price: $5.95

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Balance Billing in Private Health Insurance Plans – IF10263

Balance Billing in Private Health Insurance Plans – IF10263 published on

Balance billing is when a health care provider bills a consumer for charges (other than cost sharing) that exceed the health insurance plan’s payment for a covered service.

Date of Report: July 23, 2015
Pages: 2
Order Number: IF10263
Price: $5.95

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CMS Proposed Rule on Medicaid Managed Care

CMS Proposed Rule on Medicaid Managed Care published on

On May 26, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule laying out the agency’s plan to update the federal regulations pertaining to Medicaid managed care, under which states contract with private health insurers to provide health care to enrollees. In general, federal agencies develop regulations to implement the laws passed by the Congress. CMS has that responsibility for Medicaid and the State Children’s Health Insurance Program (CHIP). This includes how states deliver services to Medicaid enrollees through risk-based managed care, the primary focus of the proposed rule. The proposed rule also addresses managed care in CHIP and third party liability (TPL) in Medicaid, but those topics are not the focus of this brief report. 

Date of Report: June 3, 2015
Pages: 2
Order Number: IF10234
Price: $5.95

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The September 11, 2001 Terrorist Attacks: Reauthorization of Health and Injury Compensation Programs – IF10227

The September 11, 2001 Terrorist Attacks: Reauthorization of Health and Injury Compensation Programs – IF10227 published on

The September 11, 2001, terrorist attacks claimed nearly 3,000 lives that day, at the World Trade Center (WTC) in New York City, the Pentagon, and a field in Shanksville, Pennsylvania. Rescue, recovery, and clean-up operations took more than a year and involved thousands of workers.

Date of Report: May 13, 2015
Pages: 2
Order Number: IF10227
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U.S. Global Health Assistance: The FY2016 Budget – IF10131

U.S. Global Health Assistance: The FY2016 Budget – IF10131 published on

The President’s FY2016 budget request includes more than $9 billion for global health assistance, including roughly $8 billion through State, Foreign Operations appropriation and some $910 million through Department of Labor, Health and Human Services (HHS), and Education appropriation. This report excludes emergency funding for Ebola responses. For information on Emergency Ebola Appropriations, see CRS Report R43807, FY2015 Funding to Counter Ebola and the Islamic State (IS).

Date of Report: May 11, 2015
Pages: 2
Order Number: IF10131
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African Centre for Disease Control and Prevention: Development and U.S. Assistance – IN10268

African Centre for Disease Control and Prevention: Development and U.S. Assistance – IN10268 published on

On April 13, 2015, U.S. Secretary of State John Kerry and Dr. Nkosazana Dlamini-Zuma, Chairperson of the African Union (AU) Commission (AUC), signed a Memorandum of Cooperation supporting the establishment of an African Centre for Disease Control and Prevention (ACDCP). Work toward that end had been underway since July 2013, when African leaders, during a summit on key disease response efforts, approved an Ethiopian proposal to establish such a center and tasked the AUC with initiating steps to create it. In 2014, in response to the devastating Ebola epidemic in West Africa (see CRS In Focus IF10178, Ebola: 2104 Outbreak in West Africa), the AU fast-tracked these efforts. The AU also countered the outbreak by deploying, with U.S. assistance, more than 800 African public health responders—an effort seen as a model for the kind of actions that the ACDCP may support.

Date of Report: 5/5/2015
Pages: 3
Order Number: IN10268
Price: $5.95

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Medicaid’s Institutions for Mental Disease (IMD) Exclusion – IF10222

Medicaid’s Institutions for Mental Disease (IMD) Exclusion – IF10222 published on

Medicaid is a joint federal-state program that finances the delivery of primary and acute medical services, as well as long-term services and supports, for a diverse low-income population, including children, pregnant women, adults, individuals with disabilities, and people aged 65 and older. (See CRS Report R43357, Medicaid: An Overview.)  Medicaid’s IMD exclusion limits the circumstances under which federal Medicaid matching funds are available for inpatient mental health care. Policymakers have concerns about access to mental health care, and in recent years some have introduced bills to amend or eliminate the IMD exclusion. The scope of the unmet need for inpatient mental health care for individuals with mental illness on Medicaid is unknown, as is the extent to which the need might be met by increasing community-based care or inpatient care in facilities that are not IMDs. 

Date of Report: 5/8/2015
Pages: 2
Order Number: IF10222
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Opioid Treatment Programs and Related Federal Regulations – IF10219

Opioid Treatment Programs and Related Federal Regulations – IF10219 published on

Federally certified opioid treatment programs (OTPs)—also called narcotic treatment programs or, often, methadone clinics—may offer opioid medications, counseling, and other services for individuals addicted to heroin or other opioids. The use of opioid medications to treat opioid addiction is subject to federal regulations beyond those that apply to the same medications used for other purposes (e.g., treating pain). With few exceptions, the use of the opioid medication methadone to treat opioid addiction is limited to OTPs; however, physicians who wish to treat opioid addiction using the opioid medication buprenorphine may obtain a waiver to do so outside an OTP. A non-opioid medication used in the treatment of opioid addiction, naltrexone, may be used by OTPs, physicians with waivers, or anyone with the authority to write prescriptions.

Date of Report: Opioid Treatment Programs and Related Federal Regulations
Pages: 2
Order Number: 5/4/2015
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