Patient Protection and Affordable Care Act
Grants: Creating Healthier Communities

Sec. 4201 Community Transformation Grants

• Purpose. The Secretary of Health and Human Services, through the Centers for Disease Control and Prevention (CDC), must award grants, on a competitive basis, to eligible entities for the purpose of designing and implementing “evidence-based community preventive health activities” that address issues such as chronic disease prevalence and health disparities while developing “a stronger evidence-base of effective prevention programming.”123 A minimum of 20% of these grants must go to “rural and frontier areas.”124
• Eligibility. State and local agencies, community-based organization networks, state and local non-profit organizations, and Indian tribes are eligible for grants.125  These entities must submit an application to the Director of the CDC and demonstrate their ability to engage with diverse stakeholders in their community.126
• Community Transformation Plan. Upon receipt of funds, grantees must submit a Community Transformation Plan to the Director for their approval. This plan must describe changes necessary, in areas such as policy and infrastructure, “to promote healthy living and reduce disparities.”127 The ACA does not place a limit on the possible focus on Community Transformation Plans, but does provide potential areas for grantees to focus upon such as healthy school initiatives, worksite wellness initiatives, and initiatives aimed at reducing racial and ethnic disparities.128
• Evaluation. Grantees that receive approval of their Community Transformation Plan must subsequently use the funds to implement and evaluate their plan. The evaluation must measure the effect of participation in the prevention activities on the prevalence of chronic disease.129 This will require entities to measure changes in weight, nutrition, physical activity, tobacco use, emotional well-being and mental health, “other factors using community-specific data from the Behavioral Risk Factor Surveillance Survey, and other measures specified by the Secretary.” 130 Entities must report the results of their evaluation to the Director on an annual basis, attend annual meetings to share the knowledge gained from their activities, and develop models that facilitate replication of their activities.131
• Training. The Director must (1) establish a program to train eligible entities on chronic disease prevention and control activities as well as “the link between physical, emotional, and social well-being:” (2) give grantees feedback and technical assistance regarding their Community Transformation Plan; and (3) establish “a literature review and framework for the evaluation of programs” and partner with “academic institutions or other entities with expertise in outcome evaluation.” 132
• Limitations. Grantees may not use funds to create video games or develop other programs that can increase obesity or inactivity.133

Sec. 4202 Healthy Aging, Living Well; Evaluation of Community-Based Prevention and Wellness Programs for Medicare Beneficiaries

• Grants. The Secretary of Health and Human Services, through the CDC, will award five year grants to state or local health departments and Indian tribes for the purpose of conducting five year community health pilot projects for the benefit of individuals between the ages of 55 and 64.134 Health departments or Indian tribes interested in receiving a grant must (1) develop a community based intervention focused on the specified age group; (2) have the capacity to work with providers, community organizations, and insurers; and (3) submit an application to the Secretary.135

• Public health interventions. Grantees must work with the CDC to design and implement activities aimed at issues such as nutrition, substance abuse, and physical activity.136
• Community Prevention Screenings. Grantees must screen for cancer, stroke, diabetes, and cardiovascular disease risk factors. Such screening may entail screening for mental and behavioral health issues, substance abuse, smoking, nutrition, physical activity, and other criteria determined by the Secretary. Grantees must “maintain records of screening results…to establish the baseline data for monitoring the target population.”137
• Clinical Referral and Treatment for Chronic Diseases. Grantees must refer individuals identified through screening as at risk for chronic disease for treatment. Grantees must enter into contracts with “community health centers or rural health clinics and mental health and substance use disorder service providers” to facilitate referral of at risk individuals to resources that provide clinical follow-up and can “help determine eligibility for other public programs.” Grantees should refer insured individuals to their current provider or an in-network provider and should refer uninsured individuals to the “grantee’s community based clinical partner.”138

• Evaluation.
  • Grantees must use awards funds to evaluate the impact of their program on the “prevalence of chronic disease risk factors among participants.”139
  • The Secretary must evaluate the effectiveness of the programs on an annual basis. 140 The evaluation must “consider changes in the prevalence of uncontrolled chronic disease risk factors among new Medicare enrollees” that reside in areas receiving funds “as compared with national and historical data for those States and localities for the same population.”141

Sec. 4204 Immunizations

Demonstration Program to Improve Immunization Coverage

• Grants. The Secretary of Health and Human Services, through the CDC, must award grants to States to increase immunizations “for children, adolescents, and adults through the use of evidence-based population-based interventions for high-risk populations.”142
• Application. States may obtain funds by submitting a plan to the Secretary that details their proposed interventions and describes how the interventions meet the needs and capacity of the targeted area.143  The Secretary will award grants to States after considering recommendations from the Task Force on Community Prevention Planning Services.144
• Interventions. States must use the funds to “implement interventions that are recommended by the Task Force on Community Preventive Planning Services…or other evidence-based interventions. These interventions include sending targeted immunization reminders, providing education, lowering out-of-pocket expenses, and use of “immunization information systems to allow all States to have electronic databases for immunization records.”145
• Evaluation and Reporting. States must conduct an evaluation of their progress within three years of receiving funds and submit the results of this evaluation to the Secretary.146 The Secretary must submit a report to Congress, within 4 years of enactment of the Affordable Health Choices Act, containing project findings and recommendations on the future of the program.147

GAO Study and Report on Medicare Beneficiary Access to Vaccines

• Overview. The Comptroller General must study “the ability of Medicare beneficiaries who were 65 years of age or older to access routinely recommended vaccines covered under the [Medicare prescription drug program] over the period since the establishment of such program.”148 The study must contain information on: (1) the number of beneficiaries eligible for a “routinely recommended vaccine…covered under part D;” (2) the number of beneficiaries receiving such vaccine; (3) access barriers to covered vaccines; and (4) “a summary of the findings and recommendations” by government entities and professional organizations “on the impact of including “routinely recommended vaccines” in the Medicare prescription drug benefit on Medicare beneficiary access to such vaccines.149

Report and Funding. The Comptroller General must provide Congress with the report and recommendations by June 1, 2011.150 Congress appropriated 1 million dollars “out of any funds in the Treasury not otherwise appropriated” to carry out the study during 2010. 151