Patient Protection and Affordable Care Act
Grants: Health Care Quality Improvements

Sec. 3502 Establishing Community Health Teams to Support the Patient-Centered Medical Home

• Creation. The Secretary of Health and Human Services must enter into contracts or award grants to eligible entities in order to create “health teams” that will support primary care providers.83 States, entities designated by states, and Indian tribes or organizations are eligible for funding. Interested entities must submit an application to the Secretary that includes plans for reaching financial stability within three years and delivery of prevention initiatives, patient education, and care management. Entities must build their health teams so that they meet the standards established by the Secretary pertaining to “interdisciplinary, interprofessional” providers (e.g. medical specialists, nutritionists, social workers). Finally, entities must agree to comply with the provisions of section 1945 of the Security Act pertaining to the care of patients with “chronic conditions” and payments for such care.84 Section 1945 defines “chronic conditions” as including mental health conditions, substance use disorders, asthma, diabetes, heart disease, overweight, and any other condition specified by the Secretary.85 States will specify the method of payment for health home services (e.g. tiering based on chronic conditions) and may obtain Secretary approval to use alternative payment models.86
• Health Team Requirements. Health Teams must (1) provide support to primary care providers; (2) provide support to patient centered medical homes; (3) Coordinate prevention, chronic disease management, case management, and care transitions by working with local primary care providers and other state or local resources; (4) Work with local providers to create and implement “interprofessional care plans;” (5) Develop and oversee program in a way that includes providers, patients, and other caregivers; (6) Support providers’ capacity to provide access to quality care, prevention and promotion services, specialty care and inpatient services, culturally appropriate and patient centered care, medication delivery and management, complementary and alternative services, support provider’s capacity to “collect and report data that permits evaluation of the success of the collaborative effort on patient outcomes, including collection of data on patient experience of care, and identification of areas for improvement;” and “establish a coordinated system of early identification and referral for children at risk for developmental or behavioral problems such as through the use of infolines, health information technology, or other means as determined by the Secretary;” (7) Provide support for management and transitions on a 24 hour basis; (8) Facilitate communication between local prevention and treatment programs; (9) Have, or exhibit an ability to implement, health information technology capable of certification as Electronic Health Records technology; (10) Report quality measures to the Secretary as required pursuant to 399JJ of he PHSA. 87
• Provider Requirements. Primary care providers that enter into a contract with a health team formed pursuant to this section must: (1) Share with the heath team their plan of care for each patient; (2) grant the health team with access to patient health records; (3) conduct regular meeting with the care team.88
• Reporting Requirements. Entitles that receive funds must comply with any reporting requirements established by the Secretary. 89

Sec. 3504 Design and Implementation of Regionalized Systems for Emergency Care

• Overview. The Secretary of Health and Human Services, through the Assistant Secretary for Preparedness and Response, must award a minimum of 4 “multiyear contracts or competitive grants to eligible entities to support pilot projects that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems.”90

• Eligible Entity. The ACA defines, for the purposes of this section, “eligible entity” as states, partnerships among states and local governments, Indian tribes, and partnerships among Indian tribes, “region” as areas within a state or multiple states “as determined by the Secretary, and “emergency services” as inclusive of “acute, pre-hospital, and trauma care.” 91
• Project Selection. The Secretary must award grants or contracts to entities that propose a pilot project that: (1) coordinates the development of “an approach to emergency medical and trauma system access. . . , including 9-1-1- Public Safety Answering Points and emergency medical dispatch” among regional emergency, public health and safety, and medical entities; (2) has a means of ensuring that a patient “is taken to [a] medically appropriate facility…in a timely fashion;” (3) has the ability to track “pre-hospital and hospital resources” as well as “coordinat[e]…such tracking with regional communications and hospital destination decisions;” and (4) has “a consistent region-wide pre-hospital, hospital, and inter-facility data management system” that (a) is capable of submitting data to, among others,  the National EMS Information System and National Trauma Data Bank; (b) is capable of reporting data to Federal and State registries; and (c) has sufficient information for purposes of evaluating “key elements pre-hospital care, hospital destination decisions, including initial hospital and inter-facility decisions, and relevant health outcomes of hospital care.”92  The Secretary will give preference in awarding grants to entities that provide service to medically underserved areas.93
• Application. Entities must apply for emergency care and trauma system grants pursuant to guidelines established within the Secretary’s discretion.94 The application must, however, contain assurances from entity applicants that their system (1) is “coordinated with the applicable State Office of Emergency Medical Services;” (2) has consistent medical oversight of transport within the applicable region; (3) “coordinates prehospital treatment and triage, hospital destination, and interfacility transport throughout the region;” (4) has a means of integrating a “categorization or designation system for special medical facilities” with “transport and destination protocols;” (5) has “a regional medical direction, patient tracking, and resource allocation system that supports day-to-day emergency care and surge capacity and is integrated with other components of the national and State emergency preparedness system;” and (6) “addresses pediatric concerns related to integration, planning, preparedness, and coordination of emergency medical services for infants, children, and adolescents.”95   
• Grantee Requirements. Entities that receive grants pursuant to this section must match 1 dollar of funding for each 3 dollars of federal funding.96 Entities may match funds in cash or in kind and obtain such funds from private or public sources.97 Entities that receive funds must submit a report to the Secretary, ninety days after completion of the project, that details the impact of the project on patient outcomes in critical care categories (e.g. stroke, cardiac emergencies), the project characteristics that contributed or inhibited project’s “effectiveness and efficiency,” the means to assure financial sustainability of the project in the long-term, barriers to developing the project and the means to overcome such barriers, and recommendations on the use of funds for additional “regionalization efforts.”98 The Secretary must disseminate the findings from these reports to Congress and the public, as appropriate.99

Sec. 3505 Trauma Care Centers and Service Availability

• Grant Programs. The Secretary of Health and Human Services must establish three programs to award grants to qualified trauma centers for the purpose of: (1) defraying costs of uncompensated care; (2) “futher[ing] the core missions of …trauma centers” by defraying costs such as those associated with stabilizing and transferring patients and personnel costs; and (3) providing emergency relief funds so that trauma centers remain available.100 Costs of uncompensated care “means unreimbursed costs from serving self-pay, charity, or Medicaid patients…attributable to emergency care and trauma care, including costs related to subsequent inpatient admissions to the hospital.”101
• Qualification. In order to qualify for a grant, trauma centers must

• Comply with the professional guidelines established in section 1213, unless they are located in a state that lacks a trauma care system;102 and, if seeking a grant for the costs of uncompensated care, meet at least one of the criteria identified pertaining to the percentage of patients the trauma center serves that self-pay, receive Medicaid benefits, and etc; or qualify for “a Low Income Pool or Safety Net Care Pool.”103
• Receive verification by the American College of Surgeons or a comparable state or local agency;
• Demonstrate to the Secretary their “commitment to serving trauma patients regardless of their ability to pay;”
• Have policies, such as a sliding scale, that help patients that cannot afford the total cost of their care to pay at least a portion and that “ensure fair billing and collection practices;” and
• Comply with the application process as specified by the Secretary.104
• The Secretary has discretion to require grantees “maintain access to trauma services at comparable levels to the prior year during the grant period and “provide data to a national and centralized registry of trauma cases, in accordance with guidelines developed by the American College of Surgeons, and as the Secretary may otherwise require.”105

Sec. 3509 Improving Women’s Health

Health and Human Services Office on Women’s Health

The ACA establishes an Office on Women’s Health within the Department of Health and Human Services. The Secretary of Health and Human Services will act through the office to (1) establish long and short term goals and objectives for prevention, promotion, delivery of care, research and education regarding women’s health issues; (2) provide advice regarding women’s health legal, ethical, scientific and policy issues; (3) Identify women’s health activities within HHS offices and agencies whereby coordination is feasible; (4) create the HHS Coordinating Committee on Women’s Health, comprised of senior level representatives from HHS and chaired by the Deputy Assistant Secretary for Women’s Health; (5) create the National Women’s Health Information Center in order to “facilitate the exchange,” access, and analysis, “of information regarding matters relating to health information, health promotion, preventive health services, research advances, and education in the appropriate use of health care” and “provide technical assistance with respect to the exchange of such information;”  (6) coordinate women’s health promotion activities with the private sector; and (7) exchange information between the Office and grantees, contractors, health professionals, and the public via publication “and any other means appropriate.”116

The Secretary has authority to issue grants and enter into contracts or interagency agreements with public and private entities in order to carry out the [above] mandates.117 The Secretary must evaluate the activities carried out pursuant to such grants or contracts and disseminate the information generated by the activities.118 The Secretary must report to Congress regarding the activities of the office every two years beginning no later than a year following enactment. Congress appropriated funds “as necessary” for the fiscal years between 2010 and 2014.119

Food and Drug Administration (FDA) Office of Women’s Health

The ACA establishes the Office of Women’s Health within the FDA.120 The Office must (1) provide information regarding women’s participation in clinical trials of medical devices, drugs, and biological products and information regarding the sex based data analysis in these trials to the Commissioner; (2) identify goals and objectives related to women’s health that are within the FDA’s jurisdiction; (3) disseminate information to providers and women regarding differences between men and women; (4) consult with private entities, such as drug manufacturers, health professionals, and consumer organizations on women’s policy; (5) annually estimate the funds necessary “to monitor clinical trials and analysis of data in accordance with needs that are identified;” and (6) sit on Coordinating Committee on Women’s Health.121 The ACA appropriated funds “as necessary” for the fiscal years between 2010 and 2014. 122