Bipartisan Budget Act of 2018 (P.L. 115-123): Brief Summary of Division E—The Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act
Released: 2018-03-09T00:00:00

Summary:
On February 9, 2018, President Donald Trump signed into law the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123). Division E of that law is titled the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act. This report provides a brief summary of each of the provisions included in the ACCESS Act, along with the contact information for the CRS expert who can answer questions about each provision. Division E consists of 12 titles. Each title is addressed in a separate table, and the provisions are discussed in the order they appear in the law. Topics discussed in this report include Medicare, Medicaid, the State Children's Health Insurance Program (CHIP), public health, child and family services, foster care, social impact partnerships, child support enforcement, and prison data reporting.
Subsequent CRS reports examining selected subsets of these provisions will be linked to this report as they become available, such as CRS Report R45136, Bipartisan Budget Act of 2018 (P.L. 115-123): CHIP, Public Health, Home Visiting, and Medicaid Provisions in Division E.

subsections: section_title: Introduction
paragraphs: This report briefly summarizes the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, enacted February 9, 2018, as Division E of the Bipartisan Budget Act of 2018 (BBA 2018; P.L. 115-123 ).
The provisions discussed in this report are part of a larger legislative package that was enacted to address a number of issues before Congress, including the need for an extension of temporary appropriations set to expire on February 8, 2018. An early version of this package was added by the House to H.R. 1892 (an unrelated measure), in the form of an amendment to an amendment that had been previously adopted by the Senate during its consideration of H.R. 1892 . The House adopted its amendment on February 6, 2018, by a vote of 245-182. The Senate subsequently took up the House proposal and adopted a further amendment to it on February 9, by a vote of 71-28. The House agreed to the Senate actions that same day by a vote of 240-186. The final version of H.R. 1892 , enacted as the Bipartisan Budget Act of 2018 ( P.L. 115-123 ), contained FY2018 temporary continuing appropriations, FY2018 supplemental appropriations, an increase to the debt limit, increases to the statutory spending limits for FY2018 and FY2019, tax provisions, and numerous provisions extending or making changes to mandatory spending programs, among other topics.
According to the Congressional Budget Office (CBO) cost estimate, Division E of BBA 2018 is estimated to increase direct spending outlays by a total of $829 million, and increase on- and off-budget revenues by a total of $4.6 billion, for a net savings of $3.8 billion over the period of FY2018 through FY2027.
The topics specifically addressed in this report include the following:
Medicare ( Table 2 , Table 3 , Table 4 , Table 10 , Table 11 , and Table 12 ) State Children's Health Insurance Program (CHIP) (in Table 1 ) Public Health Extenders (in Table 5 and Table 9 ) Children and Family Services (in Table 6 ) Foster Care (in Table 7 ) Social Impact Partnerships Program (in Table 8 ) Medicaid and Offsets (in Table 12 )
Along with the brief description of each provision in Division E, this report provides the contact information for the CRS analysts who can answer further questions. CRS is preparing additional reports analyzing subsets of these provisions by topic or program in greater detail. Those reports will be linked to this report as they become available. 
section_title: Abbreviated Summary of Provisions
paragraphs: Division E begins with a short title (Section 50100), Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act. Division E is divided into twelve titles. The tables below briefly describe the sections within each title and provide CRS contacts. 
subsections: section_title: Appendix. List of Abbreviations
paragraphs: ACA: Patient Protection and Affordable Care Act ( P.L. 111-148 , as amended)
ACCESS: Advancing Chronic Care, Extenders, and Social Services Act ( P.L. 115-123 )
ACO: Accountable Care Organization
BBA 2018 : Bipartisan Budget Act of 2018 ( P.L. 115-123 )
CBO: Congressional Budget Office
CHIP: State Children's Health Insurance Program
CMMI : Center for Medicare & Medicaid Innovation
CMS : Centers for Medicare & Medicaid Services
CR : Cardiac Rehabilitation
CRS: Congressional Research Service
CSE: Child Support Enforcement
CWS: Stephanie Tubbs Jones Child Welfare Services
DSH : Disproportionate Share Hospital
EHR: Electronic Health Record
ESRD: End-Stage Renal Disease
FFPSA: Family First Prevention Services Act
GAO : Government Accountability Office
GPCI : Geographic Practice Cost Index
HHS: Department of Health and Human Services
ICR : Intensive Cardiac Rehabilitation
IHS: Indian Health Service
IPAB: Independent Payment Advisory Board
LVH: Low-Volume Hospital
MA: Medicare Advantage
MACRA: Medicare Access and CHIP Reauthorization Act of 2015 ( P.L. 114-10 )
MDH: Medicare-Dependent Hospital
MedPAC: Medicare Payment Advisory Commission
MIECHV : Maternal, Infant, and Early Childhood Home Visiting
MSSP: Medicare Shared Savings Program
NQF: National Quality Forum
PREP: Personal Responsibility Education Program
PSSF: Promoting Safe and Stable Families
QRTP: Qualified Residential Treatment Program
SIP: Social Impact Partnership
SHIP : State Health Insurance Assistant Program
SNP: Special Needs Plans
SSA: Social Security Act
SSI: Supplemental Security Income
VBID: Value-Based Insurance Design