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

Introduction

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.

Abbreviated Summary of Provisions

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.

Appendix. List of Abbreviations

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