NAQC Review of Affordable Care Act (ACA)

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October 10, 2010

NAQC Review of Affordable Care Act (ACA) - Public Law No: 111-148

(Through the lens of Nursing, Quality, Care Coordination, and Patient Engagement)

The Patient Protection and Affordable Care Act (2010) is broad in scope, containing ten titles covering: provision of quality affordable healthcare, role of public programs, improving the quality and efficacy of health care, transparency and program integrity, improving access to innovative medical therapies, community living assistance services and support, revenue provisions, and strengthening quality and affordable healthcare for all Americans.

Many sections of the law relate to nurses, including advanced practice nurses and nurse educators. Some provisions mention nursing roles and patient care. Other sections tie to nursing and quality - although with language that does not appear to directly tie to nursing.

An initial review of Public Law No 111-148 was completed to gain a holistic picture of the provisions related to nursing within the quality arena. A brief description of the ten titles found within the ACA is found below.

Title I – This title formulates various reforms to health insurance and details the requirements of Health Insurance Exchanges.

Title II – Contains most of the provisions relating to the Children’s Health Insurance Program and Medicaid. Also addresses the coordination and integration of acute and long term care and improvements for dual eligible.

Title III – This pertains to the quality and efficiency of health care and includes Medicare provisions and federal initiatives related to quality, efficiency, and innovation.

Title IV - This title addresses chronic illness prevention and the improvement of public health access to care.

Title V - Health Care Workforce title outlining the various federal funding availability for nursing, physician, and other allied health education. Additionally addresses support for nurse managed health clinics, the National Health Service Corp, and workforce recruitment and retention programs.

Title VI- Transparency and Program Integrity title targeting transparency of information. Establishes a Patient-Centered Outcomes Research Institute and speaks to the program integrity of Medicare, Medicaid, CHIP integrity provisions, malpractice, and elder justice.

Title VII - This title addresses improving access to innovative medical therapies, specifically, the approval pathway for biosimilar biological products and more affordable medications for children and underserved communities.

Title VIII - This title highlights the Community Living Assistance Services and Supports Act or the CLASS Act - Establishes a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).

Title IX- This title identifies the revenue offset provisions such as increased taxes and limitations, modifications, and deduction elimination of current federal and consumer health care coverage programs.

Title X - Revises provisions of or related to Subtitles A, B, and C of Title I of the PPACA.

In June 2010, upon approval of the NAQC roadmap, the law was revisited by staff and reviewed through the lens of the roadmap’s key areas of focus: care coordination and patient engagement. A thematic summary of this law accompanies this document to assist the Alliance is the next steps of our collaborative work.

The Patient Protection and Affordability Care Act (PPACA) was signed into law early in 2010. The Affordable Care Act (print version) became available through the Government Printing Office (GPO) in spring 2010. NAQC staff began the review of the Senate Finance Committee version of the bill before the GPO print version was available. The version reviewed contained two components, the 2074 page bill and the 150 page reconciliation. The bill page numbers cited in the NAQC summary refer to this version available at:

Read the Health Care Reform Improvements Bill containing the 150 page reconciliation is available at

The final law can be ordered for a fee in print at: or accessed as a PDF at: