In March 2010, Congress passed and the president signed into law the Patient Protection and Affordable Care Act (PPACA),1 one the most far-reaching pieces of federal legislation in decades. As the final version (amended by a reconciliation bill) is well over 2,000 pages and, importantly, is phased in over the next four years, it will take some time before all elements and consequences of the legislation are fully assessed. ISM will continue to write on PPACA as new provisions come into effect. At this time, however, we would like to share with schools the requirements and changes2 that they will need to comply with between now and the end of 2010.3