42 USC 300gg-94 - Ensuring that consumers get value for their dollars

U.S Code last checked for updates: Nov 22, 2024

§ 300gg–94.

Ensuring that consumers get value for their dollars

(a)

Initial premium review process

(1)

In general

(2)

Justification and disclosure

(b)

Continuing premium review process

(1)

Informing Secretary of premium increase patterns

As a condition of receiving a grant under subsection (c)(1), a State, through its Commissioner of Insurance, shall—

(A)

provide the Secretary with information about trends in premium increases in health insurance coverage in premium rating areas in the State; and

(B)

make recommendations, as appropriate, to the State Exchange about whether particular health insurance issuers should be excluded from participation in the Exchange based on a pattern or practice of excessive or unjustified premium increases.

(2)

Monitoring by Secretary of premium increases

(A)

In general

(B)

Consideration in opening Exchange

(c)

Grants in support of process

(1)

Premium review grants during 2010 through 2014

The Secretary shall carry out a program to award grants to States during the 5-year period beginning with fiscal year 2010 to assist such States in carrying out subsection (a), including—

(A)

in reviewing and, if appropriate under State law, approving premium increases for health insurance coverage;

(B)

in providing information and recommendations to the Secretary under subsection (b)(1); and

(C)

in establishing centers (consistent with subsection (d)) at academic or other nonprofit institutions to collect medical reimbursement information from health insurance issuers, to analyze and organize such information, and to make such information available to such issuers, health care providers, health researchers, health care policy makers, and the general public.

(2)

Funding

(A)

In general

(B)

Further availability for insurance reform and consumer protection

(C)

Allocation

The Secretary shall establish a formula for determining the amount of any grant to a State under this subsection. Under such formula—

(i)

the Secretary shall consider the number of plans of health insurance coverage offered in each State and the population of the State; and

(ii)

no State qualifying for a grant under paragraph (1) shall receive less than $1,000,000, or more than $5,000,000 for a grant year.

(3)

Parity implementation

(A)

In general

(B)

Eligible State

A State shall be eligible for a grant awarded under this paragraph only if such State—

(i)

submits to the Secretary an application for such grant at such time, in such manner, and containing such information as specified by the Secretary; and

(ii)

agrees to request and review from health insurance issuers offering group or individual health insurance coverage the comparative analyses and other information required of such health insurance issuers under subsection (a)(8)(A) of section 300gg–26 of this title relating to the design and application of nonquantitative treatment limitations imposed on mental health or substance use disorder benefits.

(C)

Authorization of appropriations

(d)

Medical reimbursement data centers

(1)

Functions

A center established under subsection (c)(1)(C) shall—

(A)

develop fee schedules and other database tools that fairly and accurately reflect market rates for medical services and the geographic differences in those rates;

(B)

use the best available statistical methods and data processing technology to develop such fee schedules and other database tools;

(C)

regularly update such fee schedules and other database tools to reflect changes in charges for medical services;

(D)

make health care cost information readily available to the public through an Internet website that allows consumers to understand the amounts that health care providers in their area charge for particular medical services; and

(E)

regularly publish information concerning the statistical methodologies used by the center to analyze health charge data and make such data available to researchers and policy makers.

(2)

Conflicts of interest

(3)

Rule of construction

(July 1, 1944, ch. 373, title XXVII, § 2794, as added and amended Pub. L. 111–148, title I, § 1003, title X, § 10101(i), Mar. 23, 2010, 124 Stat. 139, 891; Pub. L. 117–328, div. FF, title I, § 1331(a), Dec. 29, 2022, 136 Stat. 5698.)

cite as: 42 USC 300gg-94