Tap any paragraph to write a margin note. Your notes collect in the Desk below the text and file under cases with @. The side-by-side margin rail opens on a larger screen.

§
Marginalia
Code · U.S. Code · Title 42 - THE PUBLIC HEALTH AND WELFARE · CHAPTER 6A— PUBLIC HEALTH SERVICE · Part C— Definitions; Miscellaneous Provisions · § 300gg–94

§ 300gg–94. Ensuring that consumers get value for their dollars

1,096 words·~5 min read·/usc/title-42/section-300gg-94

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

The Secretary, in conjunction with States, shall establish a process for the annual review, beginning with the 2010 plan year and subject to subsection (b)(2)(A), of unreasonable increases in premiums for health insurance coverage. The process established under paragraph
(1)shall require health insurance issuers to submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase. Such issuers shall prominently post such information on their Internet websites. The Secretary shall ensure the public disclosure of information on such increases and justifications for all health insurance issuers. As a condition of receiving a grant under subsection (c)(1), a State, through its Commissioner of Insurance, shall— provide the Secretary with information about trends in premium increases in health insurance coverage in premium rating areas in the State; and 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. Beginning with plan years beginning in 2014, the Secretary, in conjunction with the States and consistent with the provisions of subsection (a)(2), shall monitor premium increases of health insurance coverage offered through an Exchange and outside of an Exchange. In determining under section 18032(f)(2)(B) of this title whether to offer qualified health plans in the large group market through an Exchange, the State shall take into account any excess of premium growth outside of the Exchange as compared to the rate of such growth inside the Exchange. 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— in reviewing and, if appropriate under State law, approving premium increases for health insurance coverage; in providing information and recommendations to the Secretary under subsection (b)(1); and 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. Out of all funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary $250,000,000, to be available for expenditure for grants under paragraph
(1)and subparagraph (B). If the amounts appropriated under subparagraph
(A)are not fully obligated under grants under paragraph
(1)by the end of fiscal year 2014, any remaining funds shall remain available to the Secretary for grants to States for planning and implementing the insurance reforms and consumer protections under part A. The Secretary shall establish a formula for determining the amount of any grant to a State under this subsection. Under such formula— the Secretary shall consider the number of plans of health insurance coverage offered in each State and the population of the State; and 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. Beginning during the first fiscal year that begins after December 29, 2022 , the Secretary shall, out of funds made available pursuant to subparagraph (C), award grants to eligible States to enforce and ensure compliance with the mental health and substance use disorder parity provisions of section 300gg––26 of this title. A State shall be eligible for a grant awarded under this paragraph only if such State— 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 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. There are authorized to be appropriated $10,000,000 for each of the first five fiscal years beginning after December 29, 2022 , to remain available until expended, for purposes of awarding grants under subparagraph (A). A center established under subsection (c)(1)(C) shall— develop fee schedules and other database tools that fairly and accurately reflect market rates for medical services and the geographic differences in those rates; use the best available statistical methods and data processing technology to develop such fee schedules and other database tools; regularly update such fee schedules and other database tools to reflect changes in charges for medical services; 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 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. A center established under subsection (c)(1)(C) shall adopt by-laws that ensures that the center (and all members of the governing board of the center) is independent and free from all conflicts of interest. Such by-laws shall ensure that the center is not controlled or influenced by, and does not have any corporate relation to, any individual or entity that may make or receive payments for health care services based on the center’s analysis of health care costs. Nothing in this subsection shall be construed to permit a center established under subsection (c)(1)(C) to compel health insurance issuers to provide data to the center. ( 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 .)
Connections13 cite this · traces to 1
Traces to 1 document
3 references not yet in our index
  • Pub. L. 111-148
  • 124 Stat. 139
  • 136 Stat. 5698
Citation graph
cites case law
§ 300gg–94
Ensuring that consumers get value for their dollars
Fed. Reg.×13
Pub. L.Public Law 117-328
Pub. L.Pub. L. 111-148
Stat.124 Stat. 139
Stat.136 Stat. 5698
Cites 4Cited by 13 across 1 source
★   the supreme law of the land   ★
Don't Tread on Me
E Pluribus Unum — out of many, one

"If you don't know your rights, you don't have any."

Marginalia · a citizen's law index
A research desk, not legal advice. Always read the cited source before relying on a summary.
Questions or an issue? support@self-law.org
disclaimerMarginalia is a research index, not a law firm. Nothing on this site is legal, tax, or financial advice and no attorney–client relationship is formed by using it. Statutes, regulations, and case law change; summaries, search results, AI output, and member posts may be incomplete, out of date, or wrong. Any interpretation drawn from material on this site should be validated by a licensed attorney in your jurisdiction before you act on it.