§300e–10 — Title 42 The Public Health and Welfare | U.S. Code

Summary

Stops States from blocking certain health maintenance organizations that got federal grants, contracts, loans, or are specially qualified from advertising to get members. If a group cannot operate as an HMO in a State because the State demands things like medical society approval, physician control of the board or required physician participation, insurer-style capitalization or reserve rules, or other requirements that would keep it from following the federal rules, that group is protected. States may not forbid those HMOs from advertising services, charges, or other nonmedical features, but ads may not name, describe, or rate any individual health professional. The Secretary must, within 6 months after October 8, 1976, make a summary of State laws and practices about HMOs, update it every year, send relevant parts to each Governor each year, point out laws that conflict with these protections, and provide legal help to States to comply.

Title 42, §300e–10

The Public Health and Welfare — Source: USLM XML via OLRC

(a)In the case of any entity—

(1)which cannot do business as a health maintenance organization in a State in which it proposes to furnish basic and supplemental health services because that State by law, regulation, or otherwise—

(A)requires as a condition to doing business in that State that a medical society approve the furnishing of services by the entity,

(B)requires that physicians constitute all or a percentage of its governing body,

(C)requires that all physicians or a percentage of physicians in the locale participate or be permitted to participate in the provision of services for the entity,

(D)requires that the entity meet requirements for insurers of health care services doing business in that State respecting initial capitalization and establishment of financial reserves against insolvency, or

(E)imposes requirements which would prohibit the entity from complying with the requirements of this subchapter, and

(2)for which a grant, contract, loan, or loan guarantee was made under this subchapter or which is a qualified health maintenance organization for purposes of section 300e–9 of this title (relating to employees’ health benefits plans),

(b)No State may establish or enforce any law which prevents a health maintenance organization for which a grant, contract, loan, or loan guarantee was made under this subchapter or which is a qualified health maintenance organization for purposes of section 300e–9 of this title (relating to employees’ health benefits plans), from soliciting members through advertising its services, charges, or other nonprofessional aspects of its operation. This subsection does not authorize any advertising which identifies, refers to, or makes any qualitative judgement concerning, any health professional who provides services for a health maintenance organization.

(c)The Secretary shall, within 6 months after October 8, 1976, develop a digest of State laws, regulations, and practices pertaining to development, establishment, and operation of health maintenance organizations which shall be updated at least annually and relevant sections of which shall be provided to the Governor of each State annually. Such digest shall indicate which State laws, regulations, and practices appear to be inconsistent with the operation of this section. The Secretary shall also insure that appropriate legal consultative assistance is available to the States for the purpose of complying with the provisions of this section.

Notes & Related Subsidiaries

Editorial Notes

Prior Provisions

A prior section 1311 of act July 1, 1944, was classified to section 211a of this title prior to repeal by Pub. L. 93–222, § 7(b).

Amendments

1988—Subsec. (a)(1)(E). Pub. L. 100–517 added subpar. (E). 1986—Subsec. (c). Pub. L. 99–660 substituted “annually” for “quarterly” after “at least”. 1976—Subsec. (c). Pub. L. 94–460 added subsec. (c).

Statutory Notes and Related Subsidiaries

Effective Date

of 1986 AmendmentAmendment by Pub. L. 99–660 effective Oct. 1, 1985, see section 815(a) of Pub. L. 99–660, set out as an Effective and Termination Dates of 1986 Amendment note under section 300e–1 of this title.

Effective Date

of 1976 AmendmentAmendment by Pub. L. 94–460 effective Oct. 8, 1976, see section 118 of Pub. L. 94–460, set out as a note under section 300e of this title.

§300e–10 Restrictive State laws and practices

Summary

Title 42, §300e–10

Notes & Related Subsidiaries

Editorial Notes

Prior Provisions

Amendments

Statutory Notes and Related Subsidiaries

Effective Date

Effective Date

Citations & Metadata