§300gg–17 — Title 42 The Public Health and Welfare | U.S. Code

§300gg–17 Ensuring the quality of care

Title 42 › Chapter CHAPTER 6A— - PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER XXV— - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part Part A— - Individual and Group Market Reforms › Subpart Subpart II— - Improving Coverage › § 300gg–17

Last updated Apr 6, 2026|Official source

Summary

Require the Health Secretary to write rules within 2 years after March 23, 2010 about what group health plans and insurers must report. The rules must cover whether a plan uses things that improve care, such as quality tracking, case management, care coordination, chronic disease programs, medication and care follow-up (including medical homes), programs to prevent hospital readmissions, steps to make care safer and reduce errors, and wellness and health-promotion activities. Plans and insurers must send a yearly report to the Secretary and to enrollees, make the report available during each open enrollment, and the Secretary must post the reports online. The Secretary can set penalties for not following the rules and may allow exceptions for plans that mostly meet the goals. Wellness services can be personalized and run by a provider or wellness group and can include things like smoking cessation, weight and stress management, fitness, nutrition, heart and diabetes prevention, and healthy lifestyle support. Wellness programs may not ask for, collect, or keep information about lawful firearm ownership, storage, or use. Insurers cannot raise premiums, deny coverage, or cut rewards because someone lawfully owns, stores, or uses a firearm. The Secretary must also make rules within 2 years about what counts as a reimbursement structure, and the Government Accountability Office must review those rules and report within 180 days after they are issued on how these activities affect health care quality and cost.

Title 42, §300gg–17

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

(a)(1)Not later than 2 years after March 23, 2010, the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect to plan or coverage benefits and health care provider reimbursement structures that—

(A)improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 11 See References in Text note below. of the Patient Protection and Affordable Care Act, for treatment or services under the plan or coverage;

(B)implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional;

(C)implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; and

(D)implement wellness and health promotion activities.

(2)(A)A group health plan and a health insurance issuer offering group or individual health insurance coverage shall annually submit to the Secretary, and to enrollees under the plan or coverage, a report on whether the benefits under the plan or coverage satisfy the elements described in subparagraphs (A) through (D) of paragraph (1).

(B)A report under subparagraph (A) shall be made available to an enrollee under the plan or coverage during each open enrollment period.

(C)The Secretary shall make reports submitted under subparagraph (A) available to the public through an Internet website.

(D)In developing the reporting requirements under paragraph (1), the Secretary may develop and impose appropriate penalties for non-compliance with such requirements.

(E)In developing the reporting requirements under paragraph (1), the Secretary may provide for exceptions to such requirements for group health plans and health insurance issuers that substantially meet the goals of this section.

(b)For purposes of subsection (a)(1)(D), wellness and health promotion activities may include personalized wellness and prevention services, which are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants, and which may include the following wellness and prevention efforts:

(1)Smoking cessation.

(2)Weight management.

(3)Stress management.

(4)Physical fitness.

(5)Nutrition.

(6)Heart disease prevention.

(7)Healthy lifestyle support.

(8)Diabetes prevention.

(c)(1)A wellness and health promotion activity implemented under subsection (a)(1)(D) may not require the disclosure or collection of any information relating to—

(A)the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or

(B)the lawful use, possession, or storage of a firearm or ammunition by an individual.

(2)None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used for the collection of any information relating to—

(A)the lawful ownership or possession of a firearm or ammunition;

(B)the lawful use of a firearm or ammunition; or

(C)the lawful storage of a firearm or ammunition.

(3)None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used to maintain records of individual ownership or possession of a firearm or ammunition.

(4)A premium rate may not be increased, health insurance coverage may not be denied, and a discount, rebate, or reward offered for participation in a wellness program may not be reduced or withheld under any health benefit plan issued pursuant to or in accordance with the Patient Protection and Affordable Care Act or an amendment made by that Act on the basis of, or on reliance upon—

(A)the lawful ownership or possession of a firearm or ammunition; or

(B)the lawful use or storage of a firearm or ammunition.

(5)No individual shall be required to disclose any information under any data collection activity authorized under the Patient Protection and Affordable Care Act or an amendment made by that Act relating to—

(A)the lawful ownership or possession of a firearm or ammunition; or

(B)the lawful use, possession, or storage of a firearm or ammunition.

(d)Not later than 2 years after March 23, 2010, the Secretary shall promulgate regulations that provide criteria for determining whether a reimbursement structure is described in subsection (a).

(e)Not later than 180 days after the date on which regulations are promulgated under subsection (c),22 So in original. Probably should be “subsection (d),”. the Government Accountability Office shall review such regulations and conduct a study and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report regarding the impact the activities under this section have had on the quality and cost of health care.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 3602 of the Patient Protection and Affordable Care Act, referred to in subsec. (a)(1)(A), is section 3602 of Pub. L. 111–148 which is set out as a note under section 1305w–21 of this title but the reference probably should be to section 3502 of the Act which is set out as a note under section 256a–1 of this title. The Patient Protection and Affordable Care Act, referred to in subsec. (c), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119. For complete classification of this Act to the Code, see

Short Title

note set out under section 18001 of this title and Tables.

Amendments

2010—Subsecs. (c) to (e). Pub. L. 111–148, § 10101(e), added subsec. (c) and redesignated former subsecs. (c) and (d) as (d) and (e), respectively.

Statutory Notes and Related Subsidiaries

Effective Date

Section effective for plan years beginning on or after the date that is 6 months after Mar. 23, 2010, see section 1004 of Pub. L. 111–148, set out as a note under section 300gg–11 of this title.