42 U.S.C. § 300e–10: Restrictive State laws…

Summary

Stops certain state rules from keeping an HMO from operating if the HMO got a federal grant, contract, loan, or loan guarantee under this law or is approved as a qualified HMO for employee health plans. States cannot use rules like requiring medical society approval, making only doctors run the board, forcing local doctors to join, treating the HMO like a regular insurer for capitalization or reserve rules, or other requirements that would block the HMO from following the federal HMO rules. States also may not ban these HMOs from advertising their services, prices, or other nonprofessional features, but ads may not name, single out, or rate individual health professionals. The Secretary of Health and Human Services must, within 6 months after October 8, 1976, make a written summary of State laws, rules, and practices about creating and running HMOs. That summary must be updated at least once a year, sent to each Governor yearly, show which state rules seem inconsistent with this law, and the Secretary must make legal help available to States to follow it.

Title 42, §300e–10

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

(a)Entities operating as health maintenance organizations

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),

such requirements shall not apply to that entity so as to prevent it from operating as a health maintenance organization in accordance with section 300e of this title.

(b)Advertising

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)Digest of State laws, regulations, and practices; legal consultative assistance

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