42 U.S.C. § 300gg–5: Non-discrimination in…

Summary

Health plans and insurance companies that sell group or individual coverage must not refuse to let a health care provider take part just because of who the provider is, if the provider is working under their state license. Plans do not have to sign a contract with every provider who wants to join. They may pay different rates to providers based on quality or performance. The same federal rules that stop discrimination against people also apply to these group and individual health plans and insurers.

Title 42, §300gg–5

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

(a)Providers

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

(b)Individuals

The provisions of section 218c of title 29 (relating to non-discrimination) shall apply with respect to a group health plan or health insurance issuer offering group or individual health insurance coverage.

Notes & Related Subsidiaries

Editorial Notes

References in Text

Section 218c of title 29, referred to in subsec. (b), was in the original “section 1558 of the Patient Protection and Affordable Care Act”, meaning section 1558 of Pub. L. 111–148, and was translated as meaning section 18C of act June 25, 1938, ch. 676, which was added by section 1558 of Pub. L. 111–148, to reflect the probable intent of Congress.

Prior Provisions

A prior section 300gg–5, act

July 1, 1944, ch. 373, title XXVII, § 2705, as added Pub. L. 104–204, title VII, § 703(a), Sept. 26, 1996, 110 Stat. 2947, and amended, which related to parity in mental health and substance use disorder benefits, was renumbered section 2726 of act

July 1, 1944, and transferred to section 300gg–26 of this title. A prior section 2706 of act

July 1, 1944, was renumbered section 2727 and is classified to section 300gg–27 of this title. Another prior section 2706 of act

July 1, 1944, was successively renumbered by subsequent acts and transferred, see section 238e of this title.

Statutory Notes and Related Subsidiaries

Effective Date

Section effective for plan years beginning on or after Jan. 1, 2014, see section 1255 of Pub. L. 111–148, set out as a note under section 300gg of this title. Implementing Protections Against Provider Discrimination Pub. L. 116–260, div. BB, title I, § 108, Dec. 27, 2020, 134 Stat. 2859, provided that: “Not later than January 1, 2022, the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury shall issue a proposed rule implementing the protections of section 2706(a) of the Public Health Service Act (42 U.S.C. 300gg–5(a)). The Secretaries shall accept and consider public comments on any proposed rule issued pursuant to this subsection for a period of 60 days after the date of such issuance. Not later than 6 months after the date of the conclusion of the comment period, the Secretaries shall issue a final rule implementing the protections of section 2706(a) of the Public Health Service Act (42 U.S.C. 300gg–5(a)).”

§300gg–5 Non-discrimination in Health Care