42 U.S. Code § 300gg–94 - Ensuring that consumers get value for their dollars
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(a) Initial premium review process
(1) In general
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.
(2) Justification and disclosure
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.
(b) Continuing premium review process
(1) Informing Secretary of premium increase patterns
As a condition of receiving a grant under subsection (c)(1), a State, through its Commissioner of Insurance, shall—
(A) provide the Secretary with information about trends in premium increases in health insurance coverage in premium rating areas in the State; and
(2) Monitoring by Secretary of premium increases
(A) In general
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.
(B) Consideration in opening Exchange
(c) Grants in support of process
(1) Premium review grants during 2010 through 2014
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—
(A) in reviewing and, if appropriate under State law, approving premium increases for health insurance coverage;
(C) 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.
(A) In general
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).
(B) Further availability for insurance reform and consumer protection
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—
(i) the Secretary shall consider the number of plans of health insurance coverage offered in each State and the population of the State; and
(d) Medical reimbursement data centers
A center established under subsection (c)(1)(C) shall—
(A) develop fee schedules and other database tools that fairly and accurately reflect market rates for medical services and the geographic differences in those rates;
(B) use the best available statistical methods and data processing technology to develop such fee schedules and other database tools;
(C) regularly update such fee schedules and other database tools to reflect changes in charges for medical services;
(D) 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
(2) Conflicts of interest
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.
Source(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.)
Another section 2794 of act July 1, 1944, is classified to section 300gg–95 of this title.
2010—Subsec. (c)(1)(C). Pub. L. 111–148, § 10101(i)(1), added subpar. (C).
Subsec. (d). Pub. L. 111–148, § 10101(i)(2), added subsec. (d).
Section effective for fiscal years beginning with fiscal year 2010, see section 1004(a) ofPub. L. 111–148, set out as a note under section 300gg–11 of this title.
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