Public Law 119-102 (07/12/2026)

42 U.S.C. § 300e–11

Continued regulation of health maintenance organizations

Section text and notes

(a)

Determination of deficiency

section 300e–9 of this titleIf the Secretary determines that an entity which received a grant, contract, loan, or loan guarantee under this subchapter as a health maintenance organization or which was included in a health benefits plan offered to employees pursuant to —
(1)
fails to provide basic and supplemental services to its members,
(2)
section 300e(b) of this title fails to provide such services in the manner prescribed by , or
(3)
section 300e(c) of this title is not organized or operated in the manner prescribed by ,
the Secretary may take the action authorized by subsection (b).
(b)

Action by Secretary upon determination

(1)
1
1 See References in Text note below.
section 300e–9 of this titlesection 300e–9 of this title If the Secretary makes, with respect to any entity which provided assurances to the Secretary under section 300e–9(d)(1)  of this title, a determination described in subsection (a), the Secretary shall notify the entity in writing of the determination. Such notice shall specify the manner in which the entity has not complied with such assurances and direct that the entity initiate (within 30 days of the date the notice is issued by the Secretary or within such longer period as the Secretary determines is reasonable) such action as may be necessary to bring (within such period as the Secretary shall prescribe) the entity into compliance with the assurances. If the entity fails to initiate corrective action within the period prescribed by the notice or fails to comply with the assurances within such period as the Secretary prescribes, then after the Secretary provides the entity a reasonable opportunity for reconsideration of his determination, including, at the entity’s election, a fair hearing (A) the entity shall not be a qualified health maintenance organization for purposes of until such date as the Secretary determines that it is in compliance with the assurances, and (B) each employer which has offered membership in the entity in compliance with , each lawfully recognized collective bargaining representative or other employee representative which represents the employees of each such employer, and the members of such entity shall be notified by the entity that the entity is not a qualified health maintenance organization for purposes of such section. The notice required by clause (B) of the preceding sentence shall contain, in readily understandable language, the reasons for the determination that the entity is not a qualified health maintenance organization. The Secretary shall publish in the Federal Register each determination referred to in this paragraph.
(2)
If the Secretary makes, with respect to an entity which has received a grant, contract, loan, or loan guarantee under this subchapter, a determination described in subsection (a), the Secretary may, in addition to any other remedies available to him, bring a civil action in the United States district court for the district in which such entity is located to enforce its compliance with the assurances it furnished respecting the provision of basic and supplemental health services or its organization or operation, as the case may be, which assurances were made in connection with its application under this subchapter for the grant, contract, loan, or loan guarantee.

July 1, 1944, ch. 373 Pub. L. 93–222, § 287 Stat. 931 Pub. L. 94–460, title I, § 11190 Stat. 1952 Pub. L. 95–559, § 12(a)(2)92 Stat. 2140 Pub. L. 97–35, title IX, § 949(a)95 Stat. 578 (, title XIII, § 1312, as added , , ; amended , , ; , , ; , , .)

Editorial Notes

References in Text

Section 300e–9(d)(1) of this titlesection 300e–9(c)(1) of this titlePub. L. 100–517, § 7(b)102 Stat. 2580 , referred to in subsec. (b)(1), was redesignated by , , .

Prior Provisions

section 212a of this titlePub. L. 93–222, § 7(b)A prior section 1312 of act , was classified to prior to repeal by .

Amendments

Pub. L. 97–351981—Subsec. (b)(1). inserted provisions relating to opportunity for reconsideration of determination of Secretary.

Pub. L. 95–5591978—Subsec. (c). struck out subsec. (c) which provided that the Secretary, acting through the Assistant Secretary for Health, administer subsections (a) and (b) of this section in the Office of the Assistant Secretary for Health.

Pub. L. 94–460, § 111(a)section 300e–9 of this title1976—Subsec. (a). , substituted “the Secretary may take the action authorized by subsection (b)” for “the Secretary may, in addition to any other remedies available to him, bring a civil action in the United States district court for the district in which such entity is located to enforce its compliance with any assurances it furnished him respecting the provision of basic and supplemental health services or its organization or operation, as the case may be, which assurances were made under or when application was made under this subchapter for a grant, contract, loan, or loan guarantee”.

Pub. L. 94–460, § 111(b)Subsecs. (b), (c). , (c), added subsec. (b), redesignated former subsec. (b) as (c), and substituted “acting through the Assistant Secretary for Health, shall administer subsections (a) and (b)” for “through the Assistant Secretary for Health, shall administer subsection (a)”.

Statutory Notes and Related Subsidiaries

Effective Date of 1976 Amendment

Pub. L. 94–460section 118 of Pub. L. 94–460section 300e of this titleAmendment by applicable with respect to determinations of the Secretary of Health, Education, and Welfare described in subsec. (a) of this section and made after , see , set out as a note under .