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42 U.S.C. § 300gg–5 — Non-discrimination in health care

submitted 82 years ago by Pub. L. 111-148 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 152 words · no verdicts yet

in plain englishAI-generated · not legal advice

A group health plan or insurer can't discriminate against a health care provider who is licensed to practice. Plans aren't required to contract with every willing provider. But they can still set different pay rates based on quality or performance.

(a) Providers: A group health plan and an insurer offering group or individual coverage can't discriminate, in who gets to participate under the plan or coverage, against a health care provider who is acting within the scope of that provider's license or certification under state law. This doesn't require a plan or insurer to contract with every provider willing to follow the plan's or insurer's participation terms. And nothing here stops a plan, insurer, or the Secretary from setting different reimbursement rates based on quality or performance measures. (b) Individuals: The nondiscrimination rules in section 218c of title 29 also apply to a group health plan or insurer that offers group or individual health insurance coverage.
the actual law source: uscode.house.gov ↗public domain
(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 1 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.

Source credit: (July 1, 1944, ch. 373, title XXVII, § 2706, as added Pub. L. 111–148, title I, § 1201(4), Mar. 23, 2010, 124 Stat. 160.)

history & why it existsrecord from the source credit
  • 1944Enacted · Pub. L. 111-148 · 124 Stat. 160

A history note hasn’t been published yet. The record shows enactment by Pub. L. 111-148 on 1944-07-01.

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