
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC300e-11]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
             SUBCHAPTER XI--HEALTH MAINTENANCE ORGANIZATIONS
 
Sec. 300e-11. Continued regulation of health maintenance 
        organizations
        

(a) Determination of deficiency

    If 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 section 300e-9 of this title--
        (1) fails to provide basic and supplemental services to its 
    members,
        (2) fails to provide such services in the manner prescribed by 
    section 300e(b) of this title, or
        (3) is not organized or operated in the manner prescribed by 
    section 300e(c) of this title,

the Secretary may take the action authorized by subsection (b) of this 
section.

(b) Action by Secretary upon determination

    (1) If the Secretary makes, with respect to any entity which 
provided assurances to the Secretary under section 300e-9(d)(1) \1\ of 
this title, a determination described in subsection (a) of this section, 
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 section 300e-9 of this title 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 section 300e-9 of this title, 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.
---------------------------------------------------------------------------
    \1\ See References in Text note below.
---------------------------------------------------------------------------
    (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) of this section, 
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, title XIII, Sec. 1312, as added Pub. L. 93-222, 
Sec. 2, Dec. 29, 1973, 87 Stat. 931; amended Pub. L. 94-460, title I, 
Sec. 111, Oct. 8, 1976, 90 Stat. 1952; Pub. L. 95-559, Sec. 12(a)(2), 
Nov. 1, 1978, 92 Stat. 2140; Pub. L. 97-35, title IX, Sec. 949(a), Aug. 
13, 1981, 95 Stat. 578.)

                       References in Text

    Section 300e-9(d)(1) of this title, referred to in subsec. (b)(1), 
was redesignated section 300e-9(c)(1) of this title by Pub. L. 100-517, 
Sec. 7(b), Oct. 24, 1988, 102 Stat. 2580.


                            Prior Provisions

    A prior section 1312 of act July 1, 1944, was classified to section 
212a of this title prior to repeal by Pub. L. 93-222, Sec. 7(b).


                               Amendments

    1981--Subsec. (b)(1). Pub. L. 97-35 inserted provisions relating to 
opportunity for reconsideration of determination of Secretary.
    1978--Subsec. (c). Pub. L. 95-559 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.
    1976--Subsec. (a). Pub. L. 94-460, Sec. 111(a), substituted ``the 
Secretary may take the action authorized by subsection (b) of this 
section'' 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 section 
300e-9 of this title or when application was made under this subchapter 
for a grant, contract, loan, or loan guarantee''.
    Subsecs. (b), (c). Pub. L. 94-460, Sec. 111(b), (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) of this section'' for ``through the Assistant Secretary for 
Health, shall administer subsection (a) of this section''.


                    Effective Date of 1976 Amendment

    Amendment by Pub. L. 94-460 applicable with respect to 
determinations of the Secretary of Health, Education, and Welfare 
described in subsec. (a) of this section and made after Oct. 8, 1976, 
see section 118 of Pub. L. 94-460, set out as a note under section 300e 
of this title.

                  Section Referred to in Other Sections

    This section is referred to in section 1396b of this title.
