
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: 42USC300gg-22]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
   SUBCHAPTER XXV--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
 
                      Part A--Group Market Reforms
 
         subpart 4--exclusion of plans; enforcement; preemption
 
Sec. 300gg-22. Enforcement


(a) State enforcement

                         (1) State authority

        Subject to section 300gg-23 of this title, each State may 
    require that health insurance issuers that issue, sell, renew, or 
    offer health insurance coverage in the State in the small or large 
    group markets meet the requirements of this part with respect to 
    such issuers.

                 (2) Failure to implement provisions

        In the case of a determination by the Secretary that a State has 
    failed to substantially enforce a provision (or provisions) in this 
    part with respect to health insurance issuers in the State, the 
    Secretary shall enforce such provision (or provisions) under 
    subsection (b) of this section insofar as they relate to the 
    issuance, sale, renewal, and offering of health insurance coverage 
    in connection with group health plans in such State.

(b) Secretarial enforcement authority

                           (1) Limitation

        The provisions of this subsection shall apply to enforcement of 
    a provision (or provisions) of this part only--
            (A) as provided under subsection (a)(2) of this section; and
            (B) with respect to group health plans that are non-Federal 
        governmental plans.

                     (2) Imposition of penalties

        In the cases described in paragraph (1)--

        (A) In general

            Subject to the succeeding provisions of this subsection, any 
        non-Federal governmental plan that is a group health plan and 
        any health insurance issuer that fails to meet a provision of 
        this part applicable to such plan or issuer is subject to a 
        civil money penalty under this subsection.

        (B) Liability for penalty

            In the case of a failure by--
                (i) a health insurance issuer, the issuer is liable for 
            such penalty, or
                (ii) a group health plan that is a non-Federal 
            governmental plan which is--
                    (I) sponsored by 2 or more employers, the plan is 
                liable for such penalty, or
                    (II) not so sponsored, the employer is liable for 
                such penalty.

        (C) Amount of penalty

            (i) In general

                The maximum amount of penalty imposed under this 
            paragraph is $100 for each day for each individual with 
            respect to which such a failure occurs.
            (ii) Considerations in imposition

                In determining the amount of any penalty to be assessed 
            under this paragraph, the Secretary shall take into account 
            the previous record of compliance of the entity being 
            assessed with the applicable provisions of this part and the 
            gravity of the violation.
            (iii) Limitations

                (I) Penalty not to apply where failure not 
                        discovered exercising reasonable 
                        diligence

                    No civil money penalty shall be imposed under this 
                paragraph on any failure during any period for which it 
                is established to the satisfaction of the Secretary that 
                none of the entities against whom the penalty would be 
                imposed knew, or exercising reasonable diligence would 
                have known, that such failure existed.
                (II) Penalty not to apply to failures corrected 
                        within 30 days

                    No civil money penalty shall be imposed under this 
                paragraph on any failure if such failure was due to 
                reasonable cause and not to willful neglect, and such 
                failure is corrected during the 30-day period beginning 
                on the first day any of the entities against whom the 
                penalty would be imposed knew, or exercising reasonable 
                diligence would have known, that such failure existed.

        (D) Administrative review

            (i) Opportunity for hearing

                The entity assessed shall be afforded an opportunity for 
            hearing by the Secretary upon request made within 30 days 
            after the date of the issuance of a notice of assessment. In 
            such hearing the decision shall be made on the record 
            pursuant to section 554 of title 5. If no hearing is 
            requested, the assessment shall constitute a final and 
            unappealable order.
            (ii) Hearing procedure

                If a hearing is requested, the initial agency decision 
            shall be made by an administrative law judge, and such 
            decision shall become the final order unless the Secretary 
            modifies or vacates the decision. Notice of intent to modify 
            or vacate the decision of the administrative law judge shall 
            be issued to the parties within 30 days after the date of 
            the decision of the judge. A final order which takes effect 
            under this paragraph shall be subject to review only as 
            provided under subparagraph (E).

        (E) Judicial review

            (i) Filing of action for review

                Any entity against whom an order imposing a civil money 
            penalty has been entered after an agency hearing under this 
            paragraph may obtain review by the United States district 
            court for any district in which such entity is located or 
            the United States District Court for the District of 
            Columbia by filing a notice of appeal in such court within 
            30 days from the date of such order, and simultaneously 
            sending a copy of such notice by registered mail to the 
            Secretary.
            (ii) Certification of administrative record

                The Secretary shall promptly certify and file in such 
            court the record upon which the penalty was imposed.
            (iii) Standard for review

                The findings of the Secretary shall be set aside only if 
            found to be unsupported by substantial evidence as provided 
            by section 706(2)(E) of title 5.
            (iv) Appeal

                Any final decision, order, or judgment of the district 
            court concerning such review shall be subject to appeal as 
            provided in chapter 83 of title 28.

        (F) Failure to pay assessment; maintenance of action

            (i) Failure to pay assessment

                If any entity fails to pay an assessment after it has 
            become a final and unappealable order, or after the court 
            has entered final judgment in favor of the Secretary, the 
            Secretary shall refer the matter to the Attorney General who 
            shall recover the amount assessed by action in the 
            appropriate United States district court.
            (ii) Nonreviewability

                In such action the validity and appropriateness of the 
            final order imposing the penalty shall not be subject to 
            review.

        (G) Payment of penalties

            Except as otherwise provided, penalties collected under this 
        paragraph shall be paid to the Secretary (or other officer) 
        imposing the penalty and shall be available without 
        appropriation and until expended for the purpose of enforcing 
        the provisions with respect to which the penalty was imposed.

(July 1, 1944, ch. 373, title XXVII, Sec. 2722, as added Pub. L. 104-
191, title I, Sec. 102(a), Aug. 21, 1996, 110 Stat. 1968.)


                             Effective Date

    Section applicable with respect to group health plans, and health 
insurance coverage offered in connection with group health plans, for 
plan years beginning after June 30, 1997, except as otherwise provided, 
see section 102(c) of Pub. L. 104-191, set out as a note under section 
300gg of this title.

                  Section Referred to in Other Sections

    This section is referred to in section 300gg-61 of this title.
