dreamproit/uscode huggingface dataset:
42 U.S.C. § 17933 (THE PUBLIC HEALTH AND WELFARE)
§ 17933. Education on health information privacy
(a) Regional office privacy advisors
Not later than 6 months after February 17, 2009, the Secretary shall designate an individual in each regional office of the Department of Health and Human Services to offer guidance and education to covered entities, business associates, and individuals on their rights and responsibilities related to Federal privacy and security requirements for protected health information.
(b) Education initiative on uses of health information
Not later than 12 months after February 17, 2009, the Office for Civil Rights within the Department of Health and Human Services shall develop and maintain a multi-faceted national education initiative to enhance public transparency regarding the uses of protected health information, including programs to educate individuals about the potential uses of their protected health information, the effects of such uses, and the rights of individuals with respect to such uses. Such programs shall be conducted in a variety of languages and present information in a clear and understandable manner.
(Pub. L. 111–5, div. A, title XIII, § 13403, Feb. 17, 2009, 123 Stat. 263.)
42 U.S.C. § 17934 (THE PUBLIC HEALTH AND WELFARE)
§ 17934. Application of privacy provisions and penalties to business associates of covered entities
(a) Application of contract requirements
In the case of a business associate of a covered entity that obtains or creates protected health information pursuant to a written contract (or other written arrangement) described in section 164.502(e)(2) of title 45, Code of Federal Regulations, with such covered entity, the business associate may use and disclose such protected health information only if such use or disclosure, respectively, is in compliance with each applicable requirement of section 164.504(e) of such title. The additional requirements of this subchapter that relate to privacy and that are made applicable with respect to covered entities shall also be applicable to such a business associate and shall be incorporated into the business associate agreement between the business associate and the covered entity.
(b) Application of knowledge elements associated with contracts
Section 164.504(e)(1)(ii) of title 45, Code of Federal Regulations, shall apply to a business associate described in subsection (a), with respect to compliance with such subsection, in the same manner that such section applies to a covered entity, with respect to compliance with the standards in sections 164.502(e) and 164.504(e) of such title, except that in applying such section 164.504(e)(1)(ii) each reference to the business associate, with respect to a contract, shall be treated as a reference to the covered entity involved in such contract.
(c) Application of civil and criminal penalties
In the case of a business associate that violates any provision of subsection (a) or (b), the provisions of sections 1176 and 1177 of the Social Security Act (42 U.S.C. 1320d–5, 1320d–6) shall apply to the business associate with respect to such violation in the same manner as such provisions apply to a person who violates a provision of part C of title XI of such Act [42 U.S.C. 1320d et seq.].
(Pub. L. 111–5, div. A, title XIII, § 13404, Feb. 17, 2009, 123 Stat. 264.)
heading: References in Text
text: This subchapter, referred to in subsec. (a), was in the original “this subtitle”, meaning subtitle D (§ 13400 et seq.) of title XIII of div. A of Pub. L. 111–5, Feb. 17, 2009, 123 Stat. 258, which is classified principally to this subchapter. For complete classification of subtitle D to the Code, see Tables.
The Social Security Act, referred to in subsec. (c), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part C of title XI of the Act is classified generally to part C (§ 1320d et seq.) of subchapter XI of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
42 U.S.C. § 17938 (THE PUBLIC HEALTH AND WELFARE)
§ 17938. Business associate contracts required for certain entities
Each organization, with respect to a covered entity, that provides data transmission of protected health information to such entity (or its business associate) and that requires access on a routine basis to such protected health information, such as a Health Information Exchange Organization, Regional Health Information Organization, E-prescribing Gateway, or each vendor that contracts with a covered entity to allow that covered entity to offer a personal health record to patients as part of its electronic health record, is required to enter into a written contract (or other written arrangement) described in section 164.502(e)(2) of title 45, Code of Federal Regulations and a written contract (or other arrangement) described in section 164.308(b) of such title, with such entity and shall be treated as a business associate of the covered entity for purposes of the provisions of this subchapter and subparts C and E of part 164 of title 45, Code of Federal Regulations, as such provisions are in effect as of February 17, 2009.
(Pub. L. 111–5, div. A, title XIII, § 13408, Feb. 17, 2009, 123 Stat. 271.)
heading: References in Text
text: This subchapter, referred to in text, was in the original “this subtitle”, meaning subtitle D (§ 13400 et seq.) of title XIII of div. A of Pub. L. 111–5, Feb. 17, 2009, 123 Stat. 258, which is classified principally to this subchapter. For complete classification of subtitle D to the Code, see Tables.
42 U.S.C. § 17940 (THE PUBLIC HEALTH AND WELFARE)
§ 17940. Audits
The Secretary shall provide for periodic audits to ensure that covered entities and business associates that are subject to the requirements of this subchapter and subparts C and E of part 164 of title 45, Code of Federal Regulations, as such provisions are in effect as of February 17, 2009, comply with such requirements.
(Pub. L. 111–5, div. A, title XIII, § 13411, Feb. 17, 2009, 123 Stat. 276.)
heading: References in Text
text: This subchapter, referred to in text, was in the original “this subtitle”, meaning subtitle D (§ 13400 et seq.) of title XIII of div. A of Pub. L. 111–5, Feb. 17, 2009, 123 Stat. 258, which is classified principally to this subchapter. For complete classification of subtitle D to the Code, see Tables.
42 U.S.C. § 17951 (THE PUBLIC HEALTH AND WELFARE)
§ 17951. Relationship to other laws
(a) Application of HIPAA State preemption
Section 1178 of the Social Security Act (42 U.S.C. 1320d–7) shall apply to a provision or requirement under this subchapter in the same manner that such section applies to a provision or requirement under part C of title XI of such Act [42 U.S.C. 1320d et seq.] or a standard or implementation specification adopted or established under sections 1172 through 1174 of such Act [42 U.S.C. 1320d–1 to 1320d–3].
(b) Health Insurance Portability and Accountability Act of 1996
The standards governing the privacy and security of individually identifiable health information promulgated by the Secretary under sections 262(a) and 264 of the Health Insurance Portability and Accountability Act of 1996 shall remain in effect to the extent that they are consistent with this subchapter. The Secretary shall by rule amend such Federal regulations as required to make such regulations consistent with this subchapter.
(c) Construction
Nothing in this subchapter shall constitute a waiver of any privilege otherwise applicable to an individual with respect to the protected health information of such individual.
(Pub. L. 111–5, div. A, title XIII, § 13421, Feb. 17, 2009, 123 Stat. 276.)
heading: References in Text
text: This subchapter, referred to in text, was in the original “this subtitle”, meaning subtitle D (§ 13400 et seq.) of title XIII of div. A of Pub. L. 111–5, Feb. 17, 2009, 123 Stat. 258, which is classified principally to this subchapter. For complete classification of subtitle D to the Code, see Tables.
The Social Security Act, referred to in subsec. (a), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part C of title XI of the Act is classified generally to part C (§ 1320d et seq.) of subchapter XI of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
The Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (b), is Pub. L. 104–191, Aug. 21, 1996, 110 Stat. 1936. Section 262(a) of the Act enacted sections 1320d to 1320d–8 of this title. Section 264 of the Act is set out as a note under section 1320d–2 of this title. For complete classification of this Act to the Code, see Short Title of 1996 Amendments note set out under section 201 of this title and Tables.
42 U.S.C. § 17952 (THE PUBLIC HEALTH AND WELFARE)
§ 17952. Regulatory references
Each reference in this subchapter to a provision of the Code of Federal Regulations refers to such provision as in effect on February 17, 2009 (or to the most recent update of such provision).
(Pub. L. 111–5, div. A, title XIII, § 13422, Feb. 17, 2009, 123 Stat. 276.)
heading: References in Text
text: This subchapter, referred to in text, was in the original “this subtitle”, meaning subtitle D (§ 13400 et seq.) of title XIII of div. A of Pub. L. 111–5, Feb. 17, 2009, 123 Stat. 258, which is classified principally to this subchapter. For complete classification of subtitle D to the Code, see Tables.
42 U.S.C. § 18012 (THE PUBLIC HEALTH AND WELFARE)
§ 18012. Rating reforms must apply uniformly to all health insurance issuers and group health plans
Any standard or requirement adopted by a State pursuant to this title,1 or any amendment made by this title,1 shall be applied uniformly to all health plans in each insurance market to which the standard and requirements apply. The preceding sentence shall also apply to a State standard or requirement relating to the standard or requirement required by this title 1 (or any such amendment) that is not the same as the standard or requirement but that is not preempted under section 18041(d) of this title.
(Pub. L. 111–148, title I, § 1252, Mar. 23, 2010, 124 Stat. 162.)
heading: References in Text
text: This title, referred to in text, is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.
42 U.S.C. § 18013 (THE PUBLIC HEALTH AND WELFARE)
§ 18013. Annual report on self-insured plans
Not later than 1 year after March 23, 2010, and annually thereafter, the Secretary of Labor shall prepare an aggregate annual report, using data collected from the Annual Return/Report of Employee Benefit Plan (Department of Labor Form 5500), that shall include general information on self-insured group health plans (including plan type, number of participants, benefits offered, funding arrangements, and benefit arrangements) as well as data from the financial filings of self-insured employers (including information on assets, liabilities, contributions, investments, and expenses). The Secretary shall submit such reports to the appropriate committees of Congress.
(Pub. L. 111–148, title I, § 1253, as added Pub. L. 111–148, title X, § 10103(f)(2), Mar. 23, 2010, 124 Stat. 895.)
heading: Prior Provisions
text: A prior section 1253 of Pub. L. 111–148 was renumbered section 1255 and is set out as a note under section 300gg of this title.
42 U.S.C. § 18043 (THE PUBLIC HEALTH AND WELFARE)
§ 18043. Funding for the territories
(a) In general
A territory that—
(1) elects consistent with subsection (b) to establish an Exchange in accordance with part B of this subchapter and establishes such an Exchange in accordance with such part shall be treated as a State for purposes of such part and shall be entitled to payment from the amount allocated to the territory under subsection (c); or
(2) does not make such election shall be entitled to an increase in the dollar limitation applicable to the territory under subsections (f) and (g) of section 1108 of the Social Security Act (42 U.S.C. 1308) for such period in such amount for such territory and such increase shall not be taken into account in computing any other amount under such subsections.
(b) Terms and conditions
An election under subsection (a)(1) shall—
(1) not be effective unless the election is consistent with section 18041 of this title and is received not later than October 1, 2013; and
(2) be contingent upon entering into an agreement between the territory and the Secretary that requires that—
(A) funds provided under the agreement shall be used only to provide premium and cost-sharing assistance to residents of the territory obtaining health insurance coverage through the Exchange; and
(B) the premium and cost-sharing assistance provided under such agreement shall be structured in such a manner so as to prevent any gap in assistance for individuals between the income level at which medical assistance is available through the territory’s Medicaid plan under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] and the income level at which premium and cost-sharing assistance is available under the agreement.
(c) Appropriation and allocation
(1) Appropriation
Out of any funds in the Treasury not otherwise appropriated, there is appropriated for purposes of payment pursuant to subsection (a) $1,000,000,000, to be available during the period beginning with 2014 and ending with 2019.
(2) Allocation
The Secretary shall allocate the amount appropriated under paragraph (1) among the territories for purposes of carrying out this section as follows:
(A) For Puerto Rico, $925,000,000.
(B) For another territory, the portion of $75,000,000 specified by the Secretary.
(Pub. L. 111–148, title I, § 1323, as added Pub. L. 111–152, title I, § 1204(a), Mar. 30, 2010, 124 Stat. 1055.)
heading: References in Text
text: The Social Security Act, referred to in subsec. (b)(2)(B), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XIX of the Act is classified generally to subchapter XIX (§ 1396 et seq.) of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
heading: Prior Provisions
text: A prior section 18043, Pub. L. 111–148, title I, § 1323, Mar. 23, 2010, 124 Stat. 192, which related to establishment of community health insurance option, was repealed by Pub. L. 111–148, title X, § 10104(m), Mar. 23, 2010, 124 Stat. 902.
42 U.S.C. § 18044 (THE PUBLIC HEALTH AND WELFARE)
§ 18044. Level playing field
(a) In general
Notwithstanding any other provision of law, any health insurance coverage offered by a private health insurance issuer shall not be subject to any Federal or State law described in subsection (b) if a qualified health plan offered under the Consumer Operated and Oriented Plan program under section 18042 of this title, or a multi-State qualified health plan under section 18054 of this title, is not subject to such law.
(b) Laws described
The Federal and State laws described in this subsection are those Federal and State laws relating to—
(1) guaranteed renewal;
(2) rating;
(3) preexisting conditions;
(4) non-discrimination;
(5) quality improvement and reporting;
(6) fraud and abuse;
(7) solvency and financial requirements;
(8) market conduct;
(9) prompt payment;
(10) appeals and grievances;
(11) privacy and confidentiality;
(12) licensure; and
(13) benefit plan material or information.
(Pub. L. 111–148, title I, § 1324, title X, § 10104(n), Mar. 23, 2010, 124 Stat. 199, 902.)
heading: Amendments
text: 2010—Subsec. (a). Pub. L. 111–148, § 10104(n), substituted “, or a multi-State qualified health plan under section 18054 of this title” for “, a community health insurance option under section 18043 of this title, or a nationwide qualified health plan under section 18053(b) of this title”.
42 U.S.C. § 18062 (THE PUBLIC HEALTH AND WELFARE)
§ 18062. Establishment of risk corridors for plans in individual and small group markets
(a) In general
The Secretary shall establish and administer a program of risk corridors for calendar years 2014, 2015, and 2016 under which a qualified health plan offered in the individual or small group market shall participate in a payment adjustment system based on the ratio of the allowable costs of the plan to the plan’s aggregate premiums. Such program shall be based on the program for regional participating provider organizations under part D of title XVIII of the Social Security Act [42 U.S.C. 1395w–101 et seq.].
(b) Payment methodology
(1) Payments out
The Secretary shall provide under the program established under subsection (a) that if—
(A) a participating plan’s allowable costs for any plan year are more than 103 percent but not more than 108 percent of the target amount, the Secretary shall pay to the plan an amount equal to 50 percent of the target amount in excess of 103 percent of the target amount; and
(B) a participating plan’s allowable costs for any plan year are more than 108 percent of the target amount, the Secretary shall pay to the plan an amount equal to the sum of 2.5 percent of the target amount plus 80 percent of allowable costs in excess of 108 percent of the target amount.
(2) Payments in
The Secretary shall provide under the program established under subsection (a) that if—
(A) a participating plan’s allowable costs for any plan year are less than 97 percent but not less than 92 percent of the target amount, the plan shall pay to the Secretary an amount equal to 50 percent of the excess of 97 percent of the target amount over the allowable costs; and
(B) a participating plan’s allowable costs for any plan year are less than 92 percent of the target amount, the plan shall pay to the Secretary an amount equal to the sum of 2.5 percent of the target amount plus 80 percent of the excess of 92 percent of the target amount over the allowable costs.
(c) Definitions
In this section:
(1) Allowable costs
(A) In general
The amount of allowable costs of a plan for any year is an amount equal to the total costs (other than administrative costs) of the plan in providing benefits covered by the plan.
(B) Reduction for risk adjustment and reinsurance payments
Allowable costs shall 1 reduced by any risk adjustment and reinsurance payments received under section 2 18061 and 18063 of this title.
(2) Target amount
The target amount of a plan for any year is an amount equal to the total premiums (including any premium subsidies under any governmental program), reduced by the administrative costs of the plan.
(Pub. L. 111–148, title I, § 1342, Mar. 23, 2010, 124 Stat. 211.)
heading: References in Text
text: The Social Security Act, referred to in subsec. (a), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part D of title XVIII of the Act is classified generally to part D (§ 1395w–101 et seq.) of subchapter XVIII of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
42 U.S.C. § 18063 (THE PUBLIC HEALTH AND WELFARE)
§ 18063. Risk adjustment
(a) In general
(1) Low actuarial risk plans
Using the criteria and methods developed under subsection (b), each State shall assess a charge on health plans and health insurance issuers (with respect to health insurance coverage) described in subsection (c) if the actuarial risk of the enrollees of such plans or coverage for a year is less than the average actuarial risk of all enrollees in all plans or coverage in such State for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1001 et seq.]).
(2) High actuarial risk plans
Using the criteria and methods developed under subsection (b), each State shall provide a payment to health plans and health insurance issuers (with respect to health insurance coverage) described in subsection (c) if the actuarial risk of the enrollees of such plans or coverage for a year is greater than the average actuarial risk of all enrollees in all plans and coverage in such State for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974).
(b) Criteria and methods
The Secretary, in consultation with States, shall establish criteria and methods to be used in carrying out the risk adjustment activities under this section. The Secretary may utilize criteria and methods similar to the criteria and methods utilized under part C or D of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq., 1395w–101 et seq.]. Such criteria and methods shall be included in the standards and requirements the Secretary prescribes under section 18041 of this title.
(c) Scope
A health plan or a health insurance issuer is described in this subsection if such health plan or health insurance issuer provides coverage in the individual or small group market within the State. This subsection shall not apply to a grandfathered health plan or the issuer of a grandfathered health plan with respect to that plan.
(Pub. L. 111–148, title I, § 1343, Mar. 23, 2010, 124 Stat. 212.)
heading: References in Text
text: The Employee Retirement Income Security Act of 1974, referred to in subsec. (a), is Pub. L. 93–406, Sept. 2, 1974, 88 Stat. 829, which is classified principally to chapter 18 (§ 1001 et seq.) of Title 29, Labor. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of Title 29 and Tables.
The Social Security Act, referred to in subsec. (b), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Parts C and D of title XVIII of the Act are classified generally to parts C (§ 1395w–21 et seq.) and D (§ 1395w–101 et seq.), respectively, of subchapter XVIII of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.
42 U.S.C. § 18084 (THE PUBLIC HEALTH AND WELFARE)
§ 18084. Premium tax credit and cost-sharing reduction payments disregarded for Federal and federally-assisted programs
For purposes of determining the eligibility of any individual for benefits or assistance, or the amount or extent of benefits or assistance, under any Federal program or under any State or local program financed in whole or in part with Federal funds—
(1) any credit or refund allowed or made to any individual by reason of section 36B of title 26 (as added by section 1401) 1 shall not be taken into account as income and shall not be taken into account as resources for the month of receipt and the following 2 months; and
(2) any cost-sharing reduction payment or advance payment of the credit allowed under such section 36B that is made under section 18071 or 18082 of this title shall be treated as made to the qualified health plan in which an individual is enrolled and not to that individual.
(Pub. L. 111–148, title I, § 1415, Mar. 23, 2010, 124 Stat. 237.)
heading: References in Text
text: Section 1401, referred to in par. (1), means section 1401 of Pub. L. 111–148.
42 U.S.C. § 18092 (THE PUBLIC HEALTH AND WELFARE)
§ 18092. Notification of nonenrollment
Not later than June 30 of each year, the Secretary of the Treasury, acting through the Internal Revenue Service and in consultation with the Secretary of Health and Human Services, shall send a notification to each individual who files an individual income tax return and who is not enrolled in minimum essential coverage (as defined in section 5000A of title 26). Such notification shall contain information on the services available through the Exchange operating in the State in which such individual resides.
(Pub. L. 111–148, title I, § 1502(c), Mar. 23, 2010, 124 Stat. 251.)