124 STAT. 179 PUBLIC LAW 111–148—MAR. 23, 2010 section 2794(b)(1) of the Public Health Service Act (relating to patterns or practices of excessive or unjustified premium increases), into consideration when determining whether to make such health plan available through the Exchange. The Exchange shall take into account any excess of premium growth outside the Exchange as compared to the rate of such growth inside the Exchange, including information reported by the States. (f) FLEXIBILITY.— (1) REGIONAL OR OTHER INTERSTATE EXCHANGES.—An Exchange may operate in more than one State if— (A) each State in which such Exchange operates per- mits such operation; and (B) the Secretary approves such regional or interstate Exchange. (2) SUBSIDIARY EXCHANGES.—A State may establish one or more subsidiary Exchanges if— (A) each such Exchange serves a geographically distinct area; and (B) the area served by each such Exchange is at least as large as a rating area described in section 2701(a) of the Public Health Service Act. (3) AUTHORITY TO CONTRACT.— (A) IN GENERAL.—A State may elect to authorize an Exchange established by the State under this section to enter into an agreement with an eligible entity to carry out 1 or more responsibilities of the Exchange. (B) ELIGIBLE ENTITY.—In this paragraph, the term ‘‘eligible entity’’ means— (i) a person— (I) incorporated under, and subject to the laws of, 1 or more States; (II) that has demonstrated experience on a State or regional basis in the individual and small group health insurance markets and in benefits coverage; and (III) that is not a health insurance issuer or that is treated under subsection (a) or (b) of section 52 of the Internal Revenue Code of 1986 as a member of the same controlled group of corpora- tions (or under common control with) as a health insurance issuer; or (ii) the State medicaid agency under title XIX of the Social Security Act. (g) REWARDING QUALITY THROUGH MARKET-BASED INCEN- TIVES.— (1) STRATEGY DESCRIBED.—A strategy described in this paragraph is a payment structure that provides increased reimbursement or other incentives for— (A) improving health outcomes through the implementation of activities that shall include quality reporting, effective case management, care coordination, chronic disease management, medication and care compli- ance initiatives, including through the use of the medical home model, for treatment or services under the plan or coverage; Definition.
