---
kind: "section"
citation: "42 U.S.C. § 280g–15"
title: "42"
title_heading: "The Public Health and Welfare"
number: "280g–15"
heading: "State demonstration programs to evaluate alternatives to current medical tort litigation"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/280g-15"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter II — General Powers and Duties"
  - "Part P — Additional Programs"
---

# §280g–15. State demonstration programs to evaluate alternatives to current medical tort litigation

- (a) **In general—** The [Secretary](/usc/42/201.md?p=c) is authorized to award demonstration grants to [States](/usc/42/201.md?p=f) for the development, implementation, and evaluation of alternatives to current tort litigation for resolving disputes over injuries allegedly caused by [health care providers](/usc/42/300aa–33.md?p=1) or health care organizations. In awarding such grants, the [Secretary](/usc/42/201.md?p=c) shall ensure the diversity of the alternatives so funded.
- (b) **Duration—** The [Secretary](/usc/42/201.md?p=c) may award grants under [subsection (a)](#a) for a period not to exceed 5 years.
- (c) **Conditions for demonstration grants—**
  - (1) **Requirements—** Each [State](/usc/42/201.md?p=f) desiring a grant under [subsection (a)](#a) shall develop an alternative to current tort litigation that—
    - (A) allows for the resolution of disputes over injuries allegedly caused by [health care providers](/usc/42/300aa–33.md?p=1) or health care organizations; and
    - (B) promotes a reduction of health care errors by encouraging the collection and analysis of patient safety data related to disputes resolved under [subparagraph (A)](#c-1-A) by organizations that engage in efforts to improve patient safety and the quality of health care.
  - (2) **Alternative to current tort litigation—** Each [State](/usc/42/201.md?p=f) desiring a grant under [subsection (a)](#a) shall demonstrate how the proposed alternative described in [paragraph (1)(A)](#c-1-A)—
    - (A) makes the medical liability system more reliable by increasing the availability of prompt and fair resolution of disputes;
    - (B) encourages the efficient resolution of disputes;
    - (C) encourages the disclosure of health care errors;
    - (D) enhances patient safety by detecting, analyzing, and helping to reduce medical errors and adverse events;
    - (E) improves access to liability insurance;
    - (F) fully informs patients about the differences in the alternative and current tort litigation;
    - (G) provides patients the ability to opt out of or voluntarily withdraw from participating in the alternative at any time and to pursue other options, including litigation, outside the alternative;
    - (H) would not conflict with [State](/usc/42/201.md?p=f) law at the time of the application in a way that would prohibit the adoption of an alternative to current tort litigation; and
    - (I) would not limit or curtail a patient’s existing legal rights, ability to file a claim in or access a [State](/usc/42/201.md?p=f)’s legal system, or otherwise abrogate a patient’s ability to file a medical malpractice claim.
  - (3) **Sources of compensation—** Each [State](/usc/42/201.md?p=f) desiring a grant under [subsection (a)](#a) shall identify the sources from and methods by which compensation would be paid for claims resolved under the proposed alternative to current tort litigation, which may include public or private funding sources, or a combination of such sources. Funding methods shall to the extent practicable provide financial incentives for activities that improve patient safety.
  - (4) **Scope—**
    - (A) **In general—** Each [State](/usc/42/201.md?p=f) desiring a grant under [subsection (a)](#a) shall establish a scope of jurisdiction (such as Statewide, designated geographic region, a designated area of health care practice, or a designated group of [health care providers](/usc/42/300aa–33.md?p=1) or health care organizations) for the proposed alternative to current tort litigation that is sufficient to evaluate the effects of the alternative. No scope of jurisdiction shall be established under this paragraph that is based on a health care payer or patient population.
    - (B) **Notification of patients—** A [State](/usc/42/201.md?p=f) shall demonstrate how patients would be notified that they are receiving health [care services](/usc/42/300z–1.md?p=a-7) that fall within such scope, and the process by which they may opt out of or voluntarily withdraw from participating in the alternative. The decision of the patient whether to participate or continue participating in the alternative process shall be made at any time and shall not be limited in any way.
  - (5) **Preference in awarding demonstration grants—** In awarding grants under [subsection (a)](#a), the [Secretary](/usc/42/201.md?p=c) shall give preference to [States](/usc/42/201.md?p=f)—
    - (A) that have developed the proposed alternative through substantive consultation with relevant stakeholders, including patient advocates, [health care providers](/usc/42/300aa–33.md?p=1) and health care organizations, attorneys with expertise in representing patients and [health care providers](/usc/42/300aa–33.md?p=1), medical malpractice insurers, and patient safety experts;
    - (B) that make proposals that are likely to enhance patient safety by detecting, analyzing, and helping to reduce medical errors and adverse events; and
    - (C) that make proposals that are likely to improve access to liability insurance.
- (d) **Application—**
  - (1) **In general—** Each [State](/usc/42/201.md?p=f) desiring a grant under [subsection (a)](#a) shall submit to the [Secretary](/usc/42/201.md?p=c) an application, at such time, in such manner, and containing such information as the [Secretary](/usc/42/201.md?p=c) may require.
  - (2) **Review panel—**
    - (A) **In general—** In reviewing applications under [paragraph (1)](#d-1), the [Secretary](/usc/42/201.md?p=c) shall consult with a review panel composed of relevant experts appointed by the [Comptroller General](/usc/42/300x–64.md?p=b-1).
    - (B) **Composition—**
      - (i) **Nominations—** The [Comptroller General](/usc/42/300x–64.md?p=b-1) shall solicit nominations from the public for individuals to serve on the review panel.
      - (ii) **Appointment—** The [Comptroller General](/usc/42/300x–64.md?p=b-1) shall appoint, at least 9 but not more than 13, highly qualified and knowledgeable individuals to serve on the review panel and shall ensure that the following entities receive fair representation on such panel:
        - (I) Patient advocates.
        - (II) [Health care providers](/usc/42/300aa–33.md?p=1) and health care organizations.
        - (III) Attorneys with expertise in representing patients and [health care providers](/usc/42/300aa–33.md?p=1).
        - (IV) Medical malpractice insurers.
        - (V) [State](/usc/42/201.md?p=f) officials.
        - (VI) Patient safety experts.
    - (C) **Chairperson—** The [Comptroller General](/usc/42/300x–64.md?p=b-1) shall designate a member of the review panel to be the chairperson of the review panel.
    - (D) **Availability of information—** The [Secretary](/usc/42/201.md?p=c) shall make available to the review panel such information, personnel, and administrative [services](/usc/42/201.md?p=a) and assistance as the review panel may reasonably require to carry out its duties.
    - (E) **Information from agencies—** The review panel may request directly from any department or [agency](/usc/42/8262.md?p=1) of the United States any information that such panel considers necessary to carry out its duties. To the extent consistent with applicable laws and [regulations](/usc/42/201.md?p=d), the head of such department or [agency](/usc/42/8262.md?p=1) shall furnish the requested information to the review panel.
- (e) **Reports—**
  - (1) **By State—** Each [State](/usc/42/201.md?p=f) receiving a grant under [subsection (a)](#a) shall submit to the [Secretary](/usc/42/201.md?p=c) an annual report evaluating the effectiveness of activities funded with grants awarded under such subsection. Such report shall, at a minimum, include the impact of the activities funded on patient safety and on the availability and price of medical liability insurance.
  - (2) **By Secretary—** The [Secretary](/usc/42/201.md?p=c) shall submit to Congress an annual compendium of the reports submitted under [paragraph (1)](#e-1) and an analysis of the activities funded under [subsection (a)](#a) that examines any differences that result from such activities in terms of the quality of care, number and nature of medical errors, medical resources used, length of time for dispute resolution, and the availability and price of liability insurance.
- (f) **Technical assistance—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c) shall provide technical assistance to the [States](/usc/42/201.md?p=f) applying for or awarded grants under [subsection (a)](#a).
  - (2) **Requirements—** Technical assistance under [paragraph (1)](#f-1) shall include—
    - (A) guidance on non-economic damages, including the consideration of individual facts and circumstances in determining appropriate payment, guidance on identifying avoidable injuries, and guidance on disclosure to patients of health care errors and adverse events; and
    - (B) the development, in consultation with [States](/usc/42/201.md?p=f), of common definitions, formats, and data collection infrastructure for [States](/usc/42/201.md?p=f) receiving grants under this section to use in reporting to facilitate aggregation and analysis of data both within and between [States](/usc/42/201.md?p=f).
  - (3) **Use of common definitions, formats, and data collection infrastructure—** [States](/usc/42/201.md?p=f) not receiving grants under this section may also use the common definitions, formats, and data collection infrastructure developed under [paragraph (2)(B)](#f-2-B).
- (g) **Evaluation—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c), in consultation with the review panel established under [subsection (d)(2)](#d-2), shall enter into a contract with an appropriate research organization to conduct an overall evaluation of the effectiveness of grants awarded under [subsection (a)](#a) and to annually prepare and submit a report to Congress. Such an evaluation shall begin not later than 18 months following the date of implementation of the first [program](/usc/42/274l–1.md?p=4) funded by a grant under [subsection (a)](#a).
  - (2) **Contents—** The evaluation under [paragraph (1)](#g-1) shall include—
    - (A) an analysis of the effects of the grants awarded under [subsection (a)](#a) with regard to the measures described in [paragraph (3)](#g-3);
    - (B) for each [State](/usc/42/201.md?p=f), an analysis of the extent to which the alternative developed under [subsection (c)(1)](#c-1) is effective in meeting the elements described in [subsection (c)(2)](#c-2);
    - (C) a comparison among the [States](/usc/42/201.md?p=f) receiving grants under [subsection (a)](#a) of the effectiveness of the various alternatives developed by such [States](/usc/42/201.md?p=f) under [subsection (c)(1)](#c-1);
    - (D) a comparison, considering the measures described in [paragraph (3)](#g-3), of [States](/usc/42/201.md?p=f) receiving grants approved under [subsection (a)](#a) and similar [States](/usc/42/201.md?p=f) not receiving such grants; and
    - (E) a comparison, with regard to the measures described in [paragraph (3)](#g-3), of—
      - (i) [States](/usc/42/201.md?p=f) receiving grants under [subsection (a)](#a);
      - (ii) [States](/usc/42/201.md?p=f) that enacted, prior to March 23, 2010, any cap on non-economic damages; and
      - (iii) [States](/usc/42/201.md?p=f) that have enacted, prior to March 23, 2010, a requirement that the complainant obtain an opinion regarding the merit of the claim, although the substance of such opinion may have no bearing on whether the complainant may proceed with a case.
  - (3) **Measures—** The evaluations under [paragraph (2)](#g-2) shall analyze and make comparisons on the basis of—
    - (A) the nature and number of disputes over injuries allegedly caused by [health care providers](/usc/42/300aa–33.md?p=1) or health care organizations;
    - (B) the nature and number of claims in which tort litigation was pursued despite the existence of an alternative under [subsection (a)](#a);
    - (C) the disposition of disputes and claims, including the length of time and estimated costs to all parties;
    - (D) the medical liability environment;
    - (E) health care quality;
    - (F) patient safety in terms of detecting, analyzing, and helping to reduce medical errors and adverse events;
    - (G) patient and [health care provider](/usc/42/300aa–33.md?p=1) and organization satisfaction with the alternative under [subsection (a)](#a) and with the medical liability environment; and
    - (H) impact on utilization of medical [services](/usc/42/201.md?p=a), appropriately adjusted for risk.
  - (4) **Funding—** The [Secretary](/usc/42/201.md?p=c) shall reserve 5 percent of the amount appropriated in each fiscal year under [subsection (k)](#k) to carry out this subsection.
- (h) **MedPAC and MACPAC reports—**
  - (1) **MedPAC—** The Medicare Payment Advisory Commission shall conduct an independent review of the alternatives to current tort litigation that are implemented under grants under [subsection (a)](#a) to determine the impact of such alternatives on the Medicare [program](/usc/42/274l–1.md?p=4) under title XVIII of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.], and its [beneficiaries](/usc/42/300gg–91.md?p=d-2).
  - (2) **MACPAC—** The Medicaid and CHIP Payment and Access Commission shall conduct an independent review of the alternatives to current tort litigation that are implemented under grants under [subsection (a)](#a) to determine the impact of such alternatives on the Medicaid or CHIP [programs](/usc/42/274l–1.md?p=4) under titles XIX and XXI of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq., 1397aa et seq.], and their [beneficiaries](/usc/42/300gg–91.md?p=d-2).
  - (3) **Reports—** Not later than December 31, 2016, the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission shall each submit to Congress a report that includes the findings and recommendations of each respective Commission based on independent reviews conducted under paragraphs [(1)](#h-1) and [(2)](#h-2), including an analysis of the impact of the alternatives reviewed on the efficiency and effectiveness of the respective [programs](/usc/42/274l–1.md?p=4).
- (i) **Option to provide for initial planning grants—** Of the funds appropriated pursuant to [subsection (k)](#k), the [Secretary](/usc/42/201.md?p=c) may use a portion not to exceed $500,000 per [State](/usc/42/201.md?p=f) to provide planning grants to such [States](/usc/42/201.md?p=f) for the development of demonstration [project](/usc/42/13641.md?p=2) applications meeting the criteria described in [subsection (c)](#c). In selecting [States](/usc/42/201.md?p=f) to receive such planning grants, the [Secretary](/usc/42/201.md?p=c) shall give preference to those [States](/usc/42/201.md?p=f) in which [State](/usc/42/201.md?p=f) law at the time of the application would not prohibit the adoption of an alternative to current tort litigation.
- (j) **Definitions—** In this section:
  - (1) **Health care services—** The term “health [care services](/usc/42/300z–1.md?p=a-7)” means any [services](/usc/42/201.md?p=a) provided by a [health care provider](/usc/42/300aa–33.md?p=1), or by any individual working under the supervision of a [health care provider](/usc/42/300aa–33.md?p=1), that relate to—
    - (A) the diagnosis, prevention, or [treatment](/usc/42/11851.md?p=11) of any human disease or impairment; or
    - (B) the assessment of the health of human beings.
  - (2) **Health care organization—** The term “health care organization” means any individual or entity which is obligated to provide, pay for, or administer health benefits under any health plan.
  - (3) **Health care provider—** The term “[health care provider](/usc/42/300aa–33.md?p=1)” means any individual or entity—
    - (A) licensed, registered, or certified under Federal or [State](/usc/42/201.md?p=f) laws or [regulations](/usc/42/201.md?p=d) to provide health [care services](/usc/42/300z–1.md?p=a-7); or
    - (B) required to be so licensed, registered, or certified but that is exempted by other statute or regulation.
- (k) **Authorization of appropriations—** There are authorized to be appropriated to carry out this section, $50,000,000 for the 5-fiscal year period beginning with fiscal year 2011.
- (l) **Current State efforts to establish alternative to tort litigation—** Nothing in this section shall be construed to limit any prior, current, or future efforts of any [State](/usc/42/201.md?p=f) to establish any alternative to tort litigation.
- (m) **Rule of construction—** Nothing in this section shall be construed as limiting [states](/usc/42/201.md?p=f)’[^1] authority over or responsibility for their [state](/usc/42/201.md?p=f)[^1] justice systems.

## Footnotes

[^1]: So in original. Probably should be capitalized.

## Source credit

(July 1, 1944, ch. 373, title III, § 399V–4, as added Pub. L. 111–148, title X, § 10607, Mar. 23, 2010, 124 Stat. 1009; amended Pub. L. 114–301, § 3(d), Dec. 16, 2016, 130 Stat. 1515.)

## Notes

### Editorial Notes

### References in Text

The Social Security Act, referred to in subsec. (h)(1), (2), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

### Amendments

2016—Subsec. (d)(2)(C). Pub. L. 114–301, § 3(d)(1), substituted “shall designate a member of the review panel to” for “, or an individual within the Government Accountability Office designated by the Comptroller General, shall”.

Subsec. (d)(2)(D). Pub. L. 114–301, § 3(d)(2), substituted “Secretary” for “Comptroller General”.