110th CONGRESS
1st Session
H. R. 283
To amend the Public Health Service Act, the Employee Retirement
Income Security Act of 1974, and the Internal Revenue Code of 1986 to require
that group and individual health insurance coverage and group health plans
permit enrollees direct access to services of obstetrical and gynecological
physician services directly and without a referral.
IN THE HOUSE OF REPRESENTATIVES
January 5, 2007
Mrs. DAVIS of California introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the Committees
on Education and Labor and Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To amend the Public Health Service Act, the Employee Retirement
Income Security Act of 1974, and the Internal Revenue Code of 1986 to require
that group and individual health insurance coverage and group health plans
permit enrollees direct access to services of obstetrical and gynecological
physician services directly and without a referral.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Women's Obstetrician and Gynecologist Access
Now Act'.
SEC. 2. WOMEN'S ACCESS TO OBSTETRICAL AND GYNECOLOGICAL SERVICES.
(1) PUBLIC HEALTH SERVICE ACT AMENDMENTS- (A) Subpart 2 of part A of title
XXVII of the Public Health Service Act is amended by adding at the end
the following new section:
`SEC. 2707. STANDARD RELATING TO WOMEN'S ACCESS TO OBSTETRICAL AND GYNECOLOGICAL
SERVICES.
`(a) Direct Access Required-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall allow a participant or beneficiary
the option to seek obstetrical and gynecological physician services directly
from a participating obstetrician and gynecologist or directly from a
participating family practice physician and surgeon designated by the
plan or issuer as providing obstetrical and gynecological services. A
group health plan or health insurance issuer, in connection with the offering
of group health insurance coverage, shall not require a participant or
beneficiary to obtain prior approval from another physician, another provider,
the plan or issuer, or any other person prior to obtaining direct access
to obstetrical and gynecological physician services.
`(2) CONSTRUCTION- Paragraph (1) shall not be construed as preventing
a plan or issuer--
`(A) from establishing reasonable requirements for the participating
obstetrician and gynecologist or family practice physician and surgeon
to communicate with the participant's or beneficiary's primary care
physician and surgeon regarding the participant's or beneficiary's condition,
treatment, and any need for followup care; or
`(B) from establishing reasonable provisions governing utilization protocols
and the use of obstetricians and gynecologists, or family practice physicians
and surgeons, participating in the plan or issuer network, medical group,
or independent practice association, so long as these provisions--
`(i) are consistent with the intent of such paragraph;
`(ii) are those customarily applied to other physicians and surgeons,
such as primary care physicians and surgeons, to whom the participant
or beneficiary has direct access; and
`(iii) are not to be more restrictive for the provision of obstetrical
and gynecological physician services.
`(b) Notice- A group health plan under this part shall comply with the notice
requirement under section 714(b) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements of this section as if such
section applied to such plan.'.
(2) ERISA AMENDMENTS- (A) Subpart B of part 7 of subtitle B of title I
of the Employee Retirement Income Security Act of 1974 is amended by adding
at the end the following new section:
`SEC. 714. STANDARD RELATING TO WOMEN'S ACCESS TO OBSTETRICAL AND GYNECOLOGICAL
SERVICES.
`(a) Direct Access Required-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, shall allow a participant or beneficiary
the option to seek obstetrical and gynecological physician services directly
from a participating obstetrician and gynecologist or directly from a
participating family practice physician and surgeon designated by the
plan or issuer as providing obstetrical and gynecological services. A
group health plan or health insurance issuer, in connection with the offering
of group health insurance coverage, shall not require a participant or
beneficiary to obtain prior approval from another physician, another provider,
the plan or issuer, or any other person prior to obtaining direct access
to obstetrical and gynecological physician services.
`(2) CONSTRUCTION- Paragraph (1) shall not be construed as preventing
a plan or issuer--
`(A) from establishing reasonable requirements for the participating
obstetrician and gynecologist or family practice physician and surgeon
to communicate with the participant's or beneficiary's primary care
physician and surgeon regarding the participant's or beneficiary's condition,
treatment, and any need for followup care; or
`(B) from establishing reasonable provisions governing utilization protocols
and the use of obstetricians and gynecologists, or family practice physicians
and surgeons, participating in the plan or issuer network, medical group,
or independent practice association, so long as these provisions--
`(i) are consistent with the intent of such paragraph;
`(ii) are those customarily applied to other physicians and surgeons,
such as primary care physicians and surgeons, to whom the participant
or beneficiary has direct access; and
`(iii) are not to be more restrictive for the provision of obstetrical
and gynecological physician services.
`(b) Notice Under Group Health Plan- The imposition of the requirement of
this section shall be treated as a material modification in the terms of
the plan described in section 102(a)(1), for purposes of assuring notice
of such requirements under the plan; except that the summary description
required to be provided under the last sentence of section 104(b)(1) with
respect to such modification shall be provided by not later than 60 days
after the first day of the first plan year in which such requirement apply.'.
(B) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking
`section 711' and inserting `sections 711 and 714'.
(C) The table of contents in section 1 of such Act is amended by inserting
after the item relating to section 713 the following new item:
`Sec. 714. Standard relating to women's access to obstetrical and gynecological
services'.
(3) INTERNAL REVENUE CODE AMENDMENTS-
(A) IN GENERAL- Subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended--
(i) in the table of sections, by inserting after the item relating
to section 9812 the following new item:
`Sec. 9813. Standard relating to women's access to obstetrical and gynecological
services'; and
(ii) by inserting after section 9812 the following:
`SEC. 9813. STANDARD RELATING TO WOMEN'S ACCESS TO OBSTETRICAL AND GYNECOLOGICAL
SERVICES.
`(a) Direct Access Required- A group health plan, and a health insurance
issuer offering group health insurance coverage, shall allow a participant
or beneficiary the option to seek obstetrical and gynecological physician
services directly from a participating obstetrician and gynecologist or
directly from a participating family practice physician and surgeon designated
by the plan or issuer as providing obstetrical and gynecological services.
A group health plan or health insurance issuer, in connection with the offering
of group health insurance coverage, shall not require a participant or beneficiary
to obtain prior approval from another physician, another provider, the plan
or issuer, or any other person prior to obtaining direct access to obstetrical
and gynecological physician services.
`(b) Construction- Subsection (a) shall not be construed as preventing a
plan or issuer--
`(1) from establishing reasonable requirements for the participating obstetrician
and gynecologist or family practice physician and surgeon to communicate
with the participant's or beneficiary's primary care physician and surgeon
regarding the participant's or beneficiary's condition, treatment, and
any need for followup care; or
`(2) from establishing reasonable provisions governing utilization protocols
and the use of obstetricians and gynecologists, or family practice physicians
and surgeons, participating in the plan or issuer network, medical group,
or independent practice association, so long as these provisions--
`(A) are consistent with the intent of such subsection;
`(B) are those customarily applied to other physicians and surgeons,
such as primary care physicians and surgeons, to whom the participant
or beneficiary has direct access; and
`(C) are not to be more restrictive for the provision of obstetrical
and gynecological physician services.'.
(B) CONFORMING AMENDMENT- Section 4980D(d)(1) of such Code is amended
by striking `section 9811' and inserting `sections 9811 and 9813'.
(b) Individual Health Insurance- Part B of title XXVII of the Public Health
Service Act is amended by inserting after section 2752 the following new
section:
`SEC. 2753. STANDARD RELATING TO WOMEN'S ACCESS TO OBSTETRICAL AND GYNECOLOGICAL
SERVICES.
`(a) In General- The provisions of section 2707(a) shall apply to health
insurance coverage offered by a health insurance issuer in the individual
market in the same manner as they apply to health insurance coverage offered
by a health insurance issuer in connection with a group health plan in the
small or large group market.
`(b) Notice- A health insurance issuer under this part shall comply with
the notice requirement under section 714(b) of the Employee Retirement Income
Security Act of 1974 with respect to the requirements referred to in subsection
(a) as if such section applied to such issuer and such issuer were a group
health plan.'.
(1) GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE COVERAGE- Subject to
paragraph (3), the amendments made by subsection (a) apply with respect
to group health plans for plan years beginning more than 180 days after
the date of the enactment of this Act.
(2) INDIVIDUAL HEALTH INSURANCE COVERAGE- The amendment made by subsection
(b) applies with respect to health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market on or after such
date.
(3) COLLECTIVE BARGAINING EXCEPTION- In the case of a group health plan
maintained pursuant to 1 or more collective bargaining agreements between
employee representatives and 1 or more employers ratified before the date
of enactment of this Act, the amendments made subsection (a) shall not
apply to plan years beginning before the later of--
(A) the date on which the last collective bargaining agreements relating
to the plan terminates (determined without regard to any extension thereof
agreed to after the date of enactment of this Act), or
(B) the date that is 180 days after the date of the enactment of this
Act.
For purposes of subparagraph (A), any plan amendment made pursuant to
a collective bargaining agreement relating to the plan which amends the
plan solely to conform to any requirement added by subsection (a) shall
not be treated as a termination of such collective bargaining agreement.
(d) Coordination of Administration- The Secretary of Labor, the Secretary
of the Treasury, and the Secretary of Health and Human Services shall ensure,
through the execution of an interagency memorandum of understanding among
such Secretaries, that--
(1) regulations, rulings, and interpretations issued by such Secretaries
relating to the same matter over which two or more such Secretaries have
responsibility under the provisions of this Act (and the amendments made
thereby) are administered so as to have the same effect at all times;
and
(2) coordination of policies relating to enforcing the same requirements
through such Secretaries in order to have a coordinated enforcement strategy
that avoids duplication of enforcement efforts and assigns priorities
in enforcement.
END
