[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 283 Introduced in House (IH)]
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.
(a) Group Health Plans.--
(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.''.
(c) Effective Dates.--
(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.
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