[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1737 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1737

  To amend the Public Health Service Act and the Employee Retirement 
Income Security Act of 1974 to require that group and individual health 
 insurance coverage and group health plans provide adequate access to 
            services provided by obstetrician-gynecologists.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 22, 1997

   Mrs. Lowey (for herself, Mr. Lazio of New York, and Mr. Combest) 
 introduced the following bill; which was referred to the Committee on 
    Commerce, and in addition to the Committee on Education and the 
 Workforce, 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 and the Employee Retirement 
Income Security Act of 1974 to require that group and individual health 
 insurance coverage and group health plans provide adequate access to 
            services provided by obstetrician-gynecologists.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Access to Women's 
Health Care Act of 1997''.
    (b) Findings.--Congress finds the following:
            (1) Women's health historically has received little 
        attention.
            (2) A majority of women view their obstetrician-
        gynecologist as their primary or sole physician.
            (3) An obstetrician-gynecologist improves the access to the 
        health care of a woman by providing primary and preventive 
        health care throughout the women's lifetime, encompassing care 
        of the whole patient in addition to focusing on the processes 
        of the female reproductive system.
            (4) 60 percent of all office visits to obstetrician-
        gynecologists are for preventive care.
            (5) Obstetrician-gynecologists refer their patients to 
        other physicians less frequently than other primary care 
        providers, thus avoiding costly and time-consuming referrals.
            (6) Obstetrician-gynecologists manage the health of women 
        beyond the reproductive system, and are uniquely qualified on 
        the basis of education and experience to provide basic health 
        care services to women.
            (7) While more than 20 States have acted to promote 
        residents' access to obstetrician-gynecologists, patients in 
        other States or in Federally-governed health plans are not 
        protected from access restrictions or limitations.

SEC. 2. ASSURING ACCESS TO OBSTETRICAL AND GYNECOLOGICAL SERVICES UNDER 
              GROUP HEALTH PLANS AND GROUP AND INDIVIDUAL HEALTH 
              INSURANCE COVERAGE.

    (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, as 
        amended by section 703(a) of Public Law 104-204, is amended by 
        adding at the end the following new section:

``SEC. 2706. STANDARDS RELATING TO ACCESS TO OBSTETRICAL AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--If a group health plan or health insurance 
issuer, in the provision of health insurance coverage in connection 
with a group health plan, requires or provides for an enrollee to 
designate a participating primary care provider--
            ``(1) the plan or issuer shall permit a female enrollee to 
        designate an obstetrician-gynecologist who has agreed to be 
        designated as such, as the enrollee's primary care provider; 
        and
            ``(2) if such an enrollee has not designated such a 
        provider as a primary care provider, the plan or issuer--
                    ``(A) may not require prior authorization by the 
                enrollee's primary care provider or otherwise for 
                coverage of obstetric and gynecologic care provided by 
                a participating obstetrician-gynecologist, or a 
                participating health care professional practicing in 
                collaboration with the obstetrician-gynecologist and in 
                accordance with State law, to the extent such care is 
                otherwise covered, and
                    ``(B) shall treat the ordering of other gynecologic 
                care by such a participating physician as the prior 
                authorization of the primary care provider with respect 
                to such care under the coverage.
    ``(b) Construction.--Nothing in subsection (a)(2)(B) shall waive 
any requirements of coverage relating to medical necessity or 
appropriateness with respect to coverage of gynecologic care so 
ordered.
    ``(c) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to a woman eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to women to 
        encourage such women to accept less than the minimum 
        protections available under this section; or
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section.
    ``(d) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 713(d) 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.
    ``(e) Level and Type of Reimbursements.--Nothing in this section 
shall be construed to prevent a group health plan or a health insurance 
issuer offering group health insurance coverage from negotiating the 
level and type of reimbursement with a provider for care provided in 
accordance with this section.
    ``(f) Non-Preemption of More Protective State Law With Respect to 
Health Insurance Issuers.--Notwithstanding section 2723(a)(1) but 
subject to section 2723(a)(2), this section shall not be construed to 
supersede any provision of State law which establishes, implements, or 
continues in effect any standard or requirement solely relating to 
health insurance issuers in connection with group health insurance 
coverage that provides greater protections to enrollees than the 
protections provided under this section.''.
            (B) Section 2723 of such Act (42 U.S.C. 300gg-23) is 
        amended--
                    (i) in subsection (a), by inserting ``and section 
                2706(f)'' after ``Subject to paragraph (2)'', and
                    (ii) in subsection (c), as amended by section 
                604(b)(2) of Public Law 104-204, by striking ``section 
                2704'' and inserting ``sections 2704 and 2706''.
            (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
        B of title I of the Employee Retirement Income Security Act of 
        1974, as amended by section 702(a) of Public Law 104-204, is 
        amended by adding at the end the following new section:

``SEC. 713. STANDARDS RELATING TO ACCESS TO OBSTETRICAL AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--If a group health plan or health insurance 
issuer, in the provision of health insurance coverage in connection 
with a group health plan, requires or provides for an enrollee to 
designate a participating primary care provider--
            ``(1) the plan or issuer shall permit a female enrollee to 
        designate an obstetrician-gynecologist who has agreed to be 
        designated as such, as the enrollee's primary care provider; 
        and
            ``(2) if such an enrollee has not designated such a 
        provider as a primary care provider, the plan or issuer--
                    ``(A) may not require prior authorization by the 
                enrollee's primary care provider or otherwise for 
                coverage of obstetric and gynecologic care provided by 
                a participating obstetrician-gynecologist, or a 
                participating health care professional practicing in 
                collaboration with the obstetrician-gynecologist and in 
                accordance with State law, to the extent such care is 
                otherwise covered, and
                    ``(B) shall treat the ordering of other gynecologic 
                care by such a participating physician as the prior 
                authorization of the primary care provider with respect 
                to such care under the coverage.
    ``(b) Construction.--Nothing in subsection (a)(2)(B) shall waive 
any requirements of coverage relating to medical necessity or 
appropriateness with respect to coverage of gynecologic care so 
ordered.
    ``(c) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to a woman eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to women to 
        encourage such women to accept less than the minimum 
        protections available under this section; or
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section.
    ``(d) Notice.--The imposition of the requirements 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 
requirements apply.
    ``(e) Level and Type of Reimbursements.--Nothing in this section 
shall be construed to prevent a group health plan or a health insurance 
issuer offering group health insurance coverage from negotiating the 
level and type of reimbursement with a provider for care provided in 
accordance with this section.
    ``(f) Non-Preemption of More Protective State Law With Respect to 
Health Insurance Issuers.--Notwithstanding section 731(a)(1) but 
subject to section 731(a)(2), this section shall not be construed to 
supersede any provision of State law which establishes, implements, or 
continues in effect any standard or requirement solely relating to 
health insurance issuers in connection with group health insurance 
coverage that provides greater protections to enrollees than the 
protections provided under this section.''.
            (B) Section 731 of such Act (29 U.S.C. 1191) is amended--
                    (i) in subsection (a), by inserting ``and section 
                713(f)'' after ``subject to paragraph (2)'', and
                    (ii) in subsection (c), by striking ``section 711'' 
                and inserting ``sections 711 and 713''.
            (C) Section 732(a) of such Act (29 U.S.C. 1191a(a)), as 
        amended by section 603(b)(2) of Public Law 104-204, is amended 
        by striking ``section 711'' and inserting ``sections 711 and 
        713''.
            (D) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 712 the 
        following new item:

``Sec. 713. Standards relating to access to obstetrical and 
                            gynecological services.''.
    (b) Individual Health Insurance.--(1) Part B of title XXVII of the 
Public Health Service Act, as amended by section 605(a) of Public Law 
104-204, is amended by inserting after section 2751 the following new 
section:

``SEC. 2752. STANDARDS RELATING TO ACCESS TO OBSTETRICAL AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--The provisions of section 2706 (other than 
subsection (d)) shall apply to health insurance coverage offered by a 
health insurance issuer in the individual market in the same manner as 
it applies 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 713(d) 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) Non-Preemption of More Protective State Law With Respect to 
Health Insurance Issuers.--Notwithstanding section 2762(a) but subject 
to section 2762(b)(1), this section shall not be construed to supersede 
any provision of State law which establishes, implements, or continues 
in effect any standard or requirement solely relating to health 
insurance issuers in connection with group health insurance coverage 
that provides greater protections to enrollees than the protections 
provided under this section.''.
    (2) Section 2762 of such Act (42 U.S.C. 300gg-62) is amended--
            (A) in subsection (a), by inserting ``and section 2752(c)'' 
        after ``Subject to subsection (b)'', and
            (B) in subsection (b)(2), as added by section 605(b)(3)(B) 
        of Public Law 104-204, by striking ``section 2751'' and 
        inserting ``sections 2751 and 2752''.
    (c) Effective Dates.--(1) Subject to paragraph (3), the amendments 
made by subsection (a) shall apply with respect to group health plans 
for plan years beginning on or after January 1, 1998.
    (2) The amendment made by subsection (b) shall apply with respect 
to health insurance coverage offered, sold, issued, renewed, in effect, 
or operated in the individual market on or after such date.
    (3) 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 by 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) January 1, 1998.
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.
                                 <all>