[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 697 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 697

To ensure that a woman can designate an obstetrician or gynecologist as 
                       her primary care provider.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 24, 1999

 Mrs. Boxer (for herself and Ms. Snowe) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To ensure that a woman can designate an obstetrician or gynecologist as 
                       her primary care provider.

    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 Access to Care Act''.

SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et 
seq.), as amended by the Omnibus Consolidated and Emergency 
Supplemental Appropriations Act, 1999 (Public Law 105-277), is amended 
by adding at the end the following:

``SEC. 714. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

    ``(a) In General.--If a group health plan, or a health insurance 
issuer in connection with the provision of health insurance coverage, 
requires or provides for a participant or beneficiary to designate a 
participating primary care provider--
            ``(1) the plan or issuer shall permit such an individual 
        who is a female to designate a participating physician who 
        specializes in obstetrics and gynecology as the individual's 
        primary care provider in lieu of or in addition to the 
        designation by such individual of a provider who does not 
        specialize in obstetrics and gynecology as the primary care 
        provider; and
            ``(2) if such an individual has not designated a physician 
        who specializes in obstetrics or gynecology as a primary care 
        provider, the plan or issuer--
                    ``(A) may not require authorization or a referral 
                by the individual's primary care provider or otherwise 
                for coverage of routine gynecological care (such as 
                preventive women's health examinations) and pregnancy-
                related services provided by a participating health 
                care professional who specializes in obstetrics and 
                gynecology to the extent such care is otherwise 
                covered, and
                    ``(B) may treat the ordering of other gynecological 
                care by such a participating health professional as the 
                authorization of the primary care provider with respect 
                to such care under the plan or 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 gynecological care so 
ordered.''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note), 
as amended by the Omnibus Consolidated and Emergency Supplemental 
Appropriations Act, 1999 (Public Law 105-277), is amended by inserting 
after the item relating to section 713 the following new item:

``Sec. 714. Access to obstetrical and gynecological care.''.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Group Market.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-4 et seq.), as amended by the 
Omnibus Consolidated and Emergency Supplemental Appropriations Act, 
1999 (Public Law 105-277), is amended by adding at the end the 
following new section:

``SEC. 2707. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

    ``(a) In General.--If a group health plan, or a health insurance 
issuer in connection with the provision of health insurance coverage, 
requires or provides for an enrollee to designate a participating 
primary care provider--
            ``(1) the plan or issuer shall permit such an individual 
        who is a female to designate a participating physician who 
        specializes in obstetrics and gynecology as the individual's 
        primary care provider in lieu of or in addition to the 
        designation by such individual of a provider who does not 
        specialize in obstetrics and gynecology as the primary care 
        provider; and
            ``(2) if such an individual has not designated a physician 
        who specializes in obstetrics or gynecology as a primary care 
        provider, the plan or issuer--
                    ``(A) may not require authorization or a referral 
                by the individual's primary care provider or otherwise 
                for coverage of routine gynecological care (such as 
                preventive women's health examinations) and pregnancy-
                related services provided by a participating health 
                care professional who specializes in obstetrics and 
                gynecology to the extent such care is otherwise 
                covered, and
                    ``(B) may treat the ordering of other gynecological 
                care by such a participating health professional as the 
                authorization of the primary care provider with respect 
                to such care under the plan or 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 gynecological care so 
ordered.''.
    (b) Individual Market.--The first subpart 3 of part B of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg-51 et seq.) 
(relating to other requirements), as amended by the Omnibus 
Consolidated and Emergency Supplemental Appropriations Act, 1999 
(Public Law 105-277) is amended--
            (1) by redesignating such subpart as subpart 2; and
            (2) by adding at the end the following:

``SEC. 2753. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

    ``The provisions of section 2707 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.''.

SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

    Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is 
amended--
            (1) in the table of sections, by inserting after the item 
        relating to section 9812 the following new item:

                              ``Sec. 9813. Access to obstetrical and 
                                        gynecological care.''; and
            (2) by inserting after section 9812 the following:

``SEC. 9813. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.

    ``(a) In General.--If a group health plan, or a health insurance 
issuer in connection with the provision of health insurance coverage, 
requires or provides for a participant or beneficiary to designate a 
participating primary care provider--
            ``(1) the plan or issuer shall permit such an individual 
        who is a female to designate a participating physician who 
        specializes in obstetrics and gynecology as the individual's 
        primary care provider in lieu of or in addition to the 
        designation by such individual of a provider who does not 
        specialize in obstetrics and gynecology as the primary care 
        provider; and
            ``(2) if such an individual has not designated a physician 
        who specializes in obstetrics or gynecology as a primary care 
        provider, the plan or issuer--
                    ``(A) may not require authorization or a referral 
                by the individual's primary care provider or otherwise 
                for coverage of routine gynecological care (such as 
                preventive women's health examinations) and pregnancy-
                related services provided by a participating health 
                care professional who specializes in obstetrics and 
                gynecology to the extent such care is otherwise 
                covered, and
                    ``(B) may treat the ordering of other gynecological 
                care by such a participating health professional as the 
                authorization of the primary care provider with respect 
                to such care under the plan or 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 gynecological care so 
ordered.''.

SEC. 5. EFFECTIVE DATES.

    (a) In General.--Except as provided in subsection (c), the 
amendments made by this Act shall apply with respect to plan years 
beginning on or after the date of enactment of this Act.
    (b) Special Rule for Collective Bargaining Agreements.--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 this Act shall not apply to plan years beginning 
before the later of--
            (1) 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
            (2) January 1, 2000.
For purposes of paragraph (1), 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 this Act shall not 
be treated as a termination of such collective bargaining agreement.
    (c) Individual Market.--The amendment made by section 3(b) shall 
apply to health insurance coverage offered, sold, issued, renewed, in 
effect, or operated in the individual market on or after the date of 
enactment of this Act.

SEC. 6. RULE OF CONSTRUCTION.

    Nothing in this Act shall be construed to require a participating 
physician to accept designation as a primary care provider.
                                 <all>