[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 836 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 836

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 health plans and health insurance issuers provide women with 
 adequate access to providers of obstetric and gynecological services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 20, 1999

   Mr. Specter (for himself, Mr. Graham, Mr. Cochran, and Mr. Robb) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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 health plans and health insurance issuers provide women with 
 adequate access to providers of obstetric and gynecological services.

    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 1999''.
    (b) Findings.--Congress makes the following findings:
            (1) Women's health historically has received little 
        attention.
            (2) A provider of obstetric and gynecological care improves 
        a woman's access to health care by providing primary and 
        preventive health care throughout the woman's lifetime.
            (3) Sixty percent of all office visits to providers of 
        obstetric and gynecological care are for preventive care.
            (4) Providers of obstetrical and gynecological care are 
        uniquely qualified on the basis of education and experience to 
        provide basic women's health care services.
            (5) While more than 37 States have acted to promote 
        residents' access to providers of obstetrical and gynecological 
        care, patients in other States or in Federally-governed health 
        plans are not protected from access restrictions or 
        limitations.

SEC. 2. PATIENT 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, beneficiary, or enrollee to 
designate a participating primary care provider, and an individual who 
is female has not designated a provider who specializes in obstetrics 
and gynecology as a primary care provider, the plan or issuer--
            (1) may not require authorization or a referral by the 
        individual's primary care provider or otherwise for coverage of 
        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 that such care is 
        otherwise covered; and
            (2) may treat the ordering of other gynecological and 
        obstetrical care, including referrals for related care, by such 
        a participating provider 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) shall be construed 
to waive any requirements of coverage relating to medical necessity or 
appropriateness with respect to coverage of the gynecological and 
obstetrical care so ordered.
    (c) Providers.--A group health plan, or a health insurance issuer 
in connection with the provision of health insurance coverage, that 
provides benefits, in whole or in part, through participating health 
care providers shall have (in relation to the coverage) a sufficient 
number, distribution, and variety of qualified participating health 
care providers to ensure that all covered health care services, 
including specialty services, will be available and accessible in a 
timely manner to all participants, beneficiaries, and enrollees under 
the plan or coverage.
    (d) Prohibitions.--A group health plan, and a health insurance 
issuer in connection with the provision of health insurance coverage, 
may not--
            (1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan or coverage, for the purpose of avoiding the 
        requirements of this section;
            (2) provide monetary payments or rebates to individuals to 
        encourage such individuals to access less than the minimum 
        protections available under this section;
            (3) penalize or otherwise reduce or limit the reimbursement 
        of a provider because such provider provided care to an 
        individual participant, beneficiary, or enrollee in accordance 
        with this section; or
            (4) provide incentives (monetary or otherwise) to a 
        provider to induce such provider to provide care to an 
        individual participant, beneficiary, or enrollee in a manner 
        inconsistent with this section.
    (e) Level and Type of Reimbursements.--Nothing in this section 
shall be construed to prevent a group health plan or a health insurance 
issuer in connection with the provision of health insurance coverage 
from negotiating the level and type of reimbursement with a provider 
for care provided in accordance with this section.
    (f) Continued Applicability of State Law With Respect to Health 
Insurance Issuers.--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 
except to the extent that such standard or requirement prevents the 
application of a requirement of this section.

SEC. 3. PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE UNDER 
              PUBLIC HEALTH SERVICE ACT.

    (a) In General.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act, 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. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``(a) In General.--Each group health plan shall comply with the 
patient protection requirements under section 2 of the Access to 
Women's Health Care Act of 1999, and each health insurance issuer shall 
comply with patient protection requirements under such section with 
respect to group health insurance coverage it offers, and such 
requirements shall be deemed to be incorporated into this subsection.
    ``(b) Notice.--A group health plan shall comply with the notice 
requirement under section 711(d) of the Employee Retirement Income 
Security Act of 1974 with respect to the requirements referred to in 
subsection (a) and a health insurance issuer shall comply with such 
notice requirement as if such subsection applied to such issuer and 
such issuer were a group health plan.''
    (b) Individual Market.--Subpart 3 of part B of title XXVII of the 
Public Health Service Act, 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. 2753. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``(a) In General.--Each health insurance issuer shall comply with 
patient protection requirements under section 2 of the Access to 
Women's Health Care Act of 1999, with respect to individual health 
insurance coverage it offers, and such requirements shall be deemed to 
be incorporated into this subsection.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 711(d) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
referred to in subsection (a) as if such subsection applied to such 
issuer and such issuer were a group health plan.''.

SEC. 4. PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE UNDER 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, 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. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``(a) In General.--Subject to subsection (b), a group health plan 
(and a health insurance issuer offering group health insurance coverage 
in connection with such a plan) shall comply with the requirements of 
section 2 of the Access to Women's Health Care Act of 1999 (as in 
effect as of the date of enactment of such Act), and such requirements 
shall be deemed to be incorporated into this subsection.
    ``(b) Notice.--The imposition of the requirements of this section 
shall be treated as 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 shall apply.''.
    (b) Conforming Amendment.--The table of contents in section 1 of 
the Employee Retirement Income Security Act of 1974, 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. Patient access to obstetric and gynecological care.''.

SEC. 5. APPLICATION OF PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL 
              CARE TO THE INTERNAL REVENUE CODE OF 1986.

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

``Sec. 9813. Patient access to obstetric and gynecological care''; and
            (2) by inserting after section 9812 the following new 
        section:

``SEC. 9813. PATIENT ACCESS TO OBSTETRIC AND GYNECOLOGICAL CARE.

    ``A group health plan shall comply with the requirements of section 
2 of the Access to Women's Health Care Act of 1999 (as in effect as of 
the date of enactment of such Act), and such requirements shall be 
deemed to be incorporated into this section.''
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