[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2937 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 2937

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

                             June 16, 2005

   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 the Workforce 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:

``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:

``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.
                                 <all>