II

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; FINDINGS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Access to Women’s Health Care Act of 1999’’.
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1 (b) FINDINGS.—Congress makes the following find2 ings:

3 (1) Women’s health historically has received lit4 tle attention.

5 (2) A provider of obstetric and gynecological

6 care improves a woman’s access to health care by

7 providing primary and preventive health care

8 throughout the woman’s lifetime.

9 (3) Sixty percent of all office visits to providers

10 of obstetric and gynecological care are for preventive

11 care.

12 (4) Providers of obstetrical and gynecological

13 care are uniquely qualified on the basis of education

14 and experience to provide basic women’s health care

15 services.

16 (5) While more than 37 States have acted to

17 promote residents’ access to providers of obstetrical

18 and gynecological care, patients in other States or in

19 Federally-governed health plans are not protected

20 from access restrictions or limitations.

21 SEC. 2. PATIENT ACCESS TO OBSTETRICAL AND GYNECO22 LOGICAL CARE.

23 (a) IN GENERAL.—If a group health plan, or a health

24 insurance issuer in connection with the provision of health

25 insurance coverage, requires or provides for a participant,
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1 beneficiary, or enrollee to designate a participating pri2 mary care provider, and an individual who is female has

3 not designated a provider who specializes in obstetrics and

4 gynecology as a primary care provider, the plan or

5 issuer—

6 (1) may not require authorization or a referral

7 by the individual’s primary care provider or other8 wise for coverage of gynecological care (such as pre9 ventive women’s health examinations) and preg10 nancy-related services provided by a participating

11 health care professional who specializes in obstetrics

12 and gynecology to the extent that such care is other13 wise covered; and

14 (2) may treat the ordering of other gyneco15 logical and obstetrical care, including referrals for

16 related care, by such a participating provider as the

17 authorization of the primary care provider with re18 spect to such care under the plan or coverage.

19 (b) CONSTRUCTION.—Nothing in subsection (a)(2)

20 shall be construed to waive any requirements of coverage

21 relating to medical necessity or appropriateness with re22 spect to coverage of the gynecological and obstetrical care

23 so ordered.

24 (c) PROVIDERS.—A group health plan, or a health

25 insurance issuer in connection with the provision of health
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1 insurance coverage, that provides benefits, in whole or in

2 part, through participating health care providers shall

3 have (in relation to the coverage) a sufficient number, dis4 tribution, and variety of qualified participating health care

5 providers to ensure that all covered health care services,

6 including specialty services, will be available and accessible

7 in a timely manner to all participants, beneficiaries, and

8 enrollees under the plan or coverage.

9 (d) PROHIBITIONS.—A group health plan, and a

10 health insurance issuer in connection with the provision

11 of health insurance coverage, may not—

12 (1) deny to an individual eligibility, or contin13 ued eligibility, to enroll or to renew coverage under

14 the terms of the plan or coverage, for the purpose

15 of avoiding the requirements of this section;

16 (2) provide monetary payments or rebates to in17 dividuals to encourage such individuals to access less

18 than the minimum protections available under this

19 section;

20 (3) penalize or otherwise reduce or limit the re21 imbursement of a provider because such provider

22 provided care to an individual participant, bene23 ficiary, or enrollee in accordance with this section; or

24 (4) provide incentives (monetary or otherwise)

25 to a provider to induce such provider to provide care
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1 to an individual participant, beneficiary, or enrollee

2 in a manner inconsistent with this section.

3 (e) LEVEL AND TYPE OF REIMBURSEMENTS.—Noth4 ing in this section shall be construed to prevent a group

5 health plan or a health insurance issuer in connection with

6 the provision of health insurance coverage from negoti7 ating the level and type of reimbursement with a provider

8 for care provided in accordance with this section.

9 (f) CONTINUED APPLICABILITY OF STATE LAW

10 WITH RESPECT TO HEALTH INSURANCE ISSUERS.—This

11 section shall not be construed to supersede any provision

12 of State law which establishes, implements, or continues

13 in effect any standard or requirement solely relating to

14 health insurance issuers in connection with group health

15 insurance coverage except to the extent that such standard

16 or requirement prevents the application of a requirement

17 of this section.

18 SEC. 3. PATIENT ACCESS TO OBSTETRICAL AND GYNECO19 LOGICAL CARE UNDER PUBLIC HEALTH

20 SERVICE ACT.

21 (a) IN GENERAL.—Subpart 2 of part A of title

22 XXVII of the Public Health Service Act, as amended by

23 the Omnibus Consolidated and Emergency Supplemental

24 Appropriations Act, 1999 (Public Law 105–277), is

25 amended by adding at the end the following new section:
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1 ‘‘SEC. 2707. PATIENT ACCESS TO OBSTETRIC AND GYNECO2 LOGICAL CARE.

3 ‘‘(a) IN GENERAL.—Each group health plan shall

4 comply with the patient protection requirements under

5 section 2 of the Access to Women’s Health Care Act of

6 1999, and each health insurance issuer shall comply with

7 patient protection requirements under such section with

8 respect to group health insurance coverage it offers, and

9 such requirements shall be deemed to be incorporated into

10 this subsection.

11 ‘‘(b) NOTICE.—A group health plan shall comply with

12 the notice requirement under section 711(d) of the Em13 ployee Retirement Income Security Act of 1974 with re14 spect to the requirements referred to in subsection (a) and

15 a health insurance issuer shall comply with such notice

16 requirement as if such subsection applied to such issuer

17 and such issuer were a group health plan.’’

18 (b) INDIVIDUAL MARKET.—Subpart 3 of part B of

19 title XXVII of the Public Health Service Act, as amended

20 by the Omnibus Consolidated and Emergency Supple21 mental Appropriations Act, 1999 (Public Law 105–277),

22 is amended by adding at the end the following new section:

23 ‘‘SEC. 2753. PATIENT ACCESS TO OBSTETRIC AND GYNECO24 LOGICAL CARE.

25 ‘‘(a) IN GENERAL.—Each health insurance issuer

26 shall comply with patient protection requirements under
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1 section 2 of the Access to Women’s Health Care Act of

2 1999, with respect to individual health insurance coverage

3 it offers, and such requirements shall be deemed to be in4 corporated into this subsection.

5 ‘‘(b) NOTICE.—A health insurance issuer under this

6 part shall comply with the notice requirement under sec7 tion 711(d) of the Employee Retirement Income Security

8 Act of 1974 with respect to the requirements referred to

9 in subsection (a) as if such subsection applied to such

10 issuer and such issuer were a group health plan.’’.

11 SEC. 4. PATIENT ACCESS TO OBSTETRICAL AND GYNECO12 LOGICAL CARE UNDER THE EMPLOYEE RE13 TIREMENT INCOME SECURITY ACT OF 1974.

14 (a) IN GENERAL.—Subpart B of part 7 of subtitle

15 B of title I of the Employee Retirement Income Security

16 Act of 1974, as amended by the Omnibus Consolidated

17 and Emergency Supplemental Appropriations Act, 1999

18 (Public Law 105–277), is amended by adding at the end

19 the following:

20 ‘‘SEC. 714. PATIENT ACCESS TO OBSTETRIC AND GYNECO21 LOGICAL CARE.

22 ‘‘(a) IN GENERAL.—Subject to subsection (b), a

23 group health plan (and a health insurance issuer offering

24 group health insurance coverage in connection with such

25 a plan) shall comply with the requirements of section 2
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1 of the Access to Women’s Health Care Act of 1999 (as

2 in effect as of the date of enactment of such Act), and

3 such requirements shall be deemed to be incorporated into

4 this subsection.

5 ‘‘(b) NOTICE.—The imposition of the requirements of

6 this section shall be treated as material modification in

7 the terms of the plan described in section 102(a)(1), for

8 purposes of assuring notice of such requirements under

9 the plan, except that the summary description required to

10 be provided under the last sentence of section 104(b)(1)

11 with respect to such modification shall be provided by not

12 later than 60 days after the first day of the first plan

13 year in which such requirements shall apply.’’.

14 (b) CONFORMING AMENDMENT.—The table of con15 tents in section 1 of the Employee Retirement Income Se16 curity Act of 1974, as amended by the Omnibus Consoli17 dated and Emergency Supplemental Appropriations Act,

18 1999 (Public Law 105–277), is amended by inserting

19 after the item relating to section 713 the following new

20 item:

‘‘Sec. 714. Patient access to obstetric and gynecological care.’’.
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1 SEC. 5. APPLICATION OF PATIENT ACCESS TO OBSTETRIC

2 AND GYNECOLOGICAL CARE TO THE INTER3 NAL REVENUE CODE OF 1986.

4 (a) IN GENERAL.—Subchapter B of chapter 100 of

5 the Internal Revenue Code of 1986 (relating to other re6 quirements) is amended—

7 (1) in the table of sections, by inserting after

8 the item relating to section 9812 the following new

9 item:

‘‘Sec. 9813. Patient access to obstetric and gynecological care’’; and

10 (2) by inserting after section 9812 the following

11 new section:

12 ‘‘SEC. 9813. PATIENT ACCESS TO OBSTETRIC AND GYNECO13 LOGICAL CARE.

14 ‘‘A group health plan shall comply with the require15 ments of section 2 of the Access to Women’s Health Care

16 Act of 1999 (as in effect as of the date of enactment of

17 such Act), and such requirements shall be deemed to be

18 incorporated into this section.’’

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