II

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.

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.

4 This Act may be cited as the ‘‘Women’s Access to

5 Care Act’’.

6 SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN7 COME SECURITY ACT OF 1974.

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

9 B of title I of the Employee Retirement Income Security

10 Act of 1974 (29 U.S.C. 1185 et seq.), as amended by the
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1 Omnibus Consolidated and Emergency Supplemental Ap2 propriations Act, 1999 (Public Law 105–277), is amended

3 by adding at the end the following:

4 ‘‘SEC. 714. ACCESS TO OBSTETRICAL AND GYNECOLOGICAL

5 CARE.

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

7 health insurance issuer in connection with the provision

8 of health insurance coverage, requires or provides for a

9 participant or beneficiary to designate a participating pri10 mary care provider—

11 ‘‘(1) the plan or issuer shall permit such an in12 dividual who is a female to designate a participating

13 physician who specializes in obstetrics and gyne14 cology as the individual’s primary care provider in

15 lieu of or in addition to the designation by such indi16 vidual of a provider who does not specialize in ob17 stetrics and gynecology as the primary care provider;

18 and

19 ‘‘(2) if such an individual has not designated a

20 physician who specializes in obstetrics or gynecology

21 as a primary care provider, the plan or issuer—

22 ‘‘(A) may not require authorization or a

23 referral by the individual’s primary care pro24 vider or otherwise for coverage of routine gyne25 cological care (such as preventive women’s
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1 health examinations) and pregnancy-related

2 services provided by a participating health care

3 professional who specializes in obstetrics and

4 gynecology to the extent such care is otherwise

5 covered, and

6 ‘‘(B) may treat the ordering of other gyne7 cological care by such a participating health

8 professional as the authorization of the primary

9 care provider with respect to such care under

10 the plan or coverage.

11 ‘‘(b) CONSTRUCTION.—Nothing in subsection

12 (a)(2)(B) shall waive any requirements of coverage relat13 ing to medical necessity or appropriateness with respect

14 to coverage of gynecological care so ordered.’’.

15 (b) CLERICAL AMENDMENT.—The table of contents

16 in section 1 of the Employee Retirement Income Security

17 Act of 1974 (29 U.S.C. 1001 note), as amended by the

18 Omnibus Consolidated and Emergency Supplemental Ap19 propriations Act, 1999 (Public Law 105–277), is amended

20 by inserting after the item relating to section 713 the fol21 lowing new item:

‘‘Sec. 714. Access to obstetrical and gynecological care.’’.

22 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE

23 ACT.

24 (a) GROUP MARKET.—Subpart 2 of part A of title

25 XXVII of the Public Health Service Act (42 U.S.C.
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1 300gg–4 et seq.), as amended by the Omnibus Consoli2 dated and Emergency Supplemental Appropriations Act,

3 1999 (Public Law 105–277), is amended by adding at the

4 end the following new section:

5 ‘‘SEC. 2707. ACCESS TO OBSTETRICAL AND GYNECO6 LOGICAL CARE.

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

8 health insurance issuer in connection with the provision

9 of health insurance coverage, requires or provides for an

10 enrollee to designate a participating primary care

11 provider—

12 ‘‘(1) the plan or issuer shall permit such an in13 dividual who is a female to designate a participating

14 physician who specializes in obstetrics and gyne15 cology as the individual’s primary care provider in

16 lieu of or in addition to the designation by such indi17 vidual of a provider who does not specialize in ob18 stetrics and gynecology as the primary care provider;

19 and

20 ‘‘(2) if such an individual has not designated a

21 physician who specializes in obstetrics or gynecology

22 as a primary care provider, the plan or issuer—

23 ‘‘(A) may not require authorization or a

24 referral by the individual’s primary care pro25 vider or otherwise for coverage of routine gyne-
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1 cological care (such as preventive women’s

2 health examinations) and pregnancy-related

3 services provided by a participating health care

4 professional who specializes in obstetrics and

5 gynecology to the extent such care is otherwise

6 covered, and

7 ‘‘(B) may treat the ordering of other gyne8 cological care by such a participating health

9 professional as the authorization of the primary

10 care provider with respect to such care under

11 the plan or coverage.

12 ‘‘(b) CONSTRUCTION.—Nothing in subsection

13 (a)(2)(B) shall waive any requirements of coverage relat14 ing to medical necessity or appropriateness with respect

15 to coverage of gynecological care so ordered.’’.

16 (b) INDIVIDUAL MARKET.—The first subpart 3 of

17 part B of title XXVII of the Public Health Service Act

18 (42 U.S.C. 300gg–51 et seq.) (relating to other require19 ments), as amended by the Omnibus Consolidated and

20 Emergency Supplemental Appropriations Act, 1999 (Pub21 lic Law 105–277) is amended—

22 (1) by redesignating such subpart as subpart 2;

23 and

24 (2) by adding at the end the following:
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1 ‘‘SEC. 2753. ACCESS TO OBSTETRICAL AND GYNECO2 LOGICAL CARE.

3 ‘‘The provisions of section 2707 shall apply to health

4 insurance coverage offered by a health insurance issuer

5 in the individual market in the same manner as they apply

6 to health insurance coverage offered by a health insurance

7 issuer in connection with a group health plan in the small

8 or large group market.’’.

9 SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE

10 OF 1986.

11 Subchapter B of chapter 100 of the Internal Revenue

12 Code of 1986 is amended—

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

14 the item relating to section 9812 the following new

15 item:

‘‘Sec. 9813. Access to obstetrical and gynecological care.’’; and

16 (2) by inserting after section 9812 the fol17 lowing:

18 ‘‘SEC. 9813. ACCESS TO OBSTETRICAL AND GYNECO19 LOGICAL CARE.

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

21 health insurance issuer in connection with the provision

22 of health insurance coverage, requires or provides for a

23 participant or beneficiary to designate a participating pri24 mary care provider—
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1 ‘‘(1) the plan or issuer shall permit such an in2 dividual who is a female to designate a participating

3 physician who specializes in obstetrics and gyne4 cology as the individual’s primary care provider in

5 lieu of or in addition to the designation by such indi6 vidual of a provider who does not specialize in ob7 stetrics and gynecology as the primary care provider;

8 and

9 ‘‘(2) if such an individual has not designated a

10 physician who specializes in obstetrics or gynecology

11 as a primary care provider, the plan or issuer—

12 ‘‘(A) may not require authorization or a

13 referral by the individual’s primary care pro14 vider or otherwise for coverage of routine gyne15 cological care (such as preventive women’s

16 health examinations) and pregnancy-related

17 services provided by a participating health care

18 professional who specializes in obstetrics and

19 gynecology to the extent such care is otherwise

20 covered, and

21 ‘‘(B) may treat the ordering of other gyne22 cological care by such a participating health

23 professional as the authorization of the primary

24 care provider with respect to such care under

25 the plan or coverage.
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1 ‘‘(b) CONSTRUCTION.—Nothing in subsection

2 (a)(2)(B) shall waive any requirements of coverage relat3 ing to medical necessity or appropriateness with respect

4 to coverage of gynecological care so ordered.’’.

5 SEC. 5. EFFECTIVE DATES.

6 (a) IN GENERAL.—Except as provided in subsection

7 (c), the amendments made by this Act shall apply with

8 respect to plan years beginning on or after the date of

9 enactment of this Act.

10 (b) SPECIAL RULE FOR COLLECTIVE BARGAINING

11 AGREEMENTS.—In the case of a group health plan main12 tained pursuant to 1 or more collective bargaining agree13 ments between employee representatives and 1 or more

14 employers ratified before the date of enactment of this

15 Act, the amendments made by this Act shall not apply

16 to plan years beginning before the later of—

17 (1) the date on which the last collective bar18 gaining agreements relating to the plan terminates

19 (determined without regard to any extension thereof

20 agreed to after the date of enactment of this Act),

21 or

22 (2) January 1, 2000.

23 For purposes of paragraph (1), any plan amendment made

24 pursuant to a collective bargaining agreement relating to

25 the plan which amends the plan solely to conform to any
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1 requirement added by this Act shall not be treated as a

2 termination of such collective bargaining agreement.

3 (c) INDIVIDUAL MARKET.—The amendment made by

4 section 3(b) shall apply to health insurance coverage of5 fered, sold, issued, renewed, in effect, or operated in the

6 individual market on or after the date of enactment of this

7 Act.

8 SEC. 6. RULE OF CONSTRUCTION.

9 Nothing in this Act shall be construed to require a

10 participating physician to accept designation as a primary

11 care provider.

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