```

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1806 Introduced in House (IH)]

106th CONGRESS
  1st Session
                                H. R. 1806

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 provide adequate access to providers of obstetric and 
                        gynecological services.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 13, 1999

 Mrs. Lowey (for herself and Mr. Lazio) introduced the following bill; 
which was referred to the Committee on 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 provide 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 finds the following:
            (1) Women's health historically has received little 
        attention.
            (2) Women have a different set of primary care needs than 
        men and providing direct access to providers of obstetric and 
        gynecological services is an important way to address some of 
        these differences.
            (3) A majority of women view their provider of obstetric 
        and gynecological services as their primary or sole care 
        provider.
            (4) 78 percent of women think direct access to providers of 
        obstetric and gynecological services is very important.
            (5) Access to obstetric and gynecological services improves 
        the health of a woman by providing primary and preventive 
        health care throughout the woman's lifetime, encompassing care 
        of the whole patient in addition to focusing on the processes 
        of the female reproductive system.
            (6) More than 60 percent of all office visits to providers 
        of obstetric and gynecological services are for preventive 
        care.
            (7) President Clinton's Advisory Commission on Consumer 
        Protection and Quality in the Health Care Industry recommended 
        that women should be able to choose a qualified provider, 
        including obstetrician-gynecologists, certified nurse midwives, 
        and other qualified care providers offered by a plan, for the 
        provision of routine and preventive women's health care 
        services.
            (8) Providers of obstetric and gynecological services refer 
        their patients to other health care professionals less 
        frequently than other primary care providers, thus avoiding 
        costly and time-consuming referrals.
            (9) Providers of obstetric and gynecological services 
        manage the health of women beyond the reproductive system, and 
        are uniquely qualified on the basis of education and experience 
        to provide basic health care services to women.
            (10) While more than 37 States have acted to promote 
        residents' access to providers of obstetric and gynecological 
        services, patients in other States or in Federally-governed 
        health plans are not protected from access restrictions or 
        limitations.

SEC. 2. PATIENT ACCESS TO UNRESTRICTED OBSTETRIC AND GYNECOLOGICAL 
              SERVICES..

    (a) Public Health Service Act Amendments.--
            (1) Group health insurance coverage.--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. STANDARDS RELATING TO ACCESS TO UNRESTRICTED OBSTETRIC AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--In a case in which a group health plan or health 
insurance issuer offering health insurance coverage in connection with 
a group health plan provides benefits under the terms of the plan 
consisting of obstetric or gynecological services, including 
appropriate follow-up services and referrals for related obstetric or 
gynecological services, the plan or issuer shall provide for a female 
participant or beneficiary to designate a provider of obstetric and 
gynecological services who has agreed to be designated as such, as the 
participant or beneficiary's primary care provider. If such participant 
or beneficiary has not designated such a provider as a primary care 
provider, the plan or issuer--
            ``(1) may not require prior authorization by the 
        participant or beneficiary's primary care provider or otherwise 
        for coverage of obstetric or gynecological services provided by 
a participating health care professional practicing in accordance with 
State law, to the extent such care is otherwise covered; and
            ``(2) shall treat the ordering of other gynecological 
        services by such a participating health care professional as 
        the prior authorization of the primary care provider with 
        respect to such care under the coverage.
    ``(b) Adequate Number of Providers of Obstetric and Gynecological 
Services.--Each group health plan and health insurance issuer offering 
health insurance coverage in connection with a group health plan shall 
have an adequate number of providers of obstetric and gynecological 
services on its roster to satisfy the health care needs of all female 
participants and beneficiaries who choose to have such a provider as a 
primary care provider, or who otherwise need the services of a provider 
of obstetric and gynecological services.
    ``(c) Definition of ``Provider of Obstetric and Gynecological 
Services''.--For purposes of this section the term ``provider of 
obstetric and gynecological services means--
            ``(1) an obstetrician-gynecologist;
            ``(2) a nurse practitioner as defined in section 
        1861(aa)(5)(A); or
            ``(3) a certified nurse-midwife as defined in section 
        1861(gg)(2).
    ``(d) Construction.--Nothing in subsection (a)(2) shall waive any 
requirements of coverage relating to medical necessity or 
appropriateness with respect to coverage of obstetric or gynecological 
services so ordered.
    ``(e) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to a woman eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to women to 
        encourage such women to accept less than the minimum 
        protections available under this section; or
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section.
    ``(f) Level and Type of Reimbursements.--Nothing in this section 
shall be construed to prevent a group health plan or a health insurance 
issuer offering group health insurance coverage from negotiating the 
level and type of reimbursement with a provider for care provided in 
accordance with this section.
    ``(g) Non-Preemption of More Protective 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 that provides greater protections to participant and 
beneficiaries than the protections provided under this section.''.
    ``(h) 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) Individual health insurance coverage.--Part B of title 
        XXVII of such Act is amended by inserting after section 2752 
        the following new section:

``SEC. 2753. STANDARDS RELATING TO ACCESS TO UNRESTRICTED OBSTETRIC AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--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 it applies 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 this section as if such section applied to such issuer 
and such issuer were a group health plan.''.
    (b) ERISA Amendments.--
            (1) In general.--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. STANDARDS RELATING TO ACCESS TO UNRESTRICTED OBSTETRIC AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--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 2707 of the 
Public Health Service Act.
    ``(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.''.
            (2) Conforming amendment.--Section 732(a) of such Act (29 
        U.S.C. 1191a(a)) is amended by striking ``section 711'' and 
        inserting ``sections 711 and 714''.
            (3) Clerical amendment.--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:

``Sec. 714. Standards relating to access to unrestricted obstetric and 
                            gynecological services.''.
    (c) Internal Revenue Code Amendments.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by inserting after 
        section 9812 the following new section:

``SEC. 9813. STANDARDS RELATING TO ACCESS TO UNRESTRICTED OBSTETRIC AND 
              GYNECOLOGICAL SERVICES.

    ``(a) In General.--In a case in which a group health plan provides 
benefits under the terms of the plan consisting of obstetric or 
gynecological services, including appropriate follow-up services and 
referrals for diagnostic testing related to obstetric or gynecological 
services, the plan shall provide for a female participant or 
beneficiary to designate a provider of obstetric and gynecological 
services who has agreed to be designated as such, as the participant or 
beneficiary's primary care provider. If such participant or beneficiary 
has not designated such a provider as a primary care provider, the 
plan--
            ``(1) may not require prior authorization by the 
        participant or beneficiary's primary care provider or otherwise 
        for coverage of obstetric or gynecological services provided by 
        a participating health care professional practicing in 
        accordance with State law, to the extent such service is 
        otherwise covered; and
            ``(2) shall treat the ordering of other gynecological 
        services by such a participating health care professional as 
        the prior authorization of the primary care provider with 
        respect to such care under the coverage.
    ``(b) Adequate Number of Providers of Obstetric and Gynecological 
Services.--Each group health plan shall have an adequate number of 
providers of obstetric and gynecological services on its roster to 
satisfy the health care needs of all female participants and 
beneficiaries who choose to have such a provider as a primary care 
provider, or who otherwise need the services of a provider obstetric 
and gynecological services.
    ``(c) Definition of ``Provider of Obstetric and Gynecological 
Services''.--For purposes of this section the term ``provider of 
obstetric and gynecological services means--
            ``(1) an obstetrician-gynecologist;
            ``(2) a nurse practitioner as defined in section 
        1861(aa)(5)(A) of the Social Security Act (42 U.S.C. 
        1395x(aa)(5(A)); or
            ``(3) a certified nurse-midwife as defined in section 
        1861(gg)(2) of the Social Security Act (42 U.S.C. 
        1395x(gg)(2)).
    ``(d) Construction.--Nothing in subsection (a)(2) shall waive any 
requirements of coverage relating to medical necessity or 
appropriateness with respect to coverage of obstetric or gynecological 
services so ordered.
    ``(e) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to a woman eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section;
            ``(2) provide monetary payments or rebates to women to 
        encourage such women to accept less than the minimum 
        protections available under this section; or
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided care 
        to an individual participant or beneficiary in accordance with 
        this section.
    ``(f) Level and Type of Reimbursements.--Nothing in this section 
shall be construed to prevent a group health plan from negotiating the 
level and type of reimbursement with a provider for care provided in 
accordance with this section.''.
            (2) Conforming amendment.--Section 4980D(d)(1) of such Code 
        is amended by striking ``section 9811'' and inserting 
        ``sections 9811 and 9813''.
            (3) Clerical amendment.--The table of sections of 
        subchapter B of chapter 100 of such Code is amended by 
        inserting after the item relating to section 9812 the following 
        new item:

                              ``Sec. 9813. Standards relating to access 
                                        to unrestricted obstetric and 
                                        gynecological services.''.
    (d) Effective Dates and Related Rules.--
            (1) Group health plans and group health insurance 
        coverage.--
                    (A) In general.--Subject to subparagraph (B), the 
                amendments made by subsections (a)(1), (b), and (c) 
                apply with respect to group health plans for plan years 
                beginning on or after the first day of the first month 
                that begins more than 1 year after the date of the 
                enactment of this Act.
                    (B) 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 
                subsections (a)(1), (b), and (c) shall not apply to 
                plan years beginning before the later of--
                            (i) 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
                            (ii) the first day described in 
                        subparagraph (A).
                For purposes of clause (i), 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)(1), (b), or (c) 
                shall not be treated as a termination of such 
                collective bargaining agreement.
            (2) Individual health insurance coverage.--The amendment 
        made by subsection (a)(2) applies with respect to health 
        insurance coverage offered, sold, issued, renewed, in effect, 
        or operated in the individual market on or after the first day 
        of the first month that begins more than 1 year after the date 
        of the enactment of this Act.
            (3) Limitation on enforcement actions.--No enforcement 
        action shall be taken, pursuant to the amendments made by this 
        section, against a group health plan or health insurance issuer 
        with respect to a violation of a requirement imposed by such 
        amendments, and no penalty shall be imposed on any failure by 
        such plan to comply with any requirement imposed by such 
        amendments, to the extent that violation or failure occurs 
        before the date of issuance of final regulations issued in 
        connection with such requirement, if the plan or issuer has 
        sought to comply in good faith with such requirement.

SEC. 3. 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>
```