I 

111TH CONGRESS 

1ST SESSION H. R. 2940 

To amend the Employee Retirement Income Security Act of 1974, the Public 

Health Service Act, 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 18, 2009 

Mrs. DAVIS of California (for herself and Mrs. BIGGERT) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor 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 Employee Retirement Income Security Act 

of 1974, the Public Health Service Act, 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. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Women’s Obstetrician 

3 and Gynecologist Medical Access Now Act of 2009’’. 

4 SEC. 2. WOMEN’S ACCESS TO OBSTETRICAL AND GYNECO5 LOGICAL SERVICES. 

6 (a) GROUP HEALTH PLANS.— 

7 (1) ERISA AMENDMENTS.—(A) Subpart B of 

8 part 7 of subtitle B of title I of the Employee Re9 tirement Income Security Act of 1974 is amended by 

10 adding at the end the following new section: 

11 ‘‘SEC. 715. STANDARD RELATING TO WOMEN’S ACCESS TO 

12 OBSTETRICAL AND GYNECOLOGICAL SERV13 ICES. 

14 ‘‘(a) DIRECT ACCESS REQUIRED.— 

15 ‘‘(1) IN GENERAL.—A group health plan, and a 

16 health insurance issuer offering group health insur17 ance coverage, shall allow a participant or bene18 ficiary the option to seek obstetrical and gyneco19 logical physician services directly from a partici20 pating obstetrician and gynecologist or directly from 

21 a participating family practice physician and sur22 geon designated by the plan or issuer as providing 

23 obstetrical and gynecological services. A group 

24 health plan or health insurance issuer, in connection 

25 with the offering of group health insurance coverage, 

26 shall not require a participant or beneficiary to obVerDate Nov 24 2008 06:11 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2940.IH H2940

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1 tain prior approval from another physician, another 

2 provider, the plan or issuer, or any other person 

3 prior to obtaining direct access to obstetrical and 

4 gynecological physician services. 

5 ‘‘(2) CONSTRUCTION.—Paragraph (1) shall not 

6 be construed as preventing a plan or issuer— 

7 ‘‘(A) from establishing reasonable require8 ments for the participating obstetrician and 

9 gynecologist or family practice physician and 

10 surgeon to communicate with the participant’s 

11 or beneficiary’s primary care physician and sur12 geon regarding the participant’s or beneficiary’s 

13 condition, treatment, and any need for followup 

14 care; or 

15 ‘‘(B) from establishing reasonable provi16 sions governing utilization protocols and the use 

17 of obstetricians and gynecologists, or family 

18 practice physicians and surgeons, participating 

19 in the plan or issuer network, medical group, or 

20 independent practice association, so long as 

21 these provisions— 

22 ‘‘(i) are consistent with the intent of 

23 such paragraph; 

24 ‘‘(ii) are those customarily applied to 

25 other physicians and surgeons, such as priVerDate Nov 24 2008 06:11 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2940.IH H2940

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1 mary care physicians and surgeons, to 

2 whom the participant or beneficiary has di3 rect access; and 

4 ‘‘(iii) are not to be more restrictive for 

5 the provision of obstetrical and gyneco6 logical physician services. 

7 ‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 

8 imposition of the requirement of this section shall be treat9 ed as a material modification in the terms of the plan de10 scribed in section 102(a)(1), for purposes of assuring no11 tice of such requirements under the plan; except that the 

12 summary description required to be provided under the 

13 last sentence of section 104(b)(1) with respect to such 

14 modification shall be provided by not later than 60 days 

15 after the first day of the first plan year in which such 

16 requirement apply.’’. 

17 (B) Section 732(a) of such Act (29 U.S.C. 

18 1191a(a)) is amended by striking ‘‘section 711’’ and 

19 inserting ‘‘sections 711 and 715’’. 

20 (C) The table of contents in section 1 of such 

21 Act is amended by inserting after the item relating 

22 to section 713 the following new item: 

‘‘Sec. 715. Standard relating to women’s access to obstetrical and gynecological 

services’’. 

23 (2) PUBLIC HEALTH SERVICE ACT AMEND24 MENTS.—(A) Subpart 2 of part A of title XXVII of 


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1 the Public Health Service Act is amended by adding 

2 at the end the following new section: 

3 ‘‘SEC. 2708. STANDARD RELATING TO WOMEN’S ACCESS TO 

4 OBSTETRICAL AND GYNECOLOGICAL SERV5 ICES. 

6 ‘‘(a) IN GENERAL.—The provisions of section 715(a) 

7 of the Employee Retirement Income Security Act of 1974 

8 shall apply to group health plans, and health insurance 

9 issuers offering group health insurance coverage, as if in10 cluded in this subpart. 

11 ‘‘(b) NOTICE.—A group health plan under this part 

12 shall comply with the notice requirement under section 

13 715(b) of the Employee Retirement Income Security Act 

14 of 1974 with respect to the requirements of this section 

15 as if such section applied to such plan.’’. 

16 (3) INTERNAL REVENUE CODE AMEND17 MENTS.— 

18 (A) IN GENERAL.—Subchapter B of chap19 ter 100 of the Internal Revenue Code of 1986 

20 is amended— 

21 (i) in the table of sections, by insert22 ing after the item relating to section 9813 

23 the following new item: 

‘‘Sec. 9814. Standard relating to women’s access to obstetrical and gynecological services’’; and 


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1 (ii) by inserting after section 9813 the 

2 following: 

3 ‘‘SEC. 9814. STANDARD RELATING TO WOMEN’S ACCESS TO 

4 OBSTETRICAL AND GYNECOLOGICAL SERV5 ICES. 

6 ‘‘The provisions of section 715(a) of the Employee 

7 Retirement Income Security Act of 1974 shall apply to 

8 group health plans, and health insurance issuers offering 

9 group health insurance coverage, as if included in this sub10 chapter.’’. 

11 (B) CONFORMING AMENDMENT.—Section 

12 4980D(d)(1) of such Code is amended by strik13 ing ‘‘section 9811’’ and inserting ‘‘sections 

14 9811 and 9814’’. 

15 (b) INDIVIDUAL HEALTH INSURANCE.—Part B of 

16 title XXVII of the Public Health Service Act is amended 

17 by inserting after section 2753 the following new section: 

18 ‘‘SEC. 2754. STANDARD RELATING TO WOMEN’S ACCESS TO 

19 OBSTETRICAL AND GYNECOLOGICAL SERV20 ICES. 

21 ‘‘(a) IN GENERAL.—The provisions of section 

22 2708(a) shall apply to health insurance coverage offered 

23 by a health insurance issuer in the individual market in 

24 the same manner as they apply to health insurance cov25 erage offered by a health insurance issuer in connection 


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1 with a group health plan in the small or large group mar2 ket. 

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

4 part shall comply with the notice requirement under sec5 tion 715(b) of the Employee Retirement Income Security 

6 Act of 1974 with respect to the requirements referred to 

7 in subsection (a) as if such section applied to such issuer 

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

9 (c) EFFECTIVE DATES.— 

10 (1) GROUP HEALTH PLANS AND GROUP

11 HEALTH INSURANCE COVERAGE.—Subject to para12 graph (3), the amendments made by subsection (a) 

13 apply with respect to group health plans for plan 

14 years beginning more than 180 days after the date 

15 of the enactment of this Act. 

16 (2) INDIVIDUAL HEALTH INSURANCE COV17 ERAGE.—The amendment made by subsection (b) 

18 applies with respect to health insurance coverage of19 fered, sold, issued, renewed, in effect, or operated in 

20 the individual market on or after such date. 

21 (3) COLLECTIVE BARGAINING EXCEPTION.—In 

22 the case of a group health plan maintained pursuant 

23 to 1 or more collective bargaining agreements be24 tween employee representatives and 1 or more em25 ployers ratified before the date of enactment of this 


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1 Act, the amendments made subsection (a) shall not 

2 apply to plan years beginning before the later of— 

3 (A) the date on which the last collective 

4 bargaining agreements relating to the plan ter5 minates (determined without regard to any ex6 tension thereof agreed to after the date of en7 actment of this Act), or 

8 (B) the date that is 180 days after the 

9 date of the enactment of this Act. 

10 For purposes of subparagraph (A), any plan amend11 ment made pursuant to a collective bargaining 

12 agreement relating to the plan which amends the 

13 plan solely to conform to any requirement added by 

14 subsection (a) shall not be treated as a termination 

15 of such collective bargaining agreement. 

16 (d) COORDINATION OF ADMINISTRATION.—The Sec17 retary of Labor, the Secretary of the Treasury, and the 

18 Secretary of Health and Human Services shall ensure, 

19 through the execution of an interagency memorandum of 

20 understanding among such Secretaries, that— 

21 (1) regulations, rulings, and interpretations 

22 issued by such Secretaries relating to the same mat23 ter over which two or more such Secretaries have re24 sponsibility under the provisions of this Act (and the 


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1 amendments made thereby) are administered so as 

2 to have the same effect at all times; and 

3 (2) coordination of policies relating to enforcing 

4 the same requirements through such Secretaries in 

5 order to have a coordinated enforcement strategy 

6 that avoids duplication of enforcement efforts and 

7 assigns priorities in enforcement. 

Æ 


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