I 
108TH CONGRESS 
1ST SESSION H. R. 1469
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 gyneco-
logical physician services directly and without a referral. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 27, 2003
Mrs. DAVIS of California introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on Education and the Workforce, and Ways and Means, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, and the Internal 
Revenue Code of 1986 to require that group and indi-
vidual 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 Representa-
tives 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 GYNECO-
LOGICAL SERVICES. 
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(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 SERV-
ICES. 
‘‘(a) DIRECT ACCESS REQUIRED.—
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall allow a participant or bene-
ficiary the option to seek obstetrical and gyneco-
logical physician services directly from a partici-
pating obstetrician and gynecologist or directly from 
a participating family practice physician and sur-
geon 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 ob-
tain 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 require-
ments 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 sur-
geon regarding the participant’s or beneficiary’s 
condition, treatment, and any need for followup 
care; or 
‘‘(B) from establishing reasonable provi-
sions 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 pri-
mary care physicians and surgeons, to 
whom the participant or beneficiary has di-
rect access; and 
‘‘(iii) are not to be more restrictive for 
the provision of obstetrical and gyneco-
logical 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 Re-
tirement 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 SERV-
ICES. 
‘‘(a) DIRECT ACCESS REQUIRED.—
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall allow a participant or bene-
ficiary the option to seek obstetrical and gyneco-
logical physician services directly from a partici-
pating obstetrician and gynecologist or directly from
a participating family practice physician and sur-
geon 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 ob-
tain 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 require-
ments 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 sur-
geon regarding the participant’s or beneficiary’s 
condition, treatment, and any need for followup 
care; or 
‘‘(B) from establishing reasonable provi-
sions 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 pri-
mary care physicians and surgeons, to 
whom the participant or beneficiary has di-
rect access; and 
‘‘(iii) are not to be more restrictive for 
the provision of obstetrical and gyneco-
logical physician services. 
‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 
imposition of the requirement of this section shall be treat-
ed as a material modification in the terms of the plan de-
scribed in section 102(a)(1), for purposes of assuring no-
tice 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:
‘‘Sec. 714. Standard relating to women’s access to obstetrical and gynecological 
services.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended—
(i) in the table of sections, by insert-
ing after the item relating to section 9812 
the following new item:
‘‘Sec. 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 SERV-
ICES. 
‘‘(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 gyn-
ecologist 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 ap-
proval 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 commu-
nicate with the participant’s or beneficiary’s primary 
care physician and surgeon regarding the partici-
pant’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 obste-
tricians and gynecologists, or family practice physi-
cians and surgeons, participating in the plan or 
issuer network, medical group, or independent prac-
tice 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 partici-
pant or beneficiary has direct access; and 
‘‘(C) are not to be more restrictive for the 
provision of obstetrical and gynecological physi-
cian services. 
(B) CONFORMING
AMENDMENT.—Section 
4980D(d)(1) of such Code is amended by strik-
ing ‘‘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 SERV-
ICES. 
‘‘(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 cov-
erage offered by a health insurance issuer in connection 
with a group health plan in the small or large group mar-
ket.
‘‘(b) NOTICE.—A health insurance issuer under this 
part shall comply with the notice requirement under sec-
tion 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 para-
graph (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
COV-
ERAGE.—The amendment made by subsection (b) 
applies with respect to health insurance coverage of-
fered, 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 be-
tween employee representatives and 1 or more em-
ployers 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 ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment 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 amend-
ment 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 Sec-
retary 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 mat-
ter over which two or more such Secretaries have re-
sponsibility 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.
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