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107TH CONGRESS
1ST SESSION
H. R. 1440
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
APRIL 4, 2001
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,
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SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Women’s Obstetrician
and Gynecologist Medical 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-
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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-
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mary care physicians and surgeons, to
whom the participant or beneficiary has di-
rect access; and
‘‘(iii) are not 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
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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 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’’.
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(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
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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;
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‘‘(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 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.
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‘‘(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—
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(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
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(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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