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 health plans and health insurance issuers provide women with adequate access to providers of ob

10 Pages·1999·0.41 MB·English

by  United States. Congress. Senate

Ci15Libran.'
C72C-000:'£-21c3u;1fcyBlvd. n
tiiiltimoro, Maty>g;vi21244
106thcongress S.836
ISTSession
ToamendthePublicHealth ServiceAct, theEmployeeRetirementIncome
SecurityActof1974,andtheInternalRevermeCodeof1986torequire
that group health plans and health insurance issuers provide women
withadequateaccesstopro\idersofobstetricandgjmecologicalservices.
IN THE SENATE OF THE UNITED STATES
April20,1999
Mr.Specter(forhimself,Mr.Graham,Mr.Cochran,andMr.Robb)intro-
ducedthefollowingbill;whichwasreadtwiceandreferredtotheCom-
mitteeonHealth,Education,Labor,andPensions
A
BILL
To amend the Public Health Sendee Act, the Employee Re-
tirement Income SecurityAct of 1974, andthe Internal
RevenueCodeof1986torequirethatgrouphealthplans
and health insurance issuers provide women with ade-
quate access to pro\aders of obstetric and gjTiecological
services.
1 BeitenactedhytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
3 SECTION1.SHORTTITLE;FINDINGS.
—
4 (a) Short Title. This Act may be cited as the
5 "AccesstoWomen'sHealthCareActof1999".
2
—
1 (b) Findings. Congress makes the following find-
2 ings:
3 (1)Women'shealthliistoricaUyhasreceivedUt-
4 tieattention.
5 (2) A provider of obstetric and gynecological
6 care improves a woman's access to health care by
7 providing primary and preventive health care
8 throughoutthewoman'slifetime.
9 (3) SixtypercentofaUofficevisitstoproviders
10 ofobstetricandgynecologicalcareareforpreventive
11 care.
12 (4) Pro\iders of obstetrical and gynecological
13 care areuniquelyqualifiedonthebasisofeducation
14 andexperience toprovidebasicwomen's healthcare
15 services.
16 (5) Wliile more than 37 States have acted to
17 promote residents' access to providers ofobstetrical
18 andg^Tiecologicalcare,patientsinotherStatesorin
19 Federally-governed health plans are not protected
20 fromaccessrestrictionsorlimitations.
21 SEC.2.PATIENTACCESS TO OBSTETRICALANDGYNECO-
22 LOGICALCARE.
—
23 (a)InGeneral. Ifagrouphealthplan,orahealth
24 insuranceissuerinconnectionwiththeprovisionofhealth
25 insurancecoverage,requiresorprovidesforaparticipant,
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1 benelBciar}', or enrollee to designate a participating pri-
2 marycareprovider, andan individualwho is female has
3 notdesignatedaproviderwhospecializesinobstetricsand
4 gjTiecology as a primary care provider, the plan or
5 issuer
6 (1) maynot require authorization or a referral
7 by the indi\idual's primarj^ care provider or other-
8 wiseforcoverage ofgjTiecological care (suchaspre-
9 ventive women's health examinations) and preg-
10 nancy-related services provided by a participating
11 health care professionalwho specializesinobstetrics
12 andgvT^iecologytotheextentthatsuchcareisother-
13 wisecovered; and
14 (2) may treat the ordering of other gjmeco-
15 logical and obstetrical care, including referrals for
16 related care, bysuch aparticipatingproviderasthe
17 authorization ofthe primary care provider-with re-
18 specttosuchcareundertheplanorcoverage.
19 (b) Construction.—Nothing m subsection (a)(2)
20 shallbeconstruedtowaive anyrequirements ofcoverage
21 relatingto medical necessity or appropriateness with re-
22 specttocoverageofthegynecological andobstetricalcare
23 soordered.
—
24 (c) Provtoers. group health plan, or a health
25 insuranceissuerinconnectionwiththeprovisionofhealth
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1 insurance coverage, thatpro\ddes benefits, inwhole orin
2 part, through participating health care providers shall
3 have(inrelationtothecoverage)asufficientnumber,dis-
4 tribution,andvarietyofqualifiedparticipatinghealthcare
5 providers to ensure that all covered health care sendees,
6 includingspecialtyservices,willbeavailableandaccessible
7 in atimelymannerto all participants, beneficiaries, and
8 enroUeesundertheplanorcoverage.
9 (d) Prohibitions.—A group health plan, and a
10 health insurance issuer in connection with the provision
11 ofhealthinsurancecoverage,maynot
12 (1) deny to an individual ehgibility, or contin-
13 ued ehgibility, to enroll or to renew coverage under
14 the terms ofthe plan or coverage, for the purpose
15 ofavoidingtherequirementsofthissection;
16 (2)pro^ddemonetarv^paAinentsorrebatestoin-
17 dividualstoencouragesuchindi\ddualstoaccessless
18 than the minimum protections available under this
19 section;
20 (3) penalize orotherwisereduceorlimitthere-
21 imbursement of a provider because such provider
22 provided care to an indi\ddual participant, bene-
23 ficiary, orem-oUeeinaccordancewiththissection; or
24 (4) provide incentives (monetary or otherwise)
25 toapro\ddertoinducesuchpro\idertoprovidecare
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1 to an individual participant, beneficiary, or enrollee
2 inamannerinconsistentwithtliissection.
—
3 (e)Le\^landTypeofReimbursements. Noth-
4 inginthis section shallbe construed to prevent a group
5 healthplanorahealthinsuranceissuerinconnectionwith
6 the provision of health insurance coverage from negoti-
7 atingthelevelandtypeofreimbursementwithaprovider
8 forcarepro\'idedinaccordancewithtliissection.
9 (f) Continued Applicability of State Law
—
10 WithRespecttoHealthInsuranceIssuers. This
11 section shall notbe construedto supersede anyprovision
12 ofState lawwhich establishes, implements, or continues
13 in effect any standard or requirement solely relating to
14 health insurance issuers in connection with group health
15 insurancecoverageexcepttotheextentthatsuchstandard
16 orrequirementpreventsthe applicationofarequirement
17 ofthissection.
18 SEC.3. PATIENTACCESS TO OBSTETRICALANDGYNECO-
19 LOGICAL CARE UNDER PUBLIC HEALTH
20 SERVICEACT.
21 (a) In General.—Subpart 2 of part A of title
22 XXVn ofthe Public Health ServiceAct, as amendedby
23 the Omnibus Consohdated and Emergency Supplemental
24 Appropriations Act, 1999 (Public Law 105-277), is
25 amendedbyaddingatthe endthefollowingnewsection:
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1 "SEC.2707.PATIENTACCESSTOOBSTETRICANDGYNECO-
2 LOGICALCARE.
—
3 "(a) In General. Each group health plan shall
4 comply with the patient protection requirements under
5 section 2 ofthe Access to Women's Health Care Act of
6 1999, andeachhealthinsuranceissuershallcomplywith
7 patient protection requirements under such section with
8 respectto group health insurance coverage it offers, and
9 suchrequirementsshallbedeemedtobeincorporatedinto
10 thissubsection.
—
11 "(b)Notice. ^Agrouphealthplanshallcomplywith
12 the notice requirement under section 711(d) ofthe Em-
13 ployee Retirement Income SecurityAct of 1974with re-
14 specttotherequirementsreferredtoinsubsection(a)and
15 a health insurance issuer shall comply with such notice
16 requirement as ifsuch subsection apphed to such issuer
17 andsuchissuerwereagrouphealthplan."
—
18 (b) Individual Market. Subpart 3 ofpart B of
19 titleXXVIIofthePublicHealthServiceAct, asamended
20 by the Omnibus Consohdated and Emergency Supple-
21 mentalAppropriationsAct, 1999 (Pubhc Law 105-277),
22 isamendedbyaddingattheendthefollowingnewsection:
23 "SEC.2753.PATIENTACCESSTOOBSTETRICANDGYNECO-
24 LOGICALCARE.
—
25 "(a) In GeneraIj. Each health insurance issuer
26 shall complywith patient protection requirements under
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1 section 2 ofthe Access to Women's Health CareAct of
2 1999,withrespecttoindividualhealthinsurancecoverage
3 itoffers, andsuchrequirementsshallbedeemedtobein-
4 corporatedintotliissubsection.
5 "(b) Notice.—Ahealthinsurance issuerunderthis
6 part shall complywiththe notice requirementunder sec-
7 tion 711(d) oftheEmployeeRetirementIncome Security
8 Actof1974withrespecttothe requirements referredto
9 in subsection (a) as if such subsection applied to such
10 issuerandsuchissuerwereagrouphealthplan.".
11 SEC.4.PATIENTACCESSTO OBSTETRICALAND GYNECO-
12 LOGICAL CARE UNDER THE EMPLOYEE RE-
13 TIREMENTINCOMESECURITYACTOF1974.
—
14 (a) In General. Subpart B ofpart 7 ofsubtitle
15 B oftitle I oftheEmployeeRetirementIncome Security
16 Act of 1974, as amended by the Omnibus Consohdated
17 and Emergency Supplemental Appropriations Act, 1999
18 (PubhcLaw 105-277), is amendedbyaddingattheend
19 thefollo\\dng:
20 "SEC. 714.PATIENTACCESSTOOBSTETRICANDGYNECO-
21 LOGICALCARE.
—
22 "(a) In General. Subject to subsection (b), a
23 grouphealthplan (andahealthinsuranceissueroffering
24 group healthinsurance coverage in connectionwith such
25 a plan) shall complywith the requirements ofsection 2
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1 ofthe Access to Women's Health Care Act of 1999 (as
2 in effect as ofthe date of enactment of such Act), and
3 suchrequirementsshallbedeemedtobeincorporatedinto
4 tliissubsection.
—
5 "(b)Notice. Theimpositionoftherequirementsof
6 tliis section shall be treated as material modification in
7 the terms ofthe plan described in section 102(a)(1), for
8 purposes of assuring notice of such requirements under
9 theplan,exceptthatthesummarj^descriptionrequiredto
10 be providedunderthe last sentence ofsection 104(b)(1)
11 -vsithrespecttosuchmodificationshallbepro\'idedbynot
12 later than 60 days after the first day of the first plan
13 yearinwhichsuchrequirementsshallapply.".
—
14 (b) Conforming Amendment. The table of con-
15 tentsinsection 1oftheEmployeeRetirementIncomeSe-
16 curityActof1974, as amendedbytheOmnibusConsoh-
17 dated and Emergency Supplemental Appropriations Act,
18 1999 (Public Law 105-277), is amended by inserting
19 after the item relating to section 713 the following new
20 item:
"Sec.714.Patientaccesstoobstetricandgjoiecologicalcare.".
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Ci;5Ltrjrar>
C2-07-13
7500S'2cu-1tyBlvd.
g Saitimor^. MgryteP/i 21244
1 SEC.5.APPLICATIONOFPATIENTACCESSTOOBSTETRIC
2 AND GYNECOLOGICAL CARE TO THE INTER-
3 NALREVENUECODEOF1986.
—
4 (a) In General. SubchapterB ofchapter 100 of
5 theInternalRevenue Code of1986 (relatingto otherre-
6 quu-ements)isamended
7 (1) in the table of sections, by inserting after
8 the item relatingto section 9812 the following new
9 item:
"See.9813.Patientaccesstoobstetricandgynecologicalcare";and
10 (2)bymsertingaftersection9812thefollowing
11 newsection:
12 "SEC.9813.PATIENTACCESSTOOBSTETRICANDGYNECO-
13 LOGICALCARE.
14 "Agroup healthplan shaU complywiththe require-
15 mentsofsection2oftheAccesstoWomen'sHealthCare
16 Actof1999 (as in effect as ofthe date ofenactment of
17 suchAct), and such requirements shall be deemed to be
18 incorporatedintothissection."
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