GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1995

H 1

HOUSE BILL 773

Short Title:  Ob/Gyn Access.                                                                                             (Public)

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Sponsors: Representatives Bowie, Russell (Co-sponsors); Adams, Aldridge, Alexander, Allred, Barbee, Barnes, Berry, Bowen, Boyd-McIntyre, Brawley, J. Brown, Buchanan, Cansler, Clary, Crawford, Creech, Culpepper, Cummings, Decker, Dickson, Dockham, Easterling, Gamble, Gardner, Grady, Hiatt, Holmes, Howard, Hunt, H. Hunter, Ives, Justus, Lemmond, Luebke, McAllister, McCombs, Mercer, K. Miller, Miner, Mitchell, Morgan, Nichols, Nye, Owens, Preston, Pulley, Redwine, Robinson, Sharpe, Sherrill, Shubert, Tolson, Warner, Watson, Wilkins, C. Wilson, and Wood.

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Referred to:  Health and Environment.

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April 6, 1995

A BILL TO BE ENTITLED

AN ACT TO PROVIDE FOR DIRECT ACCESS BY WOMEN TO OBSTETRICIAN-GYNECOLOGISTS.

Whereas, a significant number of women in this country view their obstetrician-gynecologist (" Ob-Gyn" ) as their primary or sole physician; and

Whereas, women comprise more than one-half of the population in the United States; and

Whereas, it has been shown that 60% of all office visits to Ob-Gyns are for preventive care; and

Whereas, a significant number of women are opposed to restrictions in accessing their Ob-Gyns; and

Whereas, restrictions on women's access to their Ob-Gyns may impair the public health while failing to reduce health care costs; and

Whereas, some managed care plans prevent access by women to their Ob-Gyns by requiring referral; Now, therefore,

The General Assembly of North Carolina enacts:

Section 1.  Article 51 of Chapter 58 of the General Statutes is amended by adding a new section to read:

"§ 58-51-38.  Direct access to obstetrician-gynecologists.

(a) Each health benefit plan shall allow each female plan participant or beneficiary age 13 or older direct access within the health benefit plan, without prior approval or referral, to the health care services of an obstetrician-gynecologist participating in the health benefit plan.

For purposes of this section:

(1) 'Health benefit plan' means an HMO subscriber contract or any preferred provider, exclusive provider, or other managed care arrangement offered under a health benefit plan, as defined in G.S. 58-50-110(11).

(2) 'Health care services' means the full scope of services provided by the participating obstetrician-gynecologist in the care of or related to the female reproductive system and breasts, and in performing annual screening, counseling, and immunization for disorders and diseases in accordance with the most current published recommendations of the American College of Obstetricians and Gynecologists, and includes services provided by nurse practitioners, physician's assistants, and certified nurse midwives in collaboration with the obstetrician-gynecologist in the care of the participant or beneficiary.

(b) Each health benefit plan shall inform female participants and beneficiaries in writing of the provisions of this section.  The information shall be provided in benefit handbooks and materials and enrollment materials.

(c) This section does not prevent a health benefit plan from designating a qualified obstetrician-gynecologist as a primary care physician for the health benefit plan if the obstetrician-gynecologist is providing the full range of primary care services required under the health benefit plan."

Sec. 2.  This act applies to health benefit plans issued, renewed, or amended on or after January 1, 1996.