BILL NUMBER: AB 259 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Skinner
FEBRUARY 11, 2009
An act to amend Section 1367.695 of the Health and Safety Code,
and to amend Section 10123.84 of the Insurance Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 259, as introduced, Skinner. Health care coverage: certified
nurse-midwives: direct access.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of that act a crime. Existing law provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires a health care service plan contract or
health insurance policy to allow an enrollee or policyholder the
option to seek obstetrical and gynecological physician services
directly from an obstetrician and gynecologist or a family practice
physician and surgeon, subject to specified provisions established by
the plan or insurer.
This bill would additionally require a health care service plan
contract or health insurance policy to allow an enrollee or
policyholder the option to seek obstetrical and gynecological
services from a certified nurse-midwife, as specified. The bill would
specify that a violation of this requirement with respect to health
care service plans shall not be a crime. The bill would also make
other conforming changes and would delete certain obsolete language.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.695 of the Health and Safety Code is
amended to read:
1367.695. (a) The Legislature finds and declares that the unique,
private, and personal relationship between women patients and their
obstetricians obstetrical and
gynecologists gynecological providers warrants
direct access to obstetrical and gynecological physician
services.
(b) Commencing January 1, 1999 2010
, every health care service plan contract issued, amended, renewed,
or delivered in this state, except a specialized health care service
plan contract , shall allow an enrollee the option to seek
obstetrical and gynecological physician services
directly from a any of the following health
care providers, provided that the services fall within the scope of
practice of that provider:
(1) A participating obstetrician
and gynecologist or directly from a
gynecologist.
(2) A participating certified nurse-midwife.
(3) A participating family
practice physician and surgeon designated by the plan as providing
obstetrical and gynecological services.
(c) In implementing this section, a health care service plan may
establish reasonable provisions governing utilization protocols and
the use of obstetricians and gynecologists, certified
nurse-midwives, or family practice physicians and surgeons, as
provided for in subdivision (b), participating in the plan network,
medical group, or independent practice association, provided that
these provisions shall be consistent with the intent of this section
and shall be those customarily applied to other physicians and
surgeons, such as primary care physicians and surgeons, to whom the
enrollee has direct access, and shall not be more restrictive for the
provision of obstetrical and gynecological physician
services. An enrollee shall not be required to obtain prior
approval from another physician, another provider, or the health
care service plan prior to obtaining direct access to obstetrical and
gynecological physician services, but the plan
may establish reasonable requirements for the participating
obstetrician and gynecologist , certified nurse-midwife,
or family practice physician and surgeon, as provided for in
subdivision (b), to communicate with the enrollee's primary care
physician and surgeon regarding the enrollee's condition, treatment,
and any need for followup care.
(d) This section shall not be construed to diminish the provisions
of Section 1367.69.
(e) The Department of Managed Health Care shall report to the
Legislature, on or before January 1, 2000, on the implementation of
this section.
(e) Notwithstanding Section 1390, a violation of this section, as
it related to direct access to nurse-midwives, the amendments made to
this section by the act adding this subdivision shall not be a
crime.
SEC. 2. Section 10123.84 of the Insurance Code is amended to read:
10123.84. (a) The Legislature finds and declares that the unique,
private, and personal relationship between women patients and their
obstetricians obstetrical and
gynecologists gynecological providers warrants
direct access to obstetrical and gynecological physician
services.
(b) Commencing January 1, 1999, 2010,
every policy o f disability insurance that covers
hospital, medical, or surgical expenses, and health
insurance that is issued, amended, delivered, or renewed in
this state , shall allow a policyholder the option
to seek obstetrical and gynecological physician
services directly from an any of the
following health care providers, provided that the services fall
within the scope of practice of that provider:
(1) An obstetrician and
gynecologist or directly from a gynecologist.
(2) A certified nurse-midwife.
(3) A participating family
practice physician and surgeon designated by the plan
insurer as providing obstetrical and
gynecological services.
(c) In implementing this section, a disability
an insurer may establish reasonable provisions governing
utilization protocols and the use of obstetricians and gynecologists
, certified nurse-midwives, or family practice physicians
and surgeons, as provided for in subdivision (b), provided that these
provisions shall be consistent with the intent of this section and
shall be those customarily applied to other physicians and surgeons,
including primary care physicians and surgeons, to whom the
policyholder has direct access, and shall not be more restrictive for
the provision of obstetrical and gynecological physician
services. A policyholder shall not be required to obtain
prior approval from another physician, another provider, or the
insurer prior to obtaining direct access to obstetrical and
gynecological physician services, but the insurer
may establish reasonable requirements for the participating
obstetrician and gynecologist , the certified nurse-midwife,
or the family practice physician and surgeon, as provided in
subdivision (b), to communicate with the policyholder's primary care
physician regarding the policyholder's condition, treatment, and any
need for followup care.
(d) This section shall not be construed to diminish the provisions
of Section 10123.83.
(e) The Insurance Commissioner shall report to the Legislature, on
or before January 1, 2000, on the implementation of this section.