Bill Text

Bill Information


Add To My Favorites | print page

AB-2493 Health coverage: primary care providers: obstetrician-gynecologists.(1993-1994)

SHARE THIS: share this bill in Facebook share this bill in Twitter
AB2493:v94#DOCUMENT

Assembly Bill No. 2493
CHAPTER 759

An act to add Section 1367.69 to the Health and Safety Code, and to add Sections 10123.83 and 11512.295 to the Insurance Code, relating to health coverage.

[ Filed with Secretary of State  September 23, 1994. Approved by Governor  September 22, 1994. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 2493, Speier. Health coverage: primary care providers: obstetrician-gynecologists.
Existing law provides for licensure and regulation of health care service plans by the Commissioner of Corporations. Under existing law, willful violation of these provisions is a misdemeanor. Existing law also provides for the regulation of policies for disability insurance and nonprofit hospital service plans by the Insurance Commissioner.
Existing law requires that health care service plan contracts, nonprofit hospital service plan contracts, and disability insurance policies provide coverage for certain services and treatments.
This bill would state the findings and declarations of the Legislature with regard to the necessity for obstetrician-gynecologists to be deemed primary care providers for the purposes of health coverage. On or after January 1, 1995, this bill would require that health care service plan contracts, nonprofit hospital service plan contracts, and disability insurance policies, that cover hospital, medical, or surgical expenses, issued, amended, delivered, or renewed in this state , include obstetrician-gynecologists as primary care physicians or providers, as defined, provided they meet certain eligibility criteria.
By revising the provisions pertaining to health care service plans, this bill would create a new crime, thereby imposing a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a)  The specialty of obstetrics and gynecology is devoted to primary-preventive health care of women throughout their lifetime.
(b)  Significant numbers of women view their obstetrician-gynecologist as their primary or only physician. For many women, an obstetrician-gynecologist is often the only physician they see regularly during their reproductive years. According to a 1993 Gallup poll, women are more likely to have had a physical examination within the last two years from an obstetrician-gynecologist than from any other type of doctor (72 percent versus 57 percent) and the majority of these women (52 percent) consider their obstetrician-gynecologist to be their primary care physician.
(c)  A general medical examination was the second most frequently cited purpose for patient visits to obstetrician-gynecologists in 1989 and 1990, accounting for seven million visits each year, according to data gathered by the National Center for Health Statistics.
(d)  Women are opposed to restrictions in accessing obstetrician-gynecologists. Among women who have health coverage, a Gallup poll reported that 78 percent can currently access their obstetrician-gynecologist without going through a “gatekeeper.” Seventy-five percent of these women would object to requirements that they be referred by another physician or “gatekeeper” before they may see their obstetrician-gynecologist. Similarly, 74 percent of those who now have restricted access to obstetrician-gynecologists would approve of a system that would eliminate the need for a referral.
(e)  Obstetrician-gynecologists refer their patients less frequently than other primary care physicians, thus avoiding costly and time consuming referrals to specialists. According to a 1991 study of physician referral rates, obstetrician-gynecologists had the lowest referral rate of 4 percent compared with the rates of 7.3 percent for general internists and 8.4 percent for general and family practitioners.
(f)  More than two-thirds (69.5 percent) of all visits to obstetrician-gynecologists were made by established patients of the physician returning for care of their condition, according to data gathered by the National Center for Health Statistics. Only 4.7 percent of patient visits resulted from referrals from another physician.

SEC. 2.

 Section 1367.69 is added to the Health and Safety Code, to read:

1367.69.
 (a)  On or after January 1, 1995, every health care service plan contract that provides hospital, medical, or surgical coverage, that is issued, amended, delivered, or renewed in this state, shall include obstetrician-gynecologists as eligible primary care physicians, provided they meet the plan’s eligibility criteria for all specialists seeking primary care physician status.
(b)  For purposes of this section, the term “primary care physician” means a physician, as defined in Section 14254 of the Welfare and Institutions Code, who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. This means providing care for the majority of health care problems, including, but not limited to, preventive services, acute and chronic conditions, and psychosocial issues.

SEC. 3.

 Section 10123.83 is added to the Insurance Code, to read:

10123.83.
 (a)  On or after January 1, 1995, every policy of disability insurance that covers hospital, medical, or surgical expenses and is issued, amended, delivered, or renewed in this state shall include obstetrician-gynecologists as primary care providers provided they meet the insurer’s written eligibility criteria for all specialists seeking primary care physician status.
(b)  For purposes of this section, the term “primary care physician” means a physician, as defined in Section 14254 of the Welfare and Institutions Code, who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. This means providing care for the majority of health care problems, including, but not limited to, preventive services, acute and chronic conditions, and psychosocial issues.

SEC. 4.

 Section 11512.295 is added to the Insurance Code, immediately following Section 11512.29, to read:

11512.295.
 (a)  On or after January 1, 1995, every nonprofit hospital service plan contract that provides hospital, medical, or surgical coverage, that is issued, amended, delivered, or renewed in this state, shall include obstetrician-gynecologists as primary care providers provided they meet the plan’s written eligibility criteria for all specialists seeking primary care physician status.
(b)  For purposes of this section, the term “primary care physician” means a physician, as defined in Section 14254 of the Welfare and Institutions Code, who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. This means providing care for the majority of health care problems, including, but not limited to, preventive services, acute and chronic conditions, and psychosocial issues.

SEC. 5.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII  B of the California Constitution because the only costs which may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, changes the definition of a crime or infraction, changes the penalty for a crime or infraction, or eliminates a crime or infraction. Notwithstanding Section 17580 of the Government Code, unless otherwise specified in this act, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution.