Legislation
SECTION 4306-B
Primary and preventive obstetric and gynecologic care
Insurance (ISC) CHAPTER 28, ARTICLE 43
§ 4306-b. Primary and preventive obstetric and gynecologic care. (a)
No corporation subject to the provisions of this article shall by
contract, written policy or procedure limit a female subscriber's direct
access to primary and preventive obstetric and gynecologic services,
including annual examinations, care resulting from such annual
examinations, and treatment of acute gynecologic conditions, from a
qualified provider of such services of her choice from within the plan
or for any care related to a pregnancy, provided that: (1) such
qualified provider discusses such services and treatment plan with the
subscriber's primary care practitioner in accordance with the
requirements of the corporation; and (2) such qualified provider agrees
to adhere to the corporation's policies and procedures, including any
applicable procedures regarding referrals and obtaining prior
authorization for services other than obstetric and gynecologic services
rendered by such qualified provider, and agrees to provide services
pursuant to a treatment plan (if any) approved by the corporation.
(b) A corporation shall treat the provision of obstetric and
gynecologic care, and the ordering of related obstetric and gynecologic
items and services, pursuant to the direct access described in
subsection (a) of this section by a participating qualified provider of
such services, as the authorization of the primary care provider.
(c) It shall be the duty of the administrative officer or other person
in charge of each corporation subject to the provisions of this article
to advise each female subscriber, in writing, of the provisions of this
section.
No corporation subject to the provisions of this article shall by
contract, written policy or procedure limit a female subscriber's direct
access to primary and preventive obstetric and gynecologic services,
including annual examinations, care resulting from such annual
examinations, and treatment of acute gynecologic conditions, from a
qualified provider of such services of her choice from within the plan
or for any care related to a pregnancy, provided that: (1) such
qualified provider discusses such services and treatment plan with the
subscriber's primary care practitioner in accordance with the
requirements of the corporation; and (2) such qualified provider agrees
to adhere to the corporation's policies and procedures, including any
applicable procedures regarding referrals and obtaining prior
authorization for services other than obstetric and gynecologic services
rendered by such qualified provider, and agrees to provide services
pursuant to a treatment plan (if any) approved by the corporation.
(b) A corporation shall treat the provision of obstetric and
gynecologic care, and the ordering of related obstetric and gynecologic
items and services, pursuant to the direct access described in
subsection (a) of this section by a participating qualified provider of
such services, as the authorization of the primary care provider.
(c) It shall be the duty of the administrative officer or other person
in charge of each corporation subject to the provisions of this article
to advise each female subscriber, in writing, of the provisions of this
section.