§ 4406-B — Primary and preventive obstetric and gynecologic care

§ 4406-b. Primary and preventive obstetric and gynecologic care. 1.\nThe health maintenance organization shall not limit a female enrollee's\ndirect access to primary and preventive obstetric and gynecologic\nservices, including annual examinations, care resulting from such annual\nexaminations, and treatment of acute gynecologic conditions, from a\nqualified provider of such services of her choice from within the plan\nor for any care related to a pregnancy, provided that: (a) such\nqualified provider discusses such services and treatment plan with the\nenrollee's primary care practitioner in accordance with the requirements\nof the health maintenance organization; and (b) such qualified provider\nagrees to adhere to the health maintenance organization's policies and\nprocedures, including any applicable procedures regarding referrals and\nobtaining prior authorization for services other than obstetric and\ngynecologic services rendered by such qualified provider, and agrees to\nprovide services pursuant to a treatment plan (if any) approved by the\nhealth maintenance organization.\n 2. A health maintenance organization shall treat the provision of\nobstetric and gynecologic care, and the ordering of related obstetric\nand gynecologic items and services, pursuant to the direct access\ndescribed in subdivision one of this section by a participating\nqualified provider of such services, as the authorization of the primary\ncare provider.\n 3. It shall be the duty of the administrative officer or other person\nin charge of each health maintenance organization to advise each female\nenrollee, in writing, of the provisions of this section.\n