Section 1367.695 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.695
. (a) The Legislature finds and declares that the unique,
private, and personal relationship between women patients and their
obstetricians and gynecologists warrants direct access to obstetrical
and gynecological physician services.
(b) Commencing January 1, 1999, every health care service plan
contract issued, amended, renewed, or delivered in this state, except
a specialized health care service plan, shall allow an enrollee the
option to seek obstetrical and gynecological physician services
directly from a participating obstetrician and gynecologist or
directly from 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, 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 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.