N.Y. Public Health Law § 4406-b: Primary and preventive obstetric and gynecologic care

§ 4406-b. Primary and preventive obstetric and gynecologic care. 1.

The health maintenance organization shall not limit a female enrollee'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: (a) such

qualified provider discusses such services and treatment plan with the

enrollee's primary care practitioner in accordance with the requirements

of the health maintenance organization; and (b) such qualified provider

agrees to adhere to the health maintenance organization'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

health maintenance organization.

2. A health maintenance organization 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 subdivision one of this section by a participating

qualified provider of such services, as the authorization of the primary

care provider.

3. It shall be the duty of the administrative officer or other person

in charge of each health maintenance organization to advise each female

enrollee, in writing, of the provisions of this section.