APPROVED CHAPTER
MAY 2, 2022 692
BY GOVERNOR PUBLIC LAW
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-TWO
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H.P. 1144 - L.D. 1539
An Act To Provide Access to Fertility Care
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4320-S is enacted to read:
§4320-S. Coverage for fertility services
1. Definitions. As used in this section, unless the context otherwise indicates, the
following terms have the following meanings.
A. "Experimental fertility procedure" means a procedure for which the published
medical evidence is not sufficient for the American Society for Reproductive Medicine,
its successor organization or a comparable organization to regard the procedure as
established medical practice.
B. "Fertility diagnostic care" means procedures, products, medications and services
intended to provide information about an individual's fertility, including laboratory
assessments and imaging studies.
C. "Fertility patient" means an individual or couple with infertility, an individual or
couple who is at increased risk of transmitting a serious inheritable genetic or
chromosomal abnormality to a child or an individual unable to conceive as an
individual or with a partner because the individual or couple does not have the
necessary gametes for conception.
D. "Fertility preservation services" means procedures, products, medications and
services, intended to preserve fertility, consistent with established medical practice and
professional guidelines published by the American Society for Reproductive Medicine,
its successor organization or a comparable organization for an individual who has a
medical or genetic condition or who is expected to undergo treatment that may directly
or indirectly cause a risk of impairment of fertility. "Fertility preservation services"
includes the procurement and cryopreservation of gametes, embryos and reproductive
material and storage from the time of cryopreservation for a period of 5 years. Storage
may be offered for a longer period of time.
E. "Fertility treatment" means procedures, products, medications and services intended
to achieve pregnancy that results in a live birth with healthy outcomes and that are
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 provided in a manner consistent with established medical practice and professional
guidelines published by the American Society for Reproductive Medicine, its successor
organization or a comparable organization.
F. "Gamete" means a cell containing a haploid complement of deoxyribonucleic acid
that has the potential to form an embryo when combined with another gamete.
"Gamete" includes sperm and eggs.
G. "Infertility" means the presence of a demonstrated condition recognized by a
provider as a cause of loss or impairment of fertility or a couple's inability to achieve
pregnancy after 12 months of unprotected intercourse when the couple has the
necessary gametes for conception, including the loss of a pregnancy occurring within
that 12-month period, or after a period of less than 12 months due to a person's age or
other factors. Pregnancy resulting in a loss does not cause the time period of trying to
achieve a pregnancy to be restarted.
2. Required coverage. A carrier offering a health plan in this State shall provide
coverage as provided in this subsection and as set forth in rules adopted by the bureau to
an enrollee:
A. For fertility diagnostic care;
B. For fertility treatment if the enrollee is a fertility patient; and
C. For fertility preservation services.
3. Limitations on coverage. A health plan that provides coverage for the services
required by this section may include reasonable limitations to the extent that these
limitations are not inconsistent with the following requirements and rules adopted by the
bureau.
A. A carrier may not impose a waiting period.
B. A carrier may not use any prior diagnosis or prior fertility treatment as a basis for
excluding, limiting or otherwise restricting the availability of coverage required by this
section.
C. A carrier may not impose any limitations on coverage for any fertility services
based on an enrollee's use of donor gametes, donor embryos or surrogacy.
D. A carrier may not impose different limitations on coverage for, provide different
benefits to or impose different requirements on a class of persons protected under Title
5, chapter 337 than those of other enrollees.
E. Any limitations imposed by a carrier must be based on an enrollee's medical history
and clinical guidelines adopted by the carrier. Any clinical guidelines used by a carrier
must be based on current guidelines developed by the American Society for
Reproductive Medicine, its successor organization or a comparable organization, must
cite with specificity any data or scientific reference relied upon, must be maintained in
written form and must be made available to an enrollee in writing upon request.
4. Certain services not required. This section does not require a carrier to provide
coverage for:
A. Any experimental fertility procedure; or
B. Any nonmedical costs related to donor gametes, donor embryos or surrogacy.
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 5. Rules. The superintendent may adopt rules to implement the requirements of this
section, including, without limitation, cost-sharing, benefit design and clinical guidelines.
In adopting rules under this subsection, the superintendent shall consider the clinical
guidelines developed by the American Society for Reproductive Medicine, its successor
organization or a comparable organization. Rules adopted pursuant to this subsection are
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 2. Evaluation. Upon consultation with the United States Department of Health
and Human Services, Centers for Medicare and Medicaid Services, the Superintendent of
Insurance shall evaluate whether the coverage required by the Maine Revised Statutes, Title
24-A, section 4320-S can be incorporated as part of the essential health benefit package as
defined in Title 24-A, section 4320-D or whether the federal Centers for Medicare and
Medicaid Services would determine that the transfer of costs defrayed by the State to the
federal Centers for Medicare and Medicaid Services pursuant to 42 United States Code,
Section 18031(d)(3)(B) would be required. The superintendent shall report by December
31, 2022 to the joint standing committee of the Legislature having jurisdiction over health
coverage, insurance and financial services matters concerning its consultation with the
federal Centers for Medicare and Medicaid Services and the outcome of that consultation.
The joint standing committee of the Legislature having jurisdiction over health coverage,
insurance and financial services matters may report out a bill based on the evaluation under
this section to the First Regular Session of the 131st Legislature.
Sec. 3. Application. This Act applies to all policies, contracts and certificates
executed, delivered, issued for delivery, continued or renewed in this State on or after
January 1, 2024. For purposes of this Act, all contracts are deemed to be renewed no later
than the next yearly anniversary of the contract date.
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