Bill Summary – FastDemocracy

BILL AS INTRODUCED                                                       H.369
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                                       H.369
 Introduced by Representative Cordes of Lincoln
 Referred to Committee on
 Date:
 Subject: Health; health insurance; fertility services
 Statement of purpose of bill as introduced: This bill proposes to require health
 insurance plans and Vermont Medicaid to provide coverage for fertility-related
 services. It would also direct the Agency of Human Services to seek federal
 approval of an amendment to Vermont’s Medicaid state plan to permit the
 Medicaid coverage.
    An act relating to health insurance and Medicaid coverage for fertility-
    related services
 It is hereby enacted by the General Assembly of the State of Vermont:
 Sec. 1. 8 V.S.A. § 4099e is added to read:
 § 4099e. FERTILITY-RELATED SERVICES
    (a) Definitions. As used in this section:
         (1) “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.
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     BILL AS INTRODUCED                                                         H.369
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       (2) “Fertility diagnostic care” means procedures, products, medications,
 and services intended to provide information about an individual’s fertility,
 including laboratory assessments and imaging studies.
       (3) “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 five years. Storage may be offered for a longer period of time.
       (4) “Health care provider” has the same meaning as in 18 V.S.A.
 § 9402.
       (5) “Health insurance plan” means any individual or group health
 insurance policy; any hospital or medical service corporation or health
 maintenance organization subscriber contract; or any other health benefit plan
 offered, issued, or renewed for any person in this State by a health insurer.
 The term does not include benefit plans providing coverage for specific
 diseases or other limited benefit coverage.
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     BILL AS INTRODUCED                                                          H.369
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       (6) “Health insurer” has the same meaning as in 18 V.S.A. § 9402.
    (b) Required coverage. A health insurance plan shall provide coverage for
 the following fertility-related services for all insureds:
       (1) Fertility diagnostic care.
       (2) Intrauterine insemination treatment with donor or partner semen.
       (3) At least three retrievals of oocytes under anesthesia for in vitro
 fertilization (IVF) with donor or partner semen or egg, including appropriate
 medications for ovarian stimulation, unlimited embryo transfers, and IVF-
 related laboratory procedures, ultrasounds, and hormones. A health insurance
 plan may, but shall not be required to, provide coverage for preimplantation
 genetic testing as a component of IVF.
       (4) Clinically appropriate fertility-related medications as ordered or
 prescribed by the insured’s treating health care providers.
       (5) Fertility preservation services.
    (c) Access to services; limitations on coverage.
       (1) A health insurance plan shall not establish any rate, term, or
 condition that places a greater financial burden on an insured for access to
 fertility-related services than for access to treatment for any other health
 condition.
                                                                         VT LEG #367183 v.3
     BILL AS INTRODUCED                                                           H.369
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       (2) A health insurance plan shall not impose any limitations on coverage
 for any fertility services based on an insured’s use of donor sperm or eggs,
 donor embryos, or surrogacy.
       (3) A health insurance plan is not required to provide coverage for:
           (A) any experimental fertility procedure; or
           (B) any nonmedical costs related to donor sperm or eggs, donor
 embryos, or surrogacy.
 Sec. 2. 33 V.S.A. § 1901l is added to read:
 § 1901l. COVERAGE OF FERTILITY-RELATED SERVICES
    (a) Definitions. As used in this section:
       (1) “Fertility diagnostic care” and “fertility preservation services” have
 the same meanings as in 8 V.S.A. § 4099e.
       (2) “Health care provider” has the same meaning as in 18 V.S.A.
 § 9402.
    (b) Coverage. The Agency of Human Services shall provide Medicaid
 coverage for the following fertility-related services for all Medicaid
 beneficiaries:
       (1) Fertility diagnostic care.
       (2) Intrauterine insemination treatment with donor or partner semen.
       (3) At least three retrievals of oocytes under anesthesia for in vitro
 fertilization (IVF) with donor or partner semen or egg, including appropriate VT LEG #367183 v.3
     BILL AS INTRODUCED                                                             H.369
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 medications for ovarian stimulation, unlimited embryo transfers, and IVF-
 related laboratory procedures, ultrasounds, and hormones. The Agency may,
 but shall not be required to, provide Medicaid coverage for preimplantation
 genetic testing as a component of IVF.
       (4) Clinically appropriate fertility-related medications as ordered or
 prescribed by the beneficiary’s treating health care providers.
       (5) Fertility preservation services.
 Sec. 3. COVERAGE FOR FERTILITY-RELATED SERVICES; MEDICAID
         STATE PLAN AMENDMENT
    On or before September 1, 2023, the Agency of Human Services shall
 request approval from the Centers for Medicare and Medicaid Services to
 amend Vermont’s Medicaid state plan to include coverage for fertility-related
 services as set forth in Sec. 2 of this act.
 Sec. 4. EFFECTIVE DATES
    (a) Sec. 1 (8 V.S.A. § 4099e) shall take effect on January 1, 2024 and shall
 apply to all health insurance plans issued on and after January 1, 2024 on such
 date as a health insurer offers, issues, or renews the health insurance plan, but
 in no event later than January 1, 2025.
    (b) Sec. 2 (33 V.S.A. § 1901l) shall take effect upon approval by the
 Centers for Medicare and Medicaid Services of Vermont’s request to provide
 coverage of fertility-related services as set forth in that section.
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    BILL AS INTRODUCED                                                        H.369
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   (c) Sec. 3 (coverage for fertility-related services; Medicaid state plan
 amendment) and this section shall take effect on passage.
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