1     
INSURANCE COVERAGE MODIFICATIONS

2     
2020 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Raymond P. Ward

5     
Senate Sponsor: Curtis S. Bramble

6     

7     LONG TITLE
8     General Description:
9          This bill enacts provisions relating to certain health care benefits.
10     Highlighted Provisions:
11          This bill:
12          ▸     requires the Department of Health to apply for a Medicaid waiver or state plan
13     amendment to allow the program to provide coverage for in vitro fertilization and
14     genetic testing for certain individuals;
15          ▸     requires the Public Employees' Health Benefit Program to provide coverage for in
16     vitro fertilization and genetic testing for certain individuals;
17          ▸     requires certain insurers to study whether coverage of in vitro fertilization would
18     result in cost savings to the insurer; and
19          ▸     creates reporting requirements.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          None
24     Utah Code Sections Affected:
25     AMENDS:
26          63I-2-226, as last amended by Laws of Utah 2019, Chapters 262, 393, 405 and last
27     amended by Coordination Clause, Laws of Utah 2019, Chapter 246
28          63I-2-249, as last amended by Laws of Utah 2018, Chapters 38 and 281

29     ENACTS:
30          26-18-420, Utah Code Annotated 1953
31          31A-22-653, Utah Code Annotated 1953
32          49-20-420, Utah Code Annotated 1953
33     

34     Be it enacted by the Legislature of the state of Utah:
35          Section 1. Section 26-18-420 is enacted to read:
36          26-18-420. Coverage for in vitro fertilization and genetic testing.
37          (1) As used in this section:
38          (a) "Qualified condition" means:
39          (i) cystic fibrosis;
40          (ii) spinal muscular atrophy;
41          (iii) Morquio Syndrome;
42          (iv) myotonic dystrophy; or
43          (v) sickle cell anemia.
44          (b) "Qualified enrollee" means an individual who:
45          (i) is enrolled in the Medicaid program;
46          (ii) has been diagnosed by a physician as having a genetic trait associated with a
47     qualified condition; and
48          (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a
49     genetic trait associated with the same qualified condition as the individual.
50          (2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state
51     plan amendment with the Centers for Medicare and Medicaid Services within the United States
52     Department of Health and Human Services to implement the coverage described in Subsection
53     (3).
54          (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall
55     provide coverage to a qualified enrollee for:

56          (a) in vitro fertilization services; and
57          (b) genetic testing of a qualified enrollee who receives in vitro fertilization services
58     under Subsection (3)(a).
59          (4) The Medicaid program may not provide the coverage described in Subsection (3)
60     before the later of:
61          (a) the day on which the waiver described in Subsection (2) is approved; and
62          (b) January 1, 2021.
63          (5) Before November 1, 2022, and before November 1 of every third year thereafter,
64     the department shall:
65          (a) calculate the change in state spending attributable to the coverage under this
66     section; and
67          (b) report the amount described in Subsection (4)(a) to the Health and Human Services
68     Interim Committee and the Social Services Appropriations Subcommittee.
69          Section 2. Section 31A-22-653 is enacted to read:
70          31A-22-653. Study of coverage for in vitro fertilization and genetic testing --
71     Reporting -- Coverage requirements.
72          (1) As used in this section:
73          (a) "Qualified condition" means the same as that term is defined in Section 49-20-420.
74          (b) "Qualified insurer" means an insurer that provides a health benefit plan described in
75     Section 31A-22-600 to more than 25,000 enrollees in the state.
76          (c) "Qualified enrollee" means an enrollee of a qualified insurer who:
77          (i) has been diagnosed by a physician as having a genetic trait associated with a
78     qualified condition; and
79          (ii) intends to get pregnant with a partner who is diagnosed by a physician as having a
80     genetic trait associated with the same qualified condition as the enrollee.
81          (2) (a) A qualified insurer shall submit the information described in this Subsection (2)
82     to the department with the qualified insurer's rate filings required under Section 31A-2-201.1

83     for a plan year beginning:
84          (i) on or after January 1, 2022, but before December 31, 2022; and
85          (ii) on or after January 1, 2025, but before December 31, 2025.
86          (b) A qualified insurer shall study whether providing the coverage for the services
87     described in Subsections (3)(a) through (c) for qualified enrollees will result in cost savings for
88     the qualified insurer.
89          (c) (i) If a qualified insurer determines that providing the coverage described in
90     Subsection (3) for qualified enrollees will result in cost savings for the qualified insurer, the
91     qualified insurer shall submit a summary of the results of the study described in Subsection
92     (2)(b), and:
93          (A) describe how the qualified insurer intends to provide the coverage described in
94     Subsection (3); or
95          (B) submit an explanation of why the insurer will not provide the coverage described in
96     Subsection (3).
97          (ii) If a qualified insurer determines that providing the coverage described in
98     Subsection (3) will not result in cost savings to the qualified insurer, the qualified insurer shall
99     submit a summary of the results of the study described in Subsection (2)(b).
100          (3) A qualified insurer shall consider coverage for:
101          (a) in vitro fertilization services for a qualified enrollee; and
102          (b) genetic testing of a qualified enrollee who received in vitro fertilization services
103     under Subsection (3)(a).
104          (4) The department shall report the information received under Subsection (2) to the
105     Health and Human Services Interim Committee on or before:
106          (a) for information submitted under Subsection (2)(a)(i), November 1, 2022; and
107          (b) for information submitted under Subsection (2)(a)(ii), November 1, 2025.
108          Section 3. Section 49-20-420 is enacted to read:
109          49-20-420. Coverage for in vitro fertilization and genetic testing.

110          (1) As used in this section:
111          (a) "Qualified condition" means:
112          (i) cystic fibrosis;
113          (ii) spinal muscular atrophy;
114          (iii) Morquio Syndrome;
115          (iv) myotonic dystrophy; or
116          (v) sickle cell anemia.
117          (b) "Qualified individual" means a covered individual who:
118          (i) has been diagnosed by a physician as having a genetic trait associated with a
119     qualified condition; and
120          (ii) intends to get pregnant with a partner who is diagnosed by a physician as having a
121     genetic trait associated with the same qualified condition as the covered individual.
122          (2) For a plan year that begins on or after July 1, 2020, the program shall provide
123     coverage for a qualified individual for:
124          (a) in vitro fertilization services; and
125          (b) genetic testing of a qualified individual who receives in vitro fertilization services
126     under Subsection (2)(a).
127          (3) Before November 1, 2022, and before November 1 of every third year thereafter,
128     the program shall:
129          (a) calculate the change in state spending attributable to the coverage under this
130     section; and
131          (b) report the amount described in Subsection (3)(a) to the Health and Human Services
132     Interim Committee and the Social Services Appropriations Subcommittee.
133          Section 4. Section 63I-2-226 is amended to read:
134          63I-2-226. Repeal dates -- Title 26.
135          (1) Subsection 26-7-8(3) is repealed January 1, 2027.
136          (2) Section 26-8a-107 is repealed July 1, 2024.

137          (3) Subsection 26-8a-203(3)(a)(i) is repealed January 1, 2023.
138          [(4) Subsection 26-18-2.3(5) is repealed January 1, 2020.]
139          [(5)] (4) Subsection 26-18-2.4(3)(e) is repealed January 1, 2023.
140          [(6)] (5) Subsection 26-18-411(8), related to reporting on the health coverage
141     improvement program, is repealed January 1, 2023.
142          (6) Subsection 26-18-420(5), related to reporting on coverage for in vitro fertilization
143     and genetic testing, is repealed July 1, 2030.
144          [(7) Subsection 26-18-604(2) is repealed January 1, 2020.]
145          [(8)] (7) Subsection 26-21-28(2)(b) is repealed January 1, 2021.
146          [(9)] (8) Subsection 26-33a-106.1(2)(a) is repealed January 1, 2023.
147          [(10) Subsection 26-33a-106.5(6)(c)(iii) is repealed January 1, 2020.]
148          [(11)] (9) Title 26, Chapter 46, Utah Health Care Workforce Financial Assistance
149     Program, is repealed July 1, 2027.
150          [(12) Subsection 26-50-202(7)(b) is repealed January 1, 2020.]
151          [(13) Subsections 26-54-103(6)(d)(ii) and (iii) are repealed January 1, 2020.]
152          [(14)] (10) Subsection 26-55-107(8) is repealed January 1, 2021.
153          [(15) Subsection 26-56-103(9)(d) is repealed January 1, 2020.]
154          [(16) Title 26, Chapter 59, Telehealth Pilot Program, is repealed January 1, 2020.]
155          [(17)] (11) Subsection 26-61-202(4)(b) is repealed January 1, 2022.
156          [(18)] (12) Subsection 26-61-202(5) is repealed January 1, 2022.
157          Section 5. Section 63I-2-249 is amended to read:
158          63I-2-249. Repeal dates -- Title 49.
159          (1) Section 49-20-106 is repealed January 1, 2021.
160          (2) Subsection 49-20-417(5)(b) is repealed January 1, 2020.
161          (3) Subsection 49-20-420(3), regarding a requirement to report to the Legislature, is
162     repealed January 1, 2030.