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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 ▸ creates requirements relating to cost sharing for certain drugs; and
18 ▸ creates reporting requirements.
19 Money Appropriated in this Bill:
20 None
21 Other Special Clauses:
22 None
23 Utah Code Sections Affected:
24 AMENDS:
25 63I-2-226, as last amended by Laws of Utah 2019, Chapters 262, 393, 405 and last
26 amended by Coordination Clause, Laws of Utah 2019, Chapter 246
27 63I-2-249, as last amended by Laws of Utah 2018, Chapters 38 and 281
28 ENACTS:
29 26-18-420, Utah Code Annotated 1953
30 31A-22-653, Utah Code Annotated 1953
31 49-20-420, Utah Code Annotated 1953
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33 Be it enacted by the Legislature of the state of Utah:
34 Section 1. Section 26-18-420 is enacted to read:
35 26-18-420. Coverage for in vitro fertilization and genetic testing.
36 (1) As used in this section:
37 (a) "Qualified condition" means:
38 (i) cystic fibrosis;
39 (ii) spinal muscular atrophy;
40 (iii) Morquio Syndrome; or
41 (iv) sickle cell anemia.
42 (b) "Qualified enrollee" means an individual who:
43 (i) is enrolled in the Medicaid program;
44 (ii) has been diagnosed by a physician as having a genetic trait associated with a
45 qualified condition; and
46 (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a
47 genetic trait associated with the same qualified condition as the individual.
48 (2) Before January 1, 2021, the department shall apply for a Medicaid waiver or a state
49 plan amendment with the Centers for Medicare and Medicaid Services within the United States
50 Department of Health and Human Services to implement the coverage described in Subsection
51 (3).
52 (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall
53 provide coverage to a qualified enrollee for:
54 (a) in vitro fertilization services to prevent the child of the qualified enrollee from
55 having the same qualified condition for which the qualified enrollee is a genetic carrier;
56 (b) genetic testing of a qualified enrollee who receives in vitro fertilization under
57 Subsection (3)(a); and
58 (c) genetic testing of an embryo that results from the in vitro fertilization described in
59 Subsection (3)(a).
60 (4) Before November 1, 2022, and before November 1 of every third year thereafter,
61 the department shall:
62 (a) calculate the change in state spending attributable to the coverage under this
63 section; and
64 (b) report the amount described in Subsection (4)(a) to the Health and Human Services
65 Interim Committee and the Social Services Appropriations Subcommittee.
66 Section 2. Section 31A-22-653 is enacted to read:
67 31A-22-653. Cost sharing requirements for certain medications.
68 (1) As used in this section:
69 (a) "Generic equivalent" means a drug that:
70 (i) has an identical amount of the same active chemical ingredients in the same dosage
71 form;
72 (ii) meets applicable standards of strength, quality, and purity according to the United
73 States pharmacopeia or other nationally recognized compendium; and
74 (iii) if administered in the same amounts, will provide comparable therapeutic effects.
75 (b) "Qualified prescription drug" means a prescription drug that does not have:
76 (i) a generic equivalent;
77 (ii) a biosimilar equivalent; or
78 (iii) any other similar off-patent pharmaceutical that would provide equivalent
79 therapeutic value.
80 (2) For a health benefit plan that is entered into or renewed on or after January 1, 2021,
81 an insurer shall include any amount paid by or on behalf of an enrollee for a qualified
82 prescription drug toward the enrollee's contribution to any out-of-pocket maximum, deductible,
83 copayment, coinsurance, or other applicable cost sharing requirement.
84 Section 3. Section 49-20-420 is enacted to read:
85 49-20-420. Coverage for in vitro fertilization and genetic testing.
86 (1) As used in this section:
87 (a) "Qualified condition" means:
88 (i) cystic fibrosis;
89 (ii) spinal muscular atrophy;
90 (iii) Morquio Syndrome; or
91 (iv) sickle cell anemia.
92 (b) "Qualified enrollee" means an individual who:
93 (i) is enrolled in the Medicaid program;
94 (ii) has been diagnosed by a physician as having a genetic trait associated with a
95 qualified condition; and
96 (iii) intends to get pregnant with a partner who is diagnosed by a physician as having a
97 genetic trait associated with the same qualified condition as the individual.
98 (2) For a plan year that begins on or after July 1, 2020, the program shall provide
99 coverage for a qualified enrollee for:
100 (a) in vitro fertilization services to prevent the child of the qualified enrollee from
101 having the same qualified condition for which the qualified enrollee is a genetic carrier;
102 (b) genetic testing of a qualified enrollee who receives in vitro fertilization under
103 Subsection (2)(a); and
104 (c) genetic testing of an embryo that results from the in vitro fertilization described in
105 Subsection (2)(a).
106 (3) Before November 1, 2022, and before November 1 of every third year thereafter,
107 the program shall:
108 (a) calculate the change in state spending attributable to the coverage under this
109 section; and
110 (b) report the amount described in Subsection (3)(a) to the Health and Human Services
111 Interim Committee and the Social Services Appropriations Subcommittee.
112 Section 4. Section 63I-2-226 is amended to read:
113 63I-2-226. Repeal dates -- Title 26.
114 (1) Subsection 26-7-8(3) is repealed January 1, 2027.
115 (2) Section 26-8a-107 is repealed July 1, 2024.
116 (3) Subsection 26-8a-203(3)(a)(i) is repealed January 1, 2023.
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120 improvement program, is repealed January 1, 2023.
121 (6) Subsection 26-18-419(4), regarding a requirement to report to the Legislature, is
122 repealed January 1, 2030.
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128 Program, is repealed July 1, 2027.
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136 Section 5. Section 63I-2-249 is amended to read:
137 63I-2-249. Repeal dates -- Title 49.
138 (1) Section 49-20-106 is repealed January 1, 2021.
139 (2) Subsection 49-20-417(5)(b) is repealed January 1, 2020.
140 (3) Subsection 49-20-419(3), regarding a requirement to report to the Legislature, is
141 repealed January 1, 2030.