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7 LONG TITLE
8 General Description:
9 This bill expands insurance coverage for fertility preservation and criminalizes
10 improper conduct related to fertility treatment.
11 Highlighted Provisions:
12 This bill:
13 ▸ defines terms;
14 ▸ requires the department to apply for a Medicaid waiver or state plan amendment
15 with the Centers for Medicare and Medicaid Services to provide coverage for
16 fertility preservation treatments for an individual diagnosed with cancer;
17 ▸ requires the Public Employees Health Program to provide coverage for fertility
18 preservation treatments for an eligible member diagnosed with cancer;
19 ▸ imposes reporting requirements; and
20 ▸ establishes a criminal penalty for a health care provider that:
21 • provides "assisted reproductive treatment" to a patient; and
22 • uses the health care provider's own gamete without the written consent of the
23 patient.
24 Money Appropriated in this Bill:
25 None
26 Other Special Clauses:
27 None
28 Utah Code Sections Affected:
29 ENACTS:
30 26-18-420.1, Utah Code Annotated 1953
31 49-20-420.1, Utah Code Annotated 1953
32 76-07-401, Utah Code Annotated 1953
33 76-07-402, Utah Code Annotated 1953
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35 Be it enacted by the Legislature of the state of Utah:
36 Section 1. Section 26-18-420.1 is enacted to read:
37 26-18-420.1. Medicaid waiver for fertility preservation services.
38 (1) As used in this section:
39 (a) "Infertility" means a disease or condition:
40 (i) characterized by:
41 (A) the failure to impregnate or conceive; or
42 (B) an individual's inability to reproduce, individually or with the individual's partner;
43 and
44 (ii) diagnosed by a physician through:
45 (A) diagnostic testing; or
46 (B) physical findings related to the patient's age, medical history, sexual history, or
47 reproductive history.
48 (b) "Qualified enrollee" means an individual who:
49 (i) is enrolled in the Medicaid program;
50 (ii) has been diagnosed with a form of cancer by a physician;
51 (iii) is at least 18 years old but not older than 35 years old; and
52 (iv) is expected to undergo medication therapy, surgery, radiation, chemotherapy, or
53 other medical treatment that is recognized by medical professionals to cause a risk of infertility.
54 (c) "Physician" means an individual licensed to practice under Title 58, Chapter 67,
55 Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
56 (d) "Standard fertility preservation services" means fertility preservation procedures
57 and services that:
58 (i) are consistent with established medical practices or professional guidelines
59 published by the American Society for Reproductive Medicine or the American Society of
60 Clinical Oncology; and
61 (ii) include:
62 (A) three completed oocyte retrievals; and
63 (B) unlimited embryo transfers in accordance with the guidelines of the American
64 Society for Reproductive Medicine, using single embryo transfer when recommended and
65 medically appropriate.
66 (2) Before January 1, 2022, the department shall apply for a Medicaid waiver or a state
67 plan amendment with CMS to implement the coverage described in Subsection (3).
68 (3) If the waiver described in Subsection (2) is approved, the Medicaid program shall
69 provide coverage to a qualified enrollee for standard fertility preservation services.
70 (4) The Medicaid program may not provide the coverage described in Subsection (3)
71 before the later of:
72 (a) the day on which the waiver described in Subsection (2) is approved; and
73 (b) January 1, 2023.
74 (5) Before November 1, 2023, and before November 1 of each third year after 2023,
75 the department shall:
76 (a) calculate the change in state spending attributable to the coverage described in this
77 section; and
78 (b) report the amount described in Subsection (5)(a) to the Health and Human Services
79 Interim Committee and the Social Services Appropriations Subcommittee.
80 Section 2. Section 49-20-420.1 is enacted to read:
81 49-20-420.1. Coverage for fertility preservation services.
82 (1) As used in this section:
83 (a) "Infertility" means a disease or condition:
84 (i) characterized by:
85 (A) the failure to impregnate or conceive; or
86 (B) an individual's inability to reproduce, individually or with the individual's partner;
87 and
88 (ii) diagnosed by a physician through:
89 (A) diagnostic testing; or
90 (B) physical findings related to the patient's age, medical history, sexual history, or
91 reproductive history.
92 (b) "Qualified individual" means a covered individual who:
93 (i) has been diagnosed by a physician as having a form of cancer;
94 (ii) is at least 18 years old but not older than 35 years old; and
95 (iii) is expected to undergo medication therapy, surgery, radiation, chemotherapy, or
96 other medical treatment that is recognized by medical professionals to cause a risk of infertility.
97 (c) "Physician" means an individual licensed to practice under Title 58, Chapter 67,
98 Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
99 (d) "Standard fertility preservation services" means fertility preservation procedures
100 and services that:
101 (i) are consistent with established medical practices or professional guidelines
102 published by the American Society for Reproductive Medicine or the American Society of
103 Clinical Oncology; and
104 (ii) include:
105 (A) three completed oocyte retrievals; and
106 (B) unlimited embryo transfers in accordance with the guidelines of the American
107 Society for Reproductive Medicine, using single embryo transfer when recommended and
108 medically appropriate.
109 (2) For a plan year that begins on or after July 1, 2021, the program shall provide
110 coverage to a qualified individual for standard fertility preservation services.
111 (3) Before November 1, 2023, and before November 1 of each third year after 2023,
112 the program shall:
113 (a) calculate the change in state spending attributable to the coverage described in this
114 section; and
115 (b) report the amount described in Subsection (3)(a) to the Health and Human Services
116 Interim Committee and the Social Services Appropriations Subcommittee.
117 Section 3. Section 76-07-401 is enacted to read:
118
119 76-07-401. Definitions.
120 As used in this part:
121 (1) "Assisted reproductive treatment" means a method of causing pregnancy by any
122 means other than through sexual intercourse, including:
123 (a) intrauterine or intracervical insemination;
124 (b) donation of eggs or sperm;
125 (c) donation of embryos;
126 (d) in vitro fertilization and embryo transfer; and
127 (e) intracytoplasmic sperm injection.
128 (2) "Gamete" means a cell containing a haploid complement of DNA that has the
129 potential to form an embryo when combined with another gamete, including:
130 (a) a sperm;
131 (b) an egg; or
132 (c) nuclear DNA from one individual combined with the:
133 (i) cytoplasm of another individual; or
134 (ii) cytoplasmic DNA of another individual.
135 (3) "Health care provider" means an individual listed in Subsection 78B-3-403(12).
136 Section 4. Section 76-07-402 is enacted to read:
137 76-07-402. Genetic material misuse.
138 (1) A health care provider may not knowingly use the health care provider's own
139 gamete, when providing assisted reproductive treatment to a patient, without the patient's
140 written consent.
141 (2) A health care provider who violates Subsection (1) is guilty of a third degree
142 felony.