1     
EXPANDED INFERTILITY TREATMENT COVERAGE PILOT

2     
PROGRAM AMENDMENTS

3     
2021 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Luz Escamilla

6     
House Sponsor: Candice B. Pierucci

7     

8     LONG TITLE
9     General Description:
10          This bill amends the expanded infertility treatment coverage pilot program.
11     Highlighted Provisions:
12          This bill:
13          ▸     defines "qualified assisted reproductive technology cycle";
14          ▸     modifies the expanded infertility treatment coverage pilot program by:
15               •     providing an additional three years of coverage; and
16               •     providing coverage for each qualified assisted reproductive technology cycle;
17          ▸     provides reporting requirements to evaluate the expanded infertility treatment
18     coverage pilot program;
19          ▸     extends the repeal date of the expanded infertility treatment coverage pilot program;
20     and
21          ▸     makes technical changes.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          None
26     Utah Code Sections Affected:
27     AMENDS:
28          49-20-418, as enacted by Laws of Utah 2018, Chapter 357
29          63I-1-249, as last amended by Laws of Utah 2020, Chapter 98
30     

31     Be it enacted by the Legislature of the state of Utah:
32          Section 1. Section 49-20-418 is amended to read:
33          49-20-418. Expanded infertility treatment coverage pilot program.
34          (1) As used in this section:
35          (a) "Assisted reproductive technology" means the same as the term is defined in 42
36     [U.S. Code Sec. 26-3a-7a] U.S.C. Sec. 263a-7.
37          (b) "Physician" means the same as the term is defined in Section 58-67-102.
38          (c) "Pilot program" means the expanded infertility treatment coverage pilot program
39     described in Subsection (2).
40          (d) "Qualified assisted reproductive technology cycle" means the use of assisted
41     reproductive technology to transfer a single embryo for implantation.
42          [(d)] (e) "Qualified individual" means a covered individual who is eligible for
43     maternity benefits under the program.
44          (2) (a) Beginning plan year 2018-19, and ending plan year [2020-21] 2023-24, the
45     program shall offer a [3-year] pilot program within the state risk pool that provides coverage to
46     a qualified individual for the use of an assisted reproductive technology.
47          [(b) The] (b) (i) For plan year 2018-19, 2019-20, or 2020-21, the pilot program shall
48     offer a one-time[, lifetime maximum] benefit of $4,000 toward the costs of using an assisted
49     reproductive technology for each qualified individual.
50          (ii) For plan year 2021-22, 2022-23, or 2023-24, the pilot program shall offer a benefit
51     of $4,000 to a qualified individual toward the costs of each qualified assisted reproductive
52     technology cycle.
53          (c) The [benefit] benefits described in Subsection (2)(b) [is] are subject to the same
54     cost sharing requirements as the covered individual's plan.
55          (3) Coverage offered under the pilot program applies if:
56          (a) the patient who will use the assisted reproductive technology is a qualified
57     individual;
58          (b) (i) the patient's physician verifies that the patient or the patient's spouse has a
59     demonstrated condition recognized by a physician as a cause of infertility; or
60          (ii) the patient attests that the patient is unable to conceive a pregnancy or carry a
61     pregnancy to a live birth after a year or more of regular sexual relations without contraception;
62          (c) the patient attests that the patient has been unable to attain a successful pregnancy
63     through any less-costly, potentially effective infertility treatments for which coverage is
64     available under the health benefit plan; and
65          (d) the use of the assisted reproductive technology procedure is performed at a medical
66     facility that conforms to the minimal standards for programs of assisted reproductive
67     technology procedures adopted by the American Society for Reproductive Medicine.
68          (4) Coverage offered under the pilot program:
69          [(a) may not exceed $4,000 over the lifetime of each qualified individual;]
70          [(b)] (a) shall satisfy, in accordance with Subsection 31A-22-610.1(1)(c)(ii), the
71     requirement to provide an adoption indemnity benefit to a qualified individual under Section
72     31A-22-610.1; [and]
73          [(c)] (b) does not apply to a qualified individual if the qualified individual has received
74     the adoption indemnity benefit required under Section 31A-22-610.1[.]; and
75          (c) for plan year 2021-22, 2022-23, or 2023-24, shall apply to a qualified individual,
76     even if the qualified individual received the benefit described in Subsection (2)(b)(i).
77          (5) (a) The purpose of the pilot program is to study the efficacy of providing coverage
78     for the use of an assisted reproductive technology and is not a mandate for coverage of an
79     assisted reproductive technology within all health plans offered by the program.
80          [(b) Before November 30, 2021, the program shall report to the Social Services
81     Appropriations Subcommittee regarding the costs and benefits of the pilot program.]
82          (b) The program shall report to the Retirement and Independent Entities Interim
83     Committee regarding the costs and benefits of the pilot program:
84          (i) on or before October 1; and
85          (ii) during calendar years 2022 and 2023.
86          (6) Under Section 63J-1-603, the Legislature intends that the cost of the pilot program
87     will be paid from money above the minimum recommended level in the public employees' state
88     risk pool reserve.
89          Section 2. Section 63I-1-249 is amended to read:
90          63I-1-249. Repeal dates, Title 49.
91          (1) Title 49, Chapter 11, Part 13, Phased Retirement, is repealed January 1, 2025.
92          (2) Section 49-20-418 is repealed January 1, [2022] 2025.