Representative Ashlee Matthews proposes the following substitute bill:




Chief Sponsor: Ashlee Matthews

Senate Sponsor: Luz Escamilla


8     General Description:
9          This bill requires the Public Employees' Benefit and Insurance Program to cover
10     pregnancy and childbirth services.
11     Highlighted Provisions:
12          This bill:
13          ▸     defines terms;
14          ▸     requires coverage of pregnancy and childbirth services by the Public Employees'
15     Benefit and Insurance Program, including:
16               •     doula services;
17               •     services by a licensed direct-entry midwife; and
18               •     services at a free-standing birthing center;
19          ▸     requires the program to report on its coverage of pregnancy and childbirth services
20     to the Health and Human Services Interim Committee; and
21          ▸     provides a repeal date.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          None

26     Utah Code Sections Affected:
27     AMENDS:
28          63I-2-249, as last amended by Laws of Utah 2021, Chapter 64
29     ENACTS:
30          49-20-422, Utah Code Annotated 1953

32     Be it enacted by the Legislature of the state of Utah:
33          Section 1. Section 49-20-422 is enacted to read:
34          49-20-422. Coverage of pregnancy and childbirth services.
35          (1) As used in this section:
36          (a) "Doula" means an individual who:
37          (i) provides information and physical and emotional support:
38          (A) to a pregnant or postpartum individual; and
39          (B) related to the pregnant or postpartum individual's pregnancy; and
40          (ii) is certified by one or more organizations approved by the program.
41          (b) "Pregnancy and childbirth services" means services provided to a pregnant
42     individual before, during, or shortly after childbirth:
43          (i) by a doula for the services described in Subsections (1)(a)(i) and (ii);
44          (ii) by a direct-entry midwife licensed under Title 58, Chapter 77, Direct-Entry
45     Midwife Act, if the direct-entry midwife is engaged in the practice of direct-entry midwifery, as
46     defined in Section 58-77-102; or
47          (iii) at a birthing center that:
48          (A) is licensed under Title 26, Chapter 21, Health Care Facility Licensing and
49     Inspection Act; or
50          (B) is accredited by the Commission for the Accreditation of Birth Centers.
51          (c) "Qualified individual" means a covered individual who is:
52          (i) within the state employees' risk pool; and
53          (ii) (A) is pregnant; or
54          (B) was pregnant within the past six months.
55          (2) For a plan year that begins on or after July 1, 2023, and before July 1, 2026, the
56     program shall cover pregnancy and childbirth services to a qualified individual.

57          (3) The program may establish limits for coverage under Subsection (2), including
58     limits based on:
59          (a) the type or number of services provided; and
60          (b) a qualified individual's physical or emotional condition.
61          (4) The program shall report to the Health and Human Services Interim Committee on
62     or before October 1 of each year regarding coverage provided under Subsection (2), including:
63          (a) covered providers;
64          (b) covered services;
65          (c) provider payment rates;
66          (d) covered-individual cost sharing;
67          (e) total provider payments and covered-individual cost sharing; and
68          (f) any indicators of whether pregnancy and childbirth services covered under
69     Subsection (2) have:
70          (i) reduced pregnancy or postpartum coverage costs; or
71          (ii) improved pregnancy or postpartum care.
72          Section 2. Section 63I-2-249 is amended to read:
73          63I-2-249. Repeal dates: Title 49.
74          (1) Subsection 49-20-420(3), regarding a requirement to report to the Legislature, is
75     repealed January 1, 2030.
76          (2) Section 49-20-422, regarding coverage for pregnancy and childbirth services, is
77     repealed July 1, 2027.