B 25-0034 — Expanding Access to Fertility Treatment Amendment Act of 2023

ENGROSSEDENROLLED ORIGINAL AAN BILLACT 3______________ 25-34 5 IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 7 ___________________ 9 To amend the Women’s Health and Cancer Rights Federal Law Conformity Act of 2000 to require an individual or group health benefit plan to provide coverage for the diagnosis and treatment of infertility and standard fertility preservation services, and to require a health insurer offering health insurance coverage through Medicaid and the DC Healthcare Alliance program to cover the diagnosis and medication treatment of infertility.

ENGROSSED ORIGINAL (B) Paragraph (1) is amended by striking the phrase “contraceptive drugs” and inserting the phrase “contraceptive or fertility enhancing drugs” in its place.

(B) Paragraph (2) is amended by striking the phrase “drugs, devices, products, andor services required to be covered under sectionsections 5a, 5b, andor 5c."5c.” and inserting the phrase “or fertility enhancing drugs, devices, products, andor services required to be covered under sectionsections 5a, 5b, 5c, andor 5f.” in its place.

ENROLLED ORIGINAL (b) A new section 5f is added to read as follows:

“(A) At least 3 complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval performed prior to January 1, 2025, in ENGROSSED ORIGINAL accordance with the guidelines of ASRM, using single embryo transfer when recommended and medically appropriate;

exceptexcept, that the enrollee’s coverage shall not extend to any medical costs of the surrogate or gestational carrier after the embryo transfer procedure.

exceptexcept, that the enrollee’s coverage shall not extend to any medical costs of the surrogate or gestational carrier after the embryo transfer procedure.

“(c)“(c)(1) Beginning January 1, 2024, health insurance coverage through Medicaid and the DC Healthcare Alliance program shall provide health insurance coverage for the diagnosis of infertility and any ENGROSSED ORIGINAL medically necessary ovulation enhancing drugs and medical services related to prescribing and monitoring the use of such drugs, which shall include at least 3 cycles of ovulation-enhancing medication treatment over an enrollee’s lifetime.

“(d)“(2) WithinBy 180January days1, of2024, the effective date of this section, the Department of Health Care Finance shall submit aan reportamendment to the CouncilMedicaid afterstate consultingplan withto the Centers for Medicare & Medicaid Services onto whetherauthorize incoverage vitrothrough fertilizationMedicaid andfor standardthe fertilitydiagnosis preservationof servicesinfertility areand any medically reasonable and necessary proceduresovulation underenhancing federaldrugs law, possible methods for covering in-vitro fertilization and standardmedical fertility preservation services asrelated ato Medicaidprescribing covered benefit for both fee-for-service and managedmonitoring care organizations, including any potentially applicable waiver authorities, and the amountuse of moneysuch thatdrugs, wouldwhich needshall toinclude beat allocatedleast to3 federalcycles andof localovulation-enhancing fundsmedication fortreatment suchover coverage.an enrollee’s lifetime.

ENROLLED ORIGINAL “(d) Within 180 days of the effective date of this section, the Department of Health Care Finance shall submit a report to the Council after consulting with the Centers for Medicare & Medicaid Services on whether in vitro fertilization and standard fertility preservation services are medically reasonable and necessary procedures under federal law, possible methods for covering in-vitro fertilization and standard fertility preservation services as a Medicaid covered benefit for both fee-for-service and managed care organizations, including any potentially applicable waiver authorities, and the amount of money that would need to be allocated to federal and local funds for such coverage.

ENGROSSED ORIGINAL “(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility or use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits;

ENGROSSED ORIGINAL “(B) A person’s inability to reproduce without medical intervention either as a single individual or with their partner;

ENROLLED ORIGINAL “(3) “Treatment for infertility” means procedures consistent with established medical practices in the treatment of infertility by licensed physicians and surgeons, including diagnosis, diagnostic tests, medication, surgery, or gamete intrafallopian transfer.

“(a)(a) Amendatory section 5f(b) in section 22(b) shall apply upon the date of inclusion of its fiscal effect in an approved budget and financial plan.

“(b)(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect in an approved budget and financial plan and provide notice to the Budget Director of the ENGROSSED ORIGINAL Council of the certification.

“(c)(1)(c)(1) The Budget Director shall cause the notice of the certification to be published in the District of Columbia Register.

“(2)(2) The date of publication of the notice of the certification shall not affect the applicability of this act.

This act shall take effect following approval by the Mayor (or in the event of veto by the Mayor, action by the Council to override the veto), a 30-day period of congressional review as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December ENROLLED ORIGINAL 24, 1973 (87 Stat.

______________________________ Chairman Council of the District of Columbia _________________________________ Mayor District of Columbia 5