Fertility treatment rights, reimbursement of fertility treatments under the Medical Assistance program, and requiring insurance coverage for fertility treatments. (FE)

Under the bill, a health insurance issuer has a statutory right to cover the provision of fertility treatment provided in accordance with widely accepted and evidence-based medical standards of care, and a manufacturer of a drug or device that is approved, cleared, authorized, or licensed or otherwise legally marketed and intended for use in the provision of fertility treatment, including the storage or transport of oocytes, gametes, fertilized eggs, and embryos, has a statutory right under the bill, without prohibition, limitation, interference, or impediment, to manufacture, import, market, sell, and distribute that drug or device.

The bill provides that the attorney general may commence a civil action or proceeding on behalf of any person in the state whose rights are adversely affected by an alleged violation of the provisions of the bill. Under the bill, an individual or entity adversely affected by an alleged violation may commence a civil action, and a health care provider may commence a civil action for relief on behalf of the provider, the provider’s staff, or the provider’s patients who are or may be adversely affected by an alleged violation.

Insurance coverage and Medical Assistance The bill requires health insurance policies and self-insured governmental health plans that provide coverage for obstetrics to also provide coverage for fertility treatments that are determined by the covered individual’s health care provider to be appropriate and are performed at, or prescribed by, a medical facility that is in compliance with applicable state and federal standards. Under the bill, coverage of fertility treatments must be provided regardless of whether the individual has been diagnosed with infertility, and the coverage may only be subject to cost sharing and limitations that apply generally under the policy or plan to other medical services. The bill requires the policy or plan to provide written notice to each insured or enrollee regarding the coverage.

The bill prohibits a policy or plan from providing an incentive to encourage an individual not to seek or obtain covered fertility treatment or an incentive to induce health care providers not to provide medically appropriate fertility treatments. The bill also prohibits a policy or plan from reducing reimbursements to, or otherwise penalizing, health care providers who provide or discuss fertility treatments with individuals covered under the policy or plan.

The bill also requires the Department of Health Services to request any necessary waiver of federal Medicaid law or amendment to the state Medical Assistance plan to allow Medical Assistance reimbursement for those fertility treatments for which insurance coverage is required under the bill. The Medical Assistance program is a joint state and federal program that provides health services to individuals who have limited financial resources.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.