26B-3-216. Medicaid waiver for fertility preservation services.
| (1) |
As used in this section:
Terms Used In Utah Code 26B-3-216- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- CMS: means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. See Utah Code 26B-3-101
- Medicaid program: means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to Title XIX of the federal Social Security Act. See Utah Code 26B-3-101
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
| (a) |
“Iatrogenic infertility” means an impairment of fertility or reproductive functioning caused by surgery, chemotherapy, radiation, or other medical treatment. |
| (c) |
“Qualified enrollee” means an individual who:
| (i) |
is enrolled in the Medicaid program; |
| (ii) |
has been diagnosed with a form of cancer by a physician; and |
| (iii) |
needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility, including surgery, radiation, or chemotherapy. |
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| (d) |
“Standard fertility preservation service” means a fertility preservation procedure and service that:
| (i) |
is not considered experimental or investigational by the American Society for Reproductive Medicine or the American Society of Clinical Oncology; and |
| (ii) |
is consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology, including:
| (D) |
banking of reproductive tissues; and |
| (E) |
storage of reproductive cells and tissues. |
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| (2) |
Before January 1, 2022, the department shall apply for a Medicaid waiver or a state plan amendment with CMS to implement the coverage described in Subsection (3). |
| (3) |
If the waiver or state plan amendment described in Subsection (2) is approved, the Medicaid program shall provide coverage to a qualified enrollee for standard fertility preservation services. |
| (4) |
The Medicaid program may not provide the coverage described in Subsection (3) before the later of:
| (a) |
the day on which the waiver described in Subsection (2) is approved; and |
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| (5) |
Before November 1, 2023, and before November 1 of each third year after 2023, the department shall:
| (a) |
calculate the change in state spending attributable to the coverage described in this section; and |
| (b) |
report the amount described in Subsection (5)(a) to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee. |
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Renumbered and Amended by Chapter 306, 2023 General Session
