,,ii #aafth ,,congress #ast ,session ,s4 #adfa ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ad1 #bjai,mr4 ,booker 7for himself and ,mr4 ,menendez7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to require health insurance coverage for the treatment of infertility4 #a4 ,short title ,this ,act may be cited as the ,access to ,infertility ,treatment and ,care ,act4 #b4 ,findings ,congress finds as follows3 7#a7 ,infertility is a medical disease recognized by the ,world ,health ,organization1 the ,american ,society for ,reproductive ,medicine1 and the ,american ,medical ,association that affects men and women equally4 7#b7 ,according to the ,centers for ,disease ,control and ,prevention1 #a in #h couples have difficulty getting pregnant or sustaining a pregnancy4 7#c7 ,infertility affects a broad spectrum of prospective parents4 ,no matter what race1 religion1 sexual orientation1 or economic status one is1 infertility does not discriminate4 7#d7 ,according to the ,centers for ,disease ,control and ,prevention1 #aa percent of women in the ,united ,states between the ages of #ae and #dd have difficulty getting pregnant or staying pregnant4 ,similarly1 #i percent of men in the ,united ,states between the ages of #ae and #dd experience infertility4 7#e7 ,infertility disproportionately affects individuals with particular health complications4 ,for cancer patients and others who must undergo treatments such as chemotherapy1 radiation therapy1 hormone therapy1 or surgery that are likely to harm the reproductive system and organs1 fertility preservation becomes necessary4 7#f7 ,leading causes of infertility include chronic conditions and diseases of the endocrine or metabolic systems1 such as primary ovarian insufficiency1 polycystic ovarian syndrome1 endometriosis1 thyroid disorders1 menstrual cycle defects1 autoimmune disorders1 hormonal imbalances1 testicular disorders1 and urological health issues4 ,other causes include structural problems or blockages within the reproductive system1 exposure to infectious diseases1 occupational or environmental hazards1 or genetic influences4 7#g7 ,recent improvements in therapy and cryopreservation make pregnancy possible for more people than in past years4 7#h7 ,like all other diseases1 infertility and its treatments should be covered by health insurance4 7#i7 ,a #bjag national survey of employer-sponsored health plans found that #dd percent of employers with at least #ejj employees did not cover infertility services1 and #be percent of companies with #bj1jjj or more employees did not cover infertility services4 7#aj7 ,coverage for infertility services under ,state ,medicaid programs is limited4 ,the ,medicaid programs of only #e ,states provide diagnostic testing for women and men in all of their program eligibility pathways2 the ,medicaid program of only one ,state provides coverage for certain medications for women experiencing infertility2 and no ,state ,medicaid programs cover intrauterine insemination or in vitro fertilization4 7#aa7 ,states that do not require private insurance coverage of assisted reproductive technology have higher rates of multiple births4 7#ab7 ,the ability to have a family should not be denied to anyone on account of a lack of insurance coverage for medically necessary treatment4 #c4 ,standards relating to benefits for treatment of infertility and prevention of iatrogenic infertility 7a7 ,in general ,part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by inserting after section #bgbh the following3 #bgbi;,a4 ,standards relating to benefits for treatment of infertility and prevention of iatrogenic infertility 7a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall ensure that such plan or coverage provides coverage for-- 7#a7 the treatment of infertility1 including nonexperimental assisted reproductive technology procedures1 if such plan or coverage provides coverage for obstetrical services2 and 7#b7 standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility4 7b7 ,definitions ,in this section3 7#a7 the term assisted reproductive technology means treatments or procedures that involve the handling of human egg1 sperm1 and embryo outside of the body with the intent of facilitating a pregnancy1 including in vitro fertilization1 egg1 embryo1 or sperm cryopreservation1 egg or embryo donation1 and gestational surrogacy2 7#b7 the term infertility means a disease1 characterized by the failure to establish a clinical pregnancy-- 7,a7 after #ab months of regular1 unprotected sexual intercourse2 or 7,b7 due to a person's incapacity for reproduction either as an individual or with his or her partner1 which may be determined after a period of less than #ab months of regular1 unprotected sexual intercourse1 or based on medical1 sexual and reproductive history1 age1 physical findings1 or diagnostic testing2 and 7#c7 the term iatrogenic infertility means an impairment of fertility due to surgery1 radiation1 chemotherapy1 or other medical treatment4 7c7 ,required coverage 7#a7 ,coverage for infertility ,subject to paragraph 7#c71 a group health plan and a health insurance issuer offering group or individual health insurance coverage that includes coverage for obstetrical services shall provide coverage for treatment of infertility determined appropriate by the treating physician1 including1 as appropriate1 ovulation induction1 egg retrieval1 sperm retrieval1 artificial insemination1 in vitro fertilization1 genetic screening1 intracytoplasmic sperm injection1 and any other non-experimental treatment1 as determined by the ,secretary in consultation with appropriate professional and patient organizations such as the ,american ,society for ,reproductive ,medicine1 ,,resolve3 ,the ,national ,infertility ,association1 and the ,american ,college of ,obstetricians and ,gynecologists4 7#b7 ,coverage for iatrogenic infertility ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage of fertility preservation services for individuals who undergo medically necessary treatment that may cause iatrogenic infertility1 as determined by the treating physician1 including cryopreservation of gametes and other procedures1 as determined by the ,secretary1 consistent with established medical practices and professional guidelines published by professional medical organizations1 including the ,american ,society of ,clinical ,oncology and the ,american ,society for ,reproductive ,medicine4 7#c7 ,limitation on coverage of assisted reproductive technology ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for assisted reproductive technology as required under paragraph 7#a7 if-- 7,a7 the individual is unable to bring a pregnancy to a live birth through minimally invasive infertility treatments1 as determined appropriate by the treating physician1 with consideration given to participant's or beneficiary's specific diagnoses or condition for which coverage is available under the plan or coverage2 and 7,b7 the treatment is performed at a medical facility that-- 7i7 conforms to the standards of the ,american ,society for ,reproductive ,medicine and the ,society for ,assisted ,reproductive ,technology2 and 7ii7 is in compliance with any standards set by an appropriate ,federal agency4 7d7 ,limitation ,cost-sharing1 including deductibles and coinsurance1 or other limitations for infertility and services to prevent iatrogenic infertility may not be imposed with respect to the services required to be covered under subsection 7c7 to the extent that such cost-sharing exceeds the cost-sharing applied to similar services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such similar services4 7e7 ,prohibitions ,a group health plan and a health insurance issuer offering group or individual health insurance coverage may not-- 7#a7 provide incentives 7monetary or otherwise7 to a participant or beneficiary to encourage such participant or beneficiary not to be provided infertility treatments or fertility preservation services to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide such treatments to qualified participants or beneficiaries2 7#b7 prohibit a provider from discussing with a participant or beneficiary infertility treatments or fertility preservation technology or medical treatment options relating to this section2 or 7#c7 penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility treatments or fertility preservation services to a qualified participant or beneficiary in accordance with this section4 7f7 ,rule of construction ,nothing in this section shall be construed to require a participant or beneficiary to undergo infertility treatments or fertility preservation services4 7g7 ,notice ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted-- 7#a7 in the next mailing made by the plan or issuer to the participant or beneficiary2 7#b7 as part of any yearly informational packet sent to the participant or beneficiary2 or 7#c7 not later than ,january #a1 #bjbj1 whichever is earlier4 7h7 ,level and type of reimbursements ,nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section4 4 7b7 ,conforming amendment ,section #bgbd7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bc7;c77 is amended by striking section #bgjd and inserting sections #bgjd and #bgjh4 7c7 ,effective dates 7#a7 ,in general ,the amendments made by subsections 7a7 and 7b7 shall apply for plan years beginning on or after the date that is #f months after the date of enactment of this ,act4 7#b7 ,collective bargaining exception 7,a7 ,in general ,in the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of enactment of this ,act1 the amendments made by subsection 7a7 shall not apply to plan years beginning before the later of-- 7i7 the date on which the last collective bargaining agreements relating to the plan terminates 7determined without regard to any extension thereof agreed to after the date of enactment of this ,act71 or 7ii7 the date occurring #f months after the date of the enactment of this ,act4 7,b7 ,clarification ,for purposes of subparagraph 7,a71 any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by subsection 7a7 shall not be treated as a termination of such collective bargaining agreement4 #d4 ,federal ,employees ,health ,benefits ,program 7a7 ,in general ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7p7 ,coverage for diagnosis and treatment of infertility and prevention of iatrogenic infertility 7#a7 ,definitions ,in this subsection1 the terms infertility and iatrogenic infertility have the meanings given those terms in section #bgbi;,a of the ,public ,health ,service ,act4 7#b7 ,required coverage ,a contract under this chapter shall provide1 in a manner consistent with section #bgbi;,a of the ,public ,health ,service ,act-- 7,a7 coverage for the diagnosis and treatment of infertility1 including nonexperimental assisted reproductive technology procedures1 if such contract covers obstetrical benefits2 and 7,b7 coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility4 7#c7 ,cost ,coverage for the diagnosis or treatment of infertility and fertility preservation services under a health benefits plan described in section #hijc or #hijc;a may not be subject to any copayment or deductible greater than the copayment or deductible1 respectively1 applicable to obstetrical benefits under the plan4 7#d7 ,preemption ,subsection 7m77#a7 shall not1 with respect to a contract under this chapter1 prevent the inclusion of any terms that1 under paragraph 7#b7 of this subsection1 are required by reason of section #bgbi;,a of the ,public ,health ,service ,act4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to any contract entered into or renewed for a contract year beginning on or after the date that is #ahj days after the date of enactment of this ,act1 and any health benefits plan offered under such a contract4 #e4 ,benefits for treatment of infertility and prevention of iatrogenic infertility under the ,,tricare program 7a7 ,in general ,chapter #ee of title #aj1 ,united ,states ,code1 is amended by adding at the end the following new section3 #aaaj;c4 ,obstetrical and infertility benefits 7a7 ,in general ,any health care plan under this chapter shall provide1 in a manner consistent with section #bgbi;,a of the ,public ,health ,service ,act-- 7#a7 coverage for the diagnosis and treatment of infertility1 including nonexperimental assisted reproductive technology procedures1 if such plan covers obstetrical benefits2 and 7#b7 coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility4 7b7 ,copayment ,the ,secretary of ,defense shall establish cost-sharing requirements for the coverage of diagnosis and treatment of infertility and fertility preservation services described in subsection 7a7 that are consistent with the cost-sharing requirements applicable to health plans and health insurance coverage under section #bgbi;,a7d7 of the ,public ,health ,service ,act4 7c7 ,regulations ,the ,secretary of ,defense shall prescribe any regulations necessary to carry out this section4 7d7 ,definitions ,in this section1 the terms infertility and iatrogenic infertility have the meanings given those terms in section #bgbi;,a of the ,public ,health ,service ,act4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ee of such title is amended by adding at the end the following new item3 #aaaj;c4 ,obstetrical and infertility benefits4 4 #f4 ,treatment of infertility and prevention of iatrogenic infertility for veterans and spouses or partners of veterans 7a7 ,in general ,subchapter ,,ii of chapter #ag of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #agbj;,j4 ,infertility treatment for veterans and spouses or partners of veterans4 7a7 ,in general ,the ,secretary shall furnish treatment for infertility and fertility preservation services1 including through the use of assisted reproductive technology1 to a veteran or a spouse or partner of a veteran if the veteran1 and the spouse or partner of the veteran1 as applicable1 apply jointly for such treatment and counseling through a process prescribed by the ,secretary for purposes of this section4 7b7 ,infertility defined ,in this section1 the terms infertility and iatrogenic infertility have the meanings given those terms in section #bgbi;,a of the ,public ,health ,service ,act4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agbj;,i the following new item3 #agbj;,j4 ,infertility treatment for veterans and spouses or partners of veterans4 4 7c7 ,regulations ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall prescribe regulations to carry out section #agbj;,j of title #ch1 ,united ,states ,code1 as added by subsection 7a74 #g4 ,requirement for ,state ,medicaid plans to provide medical assistance for treatment of infertility and prevention of iatrogenic infertility 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a77#d7-- 7,a7 by striking 2 and 7,d7 and inserting 2 7,d72 and 7,b7 by inserting before the semicolon at the end the following3 2 and 7,e7 services and supplies to treat infertility and prevent iatrogenic infertility 7as such terms are defined in section #bgbi;,a7b7 of the ,public ,health ,service ,act7 in accordance with subsection 7ff72 and 7#b7 by adding at the end the following new subsection3 7ff7 ,requirements for coverage of infertility treatment and prevention of iatrogenic infertility ,for purposes of subsection 7a77#d77;,e71 a ,state shall ensure that the medical assistance provided under the ,state plan 7or waiver of such plan7 for treatment of infertility and fertility preservation services complies with the requirements and limitations of section #bgbi;,a7c7 of the ,public ,health ,service ,act in the same manner as such requirements and limitations apply to health insurance coverage offered by a group health plan or health insurance issuer4 4 7b7 ,no cost sharing for infertility treatment 7#a7 ,in general ,subsections 7a77#b77;,d7 and 7b77#b77;,d7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7a77#b77;,d77 are amended by inserting 1 services and supplies to treat infertility and provide fertility preservation services described in section #aije7;a77#d77;,e7 before 1 or each place it appears4 7#b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b77vii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77vii77 is amended by inserting and services and supplies to treat infertility and provide fertility preservation described in section #aije7;a77#d77;,e7 before the period4 7c7 ,presumptive eligibility for infertility treatment ,section #aibj;,c of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#a;c7 is amended-- 7#a7 in the section heading1 by inserting and infertility treatment after family planning services2 7#b7 in subsection 7a7-- 7,a7 by striking ,state plan and inserting ,a ,state plan2 7,b7 by striking #aije7;a77#d77;,c7 and inserting section #aije7;a77#d77;,c71 services and supplies to treat infertility and prevent iatrogenic infertility described in section #aije7;a77#d77;,e712 and 7,c7 by inserting or in conjunction with an infertility treatment service in an infertility treatment setting before the period4 7d7 ,inclusion in benchmark coverage ,section #aicg7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77 is amended by adding at the end the following new paragraph3 7#h7 ,coverage of infertility treatment and prevention of iatrogenic infertility ,notwithstanding the previous provisions of this section1 a ,state may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless such coverage includes medical assistance for services and supplies to treat infertility and provide fertility preservation described in section #aije7;a77#d77;,e7 in accordance with such section4 4 7e7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall take effect on ,october #a1 #bjbj4 7#b7 ,delay permitted if ,state legislation required ,in the case of a ,state plan approved under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that ends after the #a-year period beginning with the date of the enactment of this section4 ,for purposes of the preceding sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is deemed to be a separate regular session of the ,state legislature4