,i #aahth ,,congress #b;d ,session ,h4 ,r4 #hhba ,,in ,,the ,,house ,,of ,,representatives ,june #be1 #bjbd ,mrs4 ,chavez-,de,remer 7for herself1 ,mr4 ,nunn of ,iowa1 ,ms4 ,wild1 and ,ms4 ,wasserman ,schultz7 introduced the following bill2 which was referred to the ,committee on ,education and the ,workforce ,a ,,bill ,to ensure coverage for the treatment of infertility for certain conditions4 #a4 ,short title ,this ,act may be cited as the ,helping to ,optimize ,patients' ,experience with ,fertility ,services ,act or the ,,hope with ,fertility ,services ,act4 #b4 ensuring benefits for treatment of infertility and iatrogenic infertility 7a7 ,in general ,subpart ,b of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is amended by inserting after section #gad the following3 #gad;,a4 ,standards relating to benefits for treatment of infertility and iatrogenic infertility 7a7 ,in general ,a group health plan or a health insurance issuer offering group health insurance coverage shall ensure that such plan or coverage provides coverage for infertility or iatrogenic infertility treatments1 including-- 7#a7 the treatment of infertility1 if such plan or coverage provides coverage for obstetrical services2 and 7#b7 standard fertility preservation services when a medically necessary treatment described in subparagraph 7,a71 7,b71 7,c71 or 7,d7 of subsection 7b77#a7 causes1 or is expected to cause1 iatrogenic infertility4 7b7 ,definitions ,in this section3 7#a7 ,iatrogenic infertility ,the term iatrogenic infertility means an impairment of fertility due to damage of reproductive organs and processes resulting from-- 7,a7 a surgical or other invasive medical procedure as a result of an injury or life-threatening illness1 or involving a reproductive organ or process in a manner likely to cause damage to such organ or process2 7,b7 radiation therapy2 7,c7 chemotherapy2 or 7,d7 myeloablative conditioning4 7#b7 ,infertility ,the term infertility means a disease or condition characterized by-- 7,a7 the inability to achieve spontaneous pregnancy without medical treatment after a period of at least #ab consecutive months of unprotected sexual intercourse2 7,b7 the inability to achieve pregnancy after receiving standard clinical treatment protocols under the supervision of a treating physician who is a board-certified reproductive endocrinologist or obstetrician-gynecologist2 7,c7 being incapable of reproduction to live birth based on medical and reproductive history1 age1 physical findings or diagnostic testing of the individual1 as determined by a treating physician2 or 7,d7 the inability to achieve spontaneous pregnancy on account of a diagnosed condition that is a disorder of ovulation1 or a testicular or hormonal disease or disorder4 7#c7 ,infertility or iatrogenic infertility treatment ,the term infertility or iatrogenic infertility treatment means treatments or procedures with the intent of facilitating a pregnancy1 including-- 7,a7 such treatments or procedures that involve the handling of human egg1 sperm1 and embryo outside of the body1 including in vitro fertilization and maturation1 egg and embryo cryopreservation1 egg and embryo donation1 and intracytoplasmic sperm injection2 or 7,b7 such treatments or procedures that do not involve the handling of human egg1 sperm1 and embryo outside of the body1 including ovulation induction1 genetic screening and diagnosis1 sperm cryopreservation1 and intrauterine insemination4 7c7 ,required coverage ,a group health plan and a health insurance issuer offering group health insurance coverage that includes coverage for obstetrical services shall provide comprehensive coverage for infertility or iatrogenic infertility treatments1 as determined by the ,secretary in consultation with relevant stakeholders1 provided to a participant or beneficiary if-- 7#a7 the participant or beneficiary has infertility1 including iatrogenic infertility2 and 7#b7 the treatment or service is performed at a medical facility that is in compliance with standards set by appropriate ,federal and ,state agencies4 7d7 ,financial requirements and treatment requirements ,any coverage provided by a group health plan or health insurance issuer in accordance with this section may be subject to coverage limits 7such as medical necessity1 pre-authorization1 or pre-certification7 and cost-sharing requirements 7such as coinsurance1 copayments1 and deductibles71 as required under the group health plan or health insurance coverage1 that are no more restrictive than the predominant coverage limits and cost-sharing requirements applied to substantially all medical and surgical benefits covered under the plan or coverage4 7e7 ,prohibitions ,a group health plan and a health insurance issuer offering group 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 or iatrogenic infertility treatments to which such participant or beneficiary is entitled under this section1 or to providers to induce such providers not to provide such treatments to qualified participants and beneficiaries2 7#b7 prohibit a provider from discussing with a participant or beneficiary infertility or iatrogenic infertility treatments or medical treatment options required to be covered under this section2 or 7#c7 penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility or iatrogenic infertility treatment services to a participant or beneficiary in accordance with this section4 7f7 ,rule of construction ,nothing in this section shall be construed to-- 7#a7 require a participant or beneficiary in a group health plan or group health insurance coverage to undergo infertility or iatrogenic infertility treatments2 7#b7 impact the use by a group health plan or a health insurance issuer offering group health insurance coverage of utilization management tools2 or 7#c7 prevent a group health plan or a health insurance issuer offering group health insurance coverage from contracting with providers as to the level and type of reimbursement with a provider for care provided in accordance with this section4 7g7 ,utilization management tools requirements 7#a7 ,in general ,in the case of a group health plan or a health insurance issuer offering group health insurance coverage that imposes utilization management tools on infertility and iatrogenic infertility treatment benefits1 for the first #e plan years that begin after the date of enactment of the ,helping to ,optimize ,patients' ,experience with ,fertility ,services ,act1 such plan or issuer shall perform and document analyses of the design and application of the utilization management tool such analysis and the following information3 7,a7 ,the specific plan or coverage terms or other relevant terms regarding the utilization management tools and a description of all infertility or iatrogenic infertility treatment benefits1 to which each such term applies in each respective benefits classification4 7,b7 ,the factors used to determine that the utilization management tool will apply to infertility or iatrogenic infertility treatment benefits4 7,c7 ,the evidentiary standards used for the factors identified under subparagraph 7,b71 when applicable1 provided that every factor shall be defined1 and any other source or evidence relied upon to design and apply the utilization management tool to infertility and iatrogenic infertility treatment benefits4 7,d7 ,an analysis demonstrating that the processes1 strategies1 evidentiary standards1 and other factors used to apply the utilization management tools to infertility and iatrogenic infertility treatment benefits as written and in operation1 are consistent with1 and are applied no more stringently than with clinical guidelines for infertility or iatrogenic infertility treatments4 7,e7 ,the specific findings and conclusions reached by the group health plan or health insurance issuer with respect to the health insurance coverage1 including any results of the analyses described in this paragraph that indicate that the plan or coverage is or is not in compliance with this section4 7#b7 ,submission process 7,a7 ,annual submission ,a group health plan or health insurance issuer offering group health insurance coverage shall submit to the ,secretary the analyses described in paragraph 7#a7 annually for first #e plan years that begin after the date of enactment of the ,helping to ,optimize ,patients' ,experience with ,fertility ,services ,act4 ,for subsequent plan years1 the ,secretary may request that a group health plan or a health insurance issuer offering group health insurance coverage submit the analysis described in paragraph 7#a7 in the case of potential violations of this section or complaints regarding noncompliance with this section that concern utilization management tools and any other instances in which the ,secretary determines appropriate4 7,b7 ,additional information ,if the ,secretary concludes that a group health plan or health insurance issuer has not submitted sufficient information for the ,secretary to review the analysis described in paragraph 7#a71 the ,secretary shall specify to the plan or issuer the information the plan or issuer is required to submit pursuant to subparagraph 7,a74 ,nothing in this subparagraph shall require the ,secretary to conclude that a group health plan or health insurance issuer is in compliance with this section solely based upon the inspection of the analyses described in paragraph 7#a71 as requested under subparagraph 7,a74 7#c7 ,required action 7,a7 ,in general ,if1 after review of the analyses described in paragraph 7#a71 the ,secretary notifies the group health plan or health insurance issuer that such plan or issuer is not in compliance with this section1 the plan or issuer-- 7i7 shall specify to the ,secretary the actions the plan or issuer will take to be in compliance with this section and provide to the ,secretary additional analyses described in paragraph 7#a7 that demonstrate compliance with this section not later than #de days after the initial notification by the ,secretary that the plan or issuer is not in compliance2 and 7ii7 following the #de-;day corrective action period under clause 7i71 if the ,secretary makes a final determination that the plan or issuer still is not in compliance with this section1 not later than #g days after such determination1 shall notify all individuals enrolled in the applicable plan or health insurance coverage that such plan or coverage has been determined to be not in compliance with this section4 7,b7 ,exemption from disclosure ,documents or communications produced in connection with the ,secretary's recommendations to a group health plan or health insurance issuer shall not be subject to disclosure pursuant to section #eeb of title #e1 ,united ,states ,code4 7#d7 ,report ,for plan years beginning on or after ,january #a1 #bjbf1 the ,secretary shall submit to ,congress1 and make publicly available1 a report that contains-- 7,a7 a summary of the analysis submitted under paragraph 7#a71 including the identity of each group health plan or health insurance issuer offering health insurance coverage that is determined to be not in compliance after the final determination by the ,secretary described in paragraph 7#c77;,a77ii72 7,b7 the ,secretary's conclusions as to whether each group health plan or health insurance issuer submitted sufficient information for the ,secretary to review the analysis under paragraph 7#b72 7,c7 for each group health plan or health insurance issuer that did submit sufficient information under paragraph 7#b71 the ,secretary's conclusions as to whether and why the plan or issuer is in compliance with the requirements under this section2 7,d7 the ,secretary's specifications described in paragraph 7#c7 for each group health plan or health insurance issuer that the ,secretary determined did not submit sufficient information for the ,secretary to review the analyses described in paragraph 7#a7 for compliance with this section2 and 7,e7 the actions the ,secretary specifies under paragraph 7#c77;,a77i7 that each group health plan or health insurance issuer that the ,secretary determined is not in compliance with this section is required take to be in compliance with this section1 including the reason why the ,secretary determined the plan or issuer is not in compliance4 7h7 ,notice ,beginning with the second plan year beginning after the date of enactment of the ,helping to ,optimize ,patients' ,experience with ,fertility ,services ,act1 a group health plan and a health insurance issuer offering group health insurance coverage shall provide notice to participants and beneficiaries in such plan or coverage regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 7i7 ,effective date ,this section1 and the amendments made by this section1 shall apply with respect to plan years beginning on or after ,january #a1 #bjbf4 4 7b7 ,enforcement ,section #ejb of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aacb7 is amended-- 7#a7 in subsection 7a77#f71 by striking or 7#i7 and inserting 7#i71 or 7#ac72 7#b7 in subsection 7b77#c71 by striking subsection 7c77#i7 and inserting paragraphs 7#i7 and 7#ac7 of subsection 7c72 and 7#c7 in subsection 7c71 by adding at the end the following3 7#ac7 7,a7 ,the ,secretary may assess a civil penalty against a health insurance issuer for failing to provide coverage for infertility or iatrogenic infertility treatments as required under section #gad;,a1 in an amount up to #ajj per day1 beginning on the date on which the issuer first denies such coverage and ending on the date on which the issuer approves coverage1 with respect to each participant or beneficiary denied such coverage in violation of such section4 7,b7 ,the ,secretary may assess a civil penalty against a health insurance issuer for failing to submit an analysis as required under section #gad;,a7g77#b71 in an amount up to #ajj for each day1 beginning #de days after the date on which the ,secretary notifies such issuer that the issuer is not in compliance with the requirement under section #gad;,a7g77#b71 and ending on the date on which the issue submits the analysis as required4 4 7c7 ,conforming amendment ,section #gca7;c7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaia7;c77 is amended by striking section #gaa and inserting sections #gaa and #gad;,a4