,,ii  #aaith ,,congress  #ast ,session  
,s4 #bdjh  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,july #bc1     
#bjbe,mr4 ,booker 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    
plans to provide coverage for fertility 
treatment1 and for other purposes4  #a4 
,short title ,this ,act may be cited as 
the ,access to ,fertility ,treatment and
 ,care ,act4  #b4 ,standards relating to
 benefits for fertility treatment  7a7  
,in general  7#a7 ,,phsa ,part ,d of    
title ,,xxvii of the ,public ,health    
,service ,act 7#db ,u4,s4,c4            
#cjj;gg-#aaa et seq47 is amended by     
adding at the end the following3        
#bgii;,a-#aa4 ,standards relating to    
benefits for fertility treatment  7a7   
,in general ,a group health plan or a   
health insurance issuer offering group  
or individual health insurance coverage 
shall provide coverage for fertility    

treatment1 if such plan or coverage     
provides coverage for obstetrical       
services4  7b7 ,definition ,in this     
section1 the term fertility treatment   
includes the following3 7#a7            
,preservation of human oocytes1 sperm1  
or embryos4  7#b7 ,artificial           
insemination1 including intravaginal    
insemination1 intracervical             
insemination1 and intrauterine          
insemination4  7#c7 ,assisted           
reproductive technology1 including in   
vitro fertilization and other treatments
 or procedures in which reproductive    
genetic material1 such as oocytes1      
sperm1 and embryos1 are handled1 when   
clinically appropriate4  7#d7 ,genetic  
testing of embryos4  7#e7 ,medications  
prescribed or obtained over-the-counter1
 as indicated for fertility4  7#f7      
,gamete donation4  7#g7 ,such other     
information1 referrals1 treatments1     
procedures1 medications1 laboratory     
testing1 technologies1 and services     
relating to fertility as the ,secretary 

determines appropriate4  7c7 ,required  
coverage ,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     
fertility treatment determined          
appropriate by the health care provider1
 regardless of whether the participant1 
beneficiary1 or enrollee receiving such 
treatment has been diagnosed with       
infertility as defined by the ,american 
,society for ,reproductive ,medicine1 if
 the treatment is performed at1 or      
prescribed by1 a medical facility that  
is in compliance with relevant standards
 set by an appropriate ,federal agency4 
7d7 ,limitation ,cost-sharing1 including
 deductibles and coinsurance1 or other  
limitations for fertility treatment 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 other medical services under 

the group health plan or health         
insurance coverage or such other        
limitations are different from          
limitations imposed with respect to such
 medical services1 except where such    
limitation is more favorable with       
respect to fertility treatment4 ,the    
,secretary shall promulgate interim     
final regulations to carry out this     
subsection1 notwithstanding the notice  
and comment requirements of section #eec
 of title #e1 ,united ,states ,code4    
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 
participant1 beneficiary1 or enrollee to
 encourage such participant1            
beneficiary1 or enrollee not to seek or 
obtain fertility treatment to which such
 participant1 beneficiary1 or enrollee  
is entitled under this section or to    
providers to induce such providers not  
to provide medically appropriate        

fertility treatments to participants1   
beneficiaries1 or enrollees2  7#b7      
prohibit a provider from discussing with
 a participant1 beneficiary1 or enrollee
 fertility treatment relating to this   
section2  7#c7 penalize or otherwise    
reduce or limit the reimbursement of a  
provider because such provider provided 
fertility treatment to a qualified      
participant1 beneficiary1 or enrollee in
 accordance with this section2 or  7#d7 
on the ground prohibited under title    
,,vi of the ,civil ,rights ,act of      
#aifd1 title ,,ix of the ,education     
,amendments of #aigb1 the ,age          
,discrimination ,act of #aige1 section  
#ejd of the ,rehabilitation ,act of     
#aigc1 or section #aeeg of the ,patient 
,protection and ,affordable ,care ,act1 
exclude any individual from coverage in 
accordance with this section1 or        
discriminate against any individual with
 respect to such coverage4  7f7 ,rule of
 construction ,nothing in this section  
shall be construed to require a         

participant1 beneficiary1 or enrollee to
 undergo fertility treatment4  7g7      
,notice ,a group health plan and a      
health insurance issuer offering group  
or individual health insurance coverage 
shall provide notice to each            
participant1 beneficiary1 and enrollee  
under such plan or coverage 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 not later than the   
earlier of-- 7,a7 in the first standard 
mailing made by the plan or issuer to   
the participant1 beneficiary1 or        
enrollee following the effective date of
 such regulations2  7,b7 as part of any 
yearly informational packet sent to the 
participant1 beneficiary1 or enrollee2  
or  7,c7 ,january #a1 #bjbg2  7#b7 in   
the case of a participant1 beneficiary1 

or enrollee not enrolled in the plan or 
coverage on the date of transmission    
under paragraph 7#a71 upon initial      
enrollment of such participant1         
beneficiary1 or enrollee2 and  7#c7 on  
an annual basis after the transmission  
under paragraph 7#a7 or 7#b74  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  7#b7 ,,erisa  7,a7 ,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 adding at the end the        
following3  #gbf4 ,standards relating to
 benefits for fertility treatment  7a7  
,in general ,a group health plan or a   
health insurance issuer offering group  

health insurance coverage shall provide 
coverage for fertility treatment1 if    
such plan or coverage provides coverage 
for obstetrical services4  7b7          
,definition ,in this section1 the term  
fertility treatment includes the        
following3 7#a7 ,preservation of human  
oocytes1 sperm1 or embryos4  7#b7       
,artificial insemination1 including     
intravaginal insemination1 intracervical
 insemination1 and intrauterine         
insemination4  7#c7 ,assisted           
reproductive technology1 including in   
vitro fertilization and other treatments
 or procedures in which reproductive    
genetic material1 such as oocytes1      
sperm1 and embryos1 are handled1 when   
clinically appropriate4  7#d7 ,genetic  
testing of embryos4  7#e7 ,medications  
prescribed or obtained over-the-counter1
 as indicated for fertility4  7#f7      
,gamete donation4  7#g7 ,such other     
information1 referrals1 treatments1     
procedures1 medications1 laboratory     
testing1 technologies1 and services     

relating to fertility as the ,secretary 
of ,health and ,human ,services         
determines appropriate4  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 coverage for fertility treatment
 determined appropriate by the health   
care provider1 regardless of whether the
 participant or beneficiary receiving   
such treatment has been diagnosed with  
infertility as defined by the ,american 
,society for ,reproductive ,medicine1 if
 the treatment is performed at1 or      
prescribed by1 a medical facility that  
is in compliance with relevant standards
 set by an appropriate ,federal agency4 
7d7 ,limitation ,cost-sharing1 including
 deductibles and coinsurance1 or other  
limitations for fertility treatment 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 other medical services under 
the group health plan or health         
insurance coverage or such other        
limitations are different from          
limitations imposed with respect to such
 medical services1 except where such    
limitation is more favorable with       
respect to fertility treatment4 ,the    
,secretary shall promulgate interim     
final regulations to carry out this     
subsection1 notwithstanding the notice  
and comment requirements of section #eec
 of title #e1 ,united ,states ,code4    
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 seek  
or obtain fertility treatment to which  
such participant or beneficiary is      
entitled under this section or to       
providers to induce such providers not  
to provide medically appropriate        

fertility treatments to participants or 
beneficiaries2  7#b7 prohibit a provider
 from discussing with a participant or  
beneficiary fertility treatment relating
 to this section2  7#c7 penalize or     
otherwise reduce or limit the           
reimbursement of a provider because such
 provider provided fertility treatment  
to a qualified participant or           
beneficiary in accordance with this     
section2 or  7#d7 on the ground         
prohibited under title ,,vi of the      
,civil ,rights ,act of #aifd 7#db       
,u4,s4,c4 #bjjj;d et seq471 title ,,ix  
of the ,education ,amendments of #aigb  
7#bj ,u4,s4,c4 #afha et seq471 the ,age 
,discrimination ,act of #aige 7#db      
,u4,s4,c4 #faja et seq471 section #ejd  
of the ,rehabilitation ,act of #aigc    
7#bi ,u4,s4,c4 #gid71 or section #aeeg  
of the ,patient ,protection and         
,affordable ,care ,act 7#db ,u4,s4,c4   
#ahaaf71 exclude any individual from    
coverage in accordance with this        
section1 or discriminate against any    

individual with respect to such         
coverage4  7f7 ,rule of construction    
,nothing in this section shall be       
construed to require a participant or   
beneficiary to undergo fertility        
treatment4  7g7 ,notice ,a group health 
plan and a health insurance issuer      
offering group health insurance coverage
 shall provide notice to each           
participant and beneficiary under such  
plan or coverage 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  
not later than the earlier of-- 7,a7 in 
the first standard mailing made by the  
plan or issuer to the participant or    
beneficiary following the effective date
 of such regulations2  7,b7 as part of  
any yearly informational packet sent to 
the participant or beneficiary2 or  7,c7

 ,january #a1 #bjbg2  7#b7 in the case  
of a participant or beneficiary not     
enrolled in the plan or coverage on the 
date of transmission under paragraph    
7#a71 upon initial enrollment of such   
participant or beneficiary2 and  7#c7 on
 an annual basis after the transmission 
under paragraph 7#a7 or 7#b74  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 health insurance coverage from    
negotiating the level and type of       
reimbursement with a provider for care  
provided in accordance with this        
section4  4  7,b7 ,clerical amendment   
,the table of contents in section #a of 
the ,employee ,retirement ,income       
,security ,act of #aigd 7#bi ,u4,s4,c4  
#ajja et seq47 is amended by inserting  
after the item relating to section #gbe 
the following new item3  ,sec4 #gbf4    
,standards relating to benefits for     
fertility treatment4  4  7#c7 ,,irc     

7,a7 ,in general ,subchapter ,b of      
chapter #ajj of the ,internal ,revenue  
,code of #aihf is amended by adding at  
the end the following3  #ihbf4          
,standards relating to benefits for     
fertility treatment  7a7 ,in general ,a 
group health plan shall provide coverage
 for fertility treatment1 if such plan  
provides coverage for obstetrical       
services4  7b7 ,definition ,in this     
section1 the term fertility treatment   
includes the following3 7#a7            
,preservation of human oocytes1 sperm1  
or embryos4  7#b7 ,artificial           
insemination1 including intravaginal    
insemination1 intracervical             
insemination1 and intrauterine          
insemination4  7#c7 ,assisted           
reproductive technology1 including in   
vitro fertilization and other treatments
 or procedures in which reproductive    
genetic material1 such as oocytes1      
sperm1 and embryos1 are handled1 when   
clinically appropriate4  7#d7 ,genetic  
testing of embryos4  7#e7 ,medications  

prescribed or obtained over-the-counter1
 as indicated for fertility4  7#f7      
,gamete donation4  7#g7 ,such other     
information1 referrals1 treatments1     
procedures1 medications1 laboratory     
testing1 technologies1 and services     
relating to fertility as the ,secretary 
of ,health and ,human ,services         
determines appropriate4  7c7 ,required  
coverage ,a group health plan that      
includes coverage for obstetrical       
services shall provide coverage for     
fertility treatment determined          
appropriate by the health care provider1
 regardless of whether the participant  
or beneficiary receiving such treatment 
has been diagnosed with infertility as  
defined by the ,american ,society for   
,reproductive ,medicine1 if the         
treatment is performed at1 or prescribed
 by1 a medical facility that is in      
compliance with relevant standards set  
by an appropriate ,federal agency4  7d7 
,limitation ,cost-sharing1 including    
deductibles and coinsurance1 or other   

limitations for fertility treatment 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 other medical services under 
the group health plan or health         
insurance coverage or such other        
limitations are different from          
limitations imposed with respect to such
 medical services1 except where such    
limitation is more favorable with       
respect to fertility treatment4 ,the    
,secretary shall promulgate interim     
final regulations to carry out this     
subsection1 notwithstanding the notice  
and comment requirements of section #eec
 of title #e1 ,united ,states ,code4    
7e7 ,prohibitions ,a group health plan  
may not-- 7#a7 provide incentives       
7monetary or otherwise7 to a participant
 or beneficiary to encourage such       
participant or beneficiary not to seek  
or obtain fertility treatment to which  
such participant or beneficiary is      

entitled under this section or to       
providers to induce such providers not  
to provide medically appropriate        
fertility treatments to participants or 
beneficiaries2  7#b7 prohibit a provider
 from discussing with a participant or  
beneficiary fertility treatment relating
 to this section2  7#c7 penalize or     
otherwise reduce or limit the           
reimbursement of a provider because such
 provider provided fertility treatment  
to a qualified participant or           
beneficiary in accordance with this     
section2 or  7#d7 on the ground         
prohibited under title ,,vi of the      
,civil ,rights ,act of #aifd 7#db       
,u4,s4,c4 #bjjj;d et seq471 title ,,ix  
of the ,education ,amendments of #aigb  
7#bj ,u4,s4,c4 #afha et seq471 the ,age 
,discrimination ,act of #aige 7#db      
,u4,s4,c4 #faja et seq471 section #ejd  
of the ,rehabilitation ,act of #aigc    
7#bi ,u4,s4,c4 #gid71 or section #aeeg  
of the ,patient ,protection and         
,affordable ,care ,act 7#db ,u4,s4,c4   

#ahaaf71 exclude any individual from    
coverage in accordance with this        
section1 or discriminate against any    
individual with respect to such         
coverage4  7f7 ,rule of construction    
,nothing in this section shall be       
construed to require a participant or   
beneficiary to undergo fertility        
treatment4  7g7 ,notice ,a group health 
plan 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 and
 shall be transmitted-- 7#a7 not later  
than the earlier of-- 7,a7 in the first 
standard mailing made by the plan to the
 participant or beneficiary following   
the effective date of such regulations2 
7,b7 as part of any yearly informational
 packet sent to the participant or      

beneficiary2 or  7,c7 ,january #a1      
#bjbg2  7#b7 in the case of a           
participant or beneficiary not enrolled 
in the plan on the date of transmission 
under paragraph 7#a71 upon initial      
enrollment of such participant or       
beneficiary2 and  7#c7 on an annual     
basis after the transmission under      
paragraph 7#a7 or 7#b74  7h7 ,level and 
type of reimbursements ,nothing in this 
section shall be construed to prevent a 
group health plan from negotiating the  
level and type of reimbursement with a  
provider for care provided in accordance
 with this section4  4  7,b7 ,clerical  
amendment ,the table of sections for    
subchapter ,b of chapter #ajj of the    
,internal ,revenue ,code of #aihf is    
amended by adding at the end the        
following new item3  ,sec4 #ihbf4       
,standards relating to benefits for     
fertility treatment4  4  7b7 ,conforming
 amendments  7#a7 ,,phsa ,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 #bgii;,a-#aa4  7#b7 ,,erisa   
,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 #gbf4  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  
#c4 ,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  7q7 7#a7 ,in    
this subsection1 the term fertility     
treatment has the meaning given the term
 in section #bgii;,a-#aa7;b7 of the     
,public ,health ,service ,act4  7#b7 ,a 
contract under this chapter shall       
provide1 in a manner consistent with    

section #bgii;,a-#aa of the ,public     
,health ,service ,act1 coverage for     
fertility treatment1 if that contract   
covers obstetrical benefits4  7#c7      
,coverage for fertility treatment 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 ,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 #bgii;,a-#aa of the ,public     
,health ,service ,act4  4  7b7          
,effective date ,the amendment made by  
subsection 7a7 shall apply with respect 
to-- 7#a7 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     
,act2 and  7#b7 any health benefits plan

 offered under a contract described in  
paragraph 7#a74  #d4 ,benefits for      
fertility treatment 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 fertility benefits  7a7
 ,in general ,any health care plan under
 this chapter shall provide1 in a manner
 consistent with section #bgii;,a-#aa of
 the ,public ,health ,service ,act1     
coverage for fertility treatment1 if    
such plan covers obstetrical benefits4  
7b7 ,copayment ,the ,secretary of       
,defense shall establish cost-sharing   
requirements for the coverage of        
fertility treatment that are consistent 
with the cost-sharing requirements      
applicable to health plans and health   
insurance coverage under section        
#bgii;,a-#aa7;d7 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 term fertility treatment  
has the meaning given the term in       
section #bgii;,a-#aa7;b7 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 fertility benefits4  4 
#e4 ,fertility treatment 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,m4    
,fertility treatment for veterans and   
spouses or partners of veterans  7a7 ,in
 general ,the ,secretary shall furnish  
fertility treatment services 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      
fertility treatment through a process   

prescribed by the ,secretary for        
purposes of this section4  7b7          
,definitions ,in this section1 the term 
fertility treatment has the meaning     
given the term in section               
#bgii;,a-#aa7;b7 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,l the         
following new item3  #agbj,m4 ,fertility
 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,m of title #ch1 
,united ,states ,code1 as added by      
subsection 7a74  #f4 ,requirement for   
,state ,medicaid plans to provide       
medical assistance for fertility        
treatment  7a7 ,in general ,section     
#aije of the ,social ,security ,act 7#db

 ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in
 subsection 7a77#d77;,c71 by inserting  
7which shall include fertility treatment
 provided in accordance with subsection 
7kk77 after family planning services and
 supplies2 and  7#b7 by adding at the   
end the following new subsection3  7kk7 
,requirements for coverage of fertility 
treatment ,for purposes of subsection   
7a77#d77;,c71 a ,state shall ensure that
 the medical assistance provided under  
the ,state plan 7or waiver of such plan7
 for fertility treatment complies with  
the requirements of section             
#bgii;,a-#aa7;b7 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 ,technical amendment    
,section #aijc7;a77#e7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;b7a77#e77 is amended by inserting 
described in section #aije7;a77#d77;,c7 
after family planning services and      

supplies4  7c7 ,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 #bjbf4  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  #g4 ,medicare coverage of 
fertility treatment  7a7 ,coverage      
,section #ahfa7s77#b7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#aciex7s77#b77 is amended-- 7#a7 in     
subparagraph 7,,jj71 by inserting and   
after the semicolon at the end2 and     
7#b7 by adding at the end the following 
new subparagraph3  7,,kk7 fertility     
treatment 7as defined in section        
#bgii;,a-#aa7;b7 of the ,public ,health 
,service ,act72  4  7b7 ,payment and    
waiver of coinsurance ,section          
#ahcc7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciel7a77#a77 is   
amended-- 7#a7 by striking and before   
7,,hh72 and  7#b7 by inserting before   
the semicolon at the end the following3 
1 and 7,,ii7 with respect to fertility  
treatment 7as described in section      

#ahfa7s77#b77,,kk771 the amount paid    
shall be equal to #ajj percent of the   
lesser of the actual charge for the     
treatment or the amount determined under
 the payment basis determined under     
section #ahdh4  7c7 ,waiver of          
application of deductible ,the first    
sentence of section #ahcc7;b7 of the    
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7b77 is amended-- 7#a7 by striking
 1 and 7#ac7 and inserting 7#ac72 and   
7#b7 by striking #ahfa7n744 and         
inserting #ahfa7n71 and 7#ad7 such      
deductible shall not apply with respect 
to fertility treatment 7as described in 
section #ahfa7s77#b77,,kk7744  7d7      
,payment under physician fee schedule   
,section #ahdh7;j77#c7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;j77#c77 is amended by        
inserting 7#b77,,kk71 after risk        
assessment714  7e7 ,conforming amendment
 regarding coverage ,section            
#ahfb7;a77#a77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           

#aciey7a77#a77;,a77 is amended-- 7#a7 by
 striking or additional and inserting 1 
additional2 and  7#b7 by inserting 1 or 
fertility treatment 7as described in    
section #ahfa7s77#b77,,kk77 after       
#ahfa7;ddd77#a774  7f7 ,effective date  
,the amendments made by this section    
shall apply to services furnished on or 
after ,january #a1 #bjbf4