§ 26B-3-216 — Medicaid waiver for fertility preservation services.

(1) As used in this section:

(1)(a) "Iatrogenic infertility" means an impairment of fertility or reproductive functioning caused by surgery, chemotherapy, radiation, or other medical treatment.
(1)(b) "Physician" means an individual licensed to practice under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act.
(1)(c) "Qualified enrollee" means an individual who:
(1)(c)(i) is enrolled in the Medicaid program;
(1)(c)(ii) has been diagnosed with a form of cancer by a physician; and
(1)(c)(iii) needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility, including surgery, radiation, or chemotherapy.
(1)(d) "Standard fertility preservation service" means a fertility preservation procedure and service that:
(1)(d)(i) is not considered experimental or investigational by the American Society for Reproductive Medicine or the American Society of Clinical Oncology; and
(1)(d)(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:

(1)(d)(ii)(A) sperm banking;
(1)(d)(ii)(B) oocyte banking;
(1)(d)(ii)(C) embryo banking;
(1)(d)(ii)(D) banking of reproductive tissues; and
(1)(d)(ii)(E) storage of reproductive cells and tissues.
(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:

(4)(a) the day on which the waiver described in Subsection (2) is approved; and
(4)(b) January 1, 2023.
(5) Before November 1, 2023, and before November 1 of each third year after 2023, the department shall:

(5)(a) calculate the change in state spending attributable to the coverage described in this section; and
(5)(b) report the amount described in Subsection (5)(a) to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee.

Legislative History

Renumbered and Amended by Chapter 306, 2023 General Session