Revision: Feb. 5, 2019, 9:22 a.m.
SB 279-FN - AS INTRODUCED
2019 SESSION
19-0868
01/10
SENATE BILL 279-FN
AN ACT relative to access to fertility care.
SPONSORS: Sen. Hennessey, Dist 5; Sen. Sherman, Dist 24; Sen. Levesque, Dist 12; Sen. Kahn, Dist 10; Sen. Cavanaugh, Dist 16; Sen. Bradley, Dist 3; Sen. Morse, Dist 22
COMMITTEE: Commerce
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ANALYSIS
This bill requires insurers to cover fertility treatment.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0868
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
AN ACT relative to access to fertility care.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Findings. The general court hereby finds that infertility is a disease of the reproductive system that affects 1 in 6 couples in New Hampshire. One-third of infertility is due to male factors, one-third to female factors, and the remainder is attributed to factors in both partners or diagnostically unexplained. Some of the individuals impacted are women born without a uterus, men with azoospermia (no sperm), women with uterine abnormalities or endometriosis, women with a history of ectopic pregnancies, cancer survivors, and military veterans who received explosive shrapnel injuries. Infertility is treatable. Ninety seven percent of infertility cases are treated with conventional drug therapy or surgical procedures. Only 3 percent of cases require assisted reproductive technology, such as in vitro fertilization (IVF). IVF can be a cost-effective treatment option because, with insurance benefits, patients are known to make health care decisions based on appropriate medical advice rather than financial concerns, and thus transfer fewer embryos per cycle. This can result in a savings of $80,000 or more per pregnancy in maternity care and neonatal care costs. Individuals facing medical conditions where treatment, like chemotherapy, is known to impact future fertility, as well as hopeful parents who are carriers for serious genetic conditions, are also impacted by a lack of affordable access to fertility care. The general court finds that it is in the public interest to make medical treatment for infertility and related conditions affordable for New Hampshire residents and employers, so as to attract and retain young families, expand the state’s health care resources, reduce overall health care costs, and improve health outcomes for the resulting children.
2 New Chapter; Access to Fertility Care. Amend RSA by inserting after chapter 417-F the following new chapter:
CHAPTER 417-G
ACCESS TO FERTILITY CARE
417-G:1 Definitions. In this chapter:
I. "Commissioner" means the insurance commissioner.
II. “Fertility treatment” means health care services or products provided with the intent to achieve a pregnancy that results in a live birth with healthy outcomes.
III. "Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.
IV. “Infertility” means a disease or condition whereby an individual’s ability to become pregnant or to carry a pregnancy to live birth is impaired, or whereby an individual’s ability to cause pregnancy and live birth in the individual’s partner is impaired.
V. “Medically necessary” means that health care services or products are provided in a manner that is:
(a) Consistent with generally accepted standards of medical practice as set forth by a professional medical organization with a specialization in any aspect of reproductive health, including, without limitation, the American Society for Reproductive Medicine;
(b) Clinically appropriate in terms of type, frequency, extent, site and duration; and
(c) Demonstrated through contemporary scientific evidence to be effective in improving health outcomes.
417-G:2 Diagnosis of Infertility, Fertility Treatment, and Fertility Preservation.
I. Each health carrier that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, coverage for the medically necessary diagnosis of the etiology of infertility.
II. Each health carrier that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, coverage for medically necessary fertility treatment.
III. Each health carrier that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, coverage for medically necessary fertility preservation when a person is expected to undergo surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment of fertility. Coverage under this section shall include, without limitation, coverage for procurement, cryopreservation, and storage of gametes and embryos.
417-G:3 Health Carrier’s Rights and Obligations.
I. Benefits under this chapter shall not be limited based upon:
(a) Co-payments, deductibles, coinsurances, benefit maximums, waiting periods, or other limitations on coverage that are different than any maternity benefits provided by the health carrier;
(b) Exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications by the health carrier; or
(c) Any requirement that provides different benefits to, or imposes different requirements upon, a class protected under RSA 354-A than that provided to or required of other patients;
II. Making, issuing, circulating, or causing to be made, issued or circulated, any clinical review criteria, for the implementation of this chapter, that are based upon data that are not reasonably current shall constitute an unfair and deceptive act and practice in the business of insurance, under RSA 417:4.
417-G:4 Rulemaking. The commissioner shall adopt necessary rules, under RSA 541-A, relative to the proper administration of this chapter. Until such rules are adopted, insurers shall fulfill their obligations under this chapter by conforming to the standards of the American Society for Reproductive Medicine.
417-G:5 Severability. If any provision of this chapter or the application thereof to any person or circumstances is held invalid, the invalidity does not affect other provisions or applications of the chapter which can be given effect without the invalid provisions or applications, and to this end the provisions of this chapter are severable.
3 Effective Date. This act shall take effect January 1, 2020.
19-0868
Revised 2/5/19
SB 279-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to access to fertility care.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
METHODOLOGY:
This bill requires insurers to cover fertility care. The Insurance Department assumes to the extent previously non-covered services must now be covered there could be an impact on claims, which may impact premiums and premium tax revenue. Any impact on premiums would be experienced by entities that pay for health insurance, including county and local governments. The federal ACA law specifies that the cost of newly enacted mandates associated with coverage through the exchange must be borne by the State (so as not to impact premiums for exchange products). According to the State's benchmark, covered services include diagnostic tests to find the cause of infertility, as well as services to treat the underlying medical conditions that cause infertility including endometriosis and hormone deficiency, but do not include artificial insemination services or assisted reproductive technologies or the diagnostic tests and drugs to support the same. The Department assumes that the costs associated with artificial insemination services and assisted reproductive technologies, as well as the costs of the diagnostics tests and drugs to support the same, for exchange products, would be borne by the State's general fund.
The Department of Administrative Services indicates the bill would have zero impact on the State Health Plan Benefit Plan for Employees and Retirees. The State Plan is a governmental self-insured plan and is not governed by managed care law.
The Department of Health and Human Services indicates the bill would have no fiscal impact on the Department. The Department is not a "health carrier" as that term is defined in the bill and the bill would not be applicable to the Department or the Medicaid program.
AGENCIES CONTACTED:
Departments of Insurance, Administrative Services and Health and Human Services