HF 1658

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/11/2024 04:39pm

A bill for an act
relating to insurance; requiring health plans and medical assistance to cover
infertility treatment; amending Minnesota Statutes 2022, section 256B.0625, by
adding a subdivision; Minnesota Statutes 2023 Supplement, section 256B.0625,
subdivision 13; proposing coding for new law in Minnesota Statutes, chapter 62A.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62A.0412] COVERAGE OF INFERTILITY TREATMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin This section applies to all health plans that provide maternity
benefits to Minnesota residents.
new text end

new text begin Subd. 2. new text end

new text begin Required coverage. new text end

new text begin (a) Every health plan under subdivision 1 must provide
coverage for procedures related to infertility diagnosis and treatment that are (1) considered
medically necessary by the enrollee's treating health care provider, and (2) recognized by
either the American Society for Reproductive Medicine or the American College of Obstetrics
and Gynecologists.
new text end

new text begin (b) Coverage must include but is not limited to ovulation induction, procedures and
devices to monitor ovulation, artificial insemination, oocyte retrieval procedures, in vitro
fertilization, gamete intrafallopian transfer, oocyte replacement, cryopreservation techniques,
micromanipulation of gametes, and fertility preservation procedures for cancer patients.
Coverage must include unlimited embryo transfers, but may impose a limit of four completed
egg retrievals during a single plan year.
new text end

new text begin (c) Coverage for surgical reversal of elective sterilization and expenses related to purchase
of donor gametes is not required under this section.
new text end

new text begin (d) Cost-sharing requirements, including co-payments, deductibles, and coinsurance for
infertility coverage, must not be greater than the cost-sharing requirements for maternity
coverage under the enrollee's health plan.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For the purpose of this section, "infertility" means a disease,
condition, or status affecting the reproductive system that (1) interferes with an individual's
ability to achieve a pregnancy, or (2) decreases a woman's ability to carry a pregnancy to a
live birth.
new text end

new text begin Subd. 4. new text end

new text begin Exclusion. new text end

new text begin This section does not apply to health plans offered under chapter
256B or 256L.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, and applies to all health
plans issued or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2023 Supplement, section 256B.0625, subdivision 13, is
amended to read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, deleted text begin except for fertility drugs when
specifically used to enhance fertility, deleted text end if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
90-day supply list published by the commissioner. The 90-day supply list shall be published
by the commissioner on the department's website. The commissioner may add to, delete
from, and otherwise modify the 90-day supply list after providing public notice and the
opportunity for a 15-day public comment period. The 90-day supply list may include
cost-effective generic drugs and shall not include controlled substances.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.

(h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
supply for any prescription contraceptive if a 12-month supply is prescribed by the
prescribing health care provider. The prescribing health care provider must determine the
appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
For purposes of this paragraph, "prescription contraceptive" means any drug or device that
requires a prescription and is approved by the Food and Drug Administration to prevent
pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
approved to prevent pregnancy when administered after sexual contact. For purposes of this
paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.

Sec. 3.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 72. new text end

new text begin Coverage of infertility treatment. new text end

new text begin (a) Medical assistance covers the diagnosis
of infertility, treatment for infertility, and standard fertility preservation services that are:
new text end

new text begin (1) considered medically necessary by the enrollee's treating health care provider; and
new text end

new text begin (2) recognized by either the American Society for Reproductive Medicine, the American
College of Obstetrics and Gynecologists, or the American Society of Clinical Oncology.
new text end

new text begin (b) Coverage under this section must include but is not limited to ovulation induction,
procedures and devices to monitor ovulation, artificial insemination, oocyte retrieval
procedures, in vitro fertilization, gamete intrafallopian transfer, oocyte replacement,
cryopreservation techniques, micromanipulation of gametes, and standard fertility
preservation services.
new text end

new text begin (c) Coverage under this section must include unlimited embryo transfers, but may impose
a limit of four completed oocyte retrievals. Single embryo transfer must be used when
medically appropriate and recommended by the treating health care provider.
new text end

new text begin (d) Coverage for surgical reversal of elective sterilization is not required under this
section.
new text end

new text begin (e) Coverage must meet the requirements that would otherwise apply to a health plan
under section 62A.0412.
new text end

new text begin (f) For the purpose of this subdivision:
new text end

new text begin (1) "infertility" means a disease, condition, or status characterized by:
new text end

new text begin (i) the failure of a person with a uterus to establish a pregnancy or to carry a pregnancy
to live birth after 12 months of unprotected sexual intercourse for a person under the age
of 35, or six months for a person 35 years of age or older, regardless of whether a pregnancy
resulting in miscarriage occurred during such time;
new text end

new text begin (ii) a person's inability to reproduce either as a single individual or with the person's
partner without medical intervention; or
new text end

new text begin (iii) a licensed health care provider's findings based on a patient's medical, sexual, and
reproductive history; age; physical findings; or diagnostic testing;
new text end

new text begin (2) "diagnosis of and treatment for infertility" means the recommended procedures and
medications from the direction of a licensed health care provider that are consistent with
established, published, or approved medical practices or professional guidelines from the
American College of Obstetricians and Gynecologists or the American Society for
Reproductive Medicine; and
new text end

new text begin (3) "standard fertility preservation services" means procedures that are consistent with
the established medical practices or professional guidelines published by the American
Society for Reproductive Medicine or the American Society of Clinical Oncology for a
person who has a medical condition or is expected to undergo medication therapy, surgery,
radiation, chemotherapy, or other medical treatment that is recognized by medical
professionals to cause a risk of impairment to fertility.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end