HB589: HB589 Social services; coverage for fertility diagnostic care, treatment, and preservation services; provide

25 LC 46 1072 House Bill 589 By: Representatives Drenner of the 85th, Cannon of the 58th, Au of the 50th, and Park of the 107th A BILL TO BE ENTITLED AN ACT To amend Article 7 of Chapter 4 of Title 49 of the Official Cod e of Georgia Annotated,1 relating to medical assistance generally, so as to provide cove rage for fertility diagnostic2 care, fertility treatment, and for fertility preservation services; to provide for amending the3 Georgia Medicaid plan; to provide for a plan amendment or waive r when necessary; to4 provide for definitions; to provide for related matters; to pro vide for an effective date and5 applicability; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Article 7 of Chapter 4 of Title 49 of the Official Code of Geor gia Annotated, relating to9 medical assistance generally, is amended by adding a new Code section to read as follows:10 "49-4-159.5.11 (a) As used in this Code section, the term:12 (1) 'American Society for Reproductive Medicine' means the Ame rican Society for13 Reproductive Medicine or its successor organization.14 (2) 'Covered person' means an individual covered under a health benefit policy.15 H. B. 589 - 1 - 25 LC 46 1072 (3) 'Experimental fertility procedure' means a procedure for which the published medical16 evidence is not sufficient for the American Society for Reprodu ctive Medicine or a17 comparable organization to regard such procedure as an established medical practice.18 (4) 'Fertility diagnostic care' means procedures, products, medications, genetic testing,19 counseling, and services, including laboratory assessments and imaging studies, intended20 to provide information and counseling about an individual's fertility.21 (5) 'Fertility patient' means:22 (A) An individual or couple with infertility;23 (B) An individual unable to conceive as an individual or with a partner because the24 individual or couple does not have the necessary gametes for conception; or25 (C) A couple who is at increased risk of passing a serious inh eritable genetic or26 chromosomal abnormality to a child.27 (6) 'Fertility preservation services' means procedures, produc ts, medications, genetic28 testing, counseling, and services intended to preserve fertility and that are provided in a29 manner consistent with established medical practice and profess ional guidelines as30 published by the American Society for Reproductive Medicine or a comparable31 organization for an individual who has a medical condition or who is expected to receive32 medical treatment that may cause or has the potential to cause a risk of impairment of33 fertility. Such term includes, but is not limited to, evaluati on expenses, laboratory34 assessments, medications, and treatment associated with fertility preservation services,35 as well as the procurement and cryopreservation of gametes, embryos, and reproductive36 material and storage from the time of cryopreservation for a pe riod of three years;37 provided, however, that storage may be offered for a longer period of time.38 (7) 'Fertility treatment' means procedures, products, medicati ons, genetic testing,39 counseling, and services intended to achieve pregnancy that res ults in a live birth with40 healthy outcomes and that are provided in a manner consistent with established medical41 H. B. 589 - 2 - 25 LC 46 1072 practice and professional guidelines as published by the Americ an Society for42 Reproductive Medicine or a comparable organization.43 (8) 'Gamete' means sperm or eggs.44 (9) 'Infertility' means:45 (A) The inability to establish pregnancy or to carry a pregnancy to live birth after 1246 months of regular, unprotected sexual intercourse when the coup le has the necessary47 gametes for conception, or after a period of less than 12 months due to a person's age48 or other factors when the couple has the necessary gametes for conception. Pregnancy49 resulting in a loss shall not cause the time period of trying to achieve a pregnancy to be50 restarted; or51 (B) The presence of a condition recognized by a licensed physi cian that impacts an52 individual's ability to establish pregnancy or to carry a pregnancy based on a patient's53 medical, sexual, and reproductive history, as well as age, phys ical findings, or54 diagnostic testing, or any combination of those factors.55 (10) 'Intrauterine insemination' means a procedure that places sperm directly into a56 person's uterus at the time of ovulation to increase the chances of fertilization.57 (b) Beginning January 1, 2026, the Department of Community Hea lth shall amend the58 Georgia Medicaid plan to provide coverage to a fertility patient for the following:59 (1) Fertility diagnostic care;60 (2) Fertility treatment; and61 (3) Fertility preservation services.62 (c) The coverage required under this Code section shall include at least three complete egg63 retrievals with unlimited embryo transfers from those egg retri evals or from any egg64 retrieval performed prior to January 1, 2026, in accordance wit h the guidelines of the65 American Society for Reproductive Medicine or a comparable organization, using single66 embryo transfer when recommended and medically appropriate.67 H. B. 589 - 3 - 25 LC 46 1072 (d) Fertility preservation coverage shall be provided to an individual who has a medical68 or genetic condition or who is expected to undergo treatment that may directly or indirectly69 cause a risk of impairment of fertility. 70 (e) Coverage required under this Code section shall be provide d regardless of whether71 donor gametes or embryos are used or if an embryo will be trans ferred to the uterus of a72 third-party.73 (f) Coverage required under this Code section shall be provided without discrimination on74 the basis of a covered person's actual or perceived race, color, religion, national origin, sex,75 sexual orientation, gender, mental disability, or physical disability.76 (g) This Code section shall not be construed to require any insurer to provide coverage for:77 (1) Any experimental fertility procedure; or78 (2) Any nonmedical costs related to donor gametes, donor embryos, or surrogacy.79 (h) The amended Georgia Medicaid plan provided for in subsecti on (b) of this Code80 section shall provide coverage for fertility preservation and the diagnosis of infertility, and81 any medically necessary ovulation-enhancing drugs and medical s ervices related to82 prescribing and monitoring the use of the ovulation-enhancing d rugs, and intrauterine83 insemination that is intended to treat infertility and achieve a pregnancy that results in a84 live birth and shall include at least three cycles of ovulation -enhancing medication85 treatment over a Georgia Medicaid recipient's period of Medicaid eligibility.86 (i) On or before August 1, 2026, the Department of Community Health shall submit to the87 General Assembly, after consulting with the Centers for Medicare and Medicaid Services88 on whether in vitro fertilization and standard fertility preservation services are medically89 reasonable and necessary procedures under federal law, a report on possible methods for90 covering in-vitro fertilization and standard fertility preserva tion services as a Medicaid91 covered benefit for both fee-for-service and managed care organ izations, including any92 potentially applicable waiver authorities, and the amount of money that would need to be93 allocated to federal and local funds for such coverage.94 H. B. 589 - 4 - 25 LC 46 1072 (j) To implement the provisions of this Code section, the Depa rtment of Community95 Health shall, when necessary, submit a Georgia Medicaid plan am endment or waiver96 request to the United States Department of Health and Human Services."97 SECTION 2.98 This Act shall become effective upon its approval by the Governor or upon its becoming law99 without such approval and shall apply to Medicare plans issued or renewed on or after100 January 1, 2026.101 SECTION 3.102 All laws and parts of laws in conflict with this Act are repealed.103 H. B. 589 - 5 -