2025 -- H 5771

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LC000881

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE RHODE ISLAND

MEDICAID REFORM ACT OF 2008

     Introduced By: Representatives Alzate, Ajello, Kislak, Felix, Furtado, Stewart, Kazarian,
Cruz, Diaz, and Fogarty

     Date Introduced: February 26, 2025

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 42-12.4 of the General Laws entitled "The Rhode Island Medicaid

Reform Act of 2008" is hereby amended by adding thereto the following section:

     42-12.4-10. Fertility care.

     (a) Beginning January 1, 2026, the department shall provide coverage under the medical

assistance program for fertility diagnostic care, standard fertility preservation services, and fertility

treatment. Such coverage shall provide for:

     (1) Any medically necessary ovulation-enhancing drugs and medical services related to

prescribing and monitoring the use of ovulation-enhancing drugs that is intended to treat infertility

and establish a pregnancy that results in a live birth;

     (2) At least three (3) cycles of ovulation-enhancing medication treatment;

     (3) Intrauterine insemination; and

     (4) In the event that ovulation-enhancing medication treatment administered with intention

to prepare for intrauterine insemination results in an ovulation response that counter-indicates

intrauterine insemination, coverage for in-vitro fertilization and embryo transfer as recommended

by the treating physician.

     (b) Coverage under this section shall be provided without discrimination on the basis of

age, ancestry, disability, domestic partner status, gender, gender identity or expression, genetic

information, marital status, national origin, race, religion, sex, or sexual orientation.

     (c) On or before January 1, 2026, the department shall, after consultation with the Centers

for Medicare and Medicaid Services, submit a report to the general assembly on whether in-vitro

fertilization is a medically reasonable and necessary procedure under federal law, possible methods

for covering in-vitro fertilization as a medical assistance covered benefit for both fee-for-service

and managed care organizations, including any potentially applicable waiver authorities, and the

amount of money that would need to be allocated to federal and local funds for coverage.

     (d) For the purposes of this section, the following terms shall have the following meanings:

     (1) “Fertility diagnostic care” means procedures, products, genetic testing, medications,

counseling, and services intended to provide information and counseling about an individual’s

infertility, including laboratory assessments and imaging studies.

     (2) “Fertility treatment” means procedures, products, genetic testing, medications,

counseling, and services intended to establish a pregnancy that results in a live birth and that are

provided in a manner consistent with established medical practice and professional guidelines

published by the American Society for Reproductive Medicine, its successor organization, or a

comparable organization.

     (3) “Gamete” means sperm or egg.

     (4) “Infertility” means:

     (i) The presence of a condition recognized by a health care provider as a cause of loss or

impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age,

physical findings, diagnostic testing, or any combination of those factors;

     (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth

after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s

partner have the necessary gametes to establish a pregnancy;

     (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected

sexual intercourse due to an individual's age when the individual and the individual’s partner have

the necessary gametes to establish pregnancy;

     (iv) An individual’s inability to achieve pregnancy as an individual or with a partner

because the individual or the individual and the individual’s partner do not have the necessary

gametes to achieve a pregnancy;

     (v) An individual’s increased risk, independently or with the individual’s partner, of

transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or

     (vi) As defined by the American Society of Reproductive Medicine, its successor

organization, or comparable organization. Pregnancy resulting in a loss does not cause the time

period of trying to establish a pregnancy to be restarted.

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     (5) “Intrauterine insemination” means a procedure that places semen directly into a

patient’s uterus at or around the time of ovulation.

     (6) "Standard fertility preservation services" means procedures, products, genetic testing,

medications, counseling, and services intended to preserve fertility, consistent with established

medical practice and professional guidelines published by the American Society for Reproductive

Medicine, the American Society of Clinical Oncology, or other reputable professional medical

organizations, its successor organization, or a comparable organization, for an individual who has

a medical or genetic condition or who is expected to undergo treatment that has a possible side

effect of or may directly or indirectly cause a risk of impairment of fertility and includes, but is not

limited to, the procurement, cryopreservation, and storage of gametes, embryos, and reproductive

material.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- THE RHODE ISLAND

MEDICAID REFORM ACT OF 2008

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     This act would mandate medicaid coverage for fertility diagnostic care, standard fertility

preservation services, and fertility treatment and would require coverage for any medically

necessary ovulation-enhancing drugs and medical services related to prescribing and monitoring

the use of ovulation-enhancing drugs that is intended to treat infertility and establish a pregnancy

that results in a live birth.

     This act would take effect upon passage.

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