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A BILL 1
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25-34 3
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 5
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To amend the Women’s Health and Cancer Rights Federal Law Conformity Act of 2000 to 10
require an individual or group plan to provide coverage for the diagnosis and treatment of 11
infertility and standard fertility preservation services, and to require a health insurer 12
offering health insurance coverage through Medicaid and the DC Healthcare Alliance 13
program to cover the diagnosis and medication treatment of infertility. 14
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BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this 16
act may be cited as the “Expanding Access to Fertility Treatment Amendment Act of 2023”. 17
Sec. 2. The Women’s Health and Cancer Rights Federal Law Conformity Act of 2000, 18
effective April 3, 2001 (D.C. Law 13-254; D.C. Official Code § 31-3831 et seq.), is amended as 19
follows: 20
(a) Section 5d (D.C. Official Code § 31-3834.04) is amended as follows: 21
(1) Subsection (a)(1) is amended by striking the phrase “drugs, devices, products, 22
and services under sections 5a, 5b, and 5c.” and inserting the phrase “or fertility enhancing 23
drugs, devices, products, and services under sections 5a, 5b, 5c, and 5f.” in its place. 24
(2) Subsection (c) is amended as follows: 25
(A) The lead-in language is amended by striking the phrase “, or 5c” and 26
inserting the phrase “, 5c, or 5f” in its place. 27 ENGROSSED ORIGINAL
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(B) Paragraph (1) is amended by striking the phrase “contraceptive drugs” 28
and inserting the phrase “contraceptive or fertility enhancing drugs” in its place. 29
(C) Paragraph (2) is amended by striking the phrase “contraceptive drugs” 30
and inserting the phrase “contraceptive or fertility enhancing drugs” in its place. 31
(3) Subsection (d) is amended as follows: 32
(A) Paragraph (1) is amended by striking the phrase “contraceptive drugs” 33
and inserting the phrase “contraceptive or fertility enhancing drugs” in its place. 34
(B) Paragraph (2) is amended by striking the phrase “drugs, devices, 35
products, and services under section 5a, 5b, and 5c." and inserting the phrase “or fertility 36
enhancing drugs, devices, products, and services under section 5a, 5b, 5c, and 5f.” in its place. 37
(b) A new section 5f is added to read as follows: 38
“Sec. 5f. Coverage of fertility treatments. 39
“(a)(1) Beginning January 1, 2025, a health insurer offering a large group health benefit 40
plan shall provide coverage for the diagnosis and treatment of infertility, including in vitro 41
fertilization and standard fertility preservation services, as provided in paragraph (2) of this 42
subsection; provided that the treatment would be consistent with a physician’s or surgeon’s 43
overall plan of care. 44
“(2) The health benefit plan shall cover: 45
“(A) At least 3 complete oocyte retrievals with unlimited embryo transfers 46
from those oocyte retrievals or from any oocyte retrieval performed prior to January 1, 2025, in 47 ENGROSSED ORIGINAL
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accordance with the guidelines of ASRM, using single embryo transfer when recommended and 48
medically appropriate; and 49
“(B) The medical costs related to an embryo transfer to be made from an 50
enrollee to a third-party; except that the enrollee’s coverage shall not extend to any medical costs 51
of the surrogate or gestational carrier after the embryo transfer procedure. 52
“(b)(1) Beginning January 1, 2025, a health insurer offering an individual health benefit 53
plan or small group health plan shall provide coverage for the diagnosis and treatment of 54
infertility, including in vitro fertilization and standard fertility preservation services, as provided 55
in paragraph (2) of this subsection; provided that the treatment would be consistent with a 56
physician’s or surgeon’s overall plan of care. 57
“(2) The health benefit plan shall cover: 58
“(A) At least 3 complete oocyte retrievals with unlimited embryo transfers 59
from those oocyte retrievals or from any oocyte retrieval performed prior to January 1, 2025, in 60
accordance with the guidelines of ASRM, using single embryo transfer when recommended and 61
medically appropriate; and 62
“(B) The medical costs related to an embryo transfer to be made from an 63
enrollee to a third-party; except that the enrollee’s coverage shall not extend to any medical costs 64
of the surrogate or gestational carrier after the embryo transfer procedure. 65
“(c) Beginning January 1, 2024, health insurance coverage through Medicaid and the DC 66
Healthcare Alliance program shall provide coverage for the diagnosis of infertility and any 67 ENGROSSED ORIGINAL
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medically necessary ovulation enhancing drugs and medical services related to prescribing and 68
monitoring the use of such drugs, which shall include at least 3 cycles of ovulation-enhancing 69
medication treatment over an enrollee’s lifetime. 70
“(d) Within 180 days of the effective date of this section, the Department of Health Care 71
Finance shall submit a report to the Council after consulting with the Centers for Medicare & 72
Medicaid Services on whether in vitro fertilization and standard fertility preservation services are 73
medically reasonable and necessary procedures under federal law, possible methods for covering 74
in-vitro fertilization and standard fertility preservation services as a Medicaid covered benefit for 75
both fee-for-service and managed care organizations, including any potentially applicable waiver 76
authorities, and the amount of money that would need to be allocated to federal and local funds 77
for such coverage. 78
“(e) Coverage for the treatment of infertility shall be provided without discrimination on 79
the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender 80
identity, genetic information, marital status, national origin, race, religion, sex, or sexual 81
orientation. 82
“(f) A health insurer shall not impose: 83
“(1) Deductibles, copayments, coinsurance, benefit maximums, waiting 84
periods or any other limitations on coverage for the diagnosis and treatment of infertility, 85
including the prescription of fertility medications, different from those imposed upon benefits for 86
services not related to infertility; 87 ENGROSSED ORIGINAL
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“(2) Pre-existing condition exclusions or pre-existing condition waiting periods 88
on coverage for the diagnosis and treatment of infertility or use any prior diagnosis of or prior 89
treatment for infertility as a basis for excluding, limiting, or otherwise restricting the availability 90
of coverage for required benefits; or 91
“(3) Limitations on coverage based solely on arbitrary factors, including number 92
of attempts, dollar amounts, or age, or provide different benefits to, or impose different 93
requirements upon, a class protected under the Human Rights Act of 1977, effective December 94
13, 1977 (D.C. Law 2-38; D.C. Official Code § 2-1401.01 et seq.), than that provided to, or 95
required of, other patients. 96
“(g) Nothing in this section shall be construed to interfere with the clinical judgment of a 97
physician or surgeon. 98
“(h) The health insurer shall notify all policyholders and all prospective group 99
policyholders with whom they are negotiating of the availability of coverage provided under this 100
section. 101
“(i) For the purposes of this section, the term: 102
“(1) “ASRM” means the American Society for Reproductive Medicine. 103
“(2) “Infertility” means a disease, condition, or status characterized by: 104
“(A) The failure to establish a pregnancy or to carry a pregnancy to live 105
birth after regular, unprotected sexual intercourse in accordance with the guidelines of ASRM; 106 ENGROSSED ORIGINAL
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“(B) A person’s inability to reproduce without medical intervention either 107
as a single individual or with their partner; or 108
“(C) A licensed physician’s findings based on a patient’s medical, sexual, 109
and reproductive history, age, physical findings, or diagnostic testing. 110
“(3) “Treatment for infertility” means procedures consistent with established 111
medical practices in the treatment of infertility by licensed physicians and surgeons, including 112
diagnosis, diagnostic tests, medication, surgery, or gamete intrafallopian transfer. 113
“(4) “Standard fertility preservation services” means procedures that are 114
consistent with established medical practices or professional guidelines published by ASRM or 115
the American Society of Clinical Oncology for a person who has a medical condition or is 116
expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical 117
treatment that is recognized by medical professionals to cause a risk of impairment to fertility. 118
“(j) The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure 119
Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), shall issue 120
rules to implement the provisions of this section.”. 121
Sec. 3. Applicability. 122
“(a) Amendatory section 5f(b) in section 2 shall apply upon the date of inclusion of its 123
fiscal effect in an approved budget and financial plan. 124
“(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect 125
in an approved budget and financial plan and provide notice to the Budget Director of the 126 ENGROSSED ORIGINAL
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Council of the certification. 127
“(c)(1) The Budget Director shall cause the notice of the certification to be published in 128
the District of Columbia Register. 129
“(2) The date of publication of the notice of the certification shall not affect the 130
applicability of this act. 131
Sec. 4. Fiscal impact statement. 132
The Council adopts the fiscal impact statement in the committee report as the fiscal 133
impact statement required by section 4a of the General Legislative Procedures Act of 1975, 134
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 135
Sec. 5. Effective date. 136
This act shall take effect following approval by the Mayor (or in the event of veto by the 137
Mayor, action by the Council to override the veto), a 30-day period of congressional review as 138
provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 139
24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of 140
Columbia Register. 141