New York State Medicaid Infertility Treatment
NY-ADR
6/5/19 N.Y. St. Reg. HLT-34-18-00007-A
NEW YORK STATE REGISTER
VOLUME XLI, ISSUE 23
June 05, 2019
RULE MAKING ACTIVITIES
DEPARTMENT OF HEALTH
NOTICE OF ADOPTION
I.D No. HLT-34-18-00007-A
Filing No. 519
Filing Date. May. 21, 2019
Effective Date. Jun. 05, 2019
New York State Medicaid Infertility Treatment
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of sections 505.1 and 505.3 of Title 18 NYCRR.
Statutory authority:
Social Services Law, section 365-a(2)(ee)
Subject:
New York State Medicaid Infertility Treatment.
Purpose:
To authorize Medicaid coverage of infertility benefits.
Text or summary was published
in the August 22, 2018 issue of the Register, I.D. No. HLT-34-18-00007-P.
Final rule as compared with last published rule:
No changes.
Text of rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of Program Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, (518) 473-7488, email: [email protected]
Initial Review of Rule
As a rule that does not require a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2024, which is no later than the 5th year after the year in which this rule is being adopted.
Assessment of Public Comment
Public comments were submitted to the NYS Department of Health (DOH) in response to the regulation. The public comment period for this regulation ended on October 22, 2018. The Department received a total of four comments from representatives of the provider community, including The American College of Obstetrics and Gynecology (ACOG), The American Society for Reproductive Medicine, from legal advisors on behalf of managed care insurance plans and Medicaid members. The comments resonated with positive enthusiasm and requests for coverage of assisted reproductive technology.
Three of the four comments were similar and positive, stating that the adoption of these regulations is an obvious benefit to the patients. Two of the four comments requested that the Department define infertility and suggest coverage is expanded to include assisted reproductive technology (ART) such as artificial insemination and in vitro fertilization.
Summarized below is the Department of Health’s response to the comments:
COMMENT: A comment received inquired if transmasculine individuals will be able to utilize the infertility services coverage.
RESPONSE: Medicaid infertility benefits will be available to transmasculine individuals between the ages of 21 through 44.
COMMENT: Two comments were requests that infertility be defined.
RESPONSE: The Department will define infertility and include that definition in Medicaid program policy documents, including but not limited to the NYS Medicaid Update.
COMMENT: One comment expressed concern that assisted reproductive technology (ART) such as in vitro fertilization (IVF) and infertility evaluation or treatment for males (testis biopsies and semen analysis) will not be covered by Medicaid.
RESPONSE: Subparagraph (ee) of Section 365-a of Social Services Law as written only authorizes Medicaid coverage of ovulation enhancing drugs and appropriate monitoring of the women who receive ovulation enhancing drugs.
COMMENT: One comment expressed concern about limited formulary (only 4 drugs will be covered to promote fertility) and that the coverage does not include drugs for men.
RESPONSE: Subparagraph (ee) of Section 365-a of Social Services Law as written only authorizes Medicaid coverage of ovulation enhancing drugs and appropriate monitoring of the women who receive ovulation enhancing drugs. The listed drugs have FDA approval and compendia support for use in enhancing ovulation.
COMMENT: One comment expressed concern about excluding coverage for woman ages 45 and older experiencing infertility.
RESPONSE: The approved Medicaid State Plan Amendment limits this coverage to women ages 21 through age 44.
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