Text of VT H 55 (2025)

BILL AS INTRODUCED H.55 2025 Page 1 of 9 VT LEG #379409 v.1 H.55 1 Introduced by Representatives Headrick of Burlington, Burrows of West 2 Windsor, Casey of Montpelier, Cina of Burlington, Cole of 3 Hartford, Logan of Burlington, McCann of Montpelier, McGill 4 of Bridport, Priestley of Bradford, Surprenant of Barnard, 5 Tomlinson of Winooski, and Waszazak of Barre City 6 Referred to Committee on 7 Date: 8 Subject: Health; health insurance; gender-affirming care; fertility treatment 9 Statement of purpose of bill as introduced: This bill proposes to expand access 10 to health insurance coverage for gender-affirming health care services. It 11 would also require health insurance plans and Vermont Medicaid to provide 12 coverage for fertility-related services and direct the Agency of Human Services 13 to seek federal approval of an amendment to Vermont’s Medicaid state plan to 14 permit the Medicaid coverage. 15 An act relating to coverage for fertility treatment and gender-affirming 16 health care services 17 BILL AS INTRODUCED H.55 2025 Page 2 of 9 VT LEG #379409 v.1 It is hereby enacted by the General Assembly of the State of Vermont: 1 Sec. 1. 8 V.S.A. § 4088m is amended to read: 2 § 4088m. COVERAGE FOR GENDER-AFFIRMING HEALTH CARE 3 SERVICES 4 (a) Definitions. As used in this section: 5 (1) “Gender-affirming health care services” has the same meaning as in 6 1 V.S.A. § 150. 7 (2) “Health care provider” has the same meaning as in 18 V.S.A. 8 § 9402. 9 (3) “Health insurance plan” means Medicaid and any other public health 10 care assistance program, any individual or group health insurance policy, any 11 hospital or medical service corporation or health maintenance organization 12 subscriber contract, or any other health benefit plan offered, issued, or renewed 13 for any person in this State by a health insurer as defined by 18 V.S.A. § 9402. 14 For purposes of this section, health insurance plan includes any health benefit 15 plan offered or administered by the State or any subdivision or instrumentality 16 of the State. The term does not include benefit plans providing coverage for a 17 specific disease or other limited benefit coverage, except that it includes any 18 accident and sickness health plan. 19 (b) Coverage. 20 BILL AS INTRODUCED H.55 2025 Page 3 of 9 VT LEG #379409 v.1 (1)(A) A health insurance plan shall provide coverage for gender- 1 affirming health care services that: 2 (A) are medically necessary and clinically appropriate for the 3 individual’s diagnosis or health condition; and, as determined by the covered 4 individual’s treatment health care provider. Medically necessary gender- 5 affirming health care services shall include, if determined by the treating health 6 care provider to be clinically appropriate for a covered individual: 7 (i) facial masculinization and feminization procedures; and 8 (ii) facial hair removal, such as laser hair removal or electrolysis. 9 (B) are included in the State’s essential health benefits benchmark 10 plan A health insurance plan shall not impose barriers to accessing gender- 11 affirming health care services, such as mandating a specific duration of 12 hormone therapy or requiring correspondence from more than one health care 13 provider before authorizing gender-affirming surgery or other gender-affirming 14 health care services. 15 (2) Coverage provided pursuant to this section by Medicaid or any other 16 public health care assistance program shall comply with all federal 17 requirements imposed by the Centers for Medicare and Medicaid Services. 18 (3) Nothing in this section shall prohibit a health insurance plan from 19 providing greater coverage for gender-affirming health care services than is 20 required under this section. 21 BILL AS INTRODUCED H.55 2025 Page 4 of 9 VT LEG #379409 v.1 (c) Cost sharing. A health insurance plan shall not impose greater 1 coinsurance, co-payment, deductible, or other cost-sharing requirements for 2 coverage of gender-affirming health care services than apply to the diagnosis 3 and treatment of any other physical or mental condition under the plan. 4 (d) On or before January 15 of each year, the Department of Financial 5 Regulation shall report to the House Committee on Health Care and the Senate 6 Committees on Health and Welfare and on Finance on health insurance plans’ 7 compliance with this section, utilization of gender-affirming health care 8 services during the previous calendar year, and any identified barriers to access 9 to care. 10 Sec. 2. 8 V.S.A. § 4099f is added to read: 11 § 4099f. FERTILITY-RELATED SERVICES 12 (a) Definitions. As used in this section: 13 (1) “Experimental fertility procedure” means a procedure for which the 14 published medical evidence is not sufficient for the American Society for 15 Reproductive Medicine, its successor organization, or a comparable 16 organization to regard the procedure as established medical practice. 17 (2) “Fertility diagnostic care” means procedures, products, medications, 18 and services intended to provide information about an individual’s fertility, 19 including laboratory assessments and imaging studies. 20 BILL AS INTRODUCED H.55 2025 Page 5 of 9 VT LEG #379409 v.1 (3) “Fertility preservation services” means procedures, products, 1 medications, and services intended to preserve fertility, consistent with 2 established medical practice and professional guidelines published by the 3 American Society for Reproductive Medicine, its successor organization, or a 4 comparable organization, for an individual who has a medical or genetic 5 condition or who is expected to undergo treatment that may directly or 6 indirectly cause a risk of impairment of fertility. “Fertility preservation 7 services” includes the procurement and cryopreservation of gametes, embryos, 8 and reproductive material and storage from the time of cryopreservation for a 9 period of five years. Storage may be offered for a longer period of time. 10 (4) “Health care provider” has the same meaning as in 18 V.S.A. 11 § 9402. 12 (5) “Health insurance plan” means any individual or group health 13 insurance policy; any hospital or medical service corporation or health 14 maintenance organization subscriber contract; or any other health benefit plan 15 offered, issued, or renewed for any person in this State by a health insurer. 16 The term does not include benefit plans providing coverage for specific 17 diseases or other limited benefit coverage. 18 (6) “Health insurer” has the same meaning as in 18 V.S.A. § 9402. 19 (b) Required coverage. A health insurance plan shall provide coverage for 20 the following fertility-related services for all insureds: 21 BILL AS INTRODUCED H.55 2025 Page 6 of 9 VT LEG #379409 v.1 (1) Fertility diagnostic care. 1 (2) Intrauterine insemination treatment with donor or partner semen. 2 (3) At least three retrievals of oocytes under anesthesia for in vitro 3 fertilization (IVF) with donor or partner semen or egg, including appropriate 4 medications for ovarian stimulation; unlimited embryo transfers; and IVF- 5 related laboratory procedures, ultrasounds, and hormones. A health insurance 6 plan may, but shall not be required to, provide coverage for preimplantation 7 genetic testing as a component of IVF. 8 (4) Clinically appropriate fertility-related medications as ordered or 9 prescribed by the insured’s treating health care providers. 10 (5) Fertility preservation services. 11 (c) Access to services; limitations on coverage. 12 (1) A health insurance plan shall not establish any rate, term, or 13 condition that places a greater financial burden on an insured for access to 14 fertility-related services than for access to treatment for any other health 15 condition. 16 (2) A health insurance plan shall not impose any limitations on coverage 17 for any fertility services based on an insured’s use of donor sperm or eggs, 18 donor embryos, or surrogacy. 19 (3) A health insurance plan is not required to provide coverage for: 20 (A) any experimental fertility procedure; or 21 BILL AS INTRODUCED H.55 2025 Page 7 of 9 VT LEG #379409 v.1 (B) any nonmedical costs related to donor sperm or eggs, donor 1 embryos, or surrogacy. 2 (d) Reporting. On or before January 15 of each year, the Department of 3 Financial Regulation shall report to the House Committee on Health Care and 4 the Senate Committees on Health and Welfare and on Finance on health 5 insurance plans’ compliance with this section, utilization of fertility-related 6 services during the previous calendar year, and any identified barriers to access 7 to care. 8 Sec. 3. 33 V.S.A. § 1901n is added to read: 9 § 1901n. COVERAGE OF FERTILITY-RELATED SERVICES 10 (a) Definitions. As used in this section: 11 (1) “Fertility diagnostic care” and “fertility preservation services” have 12 the same meanings as in 8 V.S.A. § 4099f. 13 (2) “Health care provider” has the same meaning as in 18 V.S.A. 14 § 9402. 15 (b) Coverage. The Agency of Human Services shall provide Medicaid 16 coverage for the following fertility-related services for all Medicaid 17 beneficiaries: 18 (1) Fertility diagnostic care. 19 (2) Intrauterine insemination treatment with donor or partner semen. 20 BILL AS INTRODUCED H.55 2025 Page 8 of 9 VT LEG #379409 v.1 (3) At least three retrievals of oocytes under anesthesia for in vitro 1 fertilization (IVF) with donor or partner semen or egg, including appropriate 2 medications for ovarian stimulation; unlimited embryo transfers; and IVF- 3 related laboratory procedures, ultrasounds, and hormones. The Agency may, 4 but shall not be required to, provide Medicaid coverage for preimplantation 5 genetic testing as a component of IVF. 6 (4) Clinically appropriate fertility-related medications as ordered or 7 prescribed by the beneficiary’s treating health care providers. 8 (5) Fertility preservation services. 9 Sec. 4. COVERAGE FOR FERTILITY-RELATED SERVICES; MEDICAID 10 STATE PLAN AMENDMENT 11 On or before September 1, 2025, the Agency of Human Services shall 12 request approval from the Centers for Medicare and Medicaid Services to 13 amend Vermont’s Medicaid state plan to include coverage for fertility-related 14 services as set forth in Sec. 3 of this act. 15 Sec. 5. EFFECTIVE DATES 16 (a) Secs. 1 (8 V.S.A. § 4088m) and 2 (8 V.S.A. § 4099f) shall take effect 17 on January 1, 2026 and shall apply to all health insurance plans issued on and 18 after January 1, 2026 on such date as a health insurer offers, issues, or renews 19 the health insurance plan, but in no event later than January 1, 2027. 20 BILL AS INTRODUCED H.55 2025 Page 9 of 9 VT LEG #379409 v.1 (b) Sec. 3 (33 V.S.A. § 1901n) shall take effect upon approval by the 1 Centers for Medicare and Medicaid Services of Vermont’s request to provide 2 coverage of fertility-related services as set forth in that section. 3 (c) Sec. 4 (coverage for fertility-related services; Medicaid state plan 4 amendment) and this section shall take effect on passage. 5