5160-21-03 Medicaid covered reproductive health services: infertility services.  

  • Text Box: ACTION: Final Text Box: DATE: 05/27/2016 10:29 AM

     

     

     

    TO BE RESCINDED

     

    5160-21-03                  Medicaid   covered   reproductive   health   services:   infertility services.

     

     

     

    (A)  Definitions.

     

    (1)   For the purposes of this rule, "infertility" means any one of the following:

     

    (a)   A woman of childbearing age is unable to get pregnant, after at least one year of trying; or

     

    (b)   A man is unable to impregnate a woman, after at least one year of trying.

     

    (2)   For the purposes of this rule, "infertility services" means services:

     

    (a)     Performed solely for the purpose of enabling an infertile individual capable of reproducing; and

     

    (b)   With more than one desired outcome that would not have been performed if not for the fact that the services would of enable an infertile individual capable of reproducing.

     

    (B)     Medicaid  recipients  are  not  denied  medically  necessary  services  based  on  their fertility status.

     

    (C)     Medicaid  does  not  cover  infertility  services.  Under  no  circumstances  are  the following procedures covered:

     

    (1)    Drugs prescribed in accordance with Chapter 5101:3-9 of the Administrative Code and/or drugs administered in accordance with Chapter 5101:3-4 of the Administrative Code;

     

    (2)   Assisted reproductive technologies (ART);

     

    (3)   In vitro fertilization;

     

    (4)   Intrauterine insemination/artificial insemination; and

     

    (5)   Surgery, including procedures for the reversal of voluntary sterilization.

     

     

     

     

    5160-21-03

     

     

     

     

    Effective:

    TO BE RESCINDED

     

     

     

     

    07/01/2016

    2

    Five Year Review (FYR) Dates:

    02/03/2016

     

     

    CERTIFIED ELECTRONICALLY

     

     

    Certification

     

     

     

    05/27/2016

     

     

    Date

     

     

     

    Promulgated Under:

     

    119.03

     

    Statutory Authority:

    5164.02

     

    Rule Amplifies:

    5162.03, 5164.02, 5164.70

     

    Prior Effective Dates:

    07/01/2009

     

Document Information

Effective Date:
7/1/2016
File Date:
2016-05-27
Last Day in Effect:
2016-07-01
Five Year Review:
Yes
Rule File:
5160-21-03_PH_FF_R_RU_20160527_1029.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160-21-03. Medicaid covered reproductive health services: infertility services