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.

Effective: 07/01/2009
R.C. 119.032 review dates: 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02, 5111.021