Introduced by Representative Frank of Underhill
Subject: Health; Medicaid; medical necessity; circumcision
Statement of purpose: This bill proposes to prohibit Medicaid coverage for circumcisions of male children if the procedure is not medically necessary.
AN ACT RELATING TO MEDICAID COVERAGE FOR CIRCUMCISIONS OF MALE CHILDREN
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. FINDINGS
The general assembly finds:
(1) United States taxpayers currently fund at least 25 percent of all routine nontherapeutic infant circumcisions performed in this country.
(2) The American Medical Association, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology consider routine circumcision of male infants to be a medically unnecessary procedure performed for cosmetic, social, or religious reasons.
(3) Routine circumcision is not performed in Europe, Australia, most of Asia, Latin America, or South America. Eighty-five percent of the world’s male population and 98 percent of the world’s female population are not circumcised. The United States is the only country in the world that circumcises a majority of male infants for nonreligious reasons.
(4) Approximately 16 states have discontinued Medicaid coverage for medically unnecessary circumcisions.
(5) Many insurance companies have discontinued coverage for medically unnecessary circumcisions.
(6) Vermont Medicaid, the Vermont health access plan, and Dr. Dynasaur generally cover only medically necessary treatments and procedures.
Sec. 2. MEDICAID AND SCHIP COVERAGE OF CIRCUMCISIONS
(a) The agency of human services shall provide coverage through Medicaid or Dr. Dynasaur only for services required to perform medically necessary circumcisions of male children after prior authorization.
(b) “Medically necessary circumcisions” means therapeutic circumcisions for the purpose of treating disease or malformation and shall include diagnostic codes V30 through V39.2, V50.2, 605, and other similar codes as defined in the ninth edition of the International Classification of Disease, Clinical Modification (ICD-9-CM) only when the pathology or histology report establishes an existing disease or malformation. “Medically necessary circumcisions” shall not include coverage for Medicaid procedure codes 54150, 54160, and 54163.
The Vermont General Assembly
115 State Street