New RESTORE Act Overhauls Fertility Focus: Boosts Research, Creates New Medical Codes, and Protects Providers Who Refuse IVF

The new Reproductive Empowerment and Support through Optimal Restoration Act, or RESTORE Act, shifts the federal focus on fertility care. This bill is centered on promoting and funding 'Restorative Reproductive Medicine' (RRM)—a system designed to diagnose and treat underlying health issues like endometriosis, PCOS, and blocked tubes that cause infertility—rather than immediately turning to Assisted Reproductive Technology (ART), like IVF. Key provisions include requiring the Department of Health and Human Services (HHS) to conduct literature reviews on RRM and fertility awareness methods, and critically, updating medical coding systems to ensure providers who perform these restorative treatments get paid accurately.

The Fertility Coding Overhaul

If you’ve ever dealt with a complex medical bill, you know that if a doctor can’t code a procedure correctly, you’re often stuck fighting the insurance company. The RESTORE Act takes aim at this massive administrative headache (Sec. 12). It mandates that HHS work with Medicare/Medicaid and the American Medical Association to completely revamp the diagnostic (ICD) and procedural (CPT) codes for reproductive health conditions. This means creating better codes for things like severe endometriosis, PCOS, and specialized surgeries used to remove fibroids or clear blocked tubes.

Why does this matter? For patients and providers specializing in complex fertility issues, this is huge. Currently, many restorative procedures, which involve intensive time and resources—like specialized laparoscopic surgeries or comprehensive cycle charting instruction—are poorly reimbursed or not covered at all because the codes don't exist or don't reflect the complexity. The bill requires the creation of bundled payment models for RRM, meaning a single, comprehensive payment for the entire process of diagnosis, treatment, and follow-up. This could finally incentivize doctors to spend the necessary time treating the root cause rather than just managing symptoms, which is a big win for better, long-term patient care.

The Conscience Clause and Access Concerns

Here’s the part that will likely cause the most friction and impact access: Section 4. This provision strictly prohibits the federal government, or any entity receiving federal funds (like state health departments or hospitals), from penalizing a healthcare provider because they refuse to participate in, refer for, or pay for any Assisted Reproductive Technology (ART) procedure, such as IVF. This protection applies if the refusal is based on the provider's “sincerely held religious beliefs or moral convictions.”

For providers who oppose ART, this offers strong protection against discrimination. However, for patients, particularly those in rural areas or regions with limited healthcare options, this could pose a significant barrier. If the only fertility specialist in a 100-mile radius opts out of ART services, the patient may be forced to travel hundreds of miles for a referral or treatment, potentially limiting their options to only the RRM methods promoted by the bill.

Shifting Research and Funding Priorities

The RESTORE Act mandates a significant increase in federal research (Sec. 13) into the causes of reproductive conditions like endometriosis, PCOS, and male infertility (including factors like microplastics and substance use). This focus on underlying causes and restorative success rates could lead to better diagnostics and treatments down the line.

Furthermore, the bill changes how federal family planning money is distributed. It opens up Title X grant eligibility (Sec. 8) and Teen Pregnancy Prevention grant access (Sec. 9) to organizations that specialize in Restorative Reproductive Medicine and fertility awareness-based methods. This means that established family planning providers will now compete for federal dollars with these specialized restorative groups. While this expands the types of services that can be federally funded, it could also divert resources from existing, comprehensive family planning centers that offer a wider range of services.