HOUSE DOCKET, NO. 544        FILED ON: 1/11/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 911

The Commonwealth of Massachusetts

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PRESENTED BY:

Christine P. Barber

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to increase access to lactation support through proper reimbursement.

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PETITION OF:

HOUSE DOCKET, NO. 544        FILED ON: 1/11/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 911

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act to increase access to lactation support through proper reimbursement.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 175 of the General Laws, as appearing in the 2014 Official Addition, is amended by inserting as Section 47cc the following:

(A)Any blanket or general policy of insurance described in subdivision (A), (C), or (D) of section 110 which is issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth, during the period this provision is effective, or any policy of accident and sickness insurance as described in section 108 which provides hospital expense and surgical expense insurance and which is delivered or issued for delivery or subsequently renewed by agreement between the insurer and the policyholder in the commonwealth during the period that this provision is effective shall provide, to the same extent that benefits are provided for other pregnancy-related procedures coverage for lactation support consisting of, at minimum, lactation care and services by qualified lactation care providers provided that such services are within the lawful scope of practice for such providers, the costs of breastfeeding equipment, and the performance of any necessary maternal and newborn clinical assessments.

(B)  For purposes of this Section:

“Breastfeeding equipment” means manual, electric, single user and multi-user breast pumps, breast pump flanges, nipple shields, and other lactation accessories recommended by a qualified lactation care provider or other health professional, whether a rental or a purchase.

“Lactation care and services” means the clinical application of scientific principles and a multidisciplinary body of evidence to provide evaluation, problem identification, treatment, education and consultation, regarding breastfeeding and breast milk feeding to client-defined families by a qualified lactation care provider.  Lactation care and services may be delivered during pregnancy, a hospital stay, and the postpartum period, and may be delivered in an office setting, in a hospital, through home visits, through telephone support, or any combination of these. 

Lactation care and services include but are not limited to:

(1)Lactation assessment through the systematic collection of subjective and objective data;

(2)Analysis of data;

(3)Development of a lactation care plan with demonstration and instruction to parents and communication to the primary health care provider;

(4)Provision of lactation education to parents and health care providers; and

(5)The recommendation and use of assistive devices.

“Nationally recognized accrediting agency” shall mean the National Commission for Certifying Agencies (“NCCA”), the Institute for Credentialing Excellence (“ICE”), and American National Standards Institute (“ANSI”).

“Qualified lactation care provider” means a person who possesses current certification from a certification program accredited by a Nationally Recognized Accrediting Agency.

(C)     An insurer providing coverage under this paragraph and any participating entity through which the insurer offers health services shall not:

(1)deny to a covered person eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy or vary the terms of the policy for the purpose or with the effect of avoiding compliance with this paragraph;

(2)provide incentives (monetary or otherwise) to encourage a covered person to accept less than the minimum protections available under this paragraph;

(3)penalize in any way or reduce or limit the compensation of a health care practitioner for recommending or providing care to a covered person in accordance with this paragraph;

(4)provide incentives (monetary or otherwise) to a health care practitioner relating to the services provided pursuant to this paragraph intended to induce or have the effect of inducing such practitioner to provide care to a covered person in a manner inconsistent with this paragraph;

(5)restrict coverage for any portion of a period within a hospital length of stay required under this paragraph in a manner which is inconsistent with the coverage provided for any preceding portion of such stay;

(6)require prior authorization, prescription or referral for lactation care and services; or

(7)impose a deductible, coinsurance, co-payment or any other cost-sharing requirement for lactation care and services or breastfeeding equipment provided under this paragraph.

SECTION 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law.