HOUSE DOCKET, NO. 2602        FILED ON: 1/17/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 995

The Commonwealth of Massachusetts

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PRESENTED BY:

Danielle W. Gregoire

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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 relative to human donor milk coverage.

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PETITION OF:

HOUSE DOCKET, NO. 2602        FILED ON: 1/17/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 995

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 relative to human donor milk coverage.

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 32A of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after section 27 the following section:

Section 28. (a) Any coverage offered by the commission to any active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for:

(1) The provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, provided that:

(i) The covered person is an infant under the age of six months;

(ii) The milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

(iii) A licensed medical practitioner has issued a written order for the provision of such human breast milk for an infant who:

(a) Is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breastfeeding despite optimal lactation support; or

(b) Meets any of the following conditions:

(1) A body weight below healthy levels determined by the licensed medical practitioner;

(2) A congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or

(3) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Health.

SECTION 2. Chapter 118E of the General Laws, as so appearing, is hereby amended by inserting after section 10J the following section:

Section 10K. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for:

(1) The provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, provided that:

(i) The covered person is an infant under the age of six months;

(ii) The milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

(iii) A licensed medical practitioner has issued a written order for the provision of such human breast milk for an infant who:

(a) Is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breastfeeding despite optimal lactation support; or

(b) Meets any of the following conditions:

(1) A body weight below healthy levels determined by the licensed medical practitioner;

(2) A congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or

(3) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Health.

SECTION 3. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 47II the following:

Section 47JJ. An individual policy of accident and sickness insurance issued pursuant to section 108 and sickness insurance issued pursuant to section 110 shall provide benefits for residents of the Commonwealth and all group members having a principal place of employment within the Commonwealth coverage for:

(1) The provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, provided that:

(i) The covered person is an infant under the age of six months;

(ii) The milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

(iii) A licensed medical practitioner has issued a written order for the provision of such human breast milk for an infant who:

(a) Is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breastfeeding despite optimal lactation support; or

(b) Meets any of the following conditions:

(1) A body weight below healthy levels determined by the licensed medical practitioner;

(2) A congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or

(3) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Health.

SECTION 4. Chapter 176A of the General Laws, as so appearing, is hereby amended by inserting after section 8KK the following:

Section 8LL. Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the Commonwealth shall provide to all individual subscribers and members within the Commonwealth and to all group members having a principal place of employment within the Commonwealth coverage for:

(1) The provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, provided that:

(i) The covered person is an infant under the age of six months;

(ii) The milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

(iii) A licensed medical practitioner has issued a written order for the provision of such human breast milk for an infant who:

(a) Is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breastfeeding despite optimal lactation support; or

(b) Meets any of the following conditions:

(1) A body weight below healthy levels determined by the licensed medical practitioner;

(2) A congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or

(3) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Health.

SECTION 5. Chapter 176B of the General Laws, as so appearing, is hereby amended by inserting after section 4KK the following:

Section 4LL. Any subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within or without the Commonwealth shall provide to all individual subscribers and members within the Commonwealth and to all group members having a principal place of employment within the Commonwealth coverage for:

(1) The provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, provided that:

(i) The covered person is an infant under the age of six months;

(ii) The milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

(iii) A licensed medical practitioner has issued a written order for the provision of such human breast milk for an infant who:

(a) Is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breastfeeding despite optimal lactation support; or

(b) Meets any of the following conditions:

(1) A body weight below healthy levels determined by the licensed medical practitioner;

(2) A congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or

(3) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Health.

Section 6.  Chapter 176G of the General Laws, as so appearing, is hereby amended by inserting after section 4CC the following:

Section 4DD: Any individual or group health maintenance contract that is issued, renewed or delivered within or without the Commonwealth shall provide to residents of the Commonwealth and to persons having a principal place of employment within the Commonwealth coverage for:

(1) The provision of pasteurized donated human breast milk, which shall include human milk fortifiers if indicated in a medical order provided by a licensed medical practitioner, provided that:

(i) The covered person is an infant under the age of six months;

(ii) The milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

(iii) A licensed medical practitioner has issued a written order for the provision of such human breast milk for an infant who:

(a) Is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breastfeeding despite optimal lactation support; or

(b) Meets any of the following conditions:

(1) A body weight below healthy levels determined by the licensed medical practitioner;

(2) A congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or

(3) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Health.

Section 7. Sections 1 through 6 of this act shall apply to all policies, contracts and certificates of health insurance subject to chapters 32A, chapter 118E, chapter 175, chapter 176A, chapter 176B, and chapter 176G which are delivered, issued or renewed on or after September 1, 2019.