Amendment #2, as changed to H4773

Human Donor Milk Coverage

Miss Gregoire of Marlborough moves to amend the bill by striking out section 5 and inserting in place thereof the following section:-

SECTION 5. Chapter 32A of the General Laws is hereby amended by inserting after section 17S the following 2 sections:-

Section 17T. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for postpartum depression screenings conducted pursuant to section 247 of chapter 111.

Section 17U. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission  coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products, provided that:

(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;

(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and

(iii) the covered infant meets the following conditions:-

(1) is under the age of 6 months;

(2) is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and

(3) is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.

(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

And further amend the bill in section 37, in line 487, by striking out the words “2 sections” and inserting in place thereof the following words:- 3 sections.

And further amend the bill in said section 37 by inserting after section 10S the following section:-

Section 10T. (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 the provision of medically necessary pasteurized donor human milk and donor human milk-derived products, provided that:

(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;

(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and

(iii) the covered infant meets the following conditions:-

(1) is under the age of 6 months;

(2) is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and

(3) is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.

(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

And further amend the bill in section 38, in line 505, by striking out the word “section”, the second time it appears, and inserting in place thereof the following words:- 2 sections.

And further amend the bill in said section 38 by inserting after section 47VV the following section:-

Section 47WW. (a) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products, provided that:

(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;

(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and

(iii) the covered infant meets the following conditions:-

(1) is under the age of 6 months;

(2) is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and

(3) is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.

(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

And further amend the bill in section 39, in line 511, by striking out the word “section”, the second time it appears, and inserting in place thereof the following words:- 2 sections.

And further amend the bill in said section 39 by inserting after section 8WW the following section:-

Section 8XX. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products, provided that:

(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;

(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and

(iii) the covered infant meets the following conditions:-

(1) is under the age of 6 months;

(2) is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and

(3) is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.

(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

And further amend the bill in section 40, in line 517, by striking out the word “section”, the second time it appears, and inserting in place thereof the following words:- 2 sections.

And further amend the bill in said section 40 by inserting after section 4WW the following section:-

Section 4XX. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth, which is considered credible coverage under section 1 of chapter 111M, shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products, provided that:

(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;

(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and

(iii) the covered infant meets the following conditions:-

(1) is under the age of 6 months;

(2) is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and

(3) is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.

(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

And further amend the bill in section 41, in line 523, by striking out the word “section”, the second time it appears, and inserting in place thereof the following words:- 2 sections.

And further amend the bill in said section 41 by inserting after section 4OO the following section:-

Section 4PP. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products, provided that:

(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;

(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and

(iii) the covered infant meets the following conditions:-

(1) is under the age of 6 months;

(2) is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and

(3) is medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.

(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

Additional co-sponsor(s) added to Amendment #2, as changed to H4773

Human Donor Milk Coverage