Amendment #2, as changed to H.4773

Amendment #2 to H4773

Human Donor Milk Coverage

Miss Gregoire of Marlborough moves to amend the bill by adding the following section:-

"SECTION XXXX.

SECTION 1. Chapter 32A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 30 the following section:

Section 31. (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 the provision of pasteurized donor human milk and donor human milk-derived products, provided that:

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

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

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

(i) 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 and/or caloric density or participate in breastfeeding despite optimal lactation support; and

(ii) Meets any of the following conditions:

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

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

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

(b) Reimbursement provided under subsection (a) of this section for donor human milk and donor human milk-derived products for an infant in an inpatient setting shall be provided separately from the existing hospital payment for inpatient services.

SECTION 2. Chapter 118E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 10N the following section:

Section 10O. (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 pasteurized donor human milk and donor human milk-derived products, provided that:

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

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

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

(ii) Meets any of the following conditions:

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

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

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

SECTION 3. Chapter 175 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 47PP the following:

Section 47QQ. (a) 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 the provision of pasteurized donor human milk and donor human milk-derived products, provided that:

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

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

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

(ii) Meets any of the following conditions:

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

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

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

SECTION 4. Chapter 176A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 8QQ the following:

Section 8RR. (a) 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 the provision of pasteurized donor human milk and donor human milk-derived products, provided that:

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

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

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

(ii) Meets any of the following conditions:

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

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

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

SECTION 5. Chapter 176B of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 4QQ the following:

Section 4RR. (a) 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 the provision of pasteurized donor human milk and donor human milk-derived products, provided that:

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

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

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

(ii) Meets any of the following conditions:

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

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

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

SECTION 6. Chapter 176G of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 4GG the following:

Section 4HH: (a) 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 the provision of pasteurized donor human milk and donor human milk-derived products, provided that:

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

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

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

(ii) Meets any of the following conditions:

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

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

(c) A congenital or acquired condition that may benefit from the use of such human breast milk as determined by the Department of Public 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, 2023".

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

Human Donor Milk Coverage

Representative:

Danillo A. Sena