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December 05, 2025 Clouds | 26°F
The 194th General Court of the Commonwealth of Massachusetts
  1. General Laws
  2. Part I ADMINISTRATION OF THE GOVERNMENT
  3. Title XXII CORPORATIONS
  4. Chapter 176G HEALTH MAINTENANCE ORGANIZATIONS
  5. Section 4QQ Coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products

Section 4QQ

Section 4QQ: Coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products

[ Subsection (a) added by 2024, 186, Sec. 47 effective November 21, 2024.]

  Section 4QQ. (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, however, 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 is:

  (1) under the age of 6 months;

  (2) 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) 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.

[ Subsection (b) added by 2024, 186, Sec. 47 effective November 21, 2024 until December 4, 2024. For text effective December 4, 2024, see below.]

  (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) 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.

[ Subsection (b) as amended by 2024, 248, Sec. 22 effective December 4, 2024. For text effective until December 4, 2024, see above.]

  (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the health maintenance organization shall include the cost of reimbursement provided under subsection (a) 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.