Relates to reimbursement for donor human breast milk

§ 2505-b. Reimbursement for breast milk.

1. The department shall reimburse a medical care facility for prescribed medically necessary donor human breast milk provided to a recipient of medical assistance if:

(a) such recipient is:

(i) an infant under the age of three months;

(ii) critically ill; and

(iii) in the neonatal intensive care unit of the hospital;

(b) a person licensed to practice medicine and surgery orders the donor human breast milk for the recipient;

(c) the department determines that the donor human breast milk is medically necessary for the recipient;

(d) the parent or legal guardian of the recipient signs and dates an Informed consent form indicating the risks and benefits of using banked donor human breast milk; and

(e) the donor human breast milk is obtained from a donor human breast milk bank that meets the quality requirements established by the department.

2. An electronic prior authorization system that uses the best medical evidence and care and treatment guidelines consistent with national standards shall be used by the department to determine medical necessi- ty.

3. The department shall promulgate rules and regulations necessary to implement the provisions of this section.

4. The department shall implement and administer the provisions of this section in a manner consistent with applicable federal laws and regulations. The department shall seek any necessary approvals of the federal government that are required for the implementation of this section.

Justification

There is no current system to reimburse a medical care facility for prescribed medically necessary donor human breast milk provided to a recipient of medical assistance. The ideal source of nutrition for infants is Human breast milk. Mothers of preterm infants face difficulty producing adequate amounts of breast milk to sustain their premature infants; which places the infant at risk for developing necrotizing enterocolitis (NEC). This is why the need for donor breast milk has become a necessary, desirable, and routine option to support preterm infants. North American donor milk is pasteurized at 62.5 lc for 30 minutes to remove any possible infectious or bacterial contaminants; although many bioactive and immunity compounds are either entirely or partially inactivated during this process.

Preterm infant ingestion of donor milk has show to reduce feeding intolerance, prevent NEC, and improve overall long-term health outcomes for preterm infants. There are concerns surrounding loss of key biological components in donor milk due to pasteurization and storage, but this should not be a deterrent nor a factor for denial of donor milk. Donor Human breast milk should become a standardized component as a holistic and main approach of health care for preterm/premature infants. Banked donor Human breast milk is safe and effective. According to the Human Milk Banking Association of North America, quality control is ensured as part of an adherence to mandatory inspections and guidelines.

Considering that donor human breast milk costs roughly $4.50 an ounce, although it is more expensive than formula, its significantly less expensive than long term NEC hospital stays. It should also be considered that such critical and necessary medical supplies, as donor human breast milk, should be covered by medicaid for low income families.

Prior legislative history

None.

Fiscal implications

To be determined.

Effective date

This act shall take effect immediately.