2023 Pennsylvania Consolidated & Unconsolidated Statutes
Act 32 - HUMAN SERVICES CODE - MEDICAL ASSISTANCE COVERAGE FOR PASTEURIZED DONOR HUMAN MILK

Session of 2023

No. 2023-32

 

SB 500

 

AN ACT

 

Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An act to consolidate, editorially revise, and codify the public welfare laws of the Commonwealth," in public assistance, providing for medical assistance coverage for pasteurized donor human milk.

 

This act may be referred to as Owen's Law.

 

The General Assembly finds and declares as follows:

(1)  In the United States, one in nine infants are born prematurely, one of the highest rates among developed countries.

(2)  Up to 70% of mothers with infants in neonatal intensive care units cannot provide enough breast milk to meet all of their infants' needs, despite adequate lactation support and effort.

(3)  Pasteurized donor human milk provides a lifesaving health benefit for high-risk infants as a supplement or bridge when determined to be medically necessary.

(4)  Pasteurized donor human milk is evidence-based nutritional medicine that is essential to the health of medically fragile infants in both inpatient and outpatient settings due to its anti-inflammatory and immunological components.

(5)  A human milk diet for medically compromised infants provides unparalleled protection against serious health complications that can lead to longer hospital stays, multiple medical and surgical procedures, readmissions, lifelong disability or even death.

(6)  Along with avoiding serious medical complications, the use of pasteurized donor human milk in a hospital increases exclusive maternal breastfeeding rates. A mother's own milk provides the ultimate nutrition for the infant but is not always adequate to meet the infant's needs.

(7)  Pasteurized donor human milk dramatically reduces the risk of necrotizing enterocolitis, the most prevalent gastrointestinal emergency among preterm infants.

(8)  Necrotizing enterocolitis has a 24% mortality rate overall and surgical necrotizing enterocolitis has a 40% mortality rate and may result in the partial or complete destruction of the intestinal lining and may lead to short-term and lifelong health consequences, including premature death.

(9)  The use of pasteurized donor human milk has been shown to decrease the overall incidence of necrotizing enterocolitis by up to 80% and the rate of surgical necrotizing enterocolitis by more than 90%.

(10)  Infants with a wide range of congenital or acquired conditions can benefit from the use of medically prescribed pasteurized donor human milk as a component of treatment when their mothers' own milk is unavailable or cannot meet all of their needs.

(11)  Neonatal abstinence syndrome has tripled in the last 10 years, including a seven-fold increase in neonatal intensive care unit stays for drug-exposed infants who suffer from feeding intolerance and many other side effects. The use of pasteurized donor human milk to meet the nutritional needs of infants with neonatal abstinence syndrome reduces their symptoms and decreases the need for additional medical intervention and treatment.

(12)  Medical assistance coverage for prescribed and medically necessary pasteurized donor human milk for inpatient and outpatient infants is necessary to improve health outcomes and reduce medical treatment costs in this Commonwealth.

(13)  This act has the following purposes:

(i)  Promoting the health of medically fragile infants through access to evidence-based pasteurized donor human milk when medically prescribed and necessary.

(ii)  Substantially reducing the incidence of necrotizing enterocolitis in infants with risk factors for the disease.

(iii)  Improving medical outcomes for infants with serious health conditions where access to pasteurized donor human milk will aid in their recovery.

(iv)  Reducing the symptomology of neonatal abstinence syndrome for drug-exposed infants to decrease the need for extensive medical intervention and treatment.

(v)  Requiring medical assistance coverage for medically necessary pasteurized donor human milk for inpatient and outpatient infants when needed.

(vi)  Providing public awareness of the availability of pasteurized donor human milk and educating families and health care providers about this life-saving medicine.

(vii)  Improving short-term and long-term health outcomes for the smallest and most fragile residents of this Commonwealth by providing needed access to pasteurized donor human milk not only to reduce health care costs but, most importantly, to save lives.

 

The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:

 

Section 1.  The act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, is amended by adding a section to read:

Section 443.14.  Medical Assistance Coverage for Pasteurized Donor Human Milk.--(a)  Pasteurized donor human milk is compensable under the medical assistance program in accordance with the Commonwealth's approved State plan if:

(1)  The pasteurized donor human milk is medically necessary for an inpatient infant or an outpatient infant.

(2)  The infant's mother is medically or physically unable to produce maternal breast milk or produce maternal breast milk in sufficient quantities to meet the infant's needs or if the maternal breast milk is contraindicated.

(b)  The department shall regularly review and update, as needed, written guidance regarding pasteurized donor human milk. Any updated pasteurized donor human milk guidance shall be posted on the department's publicly accessible Internet website.

(c)  The Department of Health, in collaboration with the department, shall develop and conduct a public information campaign to inform families and health care providers of the availability of pasteurized donor human milk in this Commonwealth to treat inpatient infants and outpatient infants, as provided in this section and as medically necessary, including the availability of coverage through medical assistance.

(d)  The following words and phrases when used in this section shall have the meanings given to them in this subsection unless the context clearly indicates otherwise:

"Inpatient infant."  An infant who is younger than twelve months of age based on the infant's corrected gestational age, who is receiving care in an inpatient setting, for whom pasteurized donor human milk is medically necessary. Pasteurized donor human milk is medically necessary for an infant with any of the following health conditions:

(1)  An infant birth weight equal to or less than one thousand eight hundred grams.

(2)  An infant gestational age equal to or less than thirty-four weeks.

(3)  A high risk for development of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis or retinopathy of prematurity.

(4)  A congenital or acquired gastrointestinal condition or other serious medical condition associated with long-term feeding or malabsorption complications.

(5)  Congenital heart disease requiring surgery in the first year of life.

(6)  Has had or will have an organ or bone marrow transplant, or has an immunologic deficiency.

(7)  Renal disease requiring dialysis in the first year of life.

(8)  Infant hypoglycemia or jaundice.

(9)  Neonatal abstinence syndrome.

(10)  Any other health condition for which the use of pasteurized donor human milk is medically necessary as determined by the department.

"Licensed milk bank."  A milk bank licensed in this Commonwealth or through a hospital licensure process in accordance with the act of February 12, 2020 (P.L.13, No.7), known as the "Keystone Mother's Milk Bank Act."

"Necrotizing enterocolitis."  A life-threatening condition that most often occurs in a premature infant, but also occurs in a term infant or near-term infant, and that causes intestinal inflammation characterized by variable injury or damage to the intestinal tract resulting in the potential death of intestinal tissue.

"Neonatal abstinence syndrome."  A withdrawal syndrome of an infant that occurs when an infant is born after exposure to substance abuse in utero, and that is associated with multiple side effects, including tremors, vomiting, poor feeding, poor weight gain and high-pitched crying, which may lead to increased length of hospital stays and additional health care costs depending on severity.

"Outpatient infant."  An infant who is younger than twelve months of age based on the infant's corrected gestational age, who is receiving care in an outpatient setting, for whom pasteurized donor human milk is medically necessary. Pasteurized donor human milk is medically necessary for an infant with any of the following health conditions:

(1)  A congenital or acquired gastrointestinal condition or other serious medical condition associated with long-term feeding or malabsorption complications.

(2)  Congenital heart disease requiring surgery in the first year of life.

(3)  Has had or will have an organ or bone marrow transplant or has an immunologic deficiency.

(4)  A history of sepsis.

(5)  Renal disease requiring dialysis in the first year of life.

(6)  Any other health condition for which the use of pasteurized donor human milk is medically necessary as determined by the department.

"Pasteurized donor human milk."  Human milk derived from a donor as defined in section 3 of the "Keystone Mother's Milk Bank Act," which is donated to a licensed milk bank for processing and distribution.

Section 2.  This act shall take effect in 60 days.

 

APPROVED--The 21st day of November, A.D. 2023.

 

JOSH SHAPIRO