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PRINTER'S NO. 2329
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2017
Session of
2021
INTRODUCED BY THOMAS, A. DAVIS, OBERLANDER, BENHAM, BRADFORD,
CIRESI, T. DAVIS, FARRY, HANBIDGE, HOWARD, INNAMORATO,
KINSEY, RABB, ROWE, SANCHEZ AND SCHLOSSBERG, OCTOBER 27, 2021
REFERRED TO COMMITTEE ON INSURANCE, OCTOBER 27, 2021
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for inpatient and outpatient pasteurized donor
human milk.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 633.1. Coverage for Inpatient and Outpatient
Pasteurized Donor Human Milk.--(a) Every health insurance
policy that provides pregnancy-related benefits and is
delivered, issued, executed or renewed in this Commonwealth on
or after the effective date of this section shall provide
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coverage for the use of pasteurized donor human milk in
inpatient settings, as deemed medically necessary and medically
prescribed, subject to all of the following conditions:
(1) The covered person is a child under the age of twelve
(12) months based on that child's gestationally corrected age.
(2) The pasteurized donor human milk is obtained from a milk
bank licensed in Pennsylvania in accordance with the act of
February 12, 2020 (P.L.13, No.7), known as the "Keystone
Mother's Milk Bank Act."
(3) The child's mother is medically or physically unable to
produce maternal breast milk or produce maternal breast milk in
sufficient quantities to meet the child's needs or the maternal
breast milk is contraindicated.
(4) Pasteurized donor human milk has been determined to be
medically necessary in the child who exhibits one or more of the
following:
(i) An infant birth weight below eighteen hundred (1800)
grams.
(ii) An infant gestational age equal to or less than thirty-
four (34) weeks.
(iii) Infant hypoglycemia.
(iv) A high risk for development of necrotizing
enterocolitis, bronchopulmonary dysplasia or retinopathy of
prematurity.
(v) A congenital or acquired gastrointestinal condition with
long-term feeding or malabsorption complications.
(vi) Congenital heart disease requiring surgery in the first
year of life.
(vii) Has had or will have an organ or bone marrow
transplant.
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(viii) Sepsis.
(ix) Congenital hypotonias associated with feeding
difficulty or malabsorption.
(x) Renal disease requiring dialysis in the first year of
life.
(xi) Craniofacial anomalies.
(xii) An immunologic deficiency.
(xiii) Neonatal abstinence syndrome.
(xiv) Any other serious congenital or acquired condition for
which the use of pasteurized donor human milk is medically
necessary and supports the treatment and recovery of the child.
(b) Every health insurance policy that provides pregnancy-
related benefits and is delivered, issued, executed or renewed
in this Commonwealth on or after the effective date of this
section shall provide coverage for the use of pasteurized donor
human milk in outpatient settings, as deemed medically necessary
and medically prescribed, subject to all of the following
conditions:
(1) The covered person is a child under the age of twelve
(12) months based on that child's gestationally corrected age.
(2) The pasteurized donor human milk is obtained from a milk
bank licensed in Pennsylvania in accordance with the "Keystone
Mother's Milk Bank Act."
(3) The child's mother is medically or physically unable to
produce maternal breast milk or produce maternal breast milk in
sufficient quantities to meet the child's needs or the maternal
breast milk is contraindicated.
(4) Pasteurized donor human milk has been determined to be
medically necessary in the child who exhibits one or more of the
following:
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(i) A congenital or acquired gastrointestinal condition with
long-term feeding or malabsorption complications.
(ii) Congenital heart disease requiring surgery in the first
year of life.
(iii) Has had or will have an organ or bone marrow
transplant.
(iv) A history of sepsis.
(v) Congenital hypotonias associated with feeding difficulty
or malabsorption.
(vi) Renal disease requiring dialysis in the first year of
life.
(vii) Craniofacial anomalies.
(viii) An immunologic deficiency.
(ix) Any other serious congenital or acquired condition for
which the use of pasteurized donor human milk is medically
necessary and supports the treatment and recovery of the child.
(c) Reimbursement for pasteurized donor human milk under
subsection (a) shall be made separately from the hospital
payment for inpatient services.
(d) As used in this section, the term "health insurance
policy":
(1) Means an individual or group health insurance policy,
contract or plan that provides medical or health care coverage
by any health care facility or licensed health care provider on
an expense-incurred service or prepaid basis and that is offered
by or is governed under any of the following:
(i) This act.
(ii) Subdivision (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the "Human Services Code."
(iii) The act of December 29, 1972 (P.L.1701, No.364), known
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as the "Health Maintenance Organization Act."
(iv) The act of May 18, 1976 (P.L.123, No.54), known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(v) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
(2) Does not include accident only, fixed indemnity, limited
benefit, credit, dental, vision, specified disease, Medicare
supplement, Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement, long-term care or disability
income, workers' compensation or automobile medical payment
insurance.
Section 2. This act shall take effect in 60 days.
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