PRINTER'S NO. 1307
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1111
Session of
2023
INTRODUCED BY OBERLANDER, T. DAVIS, FEE, KAUFFMAN, ECKER,
FLEMING, INNAMORATO, O'MARA AND SHUSTERMAN, MAY 24, 2023
REFERRED TO COMMITTEE ON HEALTH, MAY 24, 2023
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) Donor human milk provides a lifesaving health
benefit for high-risk infants as a supplement or bridge when
determined to be medically necessary.
(4) Donor human milk is evidence-based nutritional
medicine that is essential to the health of medically fragile
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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 donor 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.
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(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.
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(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 443.13. Medical Assistance Coverage for Pasteurized
Donor Human Milk.--(a) Notwithstanding any other provision of
law, pasteurized donor human milk and related processing costs
shall be considered a compensable item under the medical
assistance program if:
(1) The pasteurized donor human milk is medically prescribed
for an inpatient infant or an outpatient infant in accordance
with this section.
(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 cost of pasteurized donor human milk shall be
reimbursed under the medical assistance program as provided
under subsection (a) for:
(1) An inpatient infant for whom the volume of the
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pasteurized donor human milk usage shall be tracked during the
course of the inpatient infant's stay, charged and reimbursed
through the inpatient stay payment.
(2) An outpatient infant for whom the volume of the
pasteurized donor human milk usage shall be calculated and
charged throughout the course of the outpatient infant's
treatment and reimbursed to the licensed milk bank providing
pasteurized donor human milk for that infant.
(c) The department shall biennially update its written
guidance on pasteurized donor human milk and the Medical
Assistance Program Outpatient Fee Schedule to reflect a medical
assistance fee for pasteurized donor human milk that is
commensurate with the current average national cost for non-
profit milk banks. The updated pasteurized donor human milk
guidance shall be posted on the department's publicly accessible
Internet website.
(d) The department, in collaboration with the Department of
Health, 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.
(e) 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 and who
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exhibits 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.
(9) Neonatal abstinence syndrome.
(10) 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.
"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
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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 and who
exhibits 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 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.
"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
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distribution.
Section 2. This act shall take effect in 60 days.
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