ASSEMBLY, No. 1470
STATE OF NEW JERSEY
217th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2016 SESSION
Sponsored by:
Assemblywoman PAMELA R. LAMPITT
District 6 (Burlington and Camden)
SYNOPSIS
Requires health benefits coverage for donated human breast milk under certain conditions.
CURRENT VERSION OF TEXT
As reported by the Assembly Financial Institutions and Insurance Committee on November 30, 2017, with amendments.
An Act concerning health benefits coverage for donated human breast milk and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. a. An individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those individual health benefits plans in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this section shall apply to those small employer health benefits plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
b. The provisions of this
section shall apply to those contracts for health care services by health
maintenance organizations under which the health maintenance organization has
reserved the right to change the schedule of charges.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
10. The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred in the provision of 1pasteurized1 donated human breast milk 1, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner,1 provided that:
(1) the covered person is an infant under the age of six months;
(2) 1[a physician prescribes the milk for the covered person] a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support1; 1[and]1
(3) 1a licensed medical practitioner has issued an order for an infant that meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health; and
(4)1 the milk is obtained from a human milk bank that meets quality guidelines established by the 1[Human Milk Banking Association of North America, or that is licensed by the]1 Department of Health.
11. This act shall take effect on 1[the 90th day after] January 1st of the year following1 enactment.