SENATE BUDGET AND APPROPRIATIONS COMMITTEE

 

STATEMENT TO

 

SENATE, No. 2976

 

with committee amendments

 

STATE OF NEW JERSEY

 

DATED:  DECEMBER 18, 2017

 

      The Senate Budget and Appropriations Committee reports favorably Senate Bill No. 2976, with committee amendments.

      As amended, this bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health insurers; health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program) to provide health benefits coverage for expenses incurred in the provision of pasteurized donated human breast milk (including human milk fortifiers under certain circumstances) provided that:

      (1)  the covered person is an infant under the age of six months;

      (2)  the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

      (3)  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 support; or

      (4) a 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.

      The bill clarifies that it does not preclude insurance carriers from performing utilization review, including periodic review of the medical necessity of a particular service.  The bill further clarifies that the benefits provided pursuant to the bill are to be provided to the same extent as for any other prescribed items under the insurance policy or plan.

      The bill provides that if there is no supply of human breast milk that meets the requirements of the bill, the insurance carrier is not required to provide coverage of expenses pursuant to the bill. 

      The bill is scheduled to take effect on January 1st of the year following enactment.

     

COMMITTEE AMENDMENTS:

      The amendments limit the required health benefits coverage for donated human breast milk to donated human breast milk that has been pasteurized, and provide for coverage to include human milk fortifiers in certain instances. 

      The amendments revise the conditions that must be met for the health benefits coverage to apply: 

      (1)  the covered person is an infant under the age of six months;

      (2)  the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and

      (3)  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 support; or

      (4) a 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.

      The amendments clarify that the bill does not preclude insurance carriers from performing utilization review, including periodic review of the medical necessity of a particular service.  The amendments further clarify that the benefits provided pursuant to the bill are to be provided to the same extent as for any other prescribed items under the insurance policy or plan.

      The amendments provide that if there is no supply of human breast milk that meets the requirements of the bill, the insurance carrier is not required to provide coverage of expenses pursuant to the bill.

      The amendments change the effective date of the bill from the 90th day after enactment to January 1st of the year following enactment.  

 

FISCAL IMPACT:

      According to bill comments made during the discussion of the bill at the October 2015 Pension and Health Benefits Review Commission meeting, this bill will increase annual costs to the State Health Benefits Program and the School Employees’ Health Benefits Program by $4.3 million to provide health benefits coverage for donated human breast milk under certain conditions as required.