Bill Text: IL HB3509 | 2019-2020 | 101st General Assembly | Chaptered

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Bill Title: Amends the State Employees Group Insurance Act of 1971, Illinois Insurance Code, and the Illinois Public Aid Code. Provides that pasteurized donated human breast milk shall be covered under health insurance and the medical assistance program under the Illinois Public Aid Code. Describes the requirements that must be met to have pasteurized human breast milk covered under health insurance and the medical assistance program. Effective January 1, 2020.

Spectrum: Partisan Bill (Democrat 14-0)

Status: (Passed) 2019-08-23 - Public Act . . . . . . . . . 101-0511 [HB3509 Detail]

Download: Illinois-2019-HB3509-Chaptered.html

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Public Act 101-0511
HB3509 Enrolled LRB101 09808 RAB 54909 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by adding Section 6.16 as follows:
(5 ILCS 375/6.16 new)
Sec. 6.16. Human breast milk coverage.
(a) Notwithstanding any other provision of this Act,
pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under a health plan for persons
who are otherwise eligible for coverage under this Act if the
covered person is an infant under the age of 6 months, a
licensed medical practitioner prescribes the milk for the
covered person, and all of the following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk
Banking Association of North America or is licensed by the
Department of Public Health;
(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 the maternal breast milk is contraindicated;

(3) the milk has been determined to be medically
necessary for the infant; and
(4) one or more of the following applies:
(A) the infant's birth weight is below 1,500 grams;
(B) the infant has a congenital or acquired
condition that places the infant at a high risk for
development of necrotizing enterocolitis;
(C) the infant has infant hypoglycemia;
(D) the infant has congenital heart disease;
(E) the infant has had or will have an organ
transplant;
(F) the infant has sepsis; or
(G) the infant has any other serious congenital or
acquired condition for which the use of donated human
breast milk is medically necessary and supports the
treatment and recovery of the infant.
(b) Notwithstanding any other provision of this Act,
pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under a health plan for persons
who are otherwise eligible for coverage under this Act if the
covered person is a child 6 months through 12 months of age, a
licensed medical practitioner prescribes the milk for the
covered person, and all of the following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk

Banking Association of North America or is licensed by the
Department of Public Health;
(2) 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;
(3) the milk has been determined to be medically
necessary for the child; and
(4) one or more of the following applies:
(A) the child has spinal muscular atrophy;
(B) the child's birth weight was below 1,500 grams
and he or she has long-term feeding or gastrointestinal
complications related to prematurity;
(C) the child has had or will have an organ
transplant; or
(D) the child has a congenital or acquired
condition for which the use of donated human breast
milk is medically necessary and supports the treatment
and recovery of the child.
Section 10. The Illinois Insurance Code is amended by
adding Section 356z.33 as follows:
(215 ILCS 5/356z.33 new)
Sec. 356z.33. Human breast milk coverage.
(a) Notwithstanding any other provision of this Act,

pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under an individual or group
health insurance for persons who are otherwise eligible for
coverage under this Act if the covered person is an infant
under the age of 6 months, a licensed medical practitioner
prescribes the milk for the covered person, and all of the
following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk
Banking Association of North America or is licensed by the
Department of Public Health;
(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 the maternal breast milk is contraindicated;
(3) the milk has been determined to be medically
necessary for the infant; and
(4) one or more of the following applies:
(A) the infant's birth weight is below 1,500 grams;
(B) the infant has a congenital or acquired
condition that places the infant at a high risk for
development of necrotizing enterocolitis;
(C) the infant has infant hypoglycemia;
(D) the infant has congenital heart disease;
(E) the infant has had or will have an organ

transplant;
(F) the infant has sepsis; or
(G) the infant has any other serious congenital or
acquired condition for which the use of donated human
breast milk is medically necessary and supports the
treatment and recovery of the infant.
(b) Notwithstanding any other provision of this Act,
pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under an individual or group
health insurance for persons who are otherwise eligible for
coverage under this Act if the covered person is a child 6
months through 12 months of age, a licensed medical
practitioner prescribes the milk for the covered person, and
all of the following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk
Banking Association of North America or is licensed by the
Department of Public Health;
(2) 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;
(3) the milk has been determined to be medically
necessary for the child; and
(4) one or more of the following applies:

(A) the child has spinal muscular atrophy;
(B) the child's birth weight was below 1,500 grams
and he or she has long-term feeding or gastrointestinal
complications related to prematurity;
(C) the child has had or will have an organ
transplant; or
(D) the child has a congenital or acquired
condition for which the use of donated human breast
milk is medically necessary and supports the treatment
and recovery of the child.
Section 15. The Illinois Public Aid Code is amended by
adding Section 5-40 as follows:
(305 ILCS 5/5-40 new)
Sec. 5-40. Human breast milk coverage.
(a) Notwithstanding any other provision of this Act,
pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under a health plan for persons
who are otherwise eligible for coverage under this Act if the
covered person is an infant under the age of 6 months, a
licensed medical practitioner prescribes the milk for the
covered person, and all of the following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk

Banking Association of North America or is licensed by the
Department of Public Health;
(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 the maternal breast milk is contraindicated;
(3) the milk has been determined to be medically
necessary for the infant; and
(4) one or more of the following applies:
(A) the infant's birth weight is below 1,500 grams;
(B) the infant has a congenital or acquired
condition that places the infant at a high risk for
development of necrotizing enterocolitis;
(C) the infant has infant hypoglycemia;
(D) the infant has congenital heart disease;
(E) the infant has had or will have an organ
transplant;
(F) the infant has sepsis; or
(G) the infant has any other serious congenital or
acquired condition for which the use of donated human
breast milk is medically necessary and supports the
treatment and recovery of the infant.
(b) Notwithstanding any other provision of this Act,
pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under a health plan for persons

who are otherwise eligible for coverage under this Act if the
covered person is a child 6 months through 12 months of age, a
licensed medical practitioner prescribes the milk for the
covered person, and all of the following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk
Banking Association of North America or is licensed by the
Department of Public Health;
(2) 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;
(3) the milk has been determined to be medically
necessary for the child; and
(4) one or more of the following applies:
(A) the child has spinal muscular atrophy;
(B) the child's birth weight was below 1,500 grams
and he or she has long-term feeding or gastrointestinal
complications related to prematurity;
(C) the child has had or will have an organ
transplant; or
(D) the child has a congenital or acquired
condition for which the use of donated human breast
milk is medically necessary and supports the treatment
and recovery of the child.
(c) Notwithstanding any other provision of this Act,

pasteurized donated human breast milk, which may include human
milk fortifiers if indicated by a prescribing licensed medical
practitioner, shall be covered under a health plan for persons
who are otherwise eligible for coverage under this Act if the
covered person is a child 12 months of age or older, a licensed
medical practitioner prescribes the milk for the covered
person, and all of the following conditions are met:
(1) the milk is obtained from a human milk bank that
meets quality guidelines established by the Human Milk
Banking Association of North America or is licensed by the
Department of Public Health;
(2) 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;
(3) the milk has been determined to be medically
necessary for the child; and
(4) the child has spinal muscular atrophy.
Section 99. Effective date. This Act takes effect January
1, 2020.