Bill Text: NJ S2976 | 2016-2017 | Regular Session | Amended
Bill Title: Requires health benefits coverage for donated human breast milk under certain conditions.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Enrolled - Dead) 2018-01-08 - Passed Assembly (Passed Both Houses) (66-1-2) [S2976 Detail]
Download: New_Jersey-2016-S2976-Amended.html
Sponsored by:
Senator LORETTA WEINBERG
District 37 (Bergen)
Senator M. TERESA RUIZ
District 29 (Essex)
SYNOPSIS
Requires health benefits coverage for donated human breast milk under certain conditions.
CURRENT VERSION OF TEXT
As reported by the Senate Budget and Appropriations Committee on December 18, 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; and
(3)]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 1; 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 who 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 Health1.
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.
1c. Nothing in this section shall preclude the hospital service corporation from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the hospital service corporation shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
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.
1c. Nothing in this section shall preclude the medical service corporation from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the medical service corporation shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
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.
1c. Nothing in this section shall preclude the health service corporation from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the health service corporation shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
1c. Nothing in this section shall preclude the insurer from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the policy.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the insurer shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
1c. Nothing in this section shall preclude the insurer from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the policy.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the insurer shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
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.
1c. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the plan.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
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.
1c. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the plan.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.1
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; and
(3)]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 1; 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 who 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 Health1.
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.
1c. Nothing in this section shall preclude the health maintenance organization from performing utilization review, including periodic review of the medical necessity of a particular service.
d. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the health maintenance organization shall not be required to provide coverage of expenses pursuant to this section.1
9. 1a.1 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; and
(3)]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 1; 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 who 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 Health1.
1b. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
c. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
d. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.1
10. 1a.1 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; and
(3)]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 1; 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 who 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 Health1.
1b. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
c. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
d. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.1
11. This act shall take effect on 1[the 90th day after] January 1st of the year following1 enactment
