BILL NUMBER:  S6583           REVISED MEMO 03/30/2016

 TITLE OF BILL :  An act to amend the social services law, in relation
to requiring medical assistance coverage for the cost of donor breast
milk in certain circumstances

 PURPOSE :

To provide one of the most effective measures for preventing death of
high risk babies that are born prematurely

 SUMMARY OF PROVISIONS :

Amends Subdivision 2 of section 365-a of the social services law to
provide for the cost of donor breast milk, for home and inpatient use,
for which a licensed medical practitioner has issued a written or
electronic order. Coverage for donor breast milk shall not be less
than an amount equal to the market cost of such milk procured from a
Human Milk Bank Association certified milk bank, plus twenty percent
of such cost for the processing thereof.

 JUSTIFICATION :

Premature infants, particularly those less than 1,500 grams or less,
are at high risk of developing necrotizing enterocolitis (NEC), a
sudden onset intestinal disease which affects approximately 6% of
              

these infants. Mortality from the disease is extremely high, ranging
from 10-50%. Even among survivors, the disease causes increased risk
of infection, may impart lifelong intestinal problems and has been
associated with an increased risk of mental retardation.

It has long been known that the greatest preventive measure for this
condition is for the infant to be fed breast milk. The mother's own
breast milk is the optimal nutrition for her baby. Donor breast milk
which is processed and pasteurized currently has the next best
nutritional profile, especially in the digestibility of the proteins.
Both are nutritionally superior to current standard preterm formulas.
In a 2012 policy statement, the American Academy of Pediatrics
recommended feeding preterm infants donated human milk when maternal
breast milk is not available. Several other organizations, including
the Academy of Breast-feeding Medicine, the European Society for
Pediatric Gastroenterology, Hepatology and Nutrition and its North
American counterpart, all agree providing this "medicine" for
high-risk infants can be life- saving, including reducing the rate of
NEC by a factor of two or more.  Unfortunately, not all mothers of
premature babies are able or well enough to lactate, and must rely on
pasteurized, donated mother's milk to provide this preventative
measure for their high-risk newborn. Presently, donated mother's milk
is not covered by insurance companies or Medicaid and is expensive,
costing approximately five dollars per ounce from a
Human-Milk-BankAssociation-of-North-America certified outlet.

Medicaid coverage of pasteurized human donor breast milk would provide
substantial costs savings within the Medicaid program. While the
number of infants in New York State who would be eligible for coverage
of donor breast milk is only 1.5%, these critically-ill, very low
birthweight, premature infants constitute the majority of the total
Medicaid budget for neonatal care. Given that use of pasteurized donor
milk is expected to reduce the risk of NEC by roughly 2.5 times, it is
clear Medicaid coverage of donor breast milk would be COST-SAVING to
the Medicaid program, and ultimately the New York State taxpayer. Of
note, these estimates do not begin to factor in out-patient costs such
as increased physician visits, repeat hospitalizations, and the
significant physical and occupational therapy costs these patients
incur upon hospital discharge.

 LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

In the aggregate, this measure would provide a cost-savings to New
York State.

 EFFECTIVE DATE :
This act shall take effect on the first of January next succeeding the
date on which it shall have become a law.

                                 BILL NUMBER:  S6583A

 TITLE OF BILL :  An act to amend the social services law, in relation
to requiring medical assistance coverage for the cost of donor breast
milk in certain circumstances

 PURPOSE :

To provide one of the most effective measures for preventing death of
high risk babies that are born prematurely

 SUMMARY OF PROVISIONS :

Amends Subdivision 2 of section 365-a of the social services law to
provide for the cost of donor breast milk, for home and inpatient use,
for which a licensed medical practitioner has issued a written or
electronic order. Coverage for donor breast milk shall not be less
than an amount equal to the market cost of such milk procured from a
Human Milk Bank Association certified milk bank, plus twenty percent
of such cost for the processing thereof.

 JUSTIFICATION :

Premature infants, particularly those less than 1,500 grams or less,
are at high risk of developing necrotizing enterocolitis (NEC), a
sudden onset intestinal disease which affects approximately 6% of
              

these infants. Mortality from the disease is extremely high, ranging
from 10-50%. Even among survivors, the disease causes increased risk
of infection, may impart lifelong intestinal problems and has been
associated with an increased risk of mental retardation.

It has long been known that the greatest preventive measure for this
condition is for the infant to be fed breast milk. The mother's own
breast milk is the optimal nutrition for her baby. Donor breast milk
which is processed and pasteurized currently has the next best
nutritional profile, especially in the digestibility of the proteins.
Both are nutritionally superior to current standard preterm formulas.
In a 2012 policy statement, the American Academy of Pediatrics
recommended feeding preterm infants donated human milk when maternal
breast milk is not available. Several other organizations, including
the Academy of Breast-feeding Medicine, the European Society for
Pediatric Gastroenterology, Hepatology and Nutrition and its North
American counterpart, all agree providing this "medicine" for
high-risk infants can be life- saving, including reducing the rate of
NEC by a factor of two or more.  Unfortunately, not all mothers of
premature babies are able or well enough to lactate, and must rely on
pasteurized, donated mother's milk to provide this preventative
measure for their high-risk newborn. Presently, donated mother's milk
is not covered by insurance companies or Medicaid and is expensive,
costing approximately five dollars per ounce from a
Human-Milk-BankAssociation-of-North-America certified outlet.

Medicaid coverage of pasteurized human donor breast milk would provide
substantial costs savings within the Medicaid program. While the
number of infants in New York State who would be eligible for coverage
of donor breast milk is only 1.5%, these critically-ill, very low
birthweight, premature infants constitute the majority of the total
Medicaid budget for neonatal care. Given that use of pasteurized donor
milk is expected to reduce the risk of NEC by roughly 2.5 times, it is
clear Medicaid coverage of donor breast milk would be COST-SAVING to
the Medicaid program, and ultimately the New York State taxpayer. Of
note, these estimates do not begin to factor in out-patient costs such
as increased physician visits, repeat hospitalizations, and the
significant physical and occupational therapy costs these patients
incur upon hospital discharge.

 LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

In the aggregate, this measure would provide a cost-savings to New
York State.

 EFFECTIVE DATE :
This act shall take effect on the first of January next succeeding the
date on which it shall have become a law.