BILL NUMBER:  S4526              Revised 03/24/17

 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 ensure high risk, premature babies have access to one of the most
effective measures of preventing death and disability.

 SUMMARY OF PROVISIONS :

Section one amends Social Services Law § 365-a(2) to provide Medicaid
coverage of donor breast milk (PDHM) for inpatient use, ordered by a
licensed medical practitioner for a high risk preterm infant who is
unable to receive own mother's breast milk or the own mother is unable
to provide. Coverage shall be for a reasonable cost of such milk
procured from a certified nonprofit milk bank, plus a reasonable
handling fee.

Section two provides this act takes effect the first of January
succeeding its enactment.

              

 JUSTIFICATION :

Premature infants, particularly those born with birth weight of 1,500
grams or less, are at high risk of developing necrotizing
enterocolitis (NEC), a sudden onset intestinal disease affecting
approximately 7% of these infants. The disease causes inflammation in
the small intestines and in some cases (30%) intestinal perforation.
Formula feeding and extreme prematurity increase the risks. Mortality
from the disease is extremely high, ranging from 10-50%. Among
survivors, the disease increases the risk of infections, prolongs the
hospital stay, leads to feeding intolerance and dependence on
intravenous nutrition, and may impart lifelong intestinal problems.
Survivors of necrotizing enterocolitis have an increased risk of
developmental disabilities such as cerebral palsy.

The own mother's breast milk is the optimal nutrition for every baby.
In the case of premature infants, it has long been known that the
greatest preventive measure for necrotizing enterocolitis is for the
infant to be fed own mother's breast milk. Donor breast milk (PDHM)
which is pasteurized donated breast milk from screened and medically
tested healthy lactating women, currently has the next best
nutritional profile, especially in the digestibility of the proteins,
the quality of the fat. Additionally, PDHM provides anti-infective
factors, intestinal growth factors and hormones, as well as substances
which promote the growth of healthy intestinal bacteria all of which
have been shown to improve health in preterm infants. Of note, these
protective factors are absent in the infant formulas. In a 2012 policy
statement, the American Academy of Pediatrics recommended feeding
preterm infants PDHM 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 lifesaving,
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 despite lactation support, and must rely on
pasteurized donor milk in order to most optimally nourish their high
risk babies and also to provide them with this preventative measure.
Presently, PDHM is not covered by insurance companies or Medicaid in
the state. At a cost of 2-3 times costs higher than formula, PDHM is
unaffordable for many families who would benefit it. While the initial
costs of PDHM may be more than formula, its use amongst those at risk
of NEC would provide substantial costs savings to the health care
system and the Medicaid program. While the number of infants in New
York State who would be eligible for coverage of PDHM under this
proposal is only 1.5%, these critically ill, very low birthweight,
premature infants constitute the majority of the total Medicaid budget
for neonatal care. With the use of PDHM expected to reduce the
incidence of NEC by roughly 50%, such coverage would not only save
lives but save considerable Medicaid dollars.

This bill is dedicated to Elizabeth Nostrand, a strong and caring
woman who worked diligently to ensure that this become law.

 LEGISLATIVE HISTORY :

Similar to S.6583B of 2016

 FISCAL IMPLICATIONS :

Savings to the Medicaid program.

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