BILL NUMBER: S1802

SPONSOR: RIVERA
 
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 handl-
ing fee.

Section two provides this act takes effect the first of January succeed-
ing 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
(NFC),.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 entero-
colitis 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 great-
est 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 heal-
thy 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 coun-

terpart, 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 pasteu-
rized donor milk in order to most optimally nourish their high risk
babies and also to provide them with this preventative measure.  Pres-
ently, 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 unaf-
fordable 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.65833 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.