SB 5702 — Requiring coverage for donor breast milk.

S-4131.1S-3169.1 SUBSTITUTE SENATE BILL 5702 State of Washington 67th Legislature 2022 Regular Session By Senate Health & Long Term Care (originally sponsored by Senators Trudeau, Dhingra, Lovelett, Lovick, Nguyen, Nobles, Randall, Saldaña, Stanford, Van De Wege, and C.

Wilson)Wilson READPrefiled FIRST01/06/22. TIME 02/01/22.

ANRead ACTfirst Relatingtime to01/10/22. requiring coverage for donor human milk;

Referred to Committee on Health & Long Term Care.

AN ACT Relating to requiring coverage for donor breast milk;

and adding a new section to chapter 74.09 RCW;RCW.

and adding a new section to chapter 43.70 RCW.

(1) A health plan issued or renewed on or after January 1, 2023, shall provide coverage for medically necessary donor humanbreast milk for inpatient use when ordered by a licensed health care provider with prescriptive authority or an international board certified lactation consultant certified by the international lactation consultant association for an infant who is medically or physically unable to receive maternal humanbreast milk or participate in chest feeding or whose parent is medically or physically unable to produce maternal humanbreast milk in sufficient quantities or caloric density or participate in chest feeding, if the infant meets at least one of the following criteria:

(a) AnHas infanta documented birth weight of below 2,500 grams;grams or less;

(b) AnHas infanta gestationalcongenital ageor equalacquired tointestinal or lesscardiac thancondition, 34and weeks;is therefore at a high risk for development of feeding intolerance, necrotizing enterocolitis, and/or infection;

(c) Infant hypoglycemia;

1 SSBSB 5702 (d)(c) AIs highwithin riskthe forfirst development72 ofhours necrotizingsince enterocolitis,birth bronchopulmonarywithout dysplasia,sufficient ormaternal retinopathybreast ofmilk prematurity;available;

(e) A congenital or acquired(d) gastrointestinalOtherwise conditionrequires withnourishment long-termby feedingbreast ormilk. malabsorption complications;

(f)(2) CongenitalDonor heartbreast diseasemilk requiringcovered surgeryunder inthis section must be obtained from a milk bank that meets minimum standards adopted by the firstdepartment yearof health under subsection (3) of life;this section.

(g)(3) AnThe organdepartment orof bonehealth marrowmust transplant;adopt minimum standards for ensuring milk bank safety.

(h)The Sepsis;standards adopted by the department of health must be consistent with evidence-based guidelines established by a national accrediting organization and must address donor screening, milk handling and processing, and recordkeeping.

(i)(4) CongenitalA hypotoniashealth associatedplan withmay feedingnot difficultyrequire oran malabsorption;enrollee to obtain prior authorization to receive coverage for donor breast milk as required under this section.

(j)(5) RenalFor diseasepurposes requiring dialysis in the first year of life;this section:

(k)(a) Craniofacial"Donor anomalies;breast milk" means human breast milk that has been contributed to a milk bank by one or more donors without any alterations, additional products, or processing other than to keep the milk safe for human consumption.

(l)(b) An"Milk immunologicbank" deficiency;means a firm or corporation that engages in the not-for-profit procurement, processing, storage, distribution, or use of human breast milk contributed by donors.

(m)(6) NeonatalThe abstinencedepartment syndrome;of health and the commissioner may adopt any rules necessary to implement this section.

(n) Any other serious congenital or acquired condition for which the use of pasteurized donor human milk and donor human milk derived products is medically necessary and supports the treatment and recovery of the child;

or (o) Any baby still inpatient within 72 hours of birth without sufficient human milk available.

(2) Donor human milk covered under this section must be obtained from a milk bank that meets minimum standards adopted by the department of health pursuant to section 4 of this act.

(3) A health plan may not require an enrollee to obtain prior authorization to receive coverage for donor human milk as required under this section.

(4) For purposes of this section:

(a) "Donor human milk" means human milk that has been contributed to a milk bank by one or more donors without any additional products or processing other than to keep the milk safe for human consumption.

(b) "Milk bank" means an organization that engages in the procurement, processing, storage, distribution, or use of human milk contributed by donors.

(5) The department of health and the commissioner may adopt any rules necessary to implement this section.

Each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not p.subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, section 1 of this act, and chapter 48.49 RCW.

2 SSB 5702 subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, section 1 of this act, and chapter 48.49 RCW.

(1) The authority shall provide coverage under this chapter for medically necessary donor humanbreast milk for inpatient use when ordered by a licensed health care provider with prescriptive authority or an internationalp. board certified lactation consultant certified by the international lactation consultant association for an infant who is medically or physically unable to receive maternal human milk or participate in chest feeding or whose parent is medically or physically unable to produce maternal human milk in sufficient quantities or caloric density or participate in chest feeding, if the infant meets at least one of the following criteria:

(a)2 AnSB 5702 international board certified lactation consultant certified by the international lactation consultant association for an infant birthwho weightis medically or physically unable to receive maternal breast milk or participate in chest feeding or whose parent is medically or physically unable to produce maternal breast milk or participate in chest feeding, if the infant meets at least one of belowthe 2,500following grams;criteria:

(b)(a) AnHas infanta gestationaldocumented agebirth equalweight toof or2,500 lessgrams thanor 34less; weeks;

(c)(b) InfantHas hypoglycemia;a congenital or acquired intestinal or cardiac condition, and is therefore at a high risk for development of feeding intolerance, necrotizing enterocolitis and/or infection;

(d)(c) AIs highwithin riskthe forfirst development72 ofhours necrotizingsince enterocolitis,birth bronchopulmonarywithout dysplasia,sufficient ormaternal retinopathybreast ofmilk prematurity;available;

(e) A congenital or acquired(d) gastrointestinalOtherwise conditionrequires withnourishment long-termby feedingbreast ormilk. malabsorption complications;

(f)(2) CongenitalDonor heartbreast diseasemilk requiringcovered surgeryunder inthis section must be obtained from a milk bank that meets minimum standards adopted by the firstdepartment yearof health under subsection (3) of life;this section.

(g)(3) AnThe organdepartment orof bonehealth marrowmust transplant;adopt minimum standards for ensuring milk bank safety.

(h) Sepsis;