SB 240 — Donor Human Milk Bank Services

Florida Senate - 2021 CS for SB 240 By Senatorthe BookCommittee 32-00432-21on 2021240__Health APolicy; bill to be entitled An act relating to donor human milk bank services;

amendingand s.Senator Book 588-02670-21 2021240c1 A bill to be entitled An act relating to donor human milk bank services;

409.906,creating F.S.;s.

authorizing383.017, theF.S.; Agency for Health Care Administration to pay for donor human milk bank services as an optional Medicaid service if certain conditions are met;

specifyingproviding coveragelegislative requirements;intent;

amendingdefining s.the term “donor human milk bank”;

409.908,requiring F.S.;the Department of Health to establish certain standards for the regulation of donor human milk banks;

addingrequiring donor human milk bankbanks services to thecomply listwith ofcertain Medicaidstandards; services authorized for reimbursement on a fee-for service basis;

amendingrequiring s.the department to adopt rules;

409.973, F.S.;

adding donor human milk bank services to the list of minimum benefits required to be covered by Medicaid managed care plans;

1511 Be It Enacted by the Legislature of the State of Florida:

1713 Section 1. Subsection1. Section (28)383.017, is added to section 409.906, Florida Statutes, is created to read:

409.906 Optional383.017 Donor Medicaidhuman services.—Subjectmilk tobanks.— specific(1) It appropriations,is the agencyintent mayof makethe paymentsLegislature for services which are optional to protect the statehealth, undersafety, Titleand XIXwelfare of thehuman Socialmilk Securitydonors Act and arerecipients furnishedof byhuman Medicaidmilk providersdonation toand recipients who are determined to beencourage eligiblethe onuse theof datesdonor onhuman whichmilk theand servicesdonor werehuman provided.milk derivatives.

Any(2) As optionalused servicein thatthis issection, providedthe shallterm be“donor providedhuman onlymilk whenbank” medicallymeans necessaryany andentity inor accordanceorganization withoperating within this state andwhich federalcollects, law.processes, stores, tests, or distributes donor human milk or donor human milk derivatives.

Optional(3) The servicesDepartment renderedof byHealth providersshall inestablish mobileminimum unitsstandards tofor Medicaidthe recipientsregulation mayof bedonor restrictedhuman ormilk prohibitedbanks bywhich must address the agency.following:

Nothing(a) The inoperation thisof sectiona shalldonor behuman construedmilk tobank preventthat orfacilitates limit the agencydonation, fromprocessing, adjustingand fees,distribution reimbursement rates, lengths of stay,donor numberhuman ofmilk visits, or number of services, or making any other adjustments necessary to comply with the availability of moneys and anydonor limitationshuman ormilk directionsderivatives; provided for in the General Appropriations Act or chapter 216.

If(b) Procedures necessaryfor todonation safeguardand thedistribution state’s systems of providingdonor serviceshuman tomilk elderly and disableddonor personshuman andmilk subjectderivatives; to the notice and review provisions of s.

216.177,and the(c) Testing Governorof maydonor directhuman themilk Agencyand fordonor Healthhuman Caremilk Administrationderivatives tobefore amenddonation, theprocessing, Medicaidand statedistribution plan to deleteensure the optionalabsence Medicaidof serviceadulterants knownand asother “Intermediatecontaminants Careas Facilitiesdetermined forby the Developmentallydepartment. Disabled.” Optional services may include:

(28) DONOR(4) A HUMAN MILK BANK SERVICES.—The agency may pay for the cost of donor human milk,milk forbank homeoperating andin inpatientthis use,state forshall whichcomply awith licensedthe physicianstandards orestablished nurseby practitionerthe hasdepartment issuedpursuant an order for an infant who is medically or physically unable to receivethis maternalsection. breast milk or breastfeed or whose mother is medically or physically unable to produce maternal breast milk or breastfeed.

Such(5) The infantdepartment mustshall haveadopt arules documentedto birthimplement weightthis ofsection. 1,500 grams or less;

haveSection a2. This congenitalact orshall acquiredtake intestinaleffect conditionJuly and1, be2021. at high risk for developing a feeding intolerance, necrotizing enterocolitis, or an infection;

or otherwise require nourishment by breast milk.

The donor human milk must be procured from a nonprofit milk bank certified by the Human Milk Banking Association of North America (HMBANA).

Coverage for donor human milk may not be less than the reasonable cost of such milk procured from an HMBANA-certified milk bank, plus reasonable processing and handling fees.

Section 2. Present paragraphs (f) through (t) of subsection (3) of section 409.908, Florida Statutes, are redesignated as paragraphs (g) through (u), respectively, and a new paragraph (f) is added to that subsection, to read:

409.908 Reimbursement of Medicaid providers.—Subject to specific appropriations, the agency shall reimburse Medicaid providers, in accordance with state and federal law, according to methodologies set forth in the rules of the agency and in policy manuals and handbooks incorporated by reference therein.

These methodologies may include fee schedules, reimbursement methods based on cost reporting, negotiated fees, competitive bidding pursuant to s.

287.057, and other mechanisms the agency considers efficient and effective for purchasing services or goods on behalf of recipients.

If a provider is reimbursed based on cost reporting and submits a cost report late and that cost report would have been used to set a lower reimbursement rate for a rate semester, then the provider’s rate for that semester shall be retroactively calculated using the new cost report, and full payment at the recalculated rate shall be effected retroactively.

Medicare-granted extensions for filing cost reports, if applicable, shall also apply to Medicaid cost reports.

Payment for Medicaid compensable services made on behalf of Medicaid eligible persons is subject to the availability of moneys and any limitations or directions provided for in the General Appropriations Act or chapter 216.

Further, nothing in this section shall be construed to prevent or limit the agency from adjusting fees, reimbursement rates, lengths of stay, number of visits, or number of services, or making any other adjustments necessary to comply with the availability of moneys and any limitations or directions provided for in the General Appropriations Act, provided the adjustment is consistent with legislative intent.

(3) Subject to any limitations or directions provided for in the General Appropriations Act, the following Medicaid services and goods may be reimbursed on a fee-for-service basis.

For each allowable service or goods furnished in accordance with Medicaid rules, policy manuals, handbooks, and state and federal law, the payment shall be the amount billed by the provider, the provider’s usual and customary charge, or the maximum allowable fee established by the agency, whichever amount is less, with the exception of those services or goods for which the agency makes payment using a methodology based on capitation rates, average costs, or negotiated fees.

(f) Donor human milk bank services.

Section 3. Present paragraphs (e) through (bb) of subsection (1) of section 409.973, Florida Statutes, are redesignated as paragraphs (f) through (cc), respectively, and a new paragraph (e) is added to that subsection, to read:

409.973 Benefits.— (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a minimum, the following services:

(e) Donor human milk bank services.

Section 4. This act shall take effect July 1, 2021.