Section 443.14 - Medical Assistance Coverage for Pasteurized Donor Human Milk.(a) Pasteurized donor human milk is compensable under the Medical Assistance Program in accordance with the Commonwealth's approved State plan if:(1) The pasteurized donor human milk is medically necessary for an inpatient infant or an outpatient infant .(2) The infant's mother is medically or physically unable to produce maternal breast milk or produce maternal breast milk in sufficient quantities to meet the infant's needs or if the maternal breast milk is contraindicated. (b) The department shall regularly review and update, as needed, written guidance regarding pasteurized donor human milk. Any updated pasteurized donor human milk guidance shall be posted on the department's publicly accessible Internet website.(c) The Department of Health, in collaboration with the department, shall develop and conduct a public information campaign to inform families and health care providers of the availability of pasteurized donor human milk in this Commonwealth to treat inpatient infants and outpatient infants, as provided in this section and as medically necessary, including the availability of coverage through medical assistance.(d) The following words and phrases when used in this section shall have the meanings given to them in this subsection unless the context clearly indicates otherwise: "Inpatient infant." An infant who is younger than twelve months of age based on the infant's corrected gestational age, who is receiving care in an inpatient setting, for whom pasteurized donor human milk is medically necessary. Pasteurized donor human milk is medically necessary for an infant with any of the following health conditions:
(1) An infant birth weight equal to or less than one thousand eight hundred grams.(2) An infant gestational age equal to or less than thirty-four weeks.(3) A high risk for development of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis or retinopathy of prematurity.(4) A congenital or acquired gastrointestinal condition or other serious medical condition associated with long-term feeding or malabsorption complications.(5) Congenital heart disease requiring surgery in the first year of life.(6) Has had or will have an organ or bone marrow transplant, or has an immunologic deficiency.(7) Renal disease requiring dialysis in the first year of life.(8) Infant hypoglycemia or jaundice.(9) Neonatal abstinence syndrome.(10) Any other health condition for which the use of pasteurized donor human milk is medically necessary as determined by the department. "Licensed milk bank." A milk bank licensed in this Commonwealth or through a hospital licensure process in accordance with the act of February 12, 2020 ( P.L. 13, No.7), known as the "Keystone Mother's Milk Bank Act."
"Necrotizing enterocolitis." A life-threatening condition that most often occurs in a premature infant, but also occurs in a term infant or near-term infant, and that causes intestinal inflammation characterized by variable injury or damage to the intestinal tract resulting in the potential death of intestinal tissue.
"Neonatal abstinence syndrome." A withdrawal syndrome of an infant that occurs when an infant is born after exposure to substance abuse in utero, and that is associated with multiple side effects, including tremors, vomiting, poor feeding, poor weight gain and high-pitched crying, which may lead to increased length of hospital stays and additional health care costs depending on severity.
"Outpatient infant." An infant who is younger than twelve months of age based on the infant's corrected gestational age, who is receiving care in an outpatient setting, for whom pasteurized donor human milk is medically necessary. Pasteurized donor human milk is medically necessary for an infant with any of the following health conditions:
(1) A congenital or acquired gastrointestinal condition or other serious medical condition associated with long-term feeding or malabsorption complications.(2) Congenital heart disease requiring surgery in the first year of life.(3) Has had or will have an organ or bone marrow transplant or has an immunologic deficiency.(5) Renal disease requiring dialysis in the first year of life.(6) Any other health condition for which the use of pasteurized donor human milk is medically necessary as determined by the department. "Pasteurized donor human milk." Human milk derived from a donor as defined in section 3 of the "Keystone Mother's Milk Bank Act," which is donated to a licensed milk bank for processing and distribution.
Added by P.L. TBD 2023 No. 32,§ 1, eff. 1/22/2024.