NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9353C Revised 06/14/16
SPONSOR: Solages (MS) 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 OR GENERAL IDEA OF BILL:
To provide one of the most effective measures for preventing death of
high risk babies that are born prematurely
SUMMARY OF SPECIFIC PROVISIONS:
Amends Subdivision 2 of section 365-a of the social services law to
provide for the coverage of donor breast milk, ordered by a licensed
medical practitioner for an infant who is unable to receive breast milk
or a mother is unable to provide. Coverage shall be for a reasonable
cost of such milk procured from a certified milk bank, plus a reasonable
handling fee.
JUSTIFICATION:
Premature infants, particularly those less than 1,500 grams or less, are
at high risk of developing necrotizing enterocolitis (NEC), a sudden
onset intestinal disease which affects approximately 6% of these
infants. Mortality from the disease is extremely high, ranging from
10-50%. Even among survivors, the disease causes increased risk of
infection, may impart lifelong intestinal problems and has been associ-
ated with an increased risk of mental retardation.
It has long been known that the greatest preventive measure for this
condition is for the infant to be fed breast milk. The mother's own
breast milk is the optimal nutrition for her baby. Donor breast milk
which is processed and pasteurized currently has the next best nutri-
tional profile, especially in the digestibility of the proteins. Both
are nutritionally superior to current standard preterm formulas. In a
2012 policy statement, the American Academy of Pediatrics recommended
feeding preterm infants donated human milk when maternal breast milk is
not available. Several other organizations, including the Academy of
Breast-feeding Medicine, the European Society for Pediatric Gastroenter-
ology, Hepatology and Nutrition and its North American counterpart, all
agree providing this "medicine" for high-risk infants can be lifesaving,
including reducing the rate of NEC by a factor of two or more. Unfortu-
nately, not all mothers of premature babies are able or well enough to
lactate, and must rely on pasteurized, donated mother's milk to provide
this preventative measure for their high-risk newborn. Presently,
donated mother's milk is not covered by insurance companies or Medicaid
and is expensive, costing approximately five dollars per ounce from a
Human-Milk-Bank-Association-of-North-America certified outlet.
Medicaid coverage of pasteurized human donor breast milk would provide
substantial costs savings within the Medicaid program. While the number
of infants in New York State who would be eligible for coverage of donor
breast milk is only 1.5%, these critically-ill, very low birthweight,
premature infants constitute the majority of the total Medicaid budget
for neonatal care. Given that use of pasteurized donor milk is expected
to reduce the risk of NEC by roughly 2.5 times, it is clear Medicaid
coverage of donor breast milk would be COST-SAVING to the Medicaid
program, and ultimately the New York State taxpayer. Of note, these
estimates do not begin to factor in out-patient costs such as increased
physician visits, repeat hospitalizations, and the significant physical
and occupational therapy costs these patients incur upon hospital
discharge.
This bill is dedicated to Elizabeth Nostrand, a strong and caring woman
who worked diligently to ensure that this become law.
PRIOR LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
In the aggregate, this measure would provide a cost-savings to New York
State.
EFFECTIVE DATE:
This act shall take effect on the first of January next succeeding the
date on which it shall have become law.
