S.6674 – Human Donor Milk Coverage Mandate

This legislation, S.6674, would require insurance policies to expand coverage for human donor milk to newborns and infants. The New York Health Plan Association (HPA) and its member health plans agree on the importance of ensuring that infants who need donor breast milk are able to receive it as part of their care. However, this bill in unnecessary as the state already has coverage of this benefit, enacted as part of the FY19 budget. Accordingly, HPA opposes S.6674.

Existing statute already requires plans to cover donor breast milk for infants in inpatient settings where medically necessary – which plans were largely doing prior to imposition of the mandate. Further, this legislation does not amend existing statute, making the actual requirement for plans difficult to determine. While existing language limits coverage of donor breast milk to specific instances where evidence shows it to beneficial and requires a licensed medical professional to issue an order, the language in this bill does not.

In addition, plans are working to move health care to a more value-based delivery system, with treatment plans and payments based on improved outcomes. Mandates on plans to cover specific services and treatments without any parameters or requirement to demonstrate improved outcomes substantially slows progress toward that goal and perpetuates a system that provides unnecessary care and services, driving up the cost of coverage for individuals and small businesses.

For all these reasons, we OPPOSE S.6674.