This section adds a new section to an existing chapter 48.43. Here is the modified chapter for context.
For group health plans other than small group health plans issued or renewed on or after January 1, 2023, a health carrier shall provide coverage for medically necessary donor human 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 board of lactation consultant examiners 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:
An infant birth weight of below 2,500 grams;
An infant gestational age equal to or less than 34 weeks;
Infant hypoglycemia;
A high risk for development of necrotizing enterocolitis, bronchopulmonary dysplasia, or retinopathy of prematurity;
A congenital or acquired gastrointestinal condition with long-term feeding or malabsorption complications;
Congenital heart disease requiring surgery in the first year of life;
An organ or bone marrow transplant;
Sepsis;
Congenital hypotonias associated with feeding difficulty or malabsorption;
Renal disease requiring dialysis in the first year of life;
Craniofacial anomalies;
An immunologic deficiency;
Neonatal abstinence syndrome;
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
Any baby still inpatient within 72 hours of birth without sufficient human milk available.
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 5 of this act.
For purposes of this section:
"Donor human milk" means human milk that has been contributed to a milk bank by one or more donors.
"Milk bank" means an organization that engages in the procurement, processing, storage, distribution, or use of human milk contributed by donors.
The commissioner may adopt any rules necessary to implement this section.
This section modifies existing section 48.43.715. Here is the modified chapter for context.
The commissioner, in consultation with the board and the health care authority, shall, by rule, select the largest small group plan in the state by enrollment as the benchmark plan for the individual and small group market for purposes of establishing the essential health benefits in Washington state.
If the essential health benefits benchmark plan for the individual and small group market does not include all of the ten essential health benefits categories, the commissioner, in consultation with the board and the health care authority, shall, by rule, supplement the benchmark plan benefits as needed.
All individual and small group health plans must cover the ten essential health benefits categories, other than a health plan offered through the federal basic health program, a grandfathered health plan, or medicaid. Such a health plan may not be offered in the state unless the commissioner finds that it is substantially equal to the benchmark plan. When making this determination, the commissioner:
Must ensure that the plan covers the ten essential health benefits categories;
May consider whether the health plan has a benefit design that would create a risk of biased selection based on health status and whether the health plan contains meaningful scope and level of benefits in each of the ten essential health benefits categories;
Notwithstanding (a) and (b) of this subsection, for benefit years beginning January 1, 2015, must establish by rule the review and approval requirements and procedures for pediatric oral services when offered in stand-alone dental plans in the nongrandfathered individual and small group markets outside of the exchange; and
Must allow health carriers to also offer pediatric oral services within the health benefit plan in the nongrandfathered individual and small group markets outside of the exchange.
Beginning December 15, 2012, and every year thereafter, the commissioner shall submit to the legislature a list of state-mandated health benefits, the enforcement of which will result in federally imposed costs to the state related to the plans sold through the exchange because the benefits are not included in the essential health benefits designated under federal law. The list must include the anticipated costs to the state of each state-mandated health benefit on the list and any statutory changes needed if funds are not appropriated to defray the state costs for the listed mandate. The commissioner may enforce a mandate on the list for the entire market only if funds are appropriated in an omnibus appropriations act specifically to pay the state portion of the identified costs.
Upon authorization by the legislature to modify the state's essential health benefits benchmark plan under 45 C.F.R. Sec. 156.111, the commissioner shall include coverage for donor human milk in the updated plan.
This section modifies existing section 41.05.017. Here is the modified chapter for context.
Each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not 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.
This section adds a new section to an existing chapter 74.09. Here is the modified chapter for context.
The authority shall provide coverage under this chapter for medically necessary donor human 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 board of lactation consultant examiners 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:
An infant birth weight of below 2,500 grams;
An infant gestational age equal to or less than 34 weeks;
Infant hypoglycemia;
A high risk for development of necrotizing enterocolitis, bronchopulmonary dysplasia, or retinopathy of prematurity;
A congenital or acquired gastrointestinal condition with long-term feeding or malabsorption complications;
Congenital heart disease requiring surgery in the first year of life;
An organ or bone marrow transplant;
Sepsis;
Congenital hypotonias associated with feeding difficulty or malabsorption;
Renal disease requiring dialysis in the first year of life;
Craniofacial anomalies;
An immunologic deficiency;
Neonatal abstinence syndrome;
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
Any baby still inpatient within 72 hours of birth without sufficient human milk available.
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 5 of this act.
The authority may require an enrollee to obtain expedited prior authorization to receive coverage for donor human milk as required under this section.
In administering this program, the authority must seek any available federal financial participation under the medical assistance program, as codified at Title XIX of the federal social security act, the state children's health insurance program, as codified at Title XXI of the federal social security act, and any other federal funding sources that are now available or may become available.
For purposes of this section:
"Donor human milk" means human milk that has been contributed to a milk bank by one or more donors.
"Milk bank" means an organization that engages in the procurement, processing, storage, distribution, or use of human milk contributed by donors.
This section adds a new section to an existing chapter 43.70. Here is the modified chapter for context.
The department shall adopt standards for ensuring milk bank safety. The standards adopted by the department must, at a minimum, consider the clinical, evidence-based guidelines established by a national accrediting organization. The standards must address donor screening, milk handling and processing, and recordkeeping. The department shall also review and consider requiring additional testing standards, including but not limited to testing for the presence of viruses, bacteria, and prescription and nonprescription drugs in donated milk.