Public Act 101-0511
 
HB3509 EnrolledLRB101 09808 RAB 54909 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  



 
 
    Section 5. The State Employees Group Insurance Act of 1971 
is amended  by adding Section 6.16 as follows:
 
    (5 ILCS 375/6.16 new)
    Sec. 6.16. Human breast milk coverage.
    (a) Notwithstanding any other provision of this Act, 
pasteurized donated human breast milk, which may include human 
milk fortifiers if indicated by a prescribing licensed medical 
practitioner, shall be covered under a health plan for persons 
who are otherwise eligible for coverage under this Act if the 
covered person is an infant under the age of 6 months, a 
licensed medical practitioner prescribes the milk for the 
covered person, and all of the following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (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 the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the infant; and
        (4) one or more of the following applies:
            (A) the infant's birth weight is below 1,500 grams;
            (B) the infant has a congenital or acquired 
        condition that places the infant at a high risk for 
        development of necrotizing enterocolitis;
            (C) the infant has infant hypoglycemia;
            (D) the infant has congenital heart disease;
            (E) the infant has had or will have an organ 
        transplant;
            (F) the infant has sepsis; or
            (G) the infant has any other  serious congenital or 
        acquired condition for which the use of donated human 
        breast milk is medically necessary and supports the 
        treatment and recovery of the infant.
    (b) Notwithstanding any other provision of this Act, 
pasteurized donated human breast milk, which may include human 
milk fortifiers if indicated by a prescribing licensed medical 
practitioner, shall be covered under a health plan for persons 
who are otherwise eligible for coverage under this Act if the 
covered person is a child 6 months through 12 months of age, a 
licensed medical practitioner prescribes the milk for the 
covered person, and all of the following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (2) the child's mother is medically or physically 
    unable to produce maternal breast milk  or produce maternal 
    breast milk in sufficient quantities to meet the child's 
    needs or the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the child; and
        (4) one or more of the following applies:
            (A) the child has spinal muscular atrophy;
            (B) the child's birth weight was below 1,500 grams 
        and he or she has long-term feeding or gastrointestinal 
        complications related to prematurity;
            (C) the child has had or will have an organ 
        transplant; or
            (D) the child has a  congenital or acquired 
        condition for which the use of donated human breast 
        milk is medically necessary and supports the treatment 
        and recovery of the child.
 
    Section 10. The Illinois Insurance Code is amended  by 
adding Section 356z.33 as follows:
 
    (215 ILCS 5/356z.33 new)
    Sec. 356z.33. Human breast milk coverage.
    (a) Notwithstanding any other provision of this Act, 
pasteurized donated human breast milk, which may include human 
milk fortifiers if indicated by a prescribing licensed medical 
practitioner, shall be covered under an individual or group 
health insurance for persons who are otherwise eligible for 
coverage under this Act if the covered person is an infant 
under the age of 6 months, a licensed medical practitioner 
prescribes the milk for the covered person, and all of the 
following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (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 the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the infant; and
        (4) one or more of the following applies:
            (A) the infant's birth weight is below 1,500 grams;
            (B) the infant has a congenital or acquired 
        condition that places the infant at a high risk for 
        development of necrotizing enterocolitis;
            (C) the infant has infant hypoglycemia;
            (D) the infant has congenital heart disease;
            (E) the infant has had or will have an organ 
        transplant;
            (F) the infant has sepsis; or
            (G) the infant has any other  serious congenital or 
        acquired condition for which the use of donated human 
        breast milk is medically necessary and supports the 
        treatment and recovery of the infant.
    (b) Notwithstanding any other provision of this Act, 
pasteurized donated human breast milk, which may include human 
milk fortifiers if indicated by a prescribing licensed medical 
practitioner, shall be covered under an individual or group 
health insurance for persons who are otherwise eligible for 
coverage under this Act if the covered person is a child 6 
months through 12 months of age, a licensed medical 
practitioner prescribes the milk for the covered person, and 
all of the following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (2) the child's mother is medically or physically 
    unable to produce maternal breast milk  or produce maternal 
    breast milk in sufficient quantities to meet the child's 
    needs or the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the child; and
        (4) one or more of the following applies:
            (A) the child has spinal muscular atrophy;
            (B) the child's birth weight was below 1,500 grams 
        and he or she has long-term feeding or gastrointestinal 
        complications related to prematurity;
            (C) the child has had or will have an organ 
        transplant; or
            (D) the child has a  congenital or acquired 
        condition for which the use of donated human breast 
        milk is medically necessary and supports the treatment 
        and recovery of the child.
 
    Section 15. The Illinois Public Aid Code is amended  by 
adding Section 5-40 as follows:
 
    (305 ILCS 5/5-40 new)
    Sec. 5-40. Human breast milk coverage.
    (a) Notwithstanding any other provision of this Act, 
pasteurized donated human breast milk, which may include human 
milk fortifiers if indicated by a prescribing licensed medical 
practitioner, shall be covered under a health plan for persons 
who are otherwise eligible for coverage under this Act if the 
covered person is an infant under the age of 6 months, a 
licensed medical practitioner prescribes the milk for the 
covered person, and all of the following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (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 the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the infant; and
        (4) one or more of the following applies:
            (A) the infant's birth weight is below 1,500 grams;
            (B) the infant has a congenital or acquired 
        condition that places the infant at a high risk for 
        development of necrotizing enterocolitis;
            (C) the infant has infant hypoglycemia;
            (D) the infant has congenital heart disease;
            (E) the infant has had or will have an organ 
        transplant;
            (F) the infant has sepsis; or
            (G) the infant has any other  serious congenital or 
        acquired condition for which the use of donated human 
        breast milk is medically necessary and supports the 
        treatment and recovery of the infant.
    (b) Notwithstanding any other provision of this Act, 
pasteurized donated human breast milk, which may include human 
milk fortifiers if indicated by a prescribing licensed medical 
practitioner, shall be covered under a health plan for persons 
who are otherwise eligible for coverage under this Act if the 
covered person is a child 6 months through 12 months of age, a 
licensed medical practitioner prescribes the milk for the 
covered person, and all of the following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (2) the child's mother is medically or physically 
    unable to produce maternal breast milk  or produce maternal 
    breast milk in sufficient quantities to meet the child's 
    needs or the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the child; and
        (4) one or more of the following applies:
            (A) the child has spinal muscular atrophy;
            (B) the child's birth weight was below 1,500 grams 
        and he or she has long-term feeding or gastrointestinal 
        complications related to prematurity;
            (C) the child has had or will have an organ 
        transplant; or
            (D) the child has a  congenital or acquired 
        condition for which the use of donated human breast 
        milk is medically necessary and supports the treatment 
        and recovery of the child.
    (c) Notwithstanding any other provision of this Act,

pasteurized donated human breast milk, which may include human

milk fortifiers if indicated by a prescribing licensed medical

practitioner, shall be covered under a health plan for persons

who are otherwise eligible for coverage under this Act if the

covered person is a child 12 months of age or older, a licensed

medical practitioner prescribes the milk for the covered

person, and all of the following conditions are met:
        (1) the milk is obtained from a  human milk bank that 
    meets quality guidelines established by the Human Milk 
    Banking Association of North America or is licensed by the 
    Department of Public Health;
        (2) the child's mother is medically or physically 
    unable to produce maternal breast milk  or produce maternal 
    breast milk in sufficient quantities to meet the child's 
    needs or the maternal breast milk is contraindicated;
        (3) the milk has been determined to be medically 
    necessary for the child; and
        (4) the child has spinal muscular atrophy.
 
 
    Section 99. Effective date. This Act takes effect January 
1, 2020.