Overview
Title
To amend titles XIX and XXI of the Social Security Act and title XXVII of the Public Health Service Act to require no-cost coverage of human milk fortifier.
ELI5 AI
The bill wants to make sure that special milk for tiny babies, called human milk fortifier, is given for free through programs like Medicaid and health insurance starting in 2025, so these babies get the nutrients they need to grow healthy.
Summary AI
H.R. 7141, titled the "Supporting Premature Infant Nutrition Act of 2024," proposes amendments to several healthcare-related statutes, including titles XIX and XXI of the Social Security Act and title XXVII of the Public Health Service Act. The bill aims to ensure that human milk fortifier, a specialized nutritional product for certain infants, is covered without cost-sharing under Medicaid, the Children's Health Insurance Program (CHIP), and both group and individual health insurance plans starting January 1, 2025. The measure outlines specific medical conditions under which infants would be eligible for this no-cost coverage, emphasizing the importance of access to essential nutrition for premature and underweight infants.
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AnalysisAI
General Summary of the Bill
The proposed legislation, titled the "Supporting Premature Infant Nutrition Act of 2024," seeks to amend several titles of the Social Security Act and the Public Health Service Act. The main aim is to ensure that human milk fortifiers are covered at no cost under various health programs, including Medicaid, the Children's Health Insurance Program (CHIP), and both group and individual health insurance plans. Effective January 1, 2025, these provisions are designed to support the nutritional needs of premature infants who require human milk fortifiers, which are specialized nutritional supplements derived from donor human milk.
Summary of Significant Issues
One major issue with the bill is its potential financial burden on state and private healthcare systems, as there is no specified federal funding to support the mandate for no-cost coverage. Additionally, the terminology used in the bill, such as "specified professional," which determines medical necessity, is not clearly defined. This could lead to inconsistencies in how the bill is applied.
There is also concern over the potential for states to delay implementing the coverage if additional state legislation is deemed necessary, possibly leading to uneven access for eligible infants. Moreover, the bill's lack of provisions addressing potential misuse or overuse of the covered products heightens the risk of inflated costs for insurers or increased premiums for policyholders. The absence of a clear definition for "human milk fortifier" adds further ambiguity in determining which specific products are eligible for coverage.
Impact on the Public Broadly
Broadly, the bill aims to remove financial barriers for families with premature infants who require supplemental nutrition through human milk fortifiers. By ensuring that such fortifiers are covered at no cost, the bill could alleviate some of the economic pressures on these families and potentially improve the health outcomes for affected infants. However, the cost implications for insurers and their beneficiaries are unclear, which might result in increased premiums for all policyholders if insurers attempt to offset the costs of providing no-cost coverage.
Impact on Specific Stakeholders
For families with premature infants, the bill represents a positive step toward providing essential nutritional support without financial burden, which is a crucial aspect of infant healthcare. However, insurers, both public and private, might face financial strain due to the mandate for no-cost coverage. The lack of federal funding to support these requirements could compel insurance providers to find alternative means, potentially affecting the cost structure of health insurance products. Additionally, healthcare practitioners tasked with determining the medical necessity of these fortifiers may face challenges due to unclear guidelines on their authority and responsibilities under the bill.
State governments might experience varying levels of pressure based on whether they need to enact new legislation to comply with the bill. This could result in a patchwork of implementation timelines, affecting the uniformity of access to these essential nutrition products across different states.
Issues
The requirement for no-cost coverage of human milk fortifier could potentially place financial strain on both state and private health insurance plans without clear allocation of federal funds to support this mandate, as described in Section 2 (including 2730).
The term 'specified professional' is vaguely defined, potentially creating ambiguity about who qualifies to determine medical necessity, as noted in Section 2.
There is potential for states to delay implementation due to the clause allowing states an exception if legislation is required, leading to inconsistent coverage across states, as mentioned in Section 2.
The mandatory no-cost coverage could result in increased premiums or costs for insurers and lack of detail on how this will be financed or the economic impact, as referenced in Sections 2 and 2730.
The text does not specify any limitations or conditions on the coverage, which could result in misuse or overuse of the coverage, as identified in Section 2730.
The lack of definition for 'human milk fortifier' within the section could lead to ambiguity about what specific products are covered, as outlined in Section 2730.
Sections
Sections are presented as they are annotated in the original legislative text. Any missing headers, numbers, or non-consecutive order is due to the original text.
1. Short title Read Opens in new tab
Summary AI
The first section of this act states that it can be officially called the “Supporting Premature Infant Nutrition Act of 2024”.
2. Requiring no-cost coverage of human milk fortifier Read Opens in new tab
Summary AI
The text outlines a legislative requirement for Medicaid, the Children's Health Insurance Plan, and group health insurance plans to cover human milk fortifiers at no cost. Starting January 1, 2025, these plans must include human milk fortifiers for medically necessary use in infants, without requiring any cost-sharing by patients.
2730. No-cost coverage of human milk fortifier Read Opens in new tab
Summary AI
Group health plans and health insurance providers must cover human milk fortifier without requiring any additional cost from the patient, as outlined in the Social Security Act.