Illinois Compiled Statutes 305 ILCS 5/5-40 – Human breast milk coverage
Current as of: 2024 | Check for updates
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(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
(1) the milk is obtained from a human milk bank that
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meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health;
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(2) the infant’s mother is medically or physically
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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;
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(3) the milk has been determined to be medically
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necessary for the infant; and
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(4) one or more of the following applies:
(A) the infant’s birth weight is below 1,500
(A) the infant’s birth weight is below 1,500
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grams;
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(B) the infant has a congenital or acquired
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condition that places the infant at a high risk for development of necrotizing enterocolitis;
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(C) the infant has infant hypoglycemia;
(D) the infant has congenital heart disease;
(E) the infant has had or will have an organ
(D) the infant has congenital heart disease;
(E) the infant has had or will have an organ
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transplant;
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(F) the infant has sepsis; or
(G) the infant has any other serious congenital
(G) the infant has any other serious congenital
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or acquired condition for which the use of donated human breast milk is medically necessary and supports the treatment and recovery of the infant.
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(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
(1) the milk is obtained from a human milk bank that
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meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health;
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(2) the child’s mother is medically or physically
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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;
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(3) the milk has been determined to be medically
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necessary for the child; and
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(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
(A) the child has spinal muscular atrophy;
(B) the child’s birth weight was below 1,500
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grams and he or she has long-term feeding or gastrointestinal complications related to prematurity;
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(C) the child has had or will have an organ
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transplant; or
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(D) the child has a congenital or acquired
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condition for which the use of donated human breast milk is medically necessary and supports the treatment and recovery of the child.
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(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
(1) the milk is obtained from a human milk bank that
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meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health;
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(2) the child’s mother is medically or physically
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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;
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(3) the milk has been determined to be medically
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necessary for the child; and
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(4) the child has spinal muscular atrophy.