Florida 2022 2022 Regular Session

Florida Senate Bill S1770 Analysis / Analysis

Filed 02/18/2022

                    The Florida Senate 
BILL ANALYSIS AND FISCAL IMPACT STATEMENT 
(This document is based on the provisions contained in the legislation as of the latest date listed below.) 
Prepared By: The Professional Staff of the Appropriations Subcommittee on Health and Human Services  
 
BILL: PCS/SB 1770 (860032) 
INTRODUCER:  Appropriations Subcommittee on Health and Human Services and Senator Book 
SUBJECT:  Donor Human Milk Bank Services 
DATE: February 18, 2022 
 
 ANALYST STAFF DIRECTOR  REFERENCE  	ACTION 
1. Smith Brown HP Favorable 
2. McKnight Money AHS  Recommend: Fav/CS 
3.     AP  
 
Please see Section IX. for Additional Information: 
COMMITTEE SUBSTITUTE - Substantial Changes 
 
I. Summary: 
PCS/SB 1770 authorizes the Florida Medicaid program to reimburse for donor human milk for 
hospital inpatient use. The Medicaid coverage would be for infants who are medically or 
physically unable to receive maternal breast milk or whose mother is medically or physically 
unable to produce maternal breast milk or breastfeed, and who also meet specified eligibility 
factors. The bill also requires the Agency for Health Care Administration (AHCA) to establish 
provider eligibility, by rule, and authorizes the AHCA to seek any necessary federal approvals to 
implement the new coverage benefit. 
 
The bill has a significant negative fiscal impact to the Florida Medicaid program. See Section V 
of this analysis. 
 
The bill takes effect on July 1, 2022. 
II. Present Situation: 
Donor Human Breast Milk 
According to the federal Centers for Disease Control and Prevention (CDC), breast milk is the 
best source of nutrition for most infants.
1
 Ideally, an infant should be fed his or her own mother’s 
                                                
1
 Centers for Disease Control and Prevention, Frequently Asked Questions (FAQ) (Aug. 10, 2021) available at 
https://www.cdc.gov/breastfeeding/faq/index.htm (last visited Jan. 22, 2022). 
REVISED:   BILL: PCS/SB 1770 (860032)   	Page 2 
 
breast milk because nutritional components within the mother’s breast milk change to meet the 
infant’s needs as he or she ages.
2
 Mothers of infants born prematurely are sometimes unable to 
produce milk because their bodies are not ready, they too are sick, or they are affected by the 
stress of having their premature infant in intensive care.
3
 Breast milk donated by nursing mothers 
provides an option for infants who are unable to receive adequate nutrition from their mother’s 
own milk or from commercial infant formulas. Very few illnesses are transmitted via breast milk, 
even in cases where someone else’s breast milk is given to another child.
4
 
 
The American Academy of Pediatrics notes that human donor breast milk can be effective for 
high-risk and very low birthweight infants if the child’s mother is unable to provide enough 
milk.
5
 Additionally, the World Health Organization (WHO) indicates that human donor breast 
milk can prevent some digestive disorders but specifies that any donor milk must come from safe 
facilities and is not recommended for sick infants or those weighing less than 1000 grams.
6,
 
7
 In 
the absence of a mother’s milk, the WHO notes that standard formula is also an acceptable 
alternative.
8
  
 
Currently, the federal Food and Drug Administration (FDA) considers human donor breast milk 
a “food” source rather than a medical product. The FDA does not have established guidelines or 
standards for human donor breast milk or milk banks, although it does recommend consulting 
with a health care provider before feeding it to an infant.
9
 Additionally, the FDA recommends 
that the caregiver only feed an infant milk from a source that has screened its donors and has 
taken precautions to ensure milk safety, such as a milk bank.
10
 
 
The Human Milk Banking Association of North America (HMBANA) 
Founded in 1985, the Human Milk Banking Association of North America (HMBANA) serves 
as the professional organization that accredits nonprofit milk banks in the United States and 
Canada.
11
 The HMBANA is funded by membership fees from its 31 member nonprofit milk 
banks, foundation funds, and individual donors.
12
 There is one HMBANA-accredited location in 
                                                
2
 Id. 
3
 Naseem S. Miller, Bill aims to get Medicaid coverage for donor breast milk: 'Something like this makes smart policy', 
Orlando Sentinel (Mar. 15, 2019) available at https://www.orlandosentinel.com/health/os-ne-mothers-milk-bank-bill-
20190315-story.html (last visited Jan. 22, 2022). 
4
 Centers for Disease Control and Prevention, Frequently Asked Questions (FAQ) (Aug. 10, 2021) available at 
https://www.cdc.gov/breastfeeding/faq/index.htm (last visited Jan. 22, 2022). 
5
 American Academy of Pediatrics Committee on Nutrition, Section on Breastfeeding and Committee on Fetus and Newborn, 
Policy Statement, Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States 
(Jan. 2017) available at https://publications.aap.org/pediatrics/article/139/1/e20163440/52000/Donor-Human-Milk-for-the-
High-Risk-Infant (last visited Jan. 22, 2022). 
6
 Agency for Health Care Administration, Senate Bill 240 Fiscal Analysis (Dec. 28, 2020) (on file with Senate Committee on 
Health Policy). 
7
World Health Organization, Recommendations for the Feeding of low-birth-weight infants in low- and middle-income 
countries, available at https://www.who.int/elena/titles/full_recommendations/feeding_lbw/en/ (last visited Jan. 22, 2022). 
8
 Id. 
9
 U.S. Food and Drug Administration, Use of Donor Human Milk (Mar. 22, 2018) available at https://www.fda.gov/science-
research/pediatrics/use-donor-human-milk (last visited Jan. 22, 2022). 
10
 Id. 
11
 Human Milk Banking Association of North America, About Us, available at https://www.hmbana.org/about-us/ (last 
visited Jan. 22, 2022). 
12
 Id.  BILL: PCS/SB 1770 (860032)   	Page 3 
 
Florida – the Mother’s Milk Bank of Florida located in Orlando.
13
 The Mother’s Milk Bank of 
Florida supplies pasteurized donor human milk to 38 of the 68
14
 neonatal intensive care units 
(NICUs) in Florida, as well as to medically fragile babies at home.
15
 
 
HMBANA Safety Guidelines
16
 
The HMBANA reports that its member milk banks follow guidelines that were developed by the 
HMBANA in consultation with the CDC and the FDA. The FDA reports that it has not been 
involved in establishing these voluntary guidelines.
17
 According to the AHCA, no federal or state 
regulations are in place to oversee the Mother’s Milk Bank of Florida.
18
 
 
Under the HMBANA’s guidelines, before milk is collected, each donor is strictly screened for 
medical and lifestyle risk factors and serum is screened for HIV, HTLV, syphilis, and Hepatitis 
B and C.
19
 After the milk is collected, it is mixed and pooled so that each pool includes human 
milk from three to five donors. This is done to ensure an even distribution of nutritional 
components. Bottles are filled with the pooled milk and then the milk is pasteurized to eliminate 
potentially harmful bacteria while retaining the majority of the milk’s beneficial nutrients. Milk 
samples are taken during the pasteurization process and cultured to check for bacterial growth. 
Any contaminated milk is discarded. No milk is dispensed after pasteurization until a culture is 
found to be negative for bacteriological growth. After pasteurization, the milk is frozen and 
shipped to hospitals and outpatient families. 
 
AHCA Report on Donor Human Milk
20
 
In 2021, the Legislature required the Agency for Health Care Administration (AHCA), in 
consultation with the Department of Health (DOH), to study and report on the use of donor 
human milk as a supplement to newborn care and health specific to newborn infants born 
prematurely and hospitalized within the NICU.
21
 On November 1, 2021, the report was 
published. The study reports that a survey of Florida NICUs in 2021 determined that 86 percent 
of them use pasteurized donor human milk (PDHM). The most common reasons for 
administering PDHM were prematurity (92 percent), birth weight threshold (76 percent), and 
                                                
13
 Id. 
14
 Naseem S. Miller, Bill aims to get Medicaid coverage for donor breast milk: 'Something like this makes smart policy', 
Orlando Sentinel (Mar. 15, 2019) available at https://www.orlandosentinel.com/health/os-ne-mothers-milk-bank-bill-
20190315-story.html (last visited Jan. 22, 2022). 
15
 Mothers’ Milk Bank of Florida, Covid-19 Update, available at https://milkbankofflorida.org/covid-19-update/ (last visited 
Jan. 22, 2022). 
16
 Human Milk Banking Association of North America, Milk Processing and Safety, available at 
https://www.hmbana.org/our-work/milk-processing-safety.html (last visited Jan. 22, 2022). 
17
 U.S. Food and Drug Administration, Use of Donor Human Milk (Mar. 22, 2018) available at https://www.fda.gov/science-
research/pediatrics/use-donor-human-milk (last visited Jan. 22, 2022). 
18
 Agency for Health Care Administration, Senate Bill 240 Fiscal Analysis (Dec. 28, 2020) (on file with Senate Committee on 
Health Policy). 
19
 Human Milk Banking Association of North America, Milk Banking and COVID-19 (Apr. 2, 2020) available at 
https://www.hmbana.org/file_download/inline/a04ca2a1-b32a-4c2e-9375-44b37270cfbd (last visited Jan. 22, 2022). 
20
 Agency for Health Care Administration, Donor Human Milk Legislative Report (Nov. 1, 2021) (on file with Senate 
Committee on Health Policy). 
21
 Chapter 2021-36, s. 3, Laws of Fla.  BILL: PCS/SB 1770 (860032)   	Page 4 
 
medical necessity (71 percent) determined by the attending physician based on diagnosis and 
symptoms. 
The report includes recommendations of best practices for the oversight of milk banks and their 
staff, operating procedures, standards for donor screening, and recommendations for the 
collection, storage, handling, processing, and dispending of donor human milk. In addition, the 
report addresses the need for high-quality clinical studies to quantify the efficacy and cost-
effectiveness of donor human milk derivatives. 
 
The AHCA report also conducted an economic analysis on the impact of inpatient feeding of 
PDHM. While PDHM use is not currently reimbursable by the Florida Medicaid program or 
commercial health insurance companies, some Florida hospitals have earned grant funding or 
donations to support the provision of PDHM, and most large facilities using PDHM have chosen 
to do so knowing that the cost will not be reimbursed. These facilities balance the direct costs of 
PDHM use with better outcomes, in hopes that improved outcomes will ultimately decrease total 
cost of care by reducing risk and severity of necrotizing enterocolitis (NEC), a severe and lethal 
complication affecting premature and low birth weight infants, and other illnesses associated 
with prematurity. 
 
In Florida, approximately 3,500 infants are born with a very low birth weight (VLBW) (birth 
weight less than 1,500 grams or 3.5 pounds) annually. The AHCA report found that if Florida 
NICUs were to stop using PDHM, there would be a 5 percent increase in the number NEC cases 
from the 2,755 VLBW infants born annually in Florida. As illustrated in the chart below, when 
comparing costs of providing PDHM ($1.1 million) to estimated costs of not using PDHM ($5.2 
million), there is an estimated $4.1 million cost avoidance statewide among all payers. 
 
 
 
The report finds that the avoided cost is largely predicated on the management of NEC. This 
cost-avoidance is among all payers; however, it is particularly relevant to the Florida Medicaid 
program given its coverage of over 50 percent of births in the State of Florida. Furthermore, the 
report states that this cost-avoidance with PDHM is an underestimate, as it does not factor in 
additional benefits after the birth hospitalization with respect to readmissions, home nursing, and 
emergency room visits. 
  BILL: PCS/SB 1770 (860032)   	Page 5 
 
Florida Medicaid Program 
The Medicaid program is a joint federal-state program that finances health coverage for 
individuals, including eligible low-income adults, children, pregnant women, elderly adults and 
persons with disabilities.
22
 The Centers for Medicare and Medicaid Services (CMS) within the 
U.S. Department of Health and Human Services (HHS) is responsible for administering the 
federal Medicaid program. Florida Medicaid is the health care safety net for low-income 
Floridians. Florida’s program is administered by the AHCA and financed through state and 
federal funds.
23
 
 
A Medicaid state plan is an agreement between a state and the federal government describing 
how the state administers its Medicaid programs. The state plan establishes groups of individuals 
covered under the Medicaid program, services that are provided, payment methodologies, and 
other administrative and organizational requirements. 
 
In order to participate in Medicaid, federal law requires states to cover certain population groups 
(mandatory eligibility groups) and gives states the flexibility to cover other population groups 
(optional eligibility groups).
 
States set individual eligibility criteria within federal minimum 
standards. The AHCA may seek an amendment to the state plan as necessary to comply with 
federal or state laws or to implement program changes. States send state plan amendments to the 
federal CMS for review and approval.
24
 
 
Medicaid enrollees generally receive benefits through one of two service-delivery systems: fee-
for-service (FFS) or managed care. Under FFS, health care providers are paid by the state 
Medicaid program for each service provided to a Medicaid enrollee. Under managed care, the 
AHCA contracts with private managed care plans for the coordination and payment of services 
for Medicaid enrollees. The state pays the managed care plans a capitation payment, or fixed 
monthly payment, per recipient enrolled in the managed care plan. 
 
In Florida, the majority of Medicaid recipients receive their services through a managed care 
plan contracted with the AHCA under the Statewide Medicaid Managed Care (SMMC) 
program.
25
 The SMMC program has two components, the Managed Medical Assistance (MMA) 
program and the Long-Term Care program. Florida’s SMMC offers a health care package 
covering both acute and long-term care.
26
 The SMMC benefits are authorized by federal 
authority and are specifically required in ss. 409.973 and 409.98, F.S. 
 
The AHCA contracts with managed care plans on a regional basis to provide services to eligible 
recipients. The MMA program, which covers most medical and acute care services for managed 
care plan enrollees, was fully implemented in August 2014, and was re-procured for a period 
beginning December 2018 and ending in 2023.
27
 In 2020, the Legislature extended the allowable 
                                                
22
 Medicaid.gov, Medicaid, available at https://www.medicaid.gov/medicaid/index.html (last visited Jan. 22, 2022). 
23
 Section 20.42, F.S. 
24
 Medicaid.gov, Medicaid State Plan Amendments, available at https://www.medicaid.gov/medicaid/medicaid-state-plan-
amendments/index.html (last visited Jan. 22, 2022). 
25
 Id. 
26
 Id. 
27
 Id.  BILL: PCS/SB 1770 (860032)   	Page 6 
 
term of the SMMC contracts from five to six years.
28
 As a result, the AHCA’s current contracts 
will end in December 2024. 
 
Medical Necessity Requirements 
Florida Medicaid covers services that are medically necessary, as defined in its Medicaid state 
plan pursuant to Rule 59G-1.010 of the Florida Administrative Code. The AHCA routinely 
reviews new health services, products, and supplies to assess potential coverage under Florida 
Medicaid which depends on whether that service, product, or supply is medically necessary.
29
 
Care, goods, and services are deemed medically necessary if they are: 
 Necessary to protect life, to prevent significant illness or significant disability, or to alleviate 
severe pain; 
 Individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness 
or injury under treatment, and not in excess of the patient’s needs; 
 Consistent with generally accepted professional medical standards as determined by the 
Medicaid program, and not experimental or investigational; 
 Reflective of the level of service that can be safely furnished, and for which no equally 
effective and more conservative or less costly treatment is available statewide; and 
 Furnished in a manner not primarily intended for the convenience of the recipient, the 
recipient’s caretaker, or the provider.
30
 
 
Under federal law, Medicaid states must have a process in place to pay for services that are 
medically necessary but are not covered for recipients under the age of 21.
31
 This is often 
referred to as the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) 
guidelines. Health plans participating in the SMMC program must also adhere to EPSDT 
guidelines.
32
 
 
Coverage of Nutritional Supplements for Infants in Florida
33
 
Florida Medicaid covers prescription enteral and parenteral commercial formulas under the 
Durable Medical Equipment and Supplies benefit, when medically necessary. Commercial 
formula would be considered medically necessary for infants diagnosed with conditions such as 
metabolic disorders or who are unable to accept nutrition orally. In addition, if an infant needs 
commercial formula during an inpatient hospital stay, it would be covered as part of the all-
inclusive payment to the hospital, just as needed food or medicine would be covered for a patient 
of any age. 
 
The Women, Infants, and Children (WIC) program is a federally funded program that provides 
nutritional support for women and children. Administered by the DOH, WIC provides food 
assistance such as milk and infant and toddler formulas. If a child is not able to consume a 
                                                
28
 Chapter 2020-156, s. 44, Laws of Fla. 
29
 Agency for Health Care Administration, Senate Bill 240 Fiscal Analysis (Dec. 28, 2020) (on file with Senate Committee on 
Health Policy). 
30
 59G-1.010, F.A.C. 
31
 42 C.F.R. s. 441 Subpart B. 
32
 Id. 
33
 Supra note 30.  BILL: PCS/SB 1770 (860032)   	Page 7 
 
contract formula,
34
 WIC can make exceptions and provide non-contract formulas with 
appropriate medical documentation. Contract formulas currently available through WIC include: 
Enfamil, Enfagrow, Gerber Good Start Soy 1, and Gerber Good Start Soy 3. WIC does not 
provide human donor breast milk to program participants. 
 
Florida Medicaid does not reimburse separately for human donor breast milk or contract 
formulas covered through WIC. If an infant needed human donor breast milk outside of the 
hospital setting, a request would need to be made through the EPSDT coverage process. The 
AHCA reports that it is not aware of any such requests being made for infants in fee-for-service 
or Medicaid managed care.
35
 
 
Most private insurers do not cover donor human breast milk, which costs approximately $4 an 
ounce and can add up to over $1,000 per month per infant.
36
 Through donations and fundraisers, 
the Mother’s Milk Bank of Florida provides grants to low-income families to make donor human 
breast milk more affordable.
37
 
 
Medicaid Coverage of Human Donor Breast Milk in Other States 
Currently nine states (California, Connecticut, Iowa, Kansas, Missouri, New Jersey, New York,
 
 
Texas, and Utah) and the District of Columbia, provide coverage for human donor milk under 
their state Medicaid programs.
38
  
 
State Medicaid Coverage Policies for Donor Human Milk
39
 
State/Territory 	Description of Coverage 
HMBANA 
Bank in State 
California Coverage when mother’s own milk is insufficient, or 
infant cannot breastfeed, or contraindication to 
formula. Cover for inpatient and outpatient. 
Yes 
Connecticut Coverage when medically necessary, infant unable to 
breastfeed, or mother unable to produce insufficient 
milk. 
No 
Iowa Coverage for infants in the inpatient setting. Yes 
                                                
34
 Commercial infant formula manufacturers provide substantial discounts, in the form of rebates, to state WIC programs in 
return for the exclusive right to provide their products to the state’s WIC participants. Commercial formulas whose 
manufacturers have those exclusive rights are considered “contract formulas.” See Steven Carlson, Robert Greenstein, and 
Zoe Neuberger, Center on Budget and Policy Priorities, WIC’s Competitive Bidding Process for Infant Formula Is Highly 
Cost-Effective (Feb. 17, 2017) available at https://www.cbpp.org/sites/default/files/atoms/files/6-26-15fa.pdf (last viewed 
Mar. 4, 2021). 
35
 Agency for Health Care Administration, Senate Bill 240 Fiscal Analysis (Dec. 28, 2020) (on file with Senate Committee on 
Health Policy). 
36
 Naseem S. Miller, Bill aims to get Medicaid coverage for donor breast milk: 'Something like this makes smart policy', 
Orlando Sentinel (Mar. 15, 2019) available at https://www.orlandosentinel.com/health/os-ne-mothers-milk-bank-bill-
20190315-story.html (last visited Jan. 22, 2022). 
37
 Id. 
38
 Agency for Health Care Administration, Donor Human Milk Legislative Report (Nov. 1, 2021) (on file with Senate 
Committee on Health Policy). 
39
 Id.  BILL: PCS/SB 1770 (860032)   	Page 8 
 
Kansas Coverage for infants under 3 months of age who are 
critically ill and have medical necessity. Coverage for 
NICU only. Prior authorization required. 
No 
Missouri Coverage for infants under 3 months of age who are 
critically ill and have medical necessity for human 
milk diet. Coverage for NICU only. 
Yes 
 
State Medicaid Coverage Policies for Donor Human Milk
40
 
New Jersey Coverage for infants under 6 months of age, infant 
unable to breastfeed, mother unable to produce 
sufficient milk, infant body weight below healthy 
level, or medically necessary. Coverage for inpatient 
and outpatient. 
No 
New York Coverage for infants with birth weights less than 1,500 
grams, infant unable to breastfeed, mother unable to 
produce sufficient milk, or medical necessity. 
Coverage for inpatient. Prior authorization required. 
Yes 
Texas Coverage for inpatient infants at or under six months 
of age with medical necessity. Coverage for outpatient 
infants at or under 11 months of age but may be 
extended through 20 years with inability to tolerate 
formula and medical necessity. Prior authorization for 
outpatient. Subsequent reauthorization for both 
inpatient and outpatient. 
Yes 
Utah Coverage for infants under 11 months of age with 
medical necessity. Cover for outpatient only. Prior 
authorization with reauthorization. 
Yes 
District of Columbia Coverage of infants under 11 months of age who are 
unable to tolerate formula and have medical necessity. 
Coverage for inpatient and outpatient. Prior 
authorization and reauthorization required. 
No 
 
III. Effect of Proposed Changes: 
Section 1 amends s. 409.906, F.S., to authorize the Agency for Health Care Administration 
(AHCA) to reimburse through Florida Medicaid for the cost of donor human milk for inpatient 
use as ordered by a licensed physician, nurse practitioner, physician assistant, or dietician. 
 
To be eligible, the infant’s mother must be medically or physically unable to produce breastmilk 
or breastfeed; the infant must be medically unable to receive maternal breast milk or breastfeed, 
or physically unable to receive maternal milk or breastfeed. In addition, the infant must have a 
documented birth weight of 1,800 grams or less, and: 
                                                
40
 Agency for Health Care Administration, Donor Human Milk Legislative Report (Nov. 1, 2021) (on file with Senate 
Committee on Health Policy).  BILL: PCS/SB 1770 (860032)   	Page 9 
 
 Have a congenital or acquired condition and be at high risk for developing a feeding 
intolerance, necrotizing enterocolitis, or an infection; or 
 Otherwise have a medical indication for a human milk diet. 
 
Section 2 amends s. 409.908, F.S., to authorize Florida Medicaid to pay for donor human milk 
bank services as an optional covered service in the fee-for service delivery system. 
 
Section 3 amends s. 409.973, F.S., to require health plans participating in the Statewide 
Medicaid Managed Care program to cover donor human milk bank services. 
 
Section 4 provides an effective date of July 1, 2022. 
IV. Constitutional Issues: 
A. Municipality/County Mandates Restrictions: 
None. 
B. Public Records/Open Meetings Issues: 
None. 
C. Trust Funds Restrictions: 
None. 
D. State Tax or Fee Increases: 
None. 
E. Other Constitutional Issues: 
None. 
V. Fiscal Impact Statement: 
A. Tax/Fee Issues: 
None. 
B. Private Sector Impact: 
None.  BILL: PCS/SB 1770 (860032)   	Page 10 
 
C. Government Sector Impact
41
: 
Because human donor milk is not currently a covered service, PCS/SB 1770 would have 
a significant negative fiscal impact on the Florida Medicaid program. Based on data 
provided by the Agency for Health Care Administration (AHCA), the maximum 
estimated cost to the Florida Medicaid program in Fiscal Year 2022-2023 is a recurring 
$4.1 million, of which $1.6 million is general revenue.  
 
The AHCA’s estimate assumes 50 percent of infants with birth weights of 1,999 grams or 
less are eligible for Florida Medicaid, even though the bill would only reimburse for 
infants weighing 1,800 grams or less. The AHCA utilizes diagnosis codes for birth 
weights of up to 1,749 grams and up to 1,999 grams; there is no code tied to a birth 
weight of 1,800 grams. Therefore, the AHCA used the code associated with 1,999 grams 
to ensure infants weighing 1,800 grams or less are included in the estimate. 
 
 
Infants 
Eligible 
for Donor 
Milk 
Estimated 
Total 
Fiscal Impact 
General 
Revenue 
Trust Fund 
Infants born <1500g 843 $   2,758,806 $ 1,095,246 $  1,663,560 
Infants born 1500g-1999g 1009 $   1,300,690 $    516,374 $     784,316 
Total 1852  $   4,059,496   $ 1,611,620   $  2,447,876  
 
It is unknown how many infants would satisfy the health conditions specified in the bill 
and meet Medicaid’s medical necessity criteria. However, taking into consideration the 
cost comparison of providing donor human milk to estimated costs of not using donor 
human as reported in the AHCA’s Donor Human Milk Legislative Report to the Florida 
Legislature and highlighted in Section 2 of this bill analysis, there is a possible cost 
avoidance statewide among all payers particularly relevant to the Florida Medicaid 
program, given its coverage of over 50 percent of births in the State of Florida. 
Furthermore, the AHCA report states that this cost-avoidance with donor human milk is 
an underestimate, as it does not factor in additional benefits after the birth hospitalization 
with respect to readmissions, home nursing, and emergency room visits. Without 
additional data on the additional benefits, any potential savings that would offset costs 
realized from a policy change are indeterminate at this time. 
VI. Technical Deficiencies: 
None. 
VII. Related Issues: 
None. 
                                                
41
 Email from the Agency for Health Care Administration to the Senate Appropriations Subcommittee on Health and Human 
Services (Feb. 15, 2022) (on file with the Senate Appropriations Subcommittee on Health and Human Services).  BILL: PCS/SB 1770 (860032)   	Page 11 
 
VIII. Statutes Affected: 
This bill substantially amends the following sections of the Florida Statutes: 409.906, 409.908, 
and 409.973. 
IX. Additional Information: 
A. Committee Substitute – Statement of Substantial Changes: 
(Summarizing differences between the Committee Substitute and the prior version of the bill.) 
Recommended CS by Appropriations Subcommittee on Health and Human Services 
on February 16, 2022: 
The committee substitute: 
 Permits the Medicaid program to pay only for inpatient use of donor human milk and 
products. 
 Adds physician assistants and dieticians to the list of approved health care providers 
who may order such products for payment by Medicaid. 
 Increases the infant maximum documented birth weight from 1,500 grams or less, to 
1,800 grams or less, for eligibility for payment of donor human or donor human milk 
products. 
 Removes the requirement that donor human milk or donor human milk products be 
obtained from a nonprofit milk bank certified by the Human Milk Banking 
Association of North America. 
 Removes the cost reimbursement floor for donor human milk or donor human milk 
products. 
 Requires the Agency for Health Care Administration (AHCA) to establish provider 
eligibility, by rule, and authorizes the AHCA to seek any necessary federal approvals 
to implement the new coverage benefit. 
B. Amendments: 
None. 
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.