Bills › 88th General Assembly
Relating to Medicaid reimbursement for breast pumps and associated supplies
Sponsored by the Senate Human Resources Committee
Topics:Health careMedicaid
Where it is now
- Done: IntroducedJanuary 31, 2020
- Done: SubcommitteeFebruary 6, 2020
- Done: Senate committeeFebruary 18, 2020
- Stopped: Passes the SenateDied when the General Assembly ended
- Next: House committee
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2020 session adjourned on June 14, 2020, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary The Department of Human Services will change its rules to pay for breast pumps and related supplies for people on Medicaid. If a doctor says a mother or child needs a pump for medical reasons, the state will cover the cost. These new rules will also set the specific standards for the equipment and how much the state will pay for it.1
Read the official explanation
This bill directs the department of human services (DHS) under both fee-for-service and managed care administration of Medicaid to adopt administrative rules, amend any contract with a managed care organization, and apply for any Medicaid state plan amendment or waiver as may be necessary to provide reimbursement for breast pumps, including electric breast pumps and associated breast pump supplies, as prescribed by a Medicaid member’s health care provider based on a determination of medical necessity for the mother or child. The rules adopted by the DHS shall include the specifications that a covered breast pump must meet and the reimbursement rate applicable to the specific type of breast pump and associated breast pump supplies.
Fiscal note
Cost: up to $662,000 Compare with other bills
AI summary This bill requires the Department of Human Services to provide reimbursement for breast pumps and related supplies for Medicaid members when prescribed by a healthcare provider. It is estimated to increase Department of Human Services operating costs by $662,000 in fiscal year 2021 and subsequent fiscal years. While increased breastfeeding could potentially lead to future Medicaid savings, no savings are included in this estimate due to uncertainty.3
Read the fiscal note
Description
House File 2500 requires the Department of Human Services (DHS) to adopt rules to provide reimbursement for breast pumps, including electric breast pumps and associated breast pump supplies, as prescribed by a Medicaid member’s health care provider based on a determination of medical necessity under both Medicaid fee-for-service and managed care.
Background
Breast pumps are currently considered a nonmedical convenience item and are not covered under the Medicaid durable medical equipment benefit.
A February 2019 study by the United States Department of Agriculture (USDA) Economic Research Service concluded that breastfeeding provides substantial health benefits to both the mother and the child, and could result in significant Medicaid savings if the prevalence of breastfeeding were increased.
Assumptions
- Iowa Medicaid covers 16,327 live births per year.
- 81.5% of women in Iowa breastfeed their child.
- 85.0% of women breastfeeding will use a breast pump.
- The average cost of an electronic breast pump and supplies is $152.38, based on a DHS survey of other state Medicaid programs.
- The Medicaid match rate is 61.61% federal and 38.39% State.
Fiscal Impact
House File 2500 is estimated to increase DHS operating costs by $662,000 in FY 2021 and subsequent fiscal years. In addition, if providing breast pumps results in an increase in women who breastfeed, it could result in Medicaid cost avoidance in both the short- and long-term, due to fewer pediatric and maternal diseases. Due to the uncertainty about whether there will be an increase in breastfeeding, no Medicaid savings have been included in this estimate.
Sources
- Department of Human Services
- 2018 Center for Disease Control Breastfeeding Report Card
- American Academy of Pediatrics Journal
- USDA Economic Research Service
- Medicaid, Breast Pumps · February 26, 2020 · $662,000
- Medicaid, Breast Pumps · February 20, 2020 · $662,000
Lobbying
23 for · 0 against · 7 undecided · Who →