119-hr4569

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4569 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4569

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.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 July 21, 2025

 Mr. McGarvey (for himself, Ms. DeLauro, and Mr. Krishnamoorthi) 
 introduced the following bill; which was referred to the Committee on 
 Energy and Commerce

_______________________________________________________________________

 A BILL

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.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Supporting Premature Infant 
Nutrition Act of 2025''.

SEC. 2. REQUIRING NO-COST COVERAGE OF HUMAN MILK FORTIFIER.

    (a) Coverage Under Medicaid.--

    (1) Mandatory coverage.--
        (A) In general.--

Section 1902

    (a)

    (10)
        (A) of the 
 Social Security Act (42 U.S.C. 1396a

    (a)

    (10)
        (A) ) is 
 amended by striking ``and

    (30) '' and inserting ``

    (30) , 
 and

    (32) ''.
        (B) Medically needy.--

Section 1902

    (a)

    (10)
            (C) 
            (iv) of 
 the Social Security Act (42 U.S.C. 1396a

    (a)

    (10)
            (C) 
            (iv) ) 
 is amended by striking ``and

    (17) '' and inserting 
 ``

    (17) , and

    (32) ''.
            (C) Alternative benefit plans.--

Section 1937

    (b) of 
 the Social Security Act (42 U.S.C. 1396u-7

    (b) ) is 
 amended by adding at the end the following new 
 paragraph:
 ``

    (9) Human milk fortifier.--Notwithstanding the previous 
 provisions of this section, a State may not provide for medical 
 assistance through enrollment of an individual with benchmark 
 coverage or benchmark-equivalent coverage under this section 
 unless, beginning on January 1, 2026, such coverage includes 
 (and does not impose any deduction, cost sharing, or similar 
 charge for) human milk fortifier described in 

section 1905

    (a)

    (32) .''.

    (2) Inclusion as medical assistance.--

Section 1905 of the 
 Social Security Act (42 U.S.C. 1396d) is amended--
        (A) in subsection

    (a) --
            (i) in paragraph

    (31) , by striking ``and'' 
 at the end;
            (ii) by redesignating paragraph

    (32) as 
 paragraph

    (33) ; and
            (iii) by inserting after paragraph

    (31) the 
 following new paragraph:
 ``

    (32) beginning January 1, 2026, human milk fortifier (as 
 described in subsection

    (kk) ); and''; and
        (B) by adding at the end the following new 
 subsection:
 ``

    (kk) Human Milk Fortifier.--
 ``

    (1) In general.--For purposes of subsection

    (a)

    (32) , the 
 term `human milk fortifier' means a donor human milk-derived 
 product that is furnished to an infant under 1 year of age if a 
 specified professional determines that such donor human milk-
 derived product is medically necessary for the infant because--
 ``
        (A) the infant's gestational age at birth was 34 
 weeks or less;
 ``
        (B) the infant--
 ``
            (i) had a birth weight of less than 1800 
 grams; or
 ``
            (ii) has a body weight below healthy 
 levels, as determined by the specified 
 professional; or
 ``
            (C) the infant has a congenital or acquired 
 condition and such donor human milk-derived product 
 will--
 ``
            (i) improve such condition; or
 ``
            (ii) aid in the recovery of the infant 
 with respect to such condition.
 ``

    (2) === Definitions. ===
-For purposes of this subsection, the 
 following definitions apply:
 ``
        (A) Donor human milk-derived product.--The term 
 `donor human milk-derived product' means a specialty 
 nutritional product made from donor human milk wherein 
 the donor human milk has been concentrated or one or 
 more components have been removed.
 ``
        (B) Specified professional.--The term `specified 
 professional' means a physician, nurse practitioner, 
 physician's assistant, registered dietician, or other 
 licensed professional authorized by State statute to 
 make the determination described in paragraph

    (1) .''.

    (3) Prohibition of cost sharing.--
        (A) In general.--

Section 1916 of the Social 
 Security Act (42 U.S.C. 1396o) is amended--
            (i) in subsection

    (a)

    (2) --
            (I) in subparagraph
            (I) , by 
 striking at the end ``or'';
            (II) in subparagraph
        (J) , by 
 striking at the end ``; and'' and 
 inserting ``, or''; and
            (III) by adding at the end the 
 following new subparagraph:
 ``
        (K) beginning January 1, 2026, human milk 
 fortifier (as described in 

section 1905

    (a)

    (32) ); and''; 
 and
            (ii) in subsection

    (b)

    (2) --
            (I) in subparagraph
            (I) , by 
 striking at the end ``or'';
            (II) in subparagraph
        (J) , by 
 striking at the end ``; and'' and 
 inserting ``, or''; and
            (III) by adding at the end the 
 following new subparagraph:
 ``
        (K) beginning January 1, 2026, human milk 
 fortifier (as described in 

section 1905

    (a)

    (32) ); and''.
        (B) Application to alternative cost sharing.--
 

Section 1916A

    (b)

    (3)
        (B) of the Social Security Act (42 
 U.S.C. 1396o-1

    (b)

    (3)
        (B) ) is amended by adding at the 
 end the following new clause:
 ``
            (xv) Beginning January 1, 2026, human 
 milk fortifier (as described in 

section 1905

    (a)

    (32) ).''.

    (b) Coverage Under the Children's Health Insurance Plan.--

    (1) In general.--

Section 2103 of the Social Security Act 
 (42 U.S.C. 1397cc) is amended--
        (A) in subsection

    (a) , by striking ``and

    (8) '' and 
 inserting ``,

    (8) , and

    (13) ''; and
        (B) in subsection
            (c) , by adding at the end the 
 following new paragraph:
 ``

    (13) Required coverage of human milk fortifier.--The 
 child health assistance provided to a targeted low-income child 
 shall include coverage of human milk fortifier (as described in 
 

section 1905

    (a)

    (32) ).''.

    (2) Prohibition of cost sharing.--

Section 2103

    (e)

    (2) of the 
 Social Security Act (42 U.S.C. 1397cc

    (e)

    (2) ) is amended--
        (A) in the paragraph heading, by inserting ``human 
 milk fortifier,'' before ``or pregnancy-related 
 assistance''; and
        (B) by inserting ``human milk fortifier described 
 in 

section 1905

    (a)

    (32) ,'' before ``or for pregnancy-
 related assistance''.

    (3) Effective date.--
        (A) In general.--Subject to subparagraph
        (B) , the 
 amendments made by this subsection shall apply with 
 respect to child health assistance furnished on or 
 after January 1, 2026.
        (B) Exception if state legislation required.--In 
 the case of a State child health plan for child health 
 assistance under title XXI of the Social Security Act 
 which the Secretary of Health and Human Services 
 determines requires State legislation (other than 
 legislation appropriating funds) in order for the plan 
 to meet the additional requirement imposed by the 
 amendments made by this subsection, the State child 
 health plan shall not be regarded as failing to comply 
 with the requirements of such title solely on the basis 
 of its failure to meet this additional requirement 
 before the first day of the first calendar quarter 
 beginning after the close of the first regular session 
 of the State legislature that begins after the date of 
 the enactment of this Act. For purposes of the previous 
 sentence, in the case of a State that has a 2-year 
 legislative session, each year of such session shall be 
 deemed to be a separate regular session of the State 
 legislature.
            (c) Coverage Under Group Health Plans and Group and Individual 
Health Insurance.--

    (1) In general.--Subpart II of part A of title XXVII of the 
 Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is 
 amended by adding at the end the following new section:

``

SEC. 2730. NO-COST COVERAGE OF HUMAN MILK FORTIFIER.

 ``A group health plan, and a health insurance issuer offering group 
or individual health insurance coverage, shall provide coverage for, 
and shall not impose any cost sharing requirements for, human milk 
fortifier (as described in 

section 1905

    (a) 

    (kk) of the Social Security 
Act).''.

    (2) Effective date.--The amendments made by this subsection 
 shall apply to plan years beginning on or after January 1, 
 2026.
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