H.R. 4569: Supporting Premature Infant Nutrition Act of 2025

This bill, titled the "Supporting Premature Infant Nutrition Act of 2025," aims to ensure that human milk fortifiers are covered at no cost under various health insurance programs. Here’s a breakdown of what the bill proposes:

Mandatory Coverage of Human Milk Fortifier

The bill mandates that human milk fortifiers be included under Medicaid and the Children's Health Insurance Program (CHIP) coverage without any costs to the families. This would be effective starting January 1, 2026. Specifically:

• Medicaid Coverage:
  • Coverage must be included in state Medical Assistance plans.
  • Cost-sharing (like copayments) for human milk fortifiers is prohibited.
• CHIP Coverage:
  • The bill also expands CHIP to include human milk fortifiers as a required coverage item.
  • Similar to Medicaid, families would not have to share any costs for these products.

Definition of Human Milk Fortifier

Human milk fortifiers are defined in the bill as donor human milk-derived products that are deemed medically necessary for infants under 1 year, especially those who:

• Were born at 34 weeks gestation or earlier.
• Have a birth weight of less than 1800 grams.
• Have a body weight below healthy levels as determined by a qualified health professional.
• Have a congenital or acquired condition that can be improved by these products.

Coverage Under Group and Individual Health Plans

The bill extends the requirement for no-cost coverage of human milk fortifiers to group health plans and individual health insurance policies. This means all group and individual health insurers will need to provide this coverage without cost-sharing starting January 1, 2026.

Implementation and Compliance

States may have a transitional period if state legislation is required for compliance with these new requirements. The bill outlines that states must comply with the new regulations without causing a lapse in coverage for necessary services.

Relevant Companies

None found