Ohio Code 5164.072 – Coverage of donor breast milk and fortifiers
(A) As used in this section, “licensed health professional” means the following:
Terms Used In Ohio Code 5164.072
- Certified nurse practitioner: means an advanced practice registered nurse who holds a current, valid license issued under Chapter 4723 of the Revised Code and is designated as a certified nurse practitioner in accordance with section 4723. See Ohio Code 1.64
- Certified nurse-midwife: means an advanced practice registered nurse who holds a current, valid license issued under Chapter 4723 of the Revised Code and is designated as a certified nurse-midwife in accordance with section 4723. See Ohio Code 1.64
- Donor: The person who makes a gift.
- Physician assistant: means an individual who is licensed under Chapter 4730 of the Revised Code to provide services as a physician assistant to patients under the supervision, control, and direction of one or more physicians. See Ohio Code 1.64
(1) A physician authorized under Chapter 4731 of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery;
(2) An advanced practice registered nurse who holds a current, valid license issued under Chapter 4723 of the Revised Code that authorizes the practice of nursing as an advanced practice registered nurse and is designated as a clinical specialist, certified nurse-midwife, or certified nurse practitioner;
(3) A physician assistant licensed under Chapter 4730 of the Revised Code.
(B) The medicaid program shall cover pasteurized human donor milk and human milk fortifiers, in both hospital and home settings, for an infant whose gestationally corrected age is less than twelve months when all of the following apply:
(1) A licensed health professional signs an order stating that human donor milk or human milk fortifiers are medically necessary because the infant meets any of the following criteria:
(a) The infant has a birth weight less than eighteen hundred grams or body weight below healthy levels.
(b) The infant has a gestational age at birth of thirty-four weeks or less.
(c) The infant has any congenital or acquired condition for which the health professional determines that the use of pasteurized human donor milk or human milk fortifiers will support the treatment of the condition and recovery of the infant.
(2) The infant is medically or physically unable to receive maternal breast milk or participate in breast-feeding, or the infant’s mother is medically or physically unable to produce breast milk in sufficient quantities or of adequate caloric density, despite lactation support.
(C) The medicaid director may adopt rules in accordance with Chapter 119 of the Revised Code to implement this section.
Last updated October 12, 2023 at 11:41 AM