State Medicaid program; medically necessary; donor human milk-derived products; reimbursement; promulgation of rules; policy or procedure; Oklahoma Health Care Authority; federal approval; effective date.

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HOUSE OF REPRESENTATIVES - FLOOR VERSION

STATE OF OKLAHOMA

1st Session of the 60th Legislature (2025)

HOUSE BILL 1577 By: Lawson and West (Josh) of
the House

and

Daniels of the Senate

AS INTRODUCED

An Act relating to state Medicaid program; requiring
coverage of medically necessary donor human milk-
derived products under certain conditions; requiring
certain reimbursement; directing promulgation of
rules; authorizing adoption of certain policy or
procedure; directing the Oklahoma Health Care
Authority to seek certain federal approval; providing
for codification; and providing an effective date.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5026.2 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. The Oklahoma Health Care Authority shall, to the extent
permissible under federal law and subject to the federal approval
described in subsection D of this section, provide Medicaid coverage
for medically necessary donor human milk-derived products in an

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inpatient or outpatient setting for an infant whose gestationally
corrected age is under twelve (12) months; provided:
1. A physician, physician assistant, or Advanced Practice
Registered Nurse licensed in this state signs an order stating that
donor human milk-derived products are medically necessary for the
infant Medicaid beneficiary due to any of the following:
a. the infant has a birth weight of less than one
thousand five hundred (1,500) grams or an infant body
weight below healthy levels, as determined by the
ordering provider,
b. the infant's gestational age at birth was thirty-four
(34) weeks or less, or
c. the infant has any congenital or acquired condition
for which the ordering provider determines that the
use of donor human milk-derived products is medically
necessary and will support the treatment and recovery
of the infant; and
2. The donor human milk-derived products adhere to such quality
standards as may be required by the Oklahoma Health Care Authority
Board.
B. Reimbursement under subsection A of this section for donor
human milk-derived products for an infant in an inpatient setting
shall be provided separately from the existing hospital payment for
inpatient services.

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C. The Board shall promulgate rules to implement the provisions
of this section, and may adopt a policy or procedure to implement
the provisions of this section while in the process of promulgating
rules; provided, such policy or procedure shall be posted on the
Internet website of the Authority prior to adoption of the policy.
D. The Authority shall seek any federal approval necessary to
implement this section.
SECTION 2. This act shall become effective November 1, 2025.

COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
OVERSIGHT, dated 02/26/2025 – DO PASS.