New Jersey § 26:2j-4

§ 26:2j-4.

a. A health maintenance organization contract that provides hospital or medical expense

benefits and is delivered, issued, executed or renewed in this State, or approved

for issuance or renewal in this State by the Commissioner of Banking and Insurance,

on or after the effective date of P.L.2019, c. 343 ( C.17:48-6ss et al.), 1 shall provide coverage for comprehensive lactation support, counseling, and consultation,

and the costs for renting or purchasing breastfeeding equipment, in conjunction with

each birth, for the duration of breastfeeding for contract enrollees, with no cost-sharing. b. Coverage of breastfeeding equipment shall include: (1) Purchase of a single-user breast pump, subject to the following conditions: (a) A contract shall cover the purchase of a double electric breast pump. If an enrollee requests a manual pump in lieu of the double electric breast pump,

the contract shall cover the purchase of a manual pump. (b) A double electric breast pump provided pursuant to this paragraph shall be of

sufficient power and durability to establish and maintain milk supply for the duration

of breastfeeding. (c) A contract shall not require documentation of medical necessity, prior authorization,

or a prescription for a breast pump provided pursuant to this paragraph. (d) Coverage shall be available at any time during pregnancy and the postpartum period,

and shall continue for the duration of breastfeeding as defined by the contract enrollee. (e) Coverage for breast pumps shall include repair or replacement if necessary. (2) Rental or purchase of a multi-user breast pump, on the recommendation of a licensed

health care provider, subject to the following conditions: (a) When recommended by a licensed health care provider, a contract shall provide

coverage for a multi-user breast pump. (b) A health maintenance organization may determine whether a rental or purchase is

covered. (c) Coverage for a multi-user breast pump shall be covered without regard to coverage

or acquisition of a single-user breast pump. (d) A health maintenance organization may require a letter of medical necessity from

a lactation consultant or other health care provider for coverage of a multi-user

pump. The letter shall not interfere with the timely acquisition of a multi-user pump. (3) Coverage of breastfeeding equipment pursuant to this section shall include two

breast pump kits per birth event, as well as appropriate size breast pump flanges,

or other lactation accessories recommended by a health care provider. (4) Breastfeeding equipment specified in paragraphs (1) and (3) of this subsection

shall be furnished: within 48 hours of notification of need, if requested after the

birth of the child; or by the later of two weeks before the enrollee's expected due

date or 72 hours after notification, if requested prior to the birth of the child. If the health maintenance organization cannot ensure an enrollee receives breastfeeding

equipment within 48 hours, an enrollee may purchase the equipment and the contract

shall reimburse all out-of-pocket expenses incurred by the enrollee, including any

balance billing amounts. (5) Breastfeeding equipment specified in paragraph (2) of this subsection shall be

made available within 12 hours of notification of need. If equipment is not available within 12 hours of notification of need, the health

maintenance organization shall reimburse all out-of-pocket rental expenses incurred

by an enrollee, including any balance billing amounts, until the enrollee receives

breastfeeding equipment. c. Coverage of comprehensive lactation counseling and lactation consultation shall

include: (1) In-person, one-on-one lactation counseling and lactation consultation, subject

to the following conditions: (a) Coverage shall include visits that occur inside and outside a hospital or office

setting. In-person lactation counseling and lactation consultation shall be covered regardless

of location of service provision and shall include home visits. (b) Lactation counseling and lactation consultation shall be made available within

24 hours of notification of need. (2) Telephonic lactation assistance shall be covered in addition to, and not as a

substitute for, in-person, one-on-one lactation counseling or lactation consultation,

when an enrollee requests one-on-one, in-person lactation counseling or lactation

consultation. The telephonic lactation assistance shall be provided within 12 hours of notification

of need. (3) Group lactation counseling shall be covered in addition to, and not as a substitute

for, one-on-one, in-person lactation counseling or lactation consultation, if an enrollee

requests one-on-one, in-person lactation counseling or lactation consultation. Group counseling shall include educational classes and support groups. (4) A contract shall not require prior authorization, prescription or referral for

any lactation counseling or lactation consultation, regardless of provider type or

setting. (5) A health maintenance organization shall not impose medical management techniques

not described in this section. d. Except as otherwise authorized pursuant to this section, a health maintenance organization

shall not impose restrictions on the coverage provided pursuant to this section, including,

but not limited to, limitations on reimbursement to allowable amounts or reasonable

and customary charges, documentation requests, or delays on the coverage provided. e. As used in this section: “ Cost-sharing ” means deductible, co-insurance or co-payments, or similar charges. “ Breast pump kit ” means a collection of tubing, valves, flanges, collection bottles, or other parts

required to extract human milk using a breast pump. “ Lactation consultant ” means an individual who is an International Board Certified Lactation Consultant. “ Lactation consultation ” means the clinical application by a lactation consultant or other licensed health

care provider of scientific principles and a multidisciplinary body of evidence for

evaluation, problem identification, treatment, education, and consultation to child-bearing

families utilizing lactation care and services. Lactation care and services shall include, but not be limited to: (1) lactation assessment through the systematic collection of subjective and objective

data; (2) analysis of data and creation of a plan of care; (3) implementation of a lactation care plan with demonstration and instruction to

parents and communication to the primary health care provider; (4) evaluation of outcomes; (5) provision of lactation education to parents and health care providers; and (6) the recommendation and use of assistive devices. “ Lactation counseling ” means breastfeeding education and support services provided by a lactation counselor,

such as: (1) educating women, families, health care professionals, and the community about

the impact of breastfeeding and human lactation on health and what to expect in the

normal course of breastfeeding; (2) acting as an advocate for breastfeeding as the norm for feeding infants and young

children; (3) providing breastfeeding support, encouragement, and care from preconception to

weaning in order to help women and their families meet their breastfeeding goals; (4) using principles of adult education when teaching clients, health care providers,

and others in the community; and (5) identifying and referring high-risk mothers and babies and those requiring clinical

treatment appropriately. “ Lactation counselor ” means an individual, other than an International Board Certified Lactation Consultant

or a licensed health care provider, who is: (1) licensed or certified to practice lactation counseling under any law, or who is

an accredited member belonging to another profession or occupation, who provides breastfeeding

education and support services for which that person is licensed, regulated, accredited,

or certified; or (2) a community-based lactation supporter who has received at least 40 hours of specialty

education in breastfeeding and lactation, and who works within a lactation counselor's

scope of practice. “ Telephonic lactation assistance ” means lactation counseling or consultation with a lactation counselor or lactation

consultant conducted remotely through live voice communication. f. The provisions of this section shall apply to those contracts for health care services

by health maintenance organizations under which the right to change the schedule of

charges for enrollee coverage is reserved. 1

L.2019, c. 343, eff. July 11, 2020.