MedicaidCoverageMedium impact
MAB2024011901
Pennsylvania Medicaid (DHS)·PA · Pediatrics, OB-GYN·Provider Bulletin
Effective date
Jan 20, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated coverage conditions for pasteurized donor human milk (PDHM), expanding eligibility criteria and removing prior AAP clinical guidelines for authorization review. Human milk banks no longer need HMBANA certification to enroll in the MA Program.
Action Required
Immediately: Billing team must review updated PDHM coverage criteria for infants under 12 months. Outpatient PDHM still requires prior authorization via 1-800-537-8862. Inpatient PDHM payment remains bundled in hospital DRG payments. Update documentation templates to reflect new qualifying conditions including infant hypoglycemia, jaundice, and neonatal abstinence syndrome for inpatient settings.