As you may know, the United States Breastfeeding Committee (USBC) and the National Breastfeeding Center (NBfC) on Thursday, July 18th, jointly released a set of policy recommendations for insurers, addressing the Affordable Care Act (ACA)’s requirement to cover “breastfeeding support, supplies, and counseling.”
HealthConnect One joins with other national organizations that agree with reimbursement for lactation support services, but oppose the creation of a reimbursement policy that would limit reimbursement to only licensed providers or individuals holding credentials such as: International Board Certified Lactation Consultants (IBCLCs), contracted network providers, RN certified childbirth educators/breastfeeding educators, and registered dieticians. We believe that perinatal community health workers such as breastfeeding peer counselors and community-based doulas should be included in the list of approved providers of breastfeeding support and counseling services. Currently the model policy states that licensed providers or individuals with credentials are permitted providers to receive reimbursement for conducting prenatal/postpartum breastfeeding classes, facilitating breastfeeding support groups, and providing in-patient hospital support and out-patient hospital, home and physician office/clinic support. We disagree with the assertion in the model policy that describes breastfeeding counseling services as lactation consultant services. This gives the impression that only lactation consultants can provide this basic breastfeeding support and counseling. Currently, peer counselors and community-based doulas are effectively and cost-effectively providing culturally appropriate prenatal breastfeeding counseling, anticipatory guidance, and postpartum support across the country. They also provide referrals and linkages to IBCLCs for expert-level lactation issues. In fact, in underserved communities in which breastfeeding rates are low, these community health workers are more appropriate and effective providers of this basic level of lactation support, and at times the only support available.
As stated in The Surgeon General’s Call to Action to Support Breastfeeding, the U.S health system should strengthen programs that provide mother to mother support and peer counseling, especially for those at an economic disadvantage and those with diverse backgrounds. Breastfeeding peer counselors and community-based doulas are highly effective in increasing breastfeeding initiation, duration and exclusivity rates. The Affordable Care Act authorizes the use of Community Health Workers in Section 5313, and promotes their use in health reform. The model policy needs to stay consistent with the overall vision of health reform, with an expanded health care team that includes community health workers. Breastfeeding peer counselors and community-based doulas are community health workers, trained to provide basic breastfeeding education and support to women in their own communities. It is therefore HealthConnect One’s recommendation that community health workers such as peer counselors and community-based doulas be permitted providers for basic level services.
IBCLCs and other licensed providers are critical to providing expert-level care for mothers experiencing lactation problems, but excluding community health workers in this model policy is not good public health policy. Indeed, these recommendations may be detrimental to the effort to decrease disparities and inequities in breastfeeding support for underserved communities. If USBC is to serve as “a national collective voice for supporting breastfeeding as a public health imperative,” as stated in the model policy, it is important that we develop policies that support and “create and maintain a sustainable infrastructure for mother-to-mother support groups and for peer counseling programs in hospitals and community health care settings” (pg. 40, The Surgeon General’s Call to Action to Support Breastfeeding).
Reimbursement of both basic and expert-level lactation counseling is necessary to sustain an effective web of breastfeeding support for all of the families of our nation.
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- U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
- Public Law 111-148, HR3590: Patient Protection and Affordable Care Act, Section 5313; 2010.