Licensure and Reimbursement

Director: Marsha Walker, RN, IBCLC, RLC

Description:  "The goal of the USLCA is to fully integrate International Board Certified Lactation Consultants into the US healthcare system in order to provide consumer protection and ensure skilled clinical lactation services are available and provided equitably."

Committee Chair:  Judith Gutowski BA, IBCLC

Application for Committee work Click here


Rationale:
1. Licensure will provide consumers, health care providers, insurance personnel and employers with the ability to identify qualified lactation consultants.
2. Licensure will provide a means of standardizing practice and maintaining sound oversight of lactation professionals.
3. Reimbursement within the health care system will ensure access to timely, skilled, competent and culturally relevant breastfeeding support for all mothers and babies.
4. Reimbursement for services will positively impact the growth of the profession of lactation consulting creating adequate numbers of IBCLCs needed to meet current and future needs.


Model Letters: (download and enter in your information)

Model Letter: Medicaid Managed Care

Medicaid Managed Care Organization Plans Improvement: Offering expanded services of International Board Certified Lactation Consultants as preventive health services in plan benefit packages. Read more

Model Letter: Request Coverage of IBCLCs for Private Insurers

Offering services of International Board Certified Lactation Consultants as preventive health services. Read More


Publications:

Licensure FAQ's for the IBCLCs

The US Lactation Consultant Association has received a number of inquiries regarding the necessity and value of securing licensure for the IBCLC. Since there is no process for national licensure, the licensing of health professionals is done by each state. The goal of licensure is to provide for public safety. USLCA’s Licensure and Reimbursement Committee is diligently working to secure licensure for the IBCLC in a number of states. Read More

Containing Health Care Costs Help In Plain Sight (2nd Edition)

Skyrocketing healthcare costs have resulted in a greater emphasis on disease prevention by healthcare professionals, government agencies, and health insurers. By providing immune protection and proper nutrition, breastfeeding remains a cost-effective intervention for disease prevention with an accompanying reduction in health care spending. Informed women are initiating breastfeeding at an increasing rate, from 26% in 1970 to 75% in 2007. However, many women struggle to maintain breastfeeding for as long as it is medically recommended and fail to achieve the intensity and duration of breastfeeding that they planned. This is often due to poor access to effective breastfeeding support within the medical system, false and misleading infant formula marketing, and societal barriers including: lack of paid maternity leave, unsupportive places of employment, and cultural discomfort with breastfeeding. Consequently, health care dollars are spent on treating diseases and conditions that could have been effectively prevented by breastfeeding. In order to appropriately address this preventative health care gap and the excessive costs that result, consumers, health care providers, insurers and employers need to be able to identify and access qualified lactation consultants to provide services and protect quality of care. Read More

Infographic on Containing Health Care Costs

You may also click here to download the USLCA's new infographic, which highlights the important contribution the IBCLC makes in healthcare and also makes the case for reimbursement. 

Medicaid Flyer

Please click here to download an informational one-page flyer that explains why IBCLCs are the solution for mothers on Medicaid.


Articles:

Suggestions for Billing Codes for IBCLCs

There are several classifications of CPT or HCPCS Codes which IBCLCs can theoretically use to bill for their services. There are advantages and disadvantages to each of these codes. None of the codes are really suited ideally for the work that IBCLCs do, but we are required to use the available existing codes which are meant for other kinds of health care professionals so we must adapt. Read More


Reimbursement Questions and Answers for IBCLCs

The USLCA often receives inquiries about insurance and Medicaid billing and reimbursement for IBCLC services. The answers to these types of questions require consideration of many factors so there is no single solution that can be provided. In general, coding strategies and reimbursement will vary with the type of facility or the location one works in, such as a hospital, clinic, physician or private practice. Reimbursement can also depend on the credentials of the person providing the service and whether there could be a licensed provider available to share the visit. Read More

CPT Codes in table


Presentations:

"The New Health Care Provider Taxonomy: What it means to the IBCLC" by: Judith L. Gutowski, BA, IBCLC, RLC Licensure & Reimbursement Committee Chair


Other Links

Certification vs. Certificate Programmes: What's the Difference?

What is the difference between a certification and Certificate?  Read this illuminating article from IBLCE's December 2012 newsletter: http://iblce.org/news-from-the-board#Certification

U.S. Surgeon General’s Call to Action: Increase Support for Breastfeeding Families

Breastfeeding support for new families was spotlighted in an unprecedented document issued today by the Surgeon General of the United States, Dr. Regina Benjamin. The Call to Action to Support Breastfeeding challenges the entire nation to work toward removing obstacles that can make it difficult for women to achieve their breastfeeding goals, and serves as a model roadmap for governments across the world to robustly address similar challenges. Read USLCA's full Press Release.

For those IBCLCs who cannot wait to sign up with Aetna. Here are detailed instructions.

Please understand that Aetna is just putting special procedures and systems in place to “credential” IBCLCs across the United States. They have not yet trained all of their credentialing customer service representatives on these processes so there may be glitches. It will all be worked out as quickly as possible. Read More

Aetna Q&A for IBCLCs

Reimbursement 101Webinar FAQ's