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Childbirth and Breastfeeding Support Demonstration: Provider Participation

Provider Participation/Joining Our Network

Lactation counselors, lactation consultants and labor doulas must meet the certification requirements outlined in the TRICARE Operations Manual (TOM), Chapter 18, Section 11 in order to be reimbursed under TRICARE's Childbirth and Breastfeeding Support Demonstration (CBSD). See "Provider Requirements" below.

 

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Provider Types/Requirements

Lactation counselors, lactation consultants and labor doulas must meet the certification requirements outlined in the TOM, Chapter 18, Section 11 in order to be reimbursed under the demonstration. 

  • Certified labor doulas, sometimes referred to as birth doulas, aid a birthing parent during the birthing process. They provide support for the birthing parent prior to, during and after labor. Labor doulas are not medical personnel and do not provide medical services, such as examination of the cervix or prescription of medications, and do not give medical advice. 

  • Lactation consultants have the highest level of breastfeeding training and may be necessary when complex problems surrounding breastfeeding arise.

  • Lactation counselors have received specialized training to aid in breastfeeding and infant nutrition from breastmilk, and generally provide breastfeeding counseling to support normal lactation and breastfeeding parents of healthy, full-term infants.

Taxonomies

When submitting rosters with your primary or secondary specialty information to HNFS, use these taxonomy designation codes:

  • Certified labor doula – 374J00000X
  • Lactation consultant
    • RN – 163WL0100X
    • Non-RN – 174N00000X
  • Lactation counselor – 174400000X (will show as “Specialist” in the NPI registry)

Requirements

Requirements Certified Labor Doulas Lactation Consultants and Lactation Counselors
Be at least 18 years old x x
Have/maintain a current adult, child and infant CPR certification x x
Have a National Provider Identification (NPI) number x x
Not have any current Medicare or Medicaid sanctions x x
Have professional liability insurance in the amounts of $200k/$600k

x

*network providers only 

x

*network providers only 
Not have any unexplained gaps in work istory for the most recent five (5) years

x

*network providers only

x

*network providers only

Have attended a minimum of 24 education hours to include:

  • the physiology of labor;
  • labor doula training;
  • antepartum doula training; and
  • postpartum doula training
 x  
Have attended one or more breastfeeding courses x  
Have attended one or more childbirth classes x  
Not have obtained education/experience during the CLD’s own pregnancy/childbirth or the childbirth of an immediate family member x  
Doula Attestation (must sign attestation): 
  • Provided continuous in-person childbirth support for at least three childbirths, with a minimum of 15 hours over the three childbirths 
  • At least two of the three births were a vaginal birth
  • Provided antepartum and postpartum support for at least one birth
 x  
Be licensed/certified by one of the acceptable boards as noted in the table below (if offered within the state, must also have state license/certification) x x

Acceptable Boards

Provider Type Board
Certified Labor Doula

Postpartum doula certification by itself does not qualify. 
Lactation Counselor 
Lactation Consultant