DOWNLOAD THE MODEL PAYER POLICY HERE
Model Payer Policy - Payer Coverage of Breastfeeding Support and Counseling Services,
Pumps and Supplies - revised August 19, 2016
Original Post from 2014:
In the rapidly-changing landscape of insurance requirements rolling out under the Affordable Care Act, few have been more confusing than the requirement to cover “breastfeeding support, supplies, and counseling” (starting in the first plan year that began on or after August 1, 2012). The lack of guidelines or recommendations as to who may provide and be paid for lactation care, and what kinds of equipment should be covered for breastfeeding families, has created chaos for providers and patients alike.
“Many insurers have little experience with the clinical and business aspects of breastfeeding support,” says Susanne Madden, chief operating officer of the National Breastfeeding Center. “Our population's health depends on insurers getting this right, but without clear guidelines we are relying on individuals that may not be qualified in breastfeeding medicine or lactation services to identify what is needed to successfully implement this coverage mandate.” As a result, families across the Nation report extreme inconsistencies in coverage and disrupted continuity of care, often being left without access to the resources they need to meet their breastfeeding goals.
Some insurers will only cover a manual pump, which may not be adequate for every situation. For example, an electric pump is needed to maintain lactation when the mother is separated on a regular basis, or for a prolonged period of time, from her infant, as with returning to work. Similarly, a “hospital-grade” or “rental-grade” pump is needed to support initiation of lactation for mothers and infants who are separated due to illness, or who are unable to feed directly from the breast. Similarly, mothers facing breastfeeding challenges are unable to access specialized support from trained professionals and are instead having to rely on care provided during routine office visits with clinicians that may or may not be qualified in breastfeeding medicine. Still others find themselves caught in a maze of paperwork that takes weeks to resolve, or are told (erroneously) that breastfeeding support and equipment is simply not covered at all.
To bridge these gaps and support insurers in the implementation of breastfeeding coverage, the United States Breastfeeding Committee (USBC) and the National Breastfeeding Center (NBfC) came together in 2014 to develop recommendations. The resulting publication, Model Policy: Payer Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies, identifies best practices for payers that appropriately meet the requirements of the ACA and ensure adequate delivery of support for breastfeeding.
The Model Policy was drafted in a collaborative effort with medical, legal, regulatory, lactation, public health, and insurance experts. “Breastfeeding is a proven primary prevention strategy, protecting infants and mothers from a host of diseases and conditions and building a foundation for life-long health and wellness,” says Cathy Carothers, chair of the United States Breastfeeding Committee. “The USBC stands with Surgeon General Regina M. Benjamin to call on insurers and policymakers to effectively implement the provisions of the Affordable Care Act to ensure access to breastfeeding support, supplies, and counseling. We hope that the Model Policy will prove to be a useful and meaningful resource for both governmental agencies and private insurers.”
The Model Policy: Payer Coverage of Breastfeeding Counseling Services, Pumps, and Supplies was created to identify best practices for Payers that appropriately meet the requirements of the ACA, using the language, format, and terminology applicable for expedient, meaningful use by insurance companies.
The Model Policy is intended to guide Payers in determining insurance coverage. As such, it focuses on those health care professionals who can be credentialed by insurers to provide health care services in today’s insurance marketplace.
This policy does not address community-based counseling and support options, offered by organizations and individuals in settings not currently covered by insurance.
The Model Policy was drafted in a collaborative effort with medical, legal, regulatory, lactation, public health, and insurance experts. Questions? Please reach us here: firstname.lastname@example.org / 855-777-NBFC
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