Childbirth and Breastfeeding Support Demonstration: Provider Participation

Provider Participation/Joining Our Network

Lactation counselors, lactation consultants and certified labor doulas (CLD) 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.

Providers interested in joining the TRICARE West Region network may contact us for additional information. Send an email to ChildbirthSupport_Providers@hnfs.com.
Existing network groups who have these provider types should notify us via an updated roster (see taxonomies below).
Phase 2 reimbursement, available for dates of service on or after June 10, 2024, requires CLDs to be in-network or have a signed non-network participation agreement on file.

Interested in registering on our website?
Providers registered at www.tricare-west.com can access all the tools on our secure portal: submit claims and referrals and check status, verify patient eligibility, view provider remits, and more. Learn how to register on our website.

Provider Types/Requirements

CLDs, 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. CLDs 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 history for the most recent 5 years	x *Network providers only	x *Network providers only
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 *Participation in a Medicaid doula program allowed in lieu of certification	x
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
Additional requirements (must sign attestation): Provided continuous in-person childbirth support as the primary doula 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

Acceptable Boards

Provider Type	Board
Labor Doula	The CLD holds a current certification as a CLD, certified doula or similar perinatal certification (postpartum doula certification by itself does not qualify), obtained within the last three years from one of the following organizations: BirthWorks International (BWI) Childbirth and Postpartum Professional Association (CAPPA) DONA International International Childbirth Education Association (ICEA) National Black Doulas Association (NBDA) ToLabor OR Participation in a permanent statewide Medicaid doula program may be substituted for the certification requirement for labor doulas practicing in states with an active statewide doula Medicaid benefit. Participation must be in a permanent statewide Medicaid doula program, excluding geographically or time limited programs and programs with requirements wet by affordable care or managed care organizaitons. Postpartum doula certification by itself does not qualify.
Lactation Counselor	ALPP-certified as Certified Lactation Counselor
Lactation Consultant	IBCLE-certified as an International Board-Certified Lactation Consultant; or ALPP-certified as an Advanced Lactation Consultant or Advanced Nurse Lactation Consultant

Provider Type

Board

Labor Doula

The CLD holds a current certification as a CLD, certified doula or similar perinatal certification (postpartum doula certification by itself does not qualify), obtained within the last three years from one of the following organizations:
- BirthWorks International (BWI)
- Childbirth and Postpartum Professional Association (CAPPA)
- DONA International
- International Childbirth Education Association (ICEA)
- National Black Doulas Association (NBDA)
- ToLabor
  
  OR
- Participation in a permanent statewide Medicaid doula program may be substituted for the certification requirement for labor doulas practicing in states with an active statewide doula Medicaid benefit. Participation must be in a permanent statewide Medicaid doula program, excluding geographically or time limited programs and programs with requirements wet by affordable care or managed care organizaitons.

Postpartum doula certification by itself does not qualify.

Lactation Counselor

ALPP-certified as Certified Lactation Counselor

Lactation Consultant