(See the full language of the request for comment at the bottom of this post.)

CMS is considering using the same per-minute staff-cost rate used for a registered nurse, or RN since through their research they found that a large percentage of IBCLCs are also RNs. Without public comment, the outcome may be that it is required to be an RN in order to bill for services.

This is an important time to share our experience and explain that a stand alone IBCLC is a clinical specialist by virtue of the education and training required to achieve the certification. 

An International Board Certified Lactation Consultant, or IBCLC, is a board-certified lactation professional. IBCLCs complete college level education, lactation specific education, 300 – 1000 hrs of clinical training, and must pass a certification exam. Many excellent IBCLCs are also RNs. Many others are qualified IBCLCs without a nursing license.

Both RN-IBCLCs and stand-alone IBCLCs provide important care for families. Any licensed healthcare professional that has taken the healthcare prerequisites but has not completed the additional lactation specific education and clinical competencies would not be qualified.

(feel free to use any of this language in your comment)

What We Hope CMS Will Hear

• Lactation consultants are not always RNs and should not be required to hold an RN license.

• Look at Texas! Texas just passed HB136 in their 89th Legislative session which creates a Lactation Consultant provider type which can bill independently from a physician. Talk to Representative Hull or Senator Alvarado who drafted and pushed this legislation through to passage. Rules language is currently being drafted but much work has already been done. It was identified that there was a major gap in comprehensive lactation support and access to lactation consultants without barriers for families was needed in order to improve public health outcomes.

• If CMS has no plans to create a provider type as opposed to a clinical staff type, the RN clinical staff type may be a good crosswalk for pricing purposes at .76 per minute, but 30 minutes is insufficient for the clinical care and decision making being provided to patients by IBCLCs. The additional 15-minute code should include a value for skilled clinical work, not only office and staff costs.

  • Lactation visits often last 60 – 120 minutes therefore compensation should reflect the time required for the practice.
  • Comprehensive IBCLC visit is not the same as routine clinical-staff support. The IBCLC scope calls for:

• • • Performing comprehensive maternal, child and feeding assessments related to breastfeeding and human lactation.

    • Identification of concerns that affect lactation, feeding, maternal health, infant health, and family goals.

    • Integrating knowledge and evidence from the disciplines defined in the Detailed Content Outline when providing care for breastfeeding families.

    • Acknowledging parental and child health and mental status in the context of breastfeeding.

    • Developing and implementing an individualised feeding plan in consultation with the client.

    • Recording all relevant information, truthfully and fully, concerning care provided and, where appropriate, retaining records for the time specified by the local jurisdiction.

    • Referral to the parent’s or infant’s primary clinician or another appropriate professional when needed.

    • Working collaboratively and interdependently with other members of the health care team to deliver coordinated services to families.

    • Reporting, when necessary, truthfully and fully to the client’s primary health care provider, to the health care system, and/or to the appropriate social services.

• IBCLCs and lactation counselors are not the same but language in the request for comment seems to equate them. “The qualifications of the lactation consultant/counselor must be recognized by a physician society, nonphysician health care professional society/association, or other appropriate source.”

  • The IBCLC is NCCA accredited – This should be considered the minimum standard for “other appropriate source”. Peer Counselors and Certified Lactation Counselors have different / less rigorous requirements and their scope involves only common uncomplicated lactation support.

• Coverage should not restrict place of service or patient age. Support lactation care is essential prenatally in the form of education, right after birth which may mean the first 24-72 hrs when patients are still admitted in the hospital or birth center,  after discharge, and throughout the time that an individual is lactating or the child is breastfeeding.