USLCA Efforts for Licensing and Insurance Credentialing
UNDERSTANDING THE BASICS
Affordable Care Act-upheld in 2012 mandates that eligible private health insurance maternity policies rolling over after August 1, 2012 must begin covering preventative health services, including lactation care, without cost-sharing or co-pays from members.
Women's Preventative Services Package in the Affordable Care Act-specific language of the Affordable Care Act that lactation care delivery.
Center for Medicare & Medicaid Services: Medicaid Coverage of Lactation Care Services-Although this document develops the language for the Affordable Care Act's inclusion of breastfeeding care, it does not name the IBCLC as the gold standard as the lactation care provider.*
Surgeon General's Call to Action to Support Breastfeeding-This specifically mentions the IBCLC as the gold-standard provider in lactation and breastfeeding care.**
*The fact that the IBCLC was not mentioned as the gold-standard deliverer of lactation care for Medicaid is the major loophole that affects the IBCLC credentialing effort. Medicaid, thus far, pays for services by licensed providers; most IBCLCs are not licensed. What this means is that other licensed providers (dieticians, pediatricians, obstetricians, etc.) will be able to bill for lactation codes since they are licensed (regardless of their specialty, and regardless of whether or not they are IBCLCs) if any level of breastfeeding education was provided.
**The Surgeon General's Call to Action to Support Breastfeeding DOES mention IBCLCs as the gold-standard provider in lactation and breastfeeding care. The efforts of the USLCA focus on linking this federal 'edict' with the Affordable Care Act implementation.
Containing Healthcare Costs in Plain Sight-USLCA publication which breaks down the cost-effectiveness of IBCLC credentialing for health insurance companies and private physician practices. THIS IS AN EXCEPTIONAL RESOURCE.
KEEP IN MIND
Medicaid and private health insurance companies have separate policies about credentialing. Whereas Medicaid cannot currently credential non-licensed providers, private health insurance companies can credential whatever speciality they feel meets the needs of their member and AND the company's bottomline. Using USLCA's "Containing Healthcare Costs in Plain Sight" is an EXCELLENT tool to provide private health insurance companies and private physicians as to how exactly IBCLC credentialing will reduce illness, save money and attract members to their organizations.
Medicaid does, however, contract with some private health insurance companies in some states. Medicaid members choosing to use a Medicaid contracted private health insurance company in these states can receive access to IBCLC care if the private health insurance Medicaid has partnered with providers coverage of the non-licensed IBCLC.
USLCA Must-Reads
USLCA Licensing & Reimbursement Committee Website-***Please visit every link on this page to help you get a thorough understanding of the efforts, and the processes IBCLCs are and will encounter during the general health insurance credentialing efforts, and specifically with Aetna.
USBC Summary of Licensing and Reimburesment
BECOME AN INSURANCE COMPANY PROVIDER (can take 30-60 days and sometimes longer)
Aetna, so far, is the only national health insurance provider who has started credentialing all IBCLCs. States such as Nebraska, have statewide private insurance companies who have begun the credentialing process. As others become available in Texas, I will update this site.
Getting Started with Aetna:
1. USLCA Q & A from Aetna Credentialing Conference Call
2. Obtain National Provider Identification Number (NPI)*
3. Join Aetna's Network
4. CAQH Website (Register with the Unified Provider Datasource)*
* Items 1 & 4 are essential steps to take to apply for credentialing with any health insurance company. These are the two longest steps and won't need to be repeated with each application to a new health insurance company. CAQH applications are to be updated every 120 days.
FUTURE DELIVERY of LACTATION SERVICES
When IBCLCs become routinely credentialed by health insurance companies, delivery of lactation care will shift. Whereas presently, lactation services are mainly provided by healthcare systems as a 'charity' item, hospital systems will begin to see breastfeeding care as profitable.
These are some of the changes hospital IBCLCs may see:
-An expansion in their hospital's lactation program
-IBCLCs potentially negotiating higher salaries
-IBCLCs potentially joining health systems as individual providers, as in having "priviledges" vs. direct employment
-Motivation from health system administrations to strengthen policies against unncessary artificial baby milk use (since this could be perceived as a "conflicts of interest")
GET INVOLVED
Reach out to our elected officials and introduce them to the IBCLC's plight!
Texas State Representatives
Search by Zip Code: Who represents me?
Congressional Districts
Districts 15, 20, 21, 23, 25 & 28
How can San Antonio elected officials help?
Share "Containing Costs In Plain Sight" with them and help them bring this to the attention of our city's health insurance companies! They CAN help us develop a market in San Antoni. With the
SAN ANTONIO IS INTERESTED IN HEALTH!
Link local preventative health with economics!
Involve SA Metropolitan Health District
Read about SA's health initiatives
San Antonio Mayor's Office
San Antonio Office of Economic Development
Affordable Care Act-upheld in 2012 mandates that eligible private health insurance maternity policies rolling over after August 1, 2012 must begin covering preventative health services, including lactation care, without cost-sharing or co-pays from members.
Women's Preventative Services Package in the Affordable Care Act-specific language of the Affordable Care Act that lactation care delivery.
Center for Medicare & Medicaid Services: Medicaid Coverage of Lactation Care Services-Although this document develops the language for the Affordable Care Act's inclusion of breastfeeding care, it does not name the IBCLC as the gold standard as the lactation care provider.*
Surgeon General's Call to Action to Support Breastfeeding-This specifically mentions the IBCLC as the gold-standard provider in lactation and breastfeeding care.**
*The fact that the IBCLC was not mentioned as the gold-standard deliverer of lactation care for Medicaid is the major loophole that affects the IBCLC credentialing effort. Medicaid, thus far, pays for services by licensed providers; most IBCLCs are not licensed. What this means is that other licensed providers (dieticians, pediatricians, obstetricians, etc.) will be able to bill for lactation codes since they are licensed (regardless of their specialty, and regardless of whether or not they are IBCLCs) if any level of breastfeeding education was provided.
**The Surgeon General's Call to Action to Support Breastfeeding DOES mention IBCLCs as the gold-standard provider in lactation and breastfeeding care. The efforts of the USLCA focus on linking this federal 'edict' with the Affordable Care Act implementation.
Containing Healthcare Costs in Plain Sight-USLCA publication which breaks down the cost-effectiveness of IBCLC credentialing for health insurance companies and private physician practices. THIS IS AN EXCEPTIONAL RESOURCE.
KEEP IN MIND
Medicaid and private health insurance companies have separate policies about credentialing. Whereas Medicaid cannot currently credential non-licensed providers, private health insurance companies can credential whatever speciality they feel meets the needs of their member and AND the company's bottomline. Using USLCA's "Containing Healthcare Costs in Plain Sight" is an EXCELLENT tool to provide private health insurance companies and private physicians as to how exactly IBCLC credentialing will reduce illness, save money and attract members to their organizations.
Medicaid does, however, contract with some private health insurance companies in some states. Medicaid members choosing to use a Medicaid contracted private health insurance company in these states can receive access to IBCLC care if the private health insurance Medicaid has partnered with providers coverage of the non-licensed IBCLC.
USLCA Must-Reads
USLCA Licensing & Reimbursement Committee Website-***Please visit every link on this page to help you get a thorough understanding of the efforts, and the processes IBCLCs are and will encounter during the general health insurance credentialing efforts, and specifically with Aetna.
USBC Summary of Licensing and Reimburesment
BECOME AN INSURANCE COMPANY PROVIDER (can take 30-60 days and sometimes longer)
Aetna, so far, is the only national health insurance provider who has started credentialing all IBCLCs. States such as Nebraska, have statewide private insurance companies who have begun the credentialing process. As others become available in Texas, I will update this site.
Getting Started with Aetna:
1. USLCA Q & A from Aetna Credentialing Conference Call
2. Obtain National Provider Identification Number (NPI)*
3. Join Aetna's Network
4. CAQH Website (Register with the Unified Provider Datasource)*
* Items 1 & 4 are essential steps to take to apply for credentialing with any health insurance company. These are the two longest steps and won't need to be repeated with each application to a new health insurance company. CAQH applications are to be updated every 120 days.
FUTURE DELIVERY of LACTATION SERVICES
When IBCLCs become routinely credentialed by health insurance companies, delivery of lactation care will shift. Whereas presently, lactation services are mainly provided by healthcare systems as a 'charity' item, hospital systems will begin to see breastfeeding care as profitable.
These are some of the changes hospital IBCLCs may see:
-An expansion in their hospital's lactation program
-IBCLCs potentially negotiating higher salaries
-IBCLCs potentially joining health systems as individual providers, as in having "priviledges" vs. direct employment
-Motivation from health system administrations to strengthen policies against unncessary artificial baby milk use (since this could be perceived as a "conflicts of interest")
GET INVOLVED
Reach out to our elected officials and introduce them to the IBCLC's plight!
Texas State Representatives
Search by Zip Code: Who represents me?
Congressional Districts
Districts 15, 20, 21, 23, 25 & 28
How can San Antonio elected officials help?
Share "Containing Costs In Plain Sight" with them and help them bring this to the attention of our city's health insurance companies! They CAN help us develop a market in San Antoni. With the
SAN ANTONIO IS INTERESTED IN HEALTH!
Link local preventative health with economics!
Involve SA Metropolitan Health District
Read about SA's health initiatives
San Antonio Mayor's Office
San Antonio Office of Economic Development
CONTACT THE HEALTH INSURANCE COMPANIES
Sample Letter-waiting for permission to use
America's Health Insurance Plans-major American health insurance trade organization
Health insurance companies in Texas-Search by name
BENEFITS TO PEDIATRIC OFFICES
Creating an Office Setting that Promotes and Support Breastfeeding-Excellent! From the Pennsylvania Medical Society
Good blog about what having an IBCLC in their office could do for a pediatrician
Sample Letter-waiting for permission to use
America's Health Insurance Plans-major American health insurance trade organization
Health insurance companies in Texas-Search by name
BENEFITS TO PEDIATRIC OFFICES
Creating an Office Setting that Promotes and Support Breastfeeding-Excellent! From the Pennsylvania Medical Society
Good blog about what having an IBCLC in their office could do for a pediatrician
