TRICARE DOULA COVERAGE EXPANDS: NEW OPTIONS AVAILABLE FOR EXPECTING MOTHERS
The TRICARE Childbirth and Breastfeeding Support Demonstration has expanded its support for expectant moms stationed abroad. This additional program will expand the range of services and help provide the best care to expecting mothers by adding coverage for licensed labor doulas.
The expanded TRICARE Doula coverage includes postpartum care services from licensed lactation consultants and counselors, so it doesn't end with deliveries. There might be TRICARE policy changes in 2025 that are a bit scary, but this is one that mothers should look forward to. With this expansion, expecting mothers will have the right tools they want for a safe breastfeeding experience.
TRICARE Doula Coverage is Now Available Overseas and in the U.S. Territories
On January 1, the TRICARE Childbirth and Breastfeeding Support demonstration was extended to those in American territories and abroad. Also, TRICARE officials have modified certain standards, such as the visitation and doula requirements in the United States.
TRICARE Prime, TRICARE Prime Remote, or TRICARE Select users in the United States and abroad can get childbirth and breastfeeding support services through this demonstration program.
Labor doulas are non-medical, trained individuals who help the laboring woman physically and emotionally and educate them before, during, and shortly after labor. The demonstration project requires moms to be at least 20 weeks pregnant, want to give birth outside of a military hospital or clinic, and see a TRICARE-authorized practitioner in order to be eligible for doula services.
TRICARE's Childbirth Support Demonstration
According to authorities of the Defense Health Agency, over 14,000 individuals have taken part in the program since the demonstration started in the United States in January 2022. The five-year demonstration was approved by Congress and will continue until 2026.
TRICARE representatives will then decide if the coverage will be permanent. The program compares the health outcomes of mothers and children who receive these support services from lactation counselors, consultants, and/or doulas to those who do not.
What to Expect on the Expanded TRICARE Doula Coverage
TRICARE now covers up to six hours of visits by a licensed labor doula under the new regulations, and these visits can be divided into 15-minute blocks. The untimed visit during birth is not included. In the past, TRICARE's coverage was based on visits rather than hours, and it included up to six visits from a certified labor doula in addition to the visit during childbirth.
According to Karen Ruedisueli, director of health affairs in government relations for the Military Officers Association of America, the doula adjustments appear to offer more flexibility in doula sessions and maybe higher compensation for certain doulas. The patient and the doula will be able to determine how best to use their visit allowance if the visits are divided up.
Before receiving any services, those interested in the demonstration and those who live abroad must register by getting in touch with their TRICARE overseas contractor. If the contractor is able to locate a TRICARE-authorized provider, International SOS will notify pregnant women within 14 days. TRICARE is unable to ensure that every eligible beneficiary will have access to a physician.
Referrals are not required for expectant moms in the United States. However, if a TRICARE Prime member sees a non-network provider, their primary care manager must refer them. If not, point-of-service fees could be incurred without the referral. To find out if they qualify, people in the United States should contact their local TRICARE contractor.
Certification Requirements and Session Flexibility
The new regulations also prohibit trained labor doulas in the United States from asking the beneficiary to pay for covered services after the deductible has been satisfied and require them to sign a participation agreement in order to participate in the demonstration.
The providers cannot ask the beneficiary to submit their own claims. The National Black Doulas Association is now on the list of organizations that require labor doulas to hold a current certification from an authorized certifying body.
According to the guidelines, moms must be at least 27 weeks pregnant in order to be eligible for TRICARE's breastfeeding assistance benefit and the demonstration's breastfeeding support services. TRICARE's current breastfeeding support benefit may be available to those who are not eligible for breastfeeding help under the demonstration.
Six sessions of breastfeeding support are still included in the demonstration. These sessions are already covered by TRICARE. Lactation consultants or counselors can provide this assistance to mothers in group or individual sessions.
The demonstration also permits services and sessions from experts who are not TRICARE-certified medical doctors but are qualified to offer lactation counseling or consultation. Lactation consultants are educated to offer breastfeeding counseling to promote the normal lactation of nursing parents.
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