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  • Writer's pictureLisa Paul IBCLC

Tenncare missing non-RN IBCLCs in implementation

For those of you who may not know, Tenncare has recently announced that they are now allowing IBCLCs to join them. While this may seem like good news, they problem is that they have completely disregarded a large segment of our profession - IBCLCs who are not other medical providers. To say that we are just IBCLCs is a misnomer, but we are considered as non-RN IBCLCs in the insurance world. At this point, only IBCLCs who are RNs are eligible to participate. This is a big problem, as many private practice IBCLCs in our state are not RNs or other healthcare providers, and the taxonomy code distinguishes between the two. I want to emphasize this point, because the Tenncare webinar on July 11th totally misunderstood who we are. We are Lactation Consultants without another occupation. We are not midwives, MDs, RNs, SLPs or PTs, we are IBCLCs and the majority of us are in private practice. We are a valid and valuable member of the healthcare team.

On the Tenncare website it states:

"The new taxonomy codes are:

  • IBCLC: 163WL0100X (Lactation Consultant – IBCLC/RLC)

  • CLC/CLE: 174N00000X (Lactation Counselor/Educator – Certified CLC/CLE)"

The first problem is that the CLC/CLE taxonomy code is incorrectly assigned to that category. That taxonomy code is actually the code for non-RN IBCLCs. Secondly, it completely leaves out a large section of lactation consultants practicing in our state. If Tennessee really wants to provide meaningful care to the Tenncare population, the inclusion of non-RN IBCLCs is crucial. In Knoxville, we have one IBCLC in private practice who is an RN. The rest of us are non-RN IBCLCs, and I know of at least 5 of us. The following are the two taxonomy codes with a list of members in Tennessee. I don't believe this is an inclusive list, as I noticed a few missing names, but this is a good place to start with gathering data on how this could affect the implementation of this program.

Tricare recently added lactation services to their services and this is how they list it in their documentation.

163WL0100X Lactation Consultant (if an RN)

174N00000X Lactation Consultant (if not an RN) 174400000X Lactation Counselor (if the National Uniform Claims Committee creates a taxonomy designation specific to lactation counselors, that taxonomy designation shall be used)

In 2018, I started this path to get IBCLCs to be recognized as valid providers for Tenncare. In 2018, I was told at a TIPQC conference by a leader in Tenncare that they didn't have the money to support breastfeeding. (The collective gasp in the room was audible!) In August 2020, I attempted again, and Dennis Elliot, Director of Provider Services with Tenncare told me that if I wanted to take Tenncare I should partner with an OB since IBCLCs were not eligible to be providers. And now, in 2023, the answer I am getting is that my IBCLC certification doesn't count and I need to partner with some medical provider who can

supervise me on a subject in which I am the expert, not them, so I can take Tenncare! I don't want to take Tenncare, I am only pursuing this because there are so many moms in need of services, and I hate telling Tenncare moms that in order to get breastfeeding support they need to pay me out of pocket. When they ask me if I accept Tenncare, I tell them that Tenncare does not accept me.

I have been beating my head against the Tenncare wall for over 5 years. I have a successful private practice based exclusively on billing insurance for services. I have pursued in-network status to help women get the most care possible. I don't need to add Tenncare for financial reasons, I am speaking out about this because having more IBCLCs in the Tenncare system is the only way that we are going to change the tide of low breastfeeding rates in the underserved populations. I worked as a WIC Designated Breastfeeding Expert in 2 rural c

ounties before I started my business, so I am aware of the challenges rural women have in funding lactation care. My WIC colleagues were so excited about the idea of sending me referrals and were sorely disappointed to hear that due to a Tenncare oversight, they still don't have lactation experts for their hard cases.

I know this can be changed. I just don't know who can change it. I was approached by the MCOs at the conference and again by email. They want me to join, but I am stuck because Tenncare won't issue me a Medicaid ID.

I have decided to post this on my website to allow it to get the publicity it needs. Over 50% of women who are pregnant in Tennessee are on Tenncare. From a public health standpoint, we cannot afford to limit lactation care to this population based on an un-informed policy on who should be allowed to independently practice as an IBCLC.

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