Federal Policy & Legislation2024-09-10T20:06:40-04:00

Strategically guiding federal policy and legislation to improve patient safety in lactation care and equitable access to clinical lactation services, while supporting breastfeeding families and IBCLCs®.

Knowledge briefs

NLCA is pleased to introduce the first in a series of Knowledge Briefs. This Knowledge brief clarifies the various lactation personnel in the lactation field. The lactation field is replete with a bewildering array of personnel who fulfill various supportive or clinical roles, but their titles can be confusing to parents, policy makers, legislators, insurers, employers, hospitals, and the healthcare system. This document offers clarity of lactation personnel and is suitable for use in IBCLC® advocacy efforts.

Free advocacy resource download

This IBCLC® impact document can be downloaded and used in advocacy efforts with legislators, policy makers, hospitals, insurers, employers, healthcare systems, policies and by authors and researchers. It is intended to illustrate the importance and efficacy of the lactation consulting profession and the credential that represents the gold standard in clinical lactation care.

The State Advocacy Committee

To support the mission of NLCA through: (1) the introduction, advocacy and passage of state licensure bills in all 50 states; (2) advocacy for equitable reimbursement of clinical lactation care; and (3) advocacy for the integration and promotion of breastfeeding and of the IBCLC® within state healthcare policies, regulations, laws and the marketplace.

The Federal Policy Committee

The purpose of the Federal Policy Committee is to improve access to clinical lactation care provided by the holder of the IBCLC® certification and to insure that federal legislation and policy includes the lactation consultant profession as a provider of clinical lactation care.

View a NLCA’s Federal Policy Committee Intervention example and join one of our two Advocacy Committees by submitting the “Get Involved” form and let’s move our profession forward!

The State & Federal Advocacy Committee

The State Advocacy Committee.

To support the mission of NLCA through: (1) the introduction, advocacy and passage of state licensure bills in all 50 states; (2) advocacy for equitable reimbursement of clinical lactation care; and (3) advocacy for the integration and promotion of breastfeeding and of the IBCLC® within state healthcare policies, regulations, laws and the marketplace.

The Federal Policy Committee.

The purpose of the Federal Policy Committee is to improve access to clinical lactation care provided by the holder of the IBCLC® certification and to insure that federal legislation and policy includes the lactation consultant profession as a provider of clinical lactation care.

View a NLCA’s Federal Policy Committee Intervention example, and join one of our two Advocacy Committees by filling out the “Get Involved” form and let’s move our profession forward!

Understanding federal health legislation and policy.

Federal healthcare laws, regulations and policies can be effective vehicles for improving public health and how healthcare is delivered.

Federal Laws2024-06-27T17:34:02-04:00

The U.S. Congress passes national laws (sometimes called Acts) to address social, health, or economic problems or needs. Laws go through the bill process before becoming established as a law. A bill has to be written, sponsored by a legislator, debated and passed through both the House of Representatives and the Senate after various committee and budget hearings before going to the President to be signed into law.

Laws are then referred to the appropriate government or regulatory agency for enforcement and/or implementation. The governmental agency is allowed to create regulations or policies to implement the intent of laws placed under their purview.

Regulations2024-06-27T17:37:28-04:00

Regulations or policies concerning particular laws are created by the respective governmental agencies that have the duty or authority over such laws. Regulations do not go through the bill process. Proposed regulations do, however, get published for public comment for a period of time before they are finalized and adopted by an agency.  Regulations are published by executive branch agencies to clarify their interpretation of laws within their purview and to give the public guidance as to how the agency will implement those laws. Regulations can state requirements or prohibitions.

Policies2024-06-27T17:37:36-04:00

Some agencies also publish guidance or other policy statements, which further clarify how an agency understands and implements existing laws and regulations. Guidance and other policy statements describe suggested or recommended actions. Guidance and policy statements do not provide mandatory requirements unless they are incorporated into a regulation or mandated under terms and conditions of an agreement, such as a funding agreement.

Federal Health Agencies2024-06-27T17:37:39-04:00

The US Department of Health and Human Services (HHS) is the federal government’s principal agency responsible for health-related issues. HHS has 11 operating divisions, including eight agencies in the US Public Health Service. A few of the operating divisions that include breastfeeding issues are the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA) under which is the Maternal Child Health Bureau (MCHB). The US Department of Agriculture (USDA) houses the Food and Nutrition Service which administers the WIC program.

Advocacy2024-06-27T17:37:43-04:00

If you want to change a law, or have one enacted it has to be done through a legislator who would be willing to sponsor a bill. Only legislators can introduce bills to the House or Senate, so to get a bill started you must first find someone who is willing to take on the issue. When trying to change a regulation, you would need to determine which agency is responsible for making the regulation and contact that agency to get the issue placed on their agenda.

Advocating for the IBCLC at the Federal Level2024-06-27T17:37:47-04:00

There are a number of federal laws, policies, and programs related to breastfeeding that exist at the federal level. An inventory of many of these can be found on the US Breastfeeding Committee’s website at www.usbreastfeeding.org. It is fine to advocate for breastfeeding, but as we look to advocate for the IBCLC profession, most of these laws, policies, and programs do not mention the IBCLC. However, some offer the potential for advocacy efforts to better integrate the IBCLC profession into the federal health realm. Below is a selection of federal healthcare advocacy opportunities.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC)2024-06-27T17:52:59-04:00

Administered by the USDA Food and Nutrition Service, WIC is a nutrition program that provides healthy foods, nutrition education, breastfeeding support, and referrals to healthcare and other services to families that meet the income qualification. There are 90 WIC state agencies that administer the program and guide the 1,900 local agencies in 10,000 clinic sites. While “breastfeeding support” is a federally required WIC deliverable, not all local WIC programs provide access to an IBCLC, either on staff or by referral. Michigan is a good example of how IBCLCs can be integrated into the WIC program. Michigan requires each local agency to have an IBCLC to serve as the lead breastfeeding technical support expert (https://www.michigan.gov/documents/mdch/1_07_LA_Staffing_02-25-14_448720_7.pdf).

Advocacy opportunity: Contact your state WIC breastfeeding coordinator and discuss the advisability of having an IBCLC on staff or available to WIC breastfeeding families whose issue or problem need clinical evaluation and management—which is beyond the breastfeeding education and support that WIC peer counselors provide.

The Maternal, Infant, and Early Childhood Home Visiting Program2024-06-27T17:52:22-04:00

Administered by HRSA in partnership with the Administration for Children and Families, this program supports voluntary, evidence-based home visiting for at-risk pregnant women and parents with children up to kindergarten entry. Typically run out of state health departments, they have the flexibility to tailor the program to serve the specific needs of their communities. Through a needs assessment, states identify target populations and select home visiting service delivery models that best meet state and local needs. Most state models use community health workers, but a few programs use Registered Nurses for the home visitation. Breastfeeding is part of the performance measurement system and could offer IBCLCs an opportunity to participate as trainers for home visitors as well as participating as a home visitor.

Advocacy opportunity: Contact your state department of public health to discover how your services might be integrated into this program.

Title V Maternal and Child Health Services Block Grant Program2024-06-27T17:52:04-04:00

Each year, Congress sets aside funding for the Maternal and Child Health Block Grant. State maternal and child health agencies, which are usually located within a state health department, apply annually for this Title V funding. The legislation also requires states to submit an Annual Report and to complete a statewide, comprehensive needs assessment every five years. States have flexibility in how Title V funds are used to support a wide range of activities that address state and national needs. Fifteen National Performance Measures (NPMs) across five population health domains have been established for the Title V MCH Services Block Grant program. Based on its identified priority needs, states select a minimum of five NPMs for programmatic focus. Breastfeeding is one of the Title V’s National Performance Measures.

Advocacy opportunity: Contact your state public health department to discover how you or your organization might provide technical assistance, training, or the delivery of clinical breastfeeding care to those families receiving services through the Title V funding program. Ask that the breastfeeding performance measure be chosen as one of the NPMs that the state addresses.

Early Care and Education (ECE)2024-06-27T17:51:44-04:00

CDC provides funding, training, and technical assistance to a variety of organizations to carry out obesity prevention efforts for the ECE setting. The ECE settings include child care facilities. State ECE systems can promote standards that address nutrition, infant feeding, physical activity, and screen time. Caring for Our Children, (CFOC) is a collection of national standards that represent the best practices, based on evidence, expertise, and experience, for quality health and safety policies and practices for today’s early care and education settings. Breastfeeding recommendations for ECE centers are contained within these standards (http://nrckids.org/CFOC). In collaboration with the National Center for Early Childhood Health and Wellness (NCECHW), the National Resource Center for Health and Safety in Child Care and Early Education (NRC) updates CFOC Standards. The Child Care and Development Block Grant (CCDBG) Act of 2014 provides federal funding to states for child care subsidies for low-income families with children under age 13, as well as flexibility to pair state and federal funds to improve the quality of child care available to families within existing state and local systems. The Administration for Children and Families (ACF) within the Department of Health and Human Services administers the Child Care and Development Fund (CCDF).

Advocacy opportunity: Request that CCDF, ACF, and NRC add the provision of IBCLC services to their guidelines. The IBCLC can provide education and training to child care centers and staff, serve as a referral source for families using child care facilities, and advise state agencies on how the IBCLC can contribute to improved health outcomes of infants and young children in child care settings.

Centers for Medicare & Medicaid Services (CMS)2024-06-27T17:51:28-04:00

Medicaid coverage for lactation consultant services is varied and inconsistent across states. If the service is covered, only healthcare professionals who hold a medical or nursing license are eligible for Medicaid reimbursement. Since the IBCLC credential is a certification, not a license, Medicaid beneficiaries often lack access to the services of IBCLCs. Reimbursement codes provide an extremely low reimbursement rate.

Advocacy opportunity: Ask your state Medicaid Department to support legislation that would license IBCLCs. Once licensed, ask your state Medicaid Department to submit a State Plan Amendment (SPA) requesting permission from the federal CMS office to reimburse for the clinical services delivered by licensed IBCLCs. If after much work, licensure efforts are not successful, then consider asking for a SPA requesting permission from the federal CMS office to reimburse for clinical services delivered by non-licensed IBCLC providers.

Bureau of Health Workforce2024-06-27T17:44:30-04:00

The Bureau of Health Workforce (BHW) is one of five bureaus and 11 offices of the Health Resources and Services Administration (HRSA) that improves the health of underserved and vulnerable populations such as rural, urban, and tribal underserved communities by strengthening the health workforce and connecting skilled professionals to communities in need. The Bureau administers loan repayment programs for health professionals and provides training grants to support institutions that train healthcare providers to practice in high-need areas nationwide.

Advocacy opportunity: Ask that training programs that prepare providers to practice as IBCLCs be included in loan repayment programs and in training grants. Ask that IBCLC training programs be added to those programs that receive funding from the Bureau. Support should also be provided for IBCLC training programs that increase opportunities for individuals from disadvantaged backgrounds including racial and ethnic minorities, that are underrepresented in the IBCLC workforce.

Office on Women’s Health (OWH)2024-08-07T20:05:23-04:00

The Office on Women’s Health (OWH) was established in 1991 within the U.S. Department of Health and Human Services (HHS). OWH coordinates women’s health efforts across HHS and addresses critical women’s health issues by informing and advancing policies, educating health care professionals and consumers, and supporting innovative programs.

In each of the Department of Health and Human Services’ 10 regions across the United States, a dedicated regional staff member serves as the area’s women’s health analyst. These Regional Women’s Health Analysts (RWHAs) are instrumental in supporting the work of OWH to improve the health of women and girls at the local level. RWHAs identify the unique health needs of women in their region and implement initiatives at the state and local levels to address those concerns.

Advocacy Opportunity:  Subscribe to receive email updates from your RWHA. Contact your Region’s analyst to introduce yourself, ask how you can consult with the activities in your region, and suggest breastfeeding and lactation initiatives pertinent to IBCLC services. Check the OWH website for more information on breastfeeding and for any funding opportunities that might apply to IBCLCs.

Healthy Start (HRSA/MCHB)2024-06-27T17:50:37-04:00

The Healthy Start Program from the Health Resources and Services Administration’s (HRSA) Maternal Child Health Bureau (MCHB) focuses on improving health outcomes before, during, and after pregnancy, and reducing racial/ethnic differences in rates of infant death and adverse perinatal outcomes. The Healthy Start EPIC Center is a national training and technical assistance center operated by the National Institute for Children’s Health Quality and funded by HRSA. The Healthy Start EPIC Center offers several training opportunities supporting Healthy Start programs, staff, and community partners to build their capacity to promote breastfeeding among the families they serve. Scholarship funding is provided for Healthy Start program staff to attend a breastfeeding education certificate  program for community health workers.

Advocacy opportunity: Contact the Healthy Start program and the Healthy Start EPIC Center to suggest that IBCLCs be utilized in their breastfeeding improvement efforts to provide training, write educational materials, and be included in community-based Healthy Start programs as referral sources for acute and chronic breastfeeding problems that exceed the capacity of community health workers to rectify.

Early Intervention (CDC)2024-06-27T17:50:28-04:00

Early Intervention is a federal program under the Centers for Disease Control and Prevention which is administered state by state. Early Intervention is a publicly funded resource which provides services and supports for babies and young children with developmental delays and disabilities. Every infant discharged from a NICU is referred to Early Intervention and is eligible to receive long term services including speech, physical and occupational therapy, among others. The goal of the program is for prevention of health problems and promotion of optimal health, restoring or improving functioning and maximizing developmental potential. Full-term infants who present after birth with health conditions or challenges, including feeding problems and nutritional needs, can also be referred to the program for in-home services at no cost to the family. Breastfeeding support by the IBCLC fits the goals of this program.

Advocacy opportunity: Contact your state or territory Early Intervention Agency at: https://www.cdc.gov/ncbddd/actearly/parents/states.html#textlinks and advocate for utilization of IBCLCs within Early Intervention teams to provide technical assistance, training, or the direct delivery of clinical lactation care to families eligible for Early Intervention.

Federal healthcare laws, regulations and policies can be effective vehicles for improving public health and how healthcare is delivered.

The Federal Register.

The Federal Register is the daily journal of the United States government. Each day Federal agencies publish documents in the Federal Register, including proposed rules, final rules, public notices, and Presidential actions. You can subscribe to the daily listing of these documents which usually offer opportunities for submitting comments relative to governmental rule-making.

https://www.federalregister.gov/

How a bill becomes a law.

Websites for federal legislation.

These websites track federal legislation (bills and laws). You can look up specific bills and laws as well as search for bills related to topics of interest to you such as breastfeeding, lactation, etc.

https://www.govtrack.us/
https://www.congress.gov/

How a bill becomes a law infographic

NLCA resources

The latest lactation information at your fingertips.

The latest lactation information at your fingertips.

Lactation news

Lactation publications

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