Notice2026-01803
Modifications to the Reimbursement of Childbirth Support Services Under the TRICARE Childbirth and Breastfeeding Support Demonstration
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
January 29, 2026
Effective
March 1, 2026
Issuing agencies
Defense Department
Abstract
The Acting Director of the Defense Health Agency (DHA) is notifying the public of modifications to the reimbursement of certified labor doulas (CLDs) performing childbirth support services under the Childbirth and Breastfeeding Support Demonstration (CBSD).
Full Text
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<title>Federal Register, Volume 91 Issue 19 (Thursday, January 29, 2026)</title>
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[Federal Register Volume 91, Number 19 (Thursday, January 29, 2026)]
[Notices]
[Pages 3870-3871]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-01803]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Modifications to the Reimbursement of Childbirth Support Services
Under the TRICARE Childbirth and Breastfeeding Support Demonstration
AGENCY: Assistant Secretary of Defense for Health Affairs, Department
of Defense.
ACTION: Notice of reimbursement modification.
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SUMMARY: The Acting Director of the Defense Health Agency (DHA) is
notifying the public of modifications to the reimbursement of certified
labor doulas (CLDs) performing childbirth support services under the
Childbirth and Breastfeeding Support Demonstration (CBSD).
DATES: The new reimbursement methodology will be effective for rates
beginning March 1, 2026.
FOR FURTHER INFORMATION CONTACT: Erica Ferron, 303-676-3626,
<a href="/cdn-cgi/l/email-protection#2346514a40420d400d454651514c4d0d404a55634b46424f574b0d4e4a4f"><span class="__cf_email__" data-cfemail="cda8bfa4aeace3aee3aba8bfbfa2a3e3aea4bb8da5a8aca1b9a5e3a0a4a1">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: Section 746 of the William M. (Mac)
Thornberry National Defense Authorization Act for Fiscal Year 2021
directed the Secretary to establish a five-year demonstration project
under TRICARE to evaluate the cost, quality of care, and impact on
maternal and fetal outcomes of covering the services of doulas and
lactation consultants or counselors not otherwise TRICARE authorized,
and to determine whether it would be appropriate to add permanent
coverage to the TRICARE benefit. This demonstration was implemented as
the CBSD, with details announced in a Federal Register notice (FRN)
published by the Assistant Secretary of Defense for Health Affairs, now
referred to as the Assistant Secretary of War for Health Affairs
(ASW(HA)) on October 29, 2021 (86 Federal Register (FR) 60006). The FRN
prescribed the qualifications for the three extra medical maternal
health providers (CLDs, certified lactation consultants, and certified
lactation counselors), the number and type of services to be
reimbursed, and the reimbursement rates for the services. The CBSD
began on January 1, 2022, in the United States. The CBSD was modified
for implementation overseas by an FRN published August 2, 2023 (88 FR
50850), with overseas coverage implemented on January 1, 2025. On April
11, 2024, the Director, DHA, published an FRN announcing a new
reimbursement methodology for CLDs intended to create a Medicare-like
reimbursement, where payment is adjusted annually to create a rate
between Medicaid rates and private pay rates (89 FR 25617). The rate
was to be updated on March 1 each year and could go up or down
depending on state Medicaid rates. This methodology was expected to be
durable but resulted in higher-than-expected variability from year to
year.
This notice announces changes to the reimbursement methodology for
childbirth support services intended to stabilize reimbursement of
CLDs. For example, if DHA were to use the previously announced
methodology for rates beginning March 1, 2026, the reimbursement rate
for continuous labor support would be expected to decrease between
$100.00 to $200.00 (depending on final Medicaid rates at the end of
2025) because state Medicaid programs added doula benefits with lower
reimbursement rates, which drives down the TRICARE rate. Such a
substantial decrease will likely result in fewer CLDs agreeing to
provide care under the CBSD, negatively impacting beneficiary access to
care and DHA's ability to complete its evaluation of the CBSD.
Due to concerns about this volatility, DHA is modifying
reimbursement for childbirth support services so that the rate approved
for March 1, 2025, will be considered a ``baseline.'' The baseline will
be updated each year by an inflation factor (the Medicare Economic
Index (MEI)). This rate will then be adjusted by the Medicare
Geographic Adjustment Factor (GAF) to develop rates for each locality.
To prevent TRICARE rates from falling below Medicaid reimbursement,
[[Page 3871]]
the DHA Director, or designee, will approve a new baseline if it is
found that TRICARE reimbursement is not keeping pace with Medicaid
reimbursement. The new baseline would be established using the
methodology announced in the 2024 FRN, with a change to step two and
the addition of a new step four:
1. Identify the state Medicaid rates for states reimbursing for
doula services.
2. Identify an appropriate Medicaid-to-Medicare Fee Index for
obstetrical services. The fee index for each included state is capped
at one.
3. Divide each state Medicaid rate by the Fee Index to develop a
Medicare rate for that state.
4. Remove significant outliers.
5. Create a weighted average based on the number of TRICARE
reimbursed deliveries that occur in each state. This weighted average
would be the national reimbursement rate for childbirth support
services under the CBSD.
6. Adjust the national rate by locality with the Medicare GAF for
each locality.
Step 2 is modified to cap the fee index at one so that the
Medicare-like rate for a state created in step 3 will never be lower
than the Medicaid rate for that state. New step 4 is added to allow the
THP Director to approve the removal of outliers, so that no one state
rate can distort the TRICARE rate unduly. The DHA will evaluate state
Medicaid doula rates annually to determine if a new baseline should be
established, with a new baseline established only if it would create a
rate higher than the rate from the previous year multiplied by the MEI.
In other words, this change will ensure that childbirth support
services rates will not decrease and that increases will be reasonably
indexed to rates nationwide. Reimbursement rates for doulas are
published by March 1 of each year at <a href="https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement">https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement</a>.
The modification to the reimbursement methodology for childbirth
support services will result in annual incremental costs of about
$280,000.00.
Dated: January 27, 2026.
Stephanie J. Bost,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2026-01803 Filed 1-28-26; 8:45 am]
BILLING CODE 6001-FR-P
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