SUPPLEMENTARY INFORMATION:

Section 746 of the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year (FY) 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 (certified labor doulas, certified lactation consultants, and certified lactation counselors), the number and type of services to be reimbursed, and the reimbursement rates for the services. The initial FRN indicated that the CBSD would begin on January 1, 2022, in the United States, and last for five years, consistent with Section 746 of the NDAA for FY 2021. The CBSD was modified for implementation overseas by an FRN published August 2, 2023 (88 FR 50850), with overseas coverage commencing on January 1, 2025.

The ASW(HA), consistent with 10 U.S.C. 1092, is extending the CBSD that was originally mandated by Section 746 of the NDAA for FY 2021 by an additional five years in order to ensure sufficient time for the Defense Health Agency to complete the program evaluation required by Section 746, as well as to engage in any rulemaking that may be necessary if it is deemed appropriate to make some or all of the CBSD permanent under the TRICARE program. The extension of the CBSD is estimated to cost approximately $19.6M over five years.

The Department is requesting comments regarding the public's support of and concerns about the services and providers under the CBSD. The Department will not respond to these comments but may consider them in making changes to the CBSD or the TRICARE Basic benefit. Comments regarding specific beneficiary claims or comments requesting a response or intervention regarding a specific case should be addressed to the appropriate TRICARE Managed Care Support Contractor. The Department receives feedback from most beneficiaries via the CBSD's Maternity Survey and so in particular requests comments from providers and other impacted members of the public.