Typical Costs Incurred

Part of the planning process for any project is budgeting for anticipated expenses. The cost of becoming Baby-Friendly designated will vary depending on the specific decisions and needs of each facility. However, there are typically three types of costs incurred by all facilities.  Those include:

  • Staff and provider training expenses
  • The cost of purchasing breast milk substitutes (infant formula), bottles, nipples, pacifiers and other infant feeding supplies
  • Fees to Baby-Friendly USA, Inc.

The information below provides general considerations for the usual costs incurred by facilities and the time frames for when those costs are typically incurred.

Training Expenses

The section on Step 2 in the Guidelines and Evaluation Criteria outlines the requirements related to training staff and providers. Your facility can meet these requirements in a variety of ways and your expenses will vary depending on the approach you take.

To estimate your costs for meeting the training requirements outlined in Step 2, you will need to determine the number of staff members and providers who are required to participate in training. Also, identify any other positions your facility has chosen to train.

Mom and BabyConsider which of the following items apply to your facility’s situation:

  • Cost of a training program offered by a training vendor
  • Purchase of curriculum for in-house training or staff time to create a curriculum
  • Reimbursement of staff and providers who seek training on their own
  • Travel expenses for off-site training
  • Equipment and materials
  • Staff time to participate in training

Remember to consider on-going training costs for new staff members and providers that will join your facility.

Purchasing Breast Milk Substitutes and Infant Feeding Supplies

Baby-Friendly designated hospitals and birth centers uphold the International Code of Marketing of Breast-milk Substitutes (International Code). A key element of the International Code is ensuring that relationships with the manufacturers and distributors of breast milk substitutes are appropriate. Facilities may not receive gifts or free products from these manufacturers or distributors and must purchase all breast milk substitutes, bottles, nipples, and pacifiers at fair market price (FMP).

It is important to understand that the FMP for each item varies from one facility to another. Each facility must determine their unique FMP. A facility may not simply pay the same price paid by another facility.  More guidance on the methods for determining FMP for your facility is available through the BFUSA portal. However, before completing these calculations at a facility level, please have purchasing leadership assess if your facility is purchasing as a system or through a buying group. For example, these calculations may have already been completed by your system.

You can download this infant feeding supply estimation worksheet to better understand the infant formula and supply needs for your facility.

Baby-Friendly USA Fees

Fees paid by hospitals and birthing centers seeking the Baby-Friendly designation are the primary source of funding support for Baby-Friendly USA. Please see the Operating Structure and Changes page for information pertaining to the single campus enrollment policy.

  • Each facility pays a “Phase Fee” as it moves through the 4-D Pathway. The Phase Fee assumes that a facility will complete each phase within twelve months. If a facility takes more than twelve months to complete a single phase, additional fees will apply. If a facility completes a phase in less than twelve months, it may move on by submitting the fee for the next phase.
  • Starting January 1, 2022, there is a one-time registration fee for Discovery.
  • In the Designation Phase, when assessment naturally occurs, a facility will be responsible for the assessment honorarium for two assessors and travel. The assessment honorarium fee is paid once with the phase fee for Designation at the beginning of the phase and travel after the assessment is done.
  1. The 4-D Pathway (Discovery-Designation) fees assume a facility will take no more than one year to complete the tasks within each phase.
    1. Discovery fee is a one-time registration fee to enter the BFUSA portal and activate administrative assistance. A facility may stay in this phase with no additional charge after they have paid the initial registration fee.
    2. A facility may stay in the phase for more than one year and will pay a phase fee for each additional year at the rate posted for that year.
    3. A facility also may request to move to the next phase prior to the phase end date and a new phase fee will be incurred at the rate posted for that year.
  2. Assessment occurs in the Designation Phase. When a facility requests to move forward to Designation, the invoice will include both the fee for the Designation Phase and the fee for two assessors at the rate for that year.
    1. A facility may stay in Designation for more than one year and will incur annual phase fees.
    2. A facility will not be invoiced twice for the full amount of two assessors.
    3. If the facility stays more than one year, they may have an additional fee for the variance of assessor fees year to year.
    4. Travel fees will be invoiced after the assessment is complete.
  3. If a facility does not pass its assessment, additional assessor fees and travel expenses will apply for re-visit.
  4. Post-Designation fees: There is an annual fee for facilities once they are designated.
  5. No refunds will be issued for any fees paid.
  6. Fee schedule dates are subject to change.

IMPORTANT: To ensure that facilities are ready to move to the next phase in a timely fashion, it is the responsibility of the facility to ensure that Baby-Friendly, USA is provided all invoicing requirements upon entrance into the D1: Discovery Phase, or at any time thereafter that requirements change

Note: The 4-D Pathway Phase Fee Schedule is published in November each year.

  • There are two different types of post-designation annual fees:
  • In addition to the Re-Des phase fee in Year 5, facilities also pay the assessor honorarium for two assessors with the Year 5 phase fee 2 by the due date in order to receive assigned assessment dates, and after the assessment, the travel fees.
  • After the five year post-designation cycle is complete, facilities move back into the AQI Phase.
  • Post-designation fees are reviewed and subject to change annually.

Congratulations on your Baby-Friendly USA Designation! The Baby-Friendly USA Designation is valid for 5 years if the facility maintains compliance with the current BFUSA Guidelines and Evaluation Criteria. In those 5 years Baby-Friendly team members will continue to work with you to help your team continue to successfully implement the Ten Steps to Successful Breastfeeding.

Annual Quality Improvement and Re-Designation

  • Annual Quality Improvement (AQI) 3-year cycle: Facilities participate in an Annual Quality Improvement (AQI) project ensure practices remain in compliance with the GEC.
    • RN monitors the efforts of each class and works with enrolled healthcare facilities to address areas of concern.
  • Re-Designation Year 1: Facilities updates and submits documents to a Review Specialist, RN, IBCLC who will meet during the Readiness Assessment Interview to discuss implementation of practices.
  • Re-Designation Year 2: Facility maintains practices and prepares for assessment. This year is also the coordination of administrative efforts required to organize all elements of the assessment.
    • Re-Designation Year 2 will have additional cost for two assessors invoiced on the phase invoice. This must be paid before assessment dates can be offered for the year.
    • Additional expenses for facilities in the 2nd year of Re-Designation include expenses associated with travel for two assessors.
    • Additional expenses can be incurred for cancellation and additional assessment days.
  • There are annual fees for all 5 years, which are subject to yearly adjustments.
  • If in rare circumstances, a facility requires a re-visit, additional fees and travel expenses will apply.
  • No refunds will be issued once fees are paid.