02/02/2005 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB60 | |
| SB22 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 60 | TELECONFERENCED | |
| += | SB 22 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 2, 2005
1:32 p.m.
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Gary Wilken, Vice Chair
Senator Lyda Green
Senator Kim Elton
MEMBERS ABSENT
Senator Donny Olson
COMMITTEE CALENDAR
SENATE BILL NO. 60
"An Act extending the termination date of the Statewide Suicide
Prevention Council; and providing for an effective date."
MOVED SB 60 OUT OF COMMITTEE
SENATE BILL NO. 22
"An Act adding birthing centers to the list of health facilities
eligible for payment of medical assistance for needy persons."
MOVED SB 22 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 60
SHORT TITLE: EXTEND SUICIDE PREVENTION COUNCIL
SPONSOR(s): SENATOR(s) STEVENS B
01/14/05 (S) READ THE FIRST TIME - REFERRALS
01/14/05 (S) HES, FIN
02/02/05 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 22
SHORT TITLE: MEDICAID COVERAGE FOR BIRTHING CENTERS
SPONSOR(s): SENATOR(s) DAVIS, DYSON
01/11/05 (S) PREFILE RELEASED 12/30/04
01/11/05 (S) READ THE FIRST TIME - REFERRALS
01/11/05 (S) HES, FIN
01/19/05 (H) HES AT 1:30 PM SENATE FINANCE 532
01/19/05 (S) Heard & Held
01/19/05 (S) MINUTE(HES)
01/26/05 (S) HES AT 1:30 PM BUTROVICH 205
01/26/05 (S) -- Meeting Canceled --
02/02/05 (S) HES AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
Pat Davidson
Legislative Audit Division
Alaska State Legislature
PO Box 113300
Juneau, Alaska 99811-3300
POSITION STATEMENT: Supports SB 60
Kathryn Craft
Suicide Prevention Council staff
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supports SB 60
Murry Butler MD
Cordova Community Medical Center
Cordova, AK
POSITION STATEMENT: Supports SB 22
Jennifer Heller RN
Ilanka Health Center
Cordova, AK
POSITION STATEMENT: Supports SB 22
Holly Steiner
New Life Midwifery
Wasilla, AK 99654
POSITION STATEMENT: Supports SB 22
Barbara Norton
Geneva Woods Birth Center
3730 Rhone Circle STE 102
Anchorage, AK 99508
POSITION STATEMENT: Supports SB 22
Jack Nielson
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Neutral on SB 22
Jerry Fuller
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Neutral on SB 22
Sharon Evans
Mat-Su Midwifery
2650 Broadview Ave.
Wasilla, AK
POSITION STATEMENT: Supports SB 22
Dana Brown
Alaska Family Health & Birth
753 Gaffney Rd.
Fairbanks, AK
POSITION STATEMENT: Supports SB 22
Kaye Kanne
Midwife's Association of Alaska Outdoor Council
PO Box 22256
Juneau, AK 99802
POSITION STATEMENT: Supports SB 22
Jack Jacobs, MD
Anchorage, AK
POSITION STATEMENT: Opposes SB 22
ACTION NARRATIVE
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 1:32:24 PM.
Present were Senators Gary Wilken, Lyda Green, and Kim Elton.
Senator Olson was excused.
SB 60-EXTEND SUICIDE PREVENTION COUNCIL
1:33:26 PM
SHANNON STRAUBE, staff to Senator Ben Stevens, introduced SB 60,
which would extend the termination date of the council from June
th
30 2005 to June 30 2006. Senator Ben Stevens submitted the bill
and the legislative audit recommended the extension.
1:34:53PM
KATHY CRAFT, Suicide Prevention Council coordinator, Department
of Health and Social Services (DHSS), offered a brief update on
the council. She advised the goals this year are to broaden the
awareness of suicide and the risk factors, to enhance prevention
services, to develop healthy communities, and to strengthen
existing and build new partnerships between public and private
entities that will advance suicide efforts in Alaska.
1:36:13 PM
The Suicide Prevention Council has a contract with the Alaska
Injury Prevention Center for a study involving psychological
autopsies. They work with the Department of Public Safety to
obtain information on individuals who commit suicides. After an
appropriate mourning time, they contact the families to see if
they would contribute to the study. They have asked for an
extension of the study, which ends June 30, 2005 so they can
gather more information. The study collects information such as
suicide rates by age group, methods of suicide, substance abuse
involvement, ethnicity, and urban vs. rural.
1:37:51 PM
MS. CRAFT said they have plans to train communities for when
suicide becomes an issue, what the community can do. They have
started a public awareness campaign titled "Suicide Hurts", and
have had posters printed. They have drafted television and radio
scripts but are lacking funds to complete the effort. They are
working on continuing the clergy initiative, which brings the
prevention treatment together with clergy. The annual report
will be submitted in two weeks.
1:39:19 PM
CHAIR DYSON asked who is able to speak regarding the graphs and
trends in the packet submitted to the committee.
MS. CRAFT answered she is.
CHAIR DYSON asked when should the state expect to see reductions
in the suicide rate.
MS. CRAFT answered it depends on economics and services
available. She said in 2004 the rate did increase.
CHAIR DYSON asked when the council was created.
MS. CRAFT advised it was 2002.
1:41:29 PM
CHAIR DYSON asked Ms. Craft about next year's goal in suicide
reduction.
MS. CRAFT advised the council would like a 10 percent reduction
in 2005.
CHAIR DYSON asked which state departments partner in the effort
to reduce statewide suicide rate.
MS. CRAFT replied the Department of Health and Social Services,
the Division of Behavioral Health and Public Health, the Trust
Authority, the Mental Health Board, the Advisory Board on
Alcoholism and Drug Abuse, the Governor's Council on
Disabilities and Special Education, the Alaska Commission on
Aging, and the new Faith-based Community Initiative Forum.
CHAIR DYSON asked about the Department of Education, the school
system and the police department.
MS. CRAFT agreed those entities would also serve to promote
their efforts.
CHAIR DYSON asked for other questions.
1:43:18 PM
CHAIR DYSON complimented the efforts of the council and asked if
it was still disproportionately rural native males committing
suicide.
MS. CRAFT answered yes. It is also disproportionately people in
their 20s. She hopes that once the structured training and the
media campaign begin they will see positive results.
1:45:19 PM
CHAIR DYSON asked the percentage of suicides involving mind-
altering drugs.
MS. CRAFT replied 73 percent for those with a history of
substance abuse, but the total is 62 percent.
CHAIR DYSON asked whether the suicide rate would be reduced if
firearms were not available.
MS. CRAFT answered they plan to address firearm security in
their community training efforts.
1:47:50 PM
SENATOR LYDA GREEN asked how the council is faring overall.
MS. CRAFT advised they are involved in writing proposals and
working with community-based suicide prevention planning. They
are working with the Division of Behavioral Health to
incorporate a plan into their grant responses. The council and
DHSS are working on a formal system regarding the budget.
1:49:47 PM
CHAIR DYSON asked Pat Davidson to explain the money spent on
furniture and the money transferred to the Terminal Leave and
Insurance Catastrophe Working Account.
PAT DAVIDSON, Division of Legislative Audit representative
advised Chair Dyson that DHSS used approximately $30,000 to buy
furniture for information technology services. There was no
direct benefit to the suicide prevention council. There is a
provision in statute that when you have joint costs, then
everyone pitches in. She added there is a format for using joint
funds that was not followed and she advised that would be
addressed in the statewide financial audit.
1:51:57 PM
CHAIR DYSON asked whether the council had any control of DHSS's
decision to use the council's money.
MS. DAVIDSON replied no. The budget act appropriation term is
Boards and Commissions. There is the ability to move monies
within the appropriation but DHSS did not follow the guidelines.
A contributing factor is unclear financial information between
the department responsible for administering funds and the
council. The council was impaired by a lack of financial
understanding, which is why almost $95,000 lapsed at the end of
the year.
1:54:07 PM
MS. DAVIDSON explained the transfers into the Terminal Leave and
Insurance Catastrophe Reserve Fund are existing statutory
provisions for otherwise lapsing funds to refill reserve
accounts. She added that the council did not know where they
were financially.
SENATOR KIM ELTON asked Ms. Davidson if there are mechanisms
available to allow for reimbursement back to the council.
MS. DAVIDSON replied that an appropriation is an opportunity to
spend money. If the council doesn't spend the money they lose
it. The Legislature could increase the current year budget and
the council could have the opportunity to access the funds that
were lost.
1:56:39 PM
SENATOR ELTON asked if there is a mechanism to redress one unit
spending the money allocated to another unit.
MS. DAVIDSON answered that a possible recommendation is the
department could appeal the appropriation. She recommends in
future years, the DHSS administrative department take
responsibility for financial communications to the council.
SENATOR GREEN asked Ms. Davidson if allocations and
appropriations could be more clearly defined in the future.
MS. DAVIDSON answered that by statute, agencies are allowed to
move money within an appropriation.
CHAIR DYSON asked the council to get back to the committee with
a reasonable performance target for the future.
1:59:38 PM
CHAIR DYSON said the suicide rates in the State of Alaska are 2-
3 times the national average. The council needs to show that it
makes a difference.
2:01:03 PM
SENATOR GREEN suggested to the council that they include their
mission and plan in their publication.
2:03:17 PM
SENATOR GREEN moved SB 60 from committee with individual
recommendations and attached fiscal note. There being no
objection, the motion carried.
2:03:49 PM
SB 22-MEDICAID COVERAGE FOR BIRTHING CENTERS
2:04:43 PM
RICHARD BENAVIDES, staff to Senator Bettye Davis introduced SB
22 and said Senator Davis feels strongly that SB 22 will help
control Medicaid costs. He added the facility fees for birthing
centers would always be lower than the hospital fees mainly
because birthing center births were low risk pregnancies.
CHAIR DYSON said the information he has seen indicates facility
charges for birthing centers and hospitals are comparative.
2:06:22 PM
MR. BENAVIDES submitted new information regarding cost
comparisons. He cited from the packet that Geneva Woods Birthing
Center, (Geneva Woods) charges a $1,500 facility fee, and
Providence Hospital facility fee is $4,000 excluding the
doctor's fee.
2:07:50 PM
CHAIR DYSON asked whether the hospital fee adds $1,000 for the
second night.
MR. BENAVIDES confirmed that and added there is no second night
at a birthing center because they are generally uncomplicated
births.
2:09:07 PM
CHAIR DYSON stated uncomplicated births with prepared parents at
a birthing center are adequate health care. He said the argument
is without the birthing center facility charge being Medicaid
reimbursement eligible, many poor people will have to choose the
more expensive hospital option, which then is Medicaid
reimbursable. He asked if any jurisdictions require birthing
centers have a formalized relationship with a hospital.
MR. BENAVIDES explained regarding complications, the mother
would transfer to a hospital.
2:11:13 PM
CHAIR DYSON noted many doctors and facilities have a formalized
relationship with a hospital. He expects the committee action
will be to refer SB 22 to the finance committee, which will then
deal with the more complicated issues such as the risk of SB 22
accelerating the Medicaid costs.
2:12:08 PM
CHAIR DYSON called Dr. Murray Butner to testify.
MURRAY BUTNER, MD, Cordova Community Medical Center, testified
that he has tried to refer some of his Denali Kid Care patients
to birthing centers but was informed that Denali Kid Care would
not cover the facility fee, thereby precluding the women from
choosing that option. He believes that SB 22 will save the state
substantial amounts of money.
CHAIR DYSON asked Dr. Butner if he had his child delivered in a
birthing center.
2:14:55 PM
DR. BUTNER answered yes. He stated his extensive knowledge of
the birthing process allowed him to choose the option. There are
pros and cons of birthing center births and of hospital births
but he expressed his opinion there should be an option for
Medicaid recipients.
CHAIR DYSON referred to a note he was handed that said state
Medicaid pays hospitals a reduced fee.
DR. BUTNER said he believes that to be true. He suggested that
somebody compare the facility costs and all associated fees with
the birthing center fee to get a true contrast.
2:16:49 PM
JENNIFER HELLER, registered nurse, Ilanka Health Center,
testified she called Providence Hospital and was quoted $3400
for the facility fee. The facility fee is $1500 at Geneva Woods.
Her support for SB 22 is based on providing choices for women.
2:18:09 PM
HOLLY STEINER, New Life Midwifery representative stated she is a
labor delivery nurse and a certified midwife. She clarified that
the birth center fee is a one-time fee, which does not multiply
the next day. It is rare to have someone stay longer than 24
hours. Her practice turns women away on a regular basis that
cannot afford the midwife fee. These women want the birthing
center service but are not afforded that option. Her experience
is the same women are charged $10,000 by the hospital for their
births. Since Medicaid is paying for this, it is costing the
state unnecessarily.
2:20:04 PM
Statistics show that midwifery care has been proven around the
world. The goal is not to make money but to provide good care to
women and decrease the infant mortality rate. Since 1997
statistics show a rise in midwifery births in the Mat-Su area.
Since 2002 they have opened up one new birth center and three
new midwifery businesses in the valley. In Juneau and Anchorage,
statistics show the same pattern. In the long run this would
definitely save the state money.
2:22:18 PM
CHAIR DYSON informed the room that SB 22 would pass out of
committee today and those who want to testify may wait for the
hearing in the Senate Finance Standing Committee.
2:22:54 PM
BARBARA NORTON, Geneva Woods Birth Center representative,
testified Geneva Woods has a written transfer agreement with
Providence Hospital. It is a requirement for their national
accreditation. She stated that while the facility charges for
the hospital may be contracted at a lower rate, intervention
increases costs with unnecessary procedures such as epidurals
and induced labor. The national Cesarean section rate is 27
percent, while birthing center Cesarean rate is between 3-6
percent in Alaska. She believes midwifery care decreases the
risk of Cesarean sections, thereby saving costs. The State of
Florida Legislature passed a bill several years ago with a goal
of having a midwife attend 25 percent of births because they
recognized the significant cost savings. She wants to ensure
that low-income women are not being denied the opportunity to
have low intervention births.
2:25:58 PM
SENATOR GREEN asked Ms. Norton to clarify her reference to
insurance companies.
MS. NORTON said most insurance companies pay 80 percent but some
insurance companies pay 100 percent of the birthing center
facility fees because they want to encourage people to use that
option.
SENATOR GREEN cautioned the committee not to overlook the
possibility that the federal government would not reimburse the
state for birthing center fees.
2:27:36 PM
CHAIR DYSON said he considered the option of making SB 22
conditional that Medicaid be available for birthing centers that
have an agreement with a hospital or as part of the national
accreditation.
2:28:21 PM
CHAIR DYSON asked Jack Nielson when his department would finish
the regulations for birthing centers.
JACK NIELSON, Department of Health and Social Services (DHSS)
stated that once the law is passed making birthing centers a
covered service, DHSS would put together regulations for the
reimbursement methodology. He commented the department is unsure
of federal approval. It could be a time consuming process and it
could be a general fund program.
2:29:37 PM
SENATOR GREEN agreed with Chair Dyson that it was a good idea to
make SB 22 contingent on federal approval for the waiver for
inclusion.
CHAIR DYSON advised Jack Nielson and Jerry Fuller he understood
DHSS was coming forth with regulations for birthing centers and
that is wasn't contingent on SB 22.
JERRY FULLER, Department of Health and Social Services (DHSS)
referred to legislation passed last year, which moved birthing
centers from a registration process to a licensing process. He
is not sure where DHSS is in accomplishing that.
CHAIR DYSON asked him to find out where the process is.
2:30:52 PM
MR. FULLER advised DHSS is neutral on SB 22 and he and Mr.
Nielson were there to answer questions.
SHARON EVANS, midwife at Mat-Su Midwifery, testified in 2004,
218 Denali Kid Care births were done by five birth centers in
the Anchorage area. Her position is the state would save
approximately $2500 per patient if SB 22 becomes law. Based on
these numbers the state would have saved $545,000 just on the
218 births alone, excluding the supplemental hospital costs.
2:33:12 PM
She asked the committee to support SB 22 so that needy women
will have options and the State of Alaska would save money.
2:34:15 PM
KAYE KANNE, Midwife's Association of Alaska representative,
addressed the issue of the federal government not matching funds
and advised the association would continue to work with the
federal government regarding recognition of birthing centers.
Meantime the state would still realize a savings. The hospital
facility fee does not include mandatory fetal monitoring, IVs,
epidurals, and Cesarean section rates. The hospital in Juneau
charges a minimum of $10,000, not including the physician fee.
She advised that Shelby Larsen is the contact person at the
state regarding drafting of the birthing center regulations and
that the association is part of that project. DHSS is involved
in a major regulation project and the birthing centers would be
part of that but it would take time to complete.
2:37:36 PM
SENATOR ELTON confirmed the major regulation project at DHSS.
2:38:30 PM
JACK JACOB, MD, and newborn specialist advised the committee to
ask critical questions. He said the statistics that he has heard
from the birthing centers are incomplete regarding costs. He
asked the committee to take into account the complications that
occur from birthing center births.
2:40:19 PM
DR. JACOBS said in his experience there is nothing unsafe about
birthing center births. What is unsafe is the infrastructure in
the United States. Other countries have created sound
infrastructure regarding safe practices. His impression is that
the birthing centers do deliver high-risk mothers. He advised
the committee to gather more information regarding complication
rates and death rates.
2:42:04 PM
CHAIR DYSON asked Dr. Jacobs whether he is inferring that
birthing centers contribute to higher death rates.
DR. JACOBS answered if patients are screened correctly and if
they are low risk patients, then the death rate should be zero.
CHAIR DYSON asked Dr. Jacob if he knew of any cases where
complications were exacerbated because the mother went to a
birthing center.
DR. JACOBS answered yes and said it is because appropriate
screening and infrastructure does not exist.
CHAIR DYSON asked Dr. Jacobs if he would recommend birthing
centers have a formal relationship with a hospital.
DR. JACOB responded that the issue is complex. There are a few
highly urban countries in Europe that have a good model.
Chair Dyson asked Dr. Jacobs if he is inferring that birthing
centers should be close to a hospital.
2:44:50 PM
DR. JACOBS replied if a birthing center is not close to a
hospital, there needs to be specific plan.
CHAIR DYSON announced a brief recess for discussion.
2:45:31 PM
CHAIR DYSON called the committee back on record.
2:46:34 PM
SENATOR WILKEN moved SB 22 out of committee with individual
recommendations and attached fiscal note. He added his concern
regarding cost. He stated the Denali Kid Care program costs the
state far beyond what was expected. The Medicaid climate incurs
extraordinary costs out of the general fund budget.
2:48:41 PM
SENATOR ELTON offered the Senate Finance Standing Committee
would look at costs given the explosion in health care costs and
additional fees charged at facilities. He believes increasing
options introduces a competitive business. He stated his
estimation is that SB 22 would save the state money.
2:50:21 PM
CHAIR DYSON recognized no objections and SB 22 moved out of
committee.
There being no further business to come before the committee,
Chair Dyson adjourned the meeting at 2:50:35 PM.
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