Legislature(2005 - 2006)SENATE FINANCE 532
01/19/2005 02:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB10 | |
| SB22 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 10 | TELECONFERENCED | |
| *+ | SB 22 | TELECONFERENCED | |
SB 22-MEDICAID COVERAGE FOR BIRTHING CENTERS
RICHARD BENAVIDES, staff to Senator Davis, advised that Senator
Davis is the primary sponsor of SB 22. He said the bill would
add birthing centers to the definition of health facility in
statute so that Medicaid could reimburse them. It also would
create a cost savings to the state when it comes to facility
reimbursement. He continued:
According to a check that we did last year, the
average cost of a natural birth from four different
hospitals in Anchorage, Fairbanks, and Juneau is
approximately $3,667. And conversely, the facility
fees for three different birthing centers averages
approximately $1,400. So there is a savings of
approximately 3 percent.
CHAIR DYSON interrupted to clarify the costs, and also that Mr.
Benavides was just talking about the facility charges.
MR. BENAVIDES answered yes, but the bill gives families that are
covered by Medicaid the added option of using a birthing center
for delivery. He maintained that birthing centers have long been
recognized as providing a positive, safe, friendly, and family
oriented experience. He said they feel it would be a win-win
situation.
CHAIR DYSON asked specifically:
Nothing we are doing here would change who is eligible
for the Medicaid, it only, and by implication anyone
who is Medicaid eligible is going to pay one or the
other. So, it's not increasing the population of the
people who would be getting Medicaid reimbursement for
their birthing services, it's only adding another
(which you represent is often better) and cheaper
option. It has been represented to me that some people
who are Medicaid eligible, when they are making their
choices, when they realize that the birthing center
option can't get reimbursed, and they have limited
funds, feel they are being forced to choose the
hospital option because of this problem that you are
trying to solve. Is that correct?
MR. BENAVIDES affirmed that Chair Dyson understood the bill.
SENATOR GREEN asked where the fiscal note was.
CHAIR DYSON said the fiscal note was zero.
LAURA GORE identified herself as someone who has been affiliated
with birth centers in Anchorage for approximately 10 years. She
stated that a lot of their clients have to choose hospitals due
to finances although it is not what they want. Over the years
she has seen an increase in people who can't afford to use the
birthing center. She stated that operating a birthing center
takes a certain amount of staff and they require reimbursement
to keep operating.
3:24:45 PM
CHAIR DYSON asked for questions.
KAREN BROWN, co-owner of the Geneva Woods Birth Center affirmed
that they are seeking birth center reimbursements so clients
could have more choices.
3:25:26 PM
SHARON EVANS, Mat-Su Wifery, offered her support for the bill.
She reported that currently Medicaid pays facility fees in 12
states. She maintained that birth center facility fees are
substantially lower than hospital facility fees. She said birth
centers offer safe, cost effective alternatives to the
escalating maternity care fee seen throughout nation. If SB 22
were adopted, the state would allow needy families to have
access to the same options for birth as families with insurance.
She maintained that by adopting SB 22, the state would save a
large amount of Medicaid funds.
SENATOR GREEN questioned whether the federal government
participates in states where Medicaid is available.
SHARON EVANS replied each state pays on it's own.
3:27:18 PM
JUDY DAVIDSON, owner/operator of Mat-Su Midwifery, thanked the
legislators for the excellent midwifery standards in Alaska.
Birth centers have proven to be cost effective and moms are at
lower risks when attended by the same midwife. Many insurance
companies recognize the lower cost of the care and pay 100
percent of birth center fees while hospital fees are normally 80
percent covered.
SENATOR GREEN said she read a HESS report summary regarding
number of births in Alaska over the last few years. Home
delivery was going up and birthing centers were going down. "Do
you know why that is," she asked.
MS. DAVIDSON answered they haven't seen that in her area. In her
experience, more than three-fourths of their clients are birth
center deliveries and one-fourth is home delivery. She said home
deliveries are traditionally about 1 percent of the population.
In Alaska, since they now have seven birth centers, rates should
go up.
SENATOR GREEN said she read there was a trend away from birth
center births and more toward home deliveries. She asked if that
was possibly because of rising health care costs.
MS. GORE said she has seen two birth centers in Anchorage that
closed down due to financial reasons. Both facilities did a fair
amount of deliveries.
3:30:55 PM
JACK NIELSON, Department of Health and Social Services
representative, stated the department is neutral on the bill but
they had a few items to consider. The bill adds birthing centers
to the list of health services that Medicaid is required to pay
by statute to be established based on reasonable costs related
to patient care incurred by the facility. The bill doesn't seem
to add birthing centers as a Medicaid service authorized by
state law to be offered by the program. That list of authorized
services is at the end of Alaska Statute 47.07.030. If the
authorization to cover birthing centers were in all three it
would make it absolutely clear that they can cover using
Medicaid and it would help in dealing with a potential federal
issue that they might have.
There is a question whether birthing centers are an allowable
Medicaid service that the federal government will participate in
financially. Although some states have obtained federal
participation in the past, the federal criteria are not clear.
There is need to define the federal guidelines. The type of
federal approval that is gained could also guide the methodology
to calculate payment rates for the birthing centers. Until they
have written approval from the federal agency, they wouldn't
know for sure the answer to some of the federal type questions,
he said.
3:34:03 PM
In 2004 there were 10,000 births in Alaska, 50 percent of which
were Medicaid. Overall, 2 percent were in birthing centers. He
said other factors would include that birthing center fees are
lower than hospital payments. He referred to a departmental
independent study showing at least a 22 percent savings when a
person chooses a birthing center. They should also consider
costs from transferring a patient from a birthing center to a
hospital, if it's needed. The department believes there would be
no overall cost increase.
CHAIR DYSON asked Mr. Nielson for his comments in writing. Chair
Dyson announced they would take SB 22 up again once the costs
were researched more thoroughly. He encouraged the sponsor to
work with Mr. Nielson to get contingency language regarding
failure of the federal government to fund the charges.
3:37:15 PM
CHAIR DYSON asked Mr. Nielson whether the department had
completed the regulations for birthing centers.
MR. NIELSON advised there are some regulations set but he was
not qualified to answer.
SENATOR DAVIS asked Mr. Nielson whether it would be a cost
savings if the federal government picked up the funds.
MR. NIELSON answered the state would be paying 10 percent of the
bill rather than 50 percent. Again, he said, the independent
study showed 22 percent savings. The federal match for Medicaid
for 2006 is around 50 percent.
CHAIR DYSON held SB 22 in committee.
There being no further business to come before the committee,
Chair Dyson adjourned the meeting at 3:40:22 PM.
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