04/10/1993 10:15 AM Senate FIN

                                                                               
  CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 91(HES):                       
                                                                               
       An  Act  prohibiting   unfair  discrimination   against                 
       direct-entry midwives  who perform services  within the                 
       scope of their certification; providing for coverage of                 
       midwife   services   under  Medicaid;   reordering  the                 
       priority  of optional  services provided  by the  state                 
       under Medicaid; and providing for an effective date.                    
                                                                               
  Co-chair  Pearce invited  Annette Kreitzer, Aide  to Senator                 
  Loren Leman, prime sponsor  of SB 91, to join  the committee                 
  at the table and give an overview of the bill.                               
                                                                               
  ANNETTE KREITZER said that SB  91 would add certified direct                 
  entry midwives to the optional services covered by Medicaid.                 
  It would reorder  the priority of optimum  services provided                 
  by  the State under  Medicaid which would  make midwives the                 
  first to  be dropped  from the  list in  case there  was not                 
  enough coverage for  all services.   It was  amended in  the                 
  Health & Social  Services Committee to add  certified direct                 
  entry  midwives   to  the  statute  that   prohibits  unfair                 
  discrimination  by  insurance  companies   against  midwives                 
  providing midwifery services.  She  explained that this bill                 
  would  not  add to  the  numbers  of pregnant  women  who do                 
  presently qualify for Medicaid.   She wanted it to  be clear                 
  that  this bill would not expand Medicaid roles, but instead                 
  would allow the  state to stretch  its dollars for  services                 
  provided under Medicaid.                                                     
                                                                               
  DAVE  WILLIAMS,  Department  of  Health  &  Social  Services                 
  Planner, Project  Choice,  Department  of  Health  &  Social                 
  Services, said the fiscal note  for Medicaid Facility showed                 
  a projected savings to the department of $180.0 under SB 91.                 
  The department projected that 250  women would use certified                 
  direct entry midwives, and that half of these women would be                 
  Medicaid eligible.  It  was suggested that it may  be higher                 
  than the projection.  He said  the department felt that more                 
  mothers  would  seek  care  and  seek  it earlier  in  their                 
  pregnancy if midwifery was  an option.  That cost  was shown                 
  on  the Medicaid  non-facility fiscal  note for $65.0.   The                 
  fiscal  note for  claims  processing was  in  the amount  of                 
  $41.2.                                                                       
                                                                               
  KAYE  KANNE, Certified  Direct-Entry Midwife,  said that  in                 
                                                                               
                                                                               
  addition  to  the  savings  pointed  out by  Dave  Williams,                 
  because  midwifes  see  their  patients  more often,  better                 
  educate their patients, and stress  the need for self  care,                 
  healthier babies are born providing even more savings to the                 
  state.                                                                       
                                                                               
  MARILYN  HOLMES  of   Midwifery  Consumers  said  that   the                 
  midwifery group  costs run about  37 percent of  the medical                 
  group.   If  women go  to doctors because  they do  not have                 
  access  to  midwives  through  Medicaid  the fee  is  $5,000                 
  (physician and  hospital combined).   She  pointed out  that                 
  midwifery  births result  in 50-70  percent less  c-sections                 
  which  cost about  $8,000.  She  pointed out  that midwifery                 
  care is more  comprehensive and  includes information  about                 
  nutrition and breast feeding.   Midwives also visit the home                 
  at  least four times after the birth.   This results in less                 
  costs after the birth because the infants receive extra care                 
  that  they  would not  receive  in  a medical  setting.   By                 
  reading the fiscal  notes, she said  that by the end  of the                 
  decade,  SB 91 could save  the state a  quarter of a million                 
  dollars a year.                                                              
                                                                               
  Co-chair Pearce  asked how  many communities  in Alaska  had                 
  licensed midwives.  Ms. Kanne said that she did not know but                 
  approximately 15 communities.                                                
                                                                               
  Senator Kelly MOVED for passage of SB 91 from committee with                 
  individual recommendations.   No objections being heard,  SB
   was   REPORTED   OUT  of   committee   with  individual                 
  recommendations,  and three fiscal  notes for the Department                 
  of  Health  & Social  Services  for $65.0  --  Medicaid Non-                 
  facility,  $41.2  --  Claims  Processing  and  $(180.0)   --                 
  Medicaid  Facility.   Co-chair  Pearce,  Senators Kelly  and                 
  Sharp  signed  "do   pass."     Senator  Jacko  signed   "no                 
  recommendation."  Senators  Frank and Kerttula had  left the                 
  meeting and did not sign.