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 91 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.