SENATE BILL NO. 22 "An Act adding birthing centers to the list of health facilities eligible for payment of medical assistance for needy persons." This was the first hearing for this bill in the Senate Finance Committee. Co-Chair Wilken moved to adopt committee substitute Version 24- LS0209\F as the working document. There being no objection, the Version "F" committee substitute was ADOPTED as the working document. Co-Chair Green communicated that during this bill's committee hearing process, the concern was "expressed about the fact that we have no doubt a very very legitimate cause for support for midwifery centers and the funding". She noted that the State's Medicaid program has been based on federal Medicaid standards; consequently, language has been included in Section 1(B) on page one, lines ten through twelve of the Version "F" committee substitute to specify that birthing centers, which are included in the definition of health facilities, would be eligible for funding "under the State plan approved under AS 47.07.040 by the United States Department of Health and Human Services". 10:37:16 AM RICHARD BENAVIDES, Staff to Senator Bettye Davis, the bill's sponsor, asked that clarification be provided in regards to whether the language in Version "F" would require the Department of Health and Social Services to develop an amendment to the State's plan or whether the State should wait for a federal determination as to whether they would fund midwifery centers. Co-Chair Green voiced being uncertain of the State's procedure in this regard. The State might be able to develop the required language. She assumed that the inclusion of midwifery centers would require federal policies to be rewritten in regards to what would be deemed acceptable for federal Medicaid "reimbursables". States must be able to provide input and ask that "various things be added to the list". She understood that the procedure in this regard has been a point of ongoing discussion. Co-Chair Green stressed that it is not the desire of the Finance Committee to provide "100 percent State Medicaid dollars for programs that are not currently funded with federal Medicaid." "The list would be endless and it would be very very difficult." Since the State "is subject to federal Medicaid with their arbitrary changes, it's very difficult" for the State, on its own, "to expand" what the State would pay, even though that use might be considered "very legitimate" and might save money. That point could be argued. 10:39:58 AM Mr. Benavides noted that during the bill's hearing in the Senate Health, Education, and Social Services Committee that Department of Health and Social Services had communicated that, were the bill to pass, the Department would be required to develop an amended plan in order to have a determination made by the federal government as to whether they would accept it. Thus the reason for his question as to whether the Department would be directed to further that endeavor or whether the federal government would make the determination as to whether they would expand their coverage. The committee substitute is unclear in its direction to the Department. 10:40:54 AM Co-Chair Green stated that input from the Department must be sought. In the meantime, she voiced the understanding that the Department did not object to the bill. Therefore, she would not be surprised were the Department to advance an amendment to the federal Medicaid program. Mr. Benavides asked that he be allowed to clarify this further with the Department and provide their response to the Committee. Co-Chair Green agreed. JERRY FULLER, Medicaid Director, Office of Program Review, Department of Health and Social Services, testified via teleconference from an offnet site, and stated that, were the bill approved by the Legislature, the Department would submit language for federal approval. He concurred with Co-Chair Green's earlier remarks as to the fluidness of the policies occurring in the federal Medicaid program. In response to a question from Co-Chair Green, Mr. Benavides stated that Mr. Fuller had answered his question. Co-Chair Green noted her intention to move this bill from Committee. In the interest of time, she asked teleconferencing participants to briefly state their position on the bill. 10:42:43 AM Mr. Fuller informed the Committee that the Department has a neutral position on this bill 10:43:01 AM TOM RYAN, testified via teleconference from Mat-Su and communicated that this bill would provide a "great benefit" to both the State and its citizens. It would save the State money and provide Alaskans other health care options. 10:43:29 AM TORA GERRICK testified via teleconference from Anchorage in support of the bill. 10:43:45 AM Senator Dyson, noting that he is one of bill's co-sponsors, thanked Co-Chair Green for her ability "to see things" that he had missed. Senator Dyson moved to report the committee substitute from Committee with individual recommendations and new fiscal note. Co-Chair Green noted that a new fiscal note would accompany the bill, as the previous one contained language that was "problematic". There being no objection, CS SB 22(FIN) was REPORTED from Committee with a new zero fiscal note dated April 28, 2005 from the Department of Health and Social Services. 10:45:10 AM 10:45:54 AM