PEBB Restores Mid-Wife Coverage

The change was prompted by a group known as PEBB Members for Maternity Care Choice
The Lund Report
April 29, 2010 -- A group of concerned PEBB members breathed a sigh of relief on April 20 when the board voted unaminously to reinstate statewide coverage for mid-wives.
 
The public employees' benefit board voted to restore home-based and birth center-based maternity care provided by licensed direct-entry midwives (LDM), services that were previously denied by Providence Health Plans, which now administers the health plan for the vast majority of PEBB members.
 
The board's decision restores the benefit as it existed under Regence BlueCross BlueShield, which lost its statewide contract effective in January. Tthe statewide plan will again cover LDM maternity services at 70 percent.
 
The campaign to reinstate mid-wife coverage came from state employees and a group known as PEBB Members for Maternity Care Choice who spoke at the March 16 meeting and piqued the interest of board members. Following that meeting, the board directed the staff to do additional research. 
 
That research revealed confusion over the issue even from Regence’s perspective. In October 2009, Dr Ralph Prows of Regence informed PEBB staff that LDMs were excluded from coverage, a statement that was later corrected.
 
PEBB’s board directed Providence Health Plans, which holds the contract, to pay claims for LDM services under the alternative care benefit at 70 percent of billed charges. 
 
Research done by PEBB Members for Maternity Care Choice along with public testimony were key factors in the board’s decision, said Rich Peppers, board chair. “Thanks for raising the issue,” he said.
 
Representatives from PEBB Members for Maternity Care Choice couldn’t have been more pleased. “I want to say an incredible thank you for your continuing dedication to PEBB’s vision, and a thank you from all of our petition signers,” said Christine Olsen, a faculty member at Oregon State University. “I really can’t explain to you how grateful I am; I’m ecstatic.” 

PEBB intends to track provider rates for cesarean sections and induction, suggested by Rep. Tina Kotek (D-Portland), an advisory member.
 
Cesarean sections, often caused by failed inductions, are increasingly understood to be overused, exposing women and babies to short- and long-term health risks.
 
Tracking breastfeeding initiation and duration rates would also further PEBB’s commitment to evidence-based, cost-effective care, according to PEBB Members for Maternity Care Choice.

 

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Comments

It's not stated above explicitly, but I hope PEBB and the new health plan partners will be tracking perinatal complication rates for all providers, LDMs included, since concerns about that are the reason for the issue of coverage of LDM care being an issue in the first place. It's not just about the site of delivery, home vs. a medical facility.