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Alaska abortion rule revision concerns pro-choice group

Amanda CoyneThe New York Times
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The Alaska Department of Health and Social Services sent out a notice last week that the department is revising its procedures related to how doctors, who provide abortions to Medicaid patients, must submit forms to be reimbursed by either the state or the federal government.

The department will take public comments on the new regulation until July 30.

The change has abortion providers worried that Alaska’s HSS, through the rule change, is trying to limit those who need abortions and change what has long been the terms by which Medicaid pays for them.

Clover Simon, spokesperson Planned Parenthood of the Great Northwest, said the new rule “unilaterally changes what constitutes a medically necessary abortion.” She said the new definition “ignores years of court orders and precedent on the definition of medically necessary.”

HSS is limited to what it can say while going through the public comment process. But in a written statement, Kimberli Poppe-Smart, HSS’s deputy commissioner, said that the change was necessary to “provide clarifications that would improve provider submission of the required form to avoid payment errors.”

She said that the HSS did not have a way to verify that abortions paid for by the state or federal government were meeting criteria for funding laid out by the Alaska Supreme Court.  

Medicaid is a joint state-federally funded program that provides health insurance to low income and disabled adults. About 38 percent of all abortions performed in year 2011 -- or 623 abortions -- were paid through Medicaid, according to the Alaska Bureau of Vital Statistics.

If the federal government is asked to pick up the cost, the abortion provider must certify that the abortion was performed because of rape, incest, or because the life of the mother is at risk. At various points in history, the state government has tried to impose those same standards on the state.

In 2001, however, the Alaska Supreme Court ruled that although the the feds can impose such standards, the state cannot “selectively deny necessary care to eligible women merely because the threat to their health arises from pregnancy.”

In other words, the state can’t decide to pay for a medically necessary knee surgery for one woman and deny a medically necessary abortion to another.

At issue since has been what constitutes a medically necessary abortion. Since 1993, the state has allowed a doctor to use his or her professional judgment. An administrative code provided guidance. The code said that a woman would be eligible to receive a publicly funded abortion if the pregnancy was a result of sexual assault, abuse or incest. It would also be covered if the procedure was necessary to prevent her death, cause her to be disabled or to “ameliorate a condition to her physical or physiological health.”

If those conditions were met and an abortion was performed, the doctor made a notation on a patient’s medical chart in order to get reimbursed.

Under the new proposed rules, the doctor must fill out a separate form that states the name of the woman and that the abortion performed was “not an elective procedure and I certify that in my professional judgment, the abortion was performed due to the health of the woman being endangered by the pregnancy.”

Poppe-Smart calls the form a review that’s “typical in Medicaid and insurance programs.”

But two things set off alarms for Planned Parenthood. The first is that separate form, which isn’t required for other procedures. Secondly, it’s unclear what is meant by “a woman being endangered by the pregnancy.”

In the end, it might not change the process at all. But, Simon said, because it’s unclear, it makes providers nervous based on the history of the state opposing abortion rights.  

Simon said that she’s spoken to HSS Commissioner William Streur, who assured her that nothing will change.

“I’d love to believe him,” she said, “but we need everything to be consistent and precise.”

Contact Amanda Coyne at Amanda@alaskadispatch.com