Alicia,
Here in NYC several HMO/PPO/insurers are using nurses for homecare and calling
them lactation consultants.  They are paid $40. for a visit of 15-30 minutes.
 An agency that has the area contract from US Healthcare to provide homecare
offered several colleagues (real IBCLC's) the same money to do consults for
moms who were nurse-identified as having breastfeeding difficulties.  They
explained what is involved in a lactation consult in terms of time and
resources and asked for $75, about half the going rate for housecalls.  The
agency refused.
        I am seeing more extremely sleepy, dry babies in my practice recently
among mothers sent home after 24 hours.  This is especially a problem with
epidural and pitocin babies.  I am unsure whether more time in the hospital
under the current system of care would be helpful, though.  I have seen many
babies discharged after 48 hours as 'breastfeeding' who have never actually
latched onto the breast.  I suspect the ideal would be early discharge with
real lactation consultant and housekeeping support; or a step down type of
maternal-infant unit care after the first 24 hours, where mom does all the
baby care under staff guidance in the hospital.  This would require quite
different attitudes and priorities than are presently in place.
Good luck with your testimony.
Catherine Watson Genna, IBCLC