Legislature(2017 - 2018)SENATE FINANCE 532

04/14/2017 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SCS CSHB 49(L&C) Out of Committee
Uniform Rule 23 Waived
Heard & Held
Uniform Rule 23 Waived
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Moved CSSB 104(FIN) Out of Committee
CS FOR HOUSE BILL NO. 49(FIN)                                                                                                 
     "An Act extending the termination date of the Board of                                                                     
     Certified Direct-Entry Midwives; and providing for an                                                                      
     effective date."                                                                                                           
1:58:49 PM                                                                                                                    
REPRESENTATIVE   SAM    KITO,   SPONSOR,    introduced   the                                                                    
legislation. He  stated that the bill  provided an extension                                                                    
of Board  of Certified  Direct-Entry Midwives  through 2021,                                                                    
which was the recommended extension from Legislative Audit.                                                                     
1:59:53 PM                                                                                                                    
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE AUDIT, shared that  there was an audit available                                                                    
dated  2016 (copy  on file).  The last  sunset audit  of the                                                                    
board was  conducted in 2014.  At that time the  Division of                                                                    
Corporation,  Business, and  Professional Licensing  (DCBPL)                                                                    
investigative    staff    had   not    actively    processed                                                                    
investigations that  posed a public safety  risk. After that                                                                    
audit was released,  the board was only  extended two years.                                                                    
The most recent  audit found that the  board was effectively                                                                    
licensing  and regulating  certified  direct entry  midwives                                                                    
and  midwife apprentices,  and she  recommended a  four-year                                                                    
extension. He  stated that  there were  four recommendations                                                                    
located in the audit document.                                                                                                  
2:04:28 PM                                                                                                                    
Senator  Olson queried  the reasons  for  the deficits.  Ms.                                                                    
Curtis   replied  that   the   board   had  struggled   with                                                                    
investigative fees.                                                                                                             
Senator Olson  wondered whether there were  lawsuits related                                                                    
to malpractice  of midwives. Ms.  Curtis replied  that there                                                                    
were  four cases  involving two  individuals  that were  not                                                                    
moving  forward  and  resulted   in  additional  costs.  She                                                                    
stressed that the audit did  not typically go into detail on                                                                    
investigative cases.                                                                                                            
Senator  Olson wondered  whether  did not  pursue a  license                                                                    
because  of  the  high  fee.  Ms.  Curtis  deferred  to  the                                                                    
Senator Olson  asked whether there  were any mergers  of the                                                                    
boards for  economic reasons in  the state or  other states.                                                                    
Ms. Curtis replied that there were no recent board mergers.                                                                     
Senator Hughes  wondered whether the investigations  were of                                                                    
licensed  individuals  or  fraudulent midwives.  Ms.  Curtis                                                                    
that, historically, there was a mixture of both.                                                                                
2:07:48 PM                                                                                                                    
SARA  CHAMBERS, DEPUTY  DIRECTOR, DIVISION  OF CORPORATIONS,                                                                    
BUSINESS,   AND   PROFESSIONAL  LICENSING,   DEPARTMENT   OF                                                                    
COMMERCE,  COMMUNITY AND  ECONOMIC DEVELOPMENT,  shared that                                                                    
the department concurred with the  first two findings in the                                                                    
audit regarding  administrative errors and fees.  She stated                                                                    
that there was a fee  increase to $3800 for fully authorized                                                                    
midwives, and  under $2000 for apprentices.  She stated that                                                                    
there  were  no  documented  departures  from  the  industry                                                                    
because  of the  fees,  but it  was a  fairly  new fee.  She                                                                    
stated that the board  only have approximately 50 licensees,                                                                    
so  there was  an  economy of  scale  issue with  unlicensed                                                                    
practice and some standard of care investigations.                                                                              
Co-Chair MacKinnon  shared that  Senator Olson  had valuable                                                                    
medical expertise.                                                                                                              
Senator Olson  wondered whether  the licensees  included the                                                                    
apprentices. Ms. Chambers responded  in the affirmative. She                                                                    
stated  that  the  latest  numbers   for  the  fee  analysis                                                                    
indicated  that there  were 43  fully licensed  midwives and                                                                    
approximately 20 apprentices.                                                                                                   
Senator Olson  wondered whether the investigations  were for                                                                    
midwives  or apprentices.  Ms.  Chambers  agreed to  provide                                                                    
that information, but  midwives had fiduciary responsibility                                                                    
over apprentices.                                                                                                               
Senator Hughes  queried the  licensure fees  for physicians,                                                                    
nurses, and  nurse practitioners. Ms. Chambers  replied that                                                                    
the physician  fee was $300,  physician assistant's  fee was                                                                    
$200, nurse's fee was approximately $200.                                                                                       
Senator  Hughes noted  that  midwives  paid a  significantly                                                                    
larger license fee, and thanked them for their dedication.                                                                      
2:13:54 PM                                                                                                                    
Co-Chair  MacKinnon wondered  whether  the department  could                                                                    
advance  the concern  that was  listed from  the officer  to                                                                    
either the  presiding officers, Labor  and Commerce,  or the                                                                    
appropriate  chairman.   She  remarked  that  there   was  a                                                                    
liability for choosing to use a midwife.                                                                                        
Co-Chair Hoffman remarked that the  bill only dealt with the                                                                    
extension. He felt that  addressing the third recommendation                                                                    
in the  audit may  require work from  the Senate  Health and                                                                    
Social Services Committee.                                                                                                      
Co-Chair MacKinnon agreed.                                                                                                      
Senator  Micciche wondered  how  long it  took  to build  an                                                                    
operation  deficit of  $183,083. Ms.  Chambers replied  that                                                                    
the board  has had a deficit  since 2012 of $65,000  and had                                                                    
grown  annually until  the most  recent  renewal cycle.  The                                                                    
deficit began to  reduce because of the  increased fees. She                                                                    
remarked that  the fees  were dropped in  2009, but  did not                                                                    
know the rationale for lowering the fee at that time.                                                                           
Senator  Micciche  wondered  whether  the  four-year  sunset                                                                    
renewal was too  long, because the board  should continue to                                                                    
be investigated.                                                                                                                
Senator  Olson supported  keeping  independent midwives.  He                                                                    
queried the  estimated forecast.  Ms. Chambers  replied that                                                                    
there was a fee analysis  to address the issues with setting                                                                    
fees. She  stated that,  assuming that  the fees  remain the                                                                    
same, the board's deficit would be eliminated by FY 21.                                                                         
2:22:31 PM                                                                                                                    
DEBORAH   SCHNIDER,  BOARD   OF  MIDWIVES,   ANCHORAGE  (via                                                                    
teleconference), testified in support of the bill.                                                                              
2:24:21 PM                                                                                                                    
JOHANNA CROSSETT,  MIDWIFE, JUNEAU, spoke in  support of the                                                                    
Senator Micciche  queried whether  there was support  of the                                                                    
licensees covering the deficit.  Ms. Crossett replied in the                                                                    
Vice-Chair Bishop  wondered whether  the midwives  might not                                                                    
want  to  pay the  fee,  and  stop licensing.  Ms.  Crossett                                                                    
replied that  the initial proposed licensing  fee was $4700.                                                                    
The  reduction to  $3800 was  a good  compromise. She  hoped                                                                    
that there would not be another fee increase.                                                                                   
2:26:25 PM                                                                                                                    
MADI NOLAN-GRIMES, MIDWIFE, JUNEAU,  spoke in support of the                                                                    
2:27:21 PM                                                                                                                    
SUZANNE  TREWILLIGER,  PRESIDENT,  MIDWIVES  ASSOCIATION  OF                                                                    
ALASKA,  EAGLE  RIVER  (via  teleconference),  testified  in                                                                    
support of the bill.                                                                                                            
Senator  Micciche wondered  whether the  number of  midwives                                                                    
was changing. Ms. Trewilliger replied  that that there was a                                                                    
reduction of thirteen midwives, and  did not know the number                                                                    
of apprentices.                                                                                                                 
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
2:31:03 PM                                                                                                                    
Vice-Chair Bishop addressed the fiscal note: FN 1(CED).                                                                         
2:32:01 PM                                                                                                                    
AT EASE                                                                                                                         
2:32:48 PM                                                                                                                    
Vice-Chair Bishop  MOVED to REPORT  SCS CSHB 49(L&C)  out of                                                                    
committee  with  individual   recommendations  and  attached                                                                    
fiscal note.                                                                                                                    
SCS CSHB  49(L&C) was REPORTED  out of committee with  a "do                                                                    
pass"  recommendation  and  with  one  previously  published                                                                    
fiscal impact note: FIN 1(CED).                                                                                                 
2:33:51 PM                                                                                                                    
AT EASE                                                                                                                         
2:40:39 PM                                                                                                                    

Document Name Date/Time Subjects
HB 49 Supporting Document Medicaid Cost Savings CDMs 2015.pdf SFIN 4/14/2017 1:30:00 PM
HB 49
HB 49 Supporting Document Licensing Fees FY06-17.pdf SFIN 4/14/2017 1:30:00 PM
HB 49
HB049 Support Letters 020217.pdf SFIN 4/14/2017 1:30:00 PM
HB 49
HB049 Supporting Documents-Full Sunset Audit 01.30.17.pdf SFIN 4/14/2017 1:30:00 PM
HB 49
SB 104 Amendment Consolidated 1 MacKinnon.pdf SFIN 4/14/2017 1:30:00 PM
SB 104