Legislature(2017 - 2018)BELTZ 105 (TSBldg)

04/11/2017 01:30 PM LABOR & COMMERCE

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Heard & Held
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Heard & Held
Moved CSSCR 10(L&C) Out of Committee
          HB  49-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                      
1:31:59 PM                                                                                                                    
CHAIR COSTELLO announced  the consideration of HB  49. She stated                                                               
that the intent  is to hear from the sponsor,  take questions and                                                               
public testimony,  and hold the  bill for  further consideration.                                                               
[CSHB 49(FIN) was before the committee.]                                                                                        
1:32:19 PM                                                                                                                    
CRYSTAL KOENEMAN,  Staff, Representative  Sam Kito,  Alaska State                                                               
Legislature, explained  that HB 49  extends the Board  of Direct-                                                               
Entry  Midwives  for  six  years,   to  2023.  Legislative  Audit                                                               
recommended a  four-year sunset extension  and the  House Finance                                                               
Committee  recommended   a  six-year   sunset.  The   sponsor  is                                                               
comfortable   with   the    finance   recommendation   with   the                                                               
understanding that  the board's deficit  will be paid  off. Also,                                                               
extending the  audit the additional  two years will  reduce costs                                                               
to the state.                                                                                                                   
1:33:28 PM                                                                                                                    
KRIS CURTIS, Legislative Auditor,  Division of Legislative Audit,                                                               
Legislative  Agencies  and  Offices,  stated  that  the  division                                                               
conducted a  sunset audit of  the Board of  Direct-Entry Midwives                                                               
to  determine  whether it  is  serving  the public  interest  and                                                               
should  be extended.  The last  sunset  audit of  this board  was                                                               
conducted  in 2014.  At that  time  the division  found that  the                                                               
investigative  staff of  the Division  of Corporations,  Business                                                               
and  Professional Licensing  (DCBPL)  was  not actively  pursuing                                                               
investigations. This  posed a  public safety  risk and  the board                                                               
was given  a two-year  extension. The 2016  audit found  that the                                                               
board  was  serving  the  public  interest  and  was  effectively                                                               
licensing  and  regulating  direct-entry  midwives.  A  four-year                                                               
extension was recommended.                                                                                                      
She  said Legislative  Audit made  three  recommendations in  the                                                               
last audit.                                                                                                                     
Recommendation  1: The  Division  of  Corporations, Business  and                                                               
Professional Licensing,  in consultation  with the  board, should                                                               
increase licensing fees to address the operating deficit.                                                                       
Ms. Curtis noted that in 2014  the deficit was about $115,000 and                                                               
in 2016  the deficit had grown  to just over $183,000.  Fees were                                                               
increased during  this time  but were  insufficient to  cover the                                                               
board's operating costs.                                                                                                        
Recommendation 2:  The director of the  Division of Corporations,                                                               
Business and  Professional Licensing should take  steps to ensure                                                               
that license records are accurate.                                                                                              
Ms. Curtis explained  that audit test work found  two errors. The                                                               
wrong license was listed as  on probation in the online database,                                                               
and  a consent  agreement that  the  board had  approved had  the                                                               
wrong year listed.                                                                                                              
Recommendation  3:  The  legislature  should  consider  alternate                                                               
forms of regulating the midwifery profession.                                                                                   
She said this is an unusual  recommendation that is made in light                                                               
of  the rising  deficit and  the  small number  of licensees.  To                                                               
address the deficit DCBPL management  plans to increase licensing                                                               
fees significantly. By 2020 fees  are expected to be about $4,000                                                               
for  direct-entry  midwives  and   about  $2,000  for  apprentice                                                               
midwives. Legislative  Audit believes this fee  structure poses a                                                               
barrier to entry into the profession  and could result in a lower                                                               
number of midwives available to the public.                                                                                     
1:36:51 PM                                                                                                                    
CHAIR  COSTELLO asked  if  this was  the  first time  Legislative                                                               
Audit  the legislature  look at  alternate forms  of licensing  a                                                               
MS. CURTIS  said they have  made that recommendation in  the past                                                               
and have  also recommended  terminating due  to a  large deficit.                                                               
She directed  attention to the Department  of Commerce, Community                                                               
and  Economic Development  (DCCED)  response on  page  21 of  the                                                               
audit.  DCCED concurred  with the  first two  recommendations and                                                               
had no position  on the third recommendation  but did acknowledge                                                               
that merging  the board with  a similar profession  would improve                                                               
its fiscal  situation. The board's  response is on page  23. They                                                               
concur with recommendations  1 and 2, but  strongly disagree with                                                               
recommendation  3. They  point  out that  midwifery  is a  unique                                                               
profession and other boards would  have difficulty regulating it.                                                               
The  suggestion to  combine  with  the Board  of  Nursing or  the                                                               
Physician's Board  would be problematic because  those boards are                                                               
in direct  competition with the  CDM profession. They  fear being                                                               
regulated out  of practice and  strongly believe that  neither of                                                               
these boards would  want midwives to have any  role in regulating                                                               
their profession.                                                                                                               
1:37:31 PM                                                                                                                    
SENATOR HUGHES joined the committee.                                                                                            
1:38:38 PM                                                                                                                    
CHAIR  COSTELLO said  she  understands  that similar  suggestions                                                               
have not been successful.                                                                                                       
1:38:59 PM                                                                                                                    
SENATOR STEVENS joined the committee.                                                                                           
CHAIR COSTELLO  asked if  it is  unusual for a  board to  carry a                                                               
deficit for a decade, as this board has.                                                                                        
MS. CURTIS  said she can't  confirm that  this board has  been in                                                               
deficit for  a decade, but  prior audits indicate  that licensing                                                               
fees  have  been  a  consistent   problem.  The  board  has  also                                                               
experienced investigative costs.                                                                                                
CHAIR COSTELLO  asked Ms.  Chambers to comment  on the  audit and                                                               
anything else the committee should know.                                                                                        
1:40:47 PM                                                                                                                    
SARA  CHAMBERS,   Deputy  Director,  Division   of  Corporations,                                                               
Businesses  and Professional  Licensing, Department  of Commerce,                                                               
Community  and Economic  Development  (DCCED),  Juneau, said  the                                                               
division  concurred with  the first  two recommendations  and has                                                               
been working  with the  board to  eliminate the  deficit. Statute                                                               
requires  all   licensing  programs  to  cover   their  expenses,                                                               
including investigations  of unlicensed activity. This  is a very                                                               
sensitive public  health profession  and their  investigative and                                                               
legal costs are  quite high relative to the  number of licensees.                                                               
Licensing  fees have  been  increased to  about  $3,800 to  cover                                                               
costs going forward and to eliminate the debt.                                                                                  
CHAIR  COSTELLO asked  what the  licensing fees  are for  nurses,                                                               
physicians and chiropractors.                                                                                                   
MS.  CHAMBERS  said  a  physician's license  is  $300  a  nurse's                                                               
license is $165,  and a chiropractor's license is  $450. The fees                                                               
generally reflect the  number of people who  support the overhead                                                               
and costs.  Physicians and nurses  have large boards  whereas the                                                               
chiropractor board is smaller.                                                                                                  
SENATOR  GARDNER commented  that if  the board  objects to  being                                                               
merged  with either  the Board  of Nursing  or the  State Medical                                                               
Board,  it is  deciding that  its  membership will  pay the  high                                                               
MS. CHAMBERS acknowledged the comment.                                                                                          
SENATOR HUGHES  asked if  there had  been any  conversations with                                                               
either  the Board  of Nursing  or  the State  Medical Board.  She                                                               
surmised that those boards wouldn't support the merge.                                                                          
MS. CHAMBERS  said there  have been  no formal  conversations but                                                               
anecdotally the top  concern is how the fees would  be managed if                                                               
the program  is bringing in  a deficit.  She added that  it isn't                                                               
unprecedented  for multiple  professions to  be housed  under one                                                               
1:45:52 PM                                                                                                                    
SENATOR MEYER joined the committee.                                                                                             
SENATOR GARDNER asked if the  committee will hear from members of                                                               
the board.                                                                                                                      
CHAIR COSTELLO said yes.                                                                                                        
1:46:22 PM                                                                                                                    
CHAIR COSTELLO opened public testimony on HB 49.                                                                                
1:46:45 PM                                                                                                                    
JOHANNA  CROSSEH, representing  herself,  said she  is a  direct-                                                               
entry midwife  in Juneau who is  testifying in support of  HB 49.                                                               
She stated, "We like our board  so much that we're willing to pay                                                               
the $3,800 licensing fee in an effort  to get us out of this debt                                                               
situation we've gotten ourselves into."                                                                                         
CHAIR  COSTELLO  asked her  to  comment  further on  the  board's                                                               
willingness   to  address   the   deficit   within  the   current                                                               
MS. CROSSEH  maintained that she  and other midwives  are willing                                                               
to  pay  the  fees  because  they  understand  how  unique  their                                                               
profession  is.   Anecdotal  reports  from  nurses   and  doctors                                                               
indicate  a lack  of support  for merging  with a  board that  is                                                               
operating in a deficit, she said.                                                                                               
CHAIR COSTELLO asked the cost of a home birth.                                                                                  
MS.  CROSSEH  said most  midwives  in  Juneau charge  $3,500  and                                                               
Medicaid pays about $1,200 for the same home birth.                                                                             
CHAIR COSTELLO asked what a hospital birth costs.                                                                               
MS. CROSSEH said  she didn't have exact figures,  but the midwife                                                               
option certainly saves the state money.                                                                                         
SENATOR  GARDNER asked  if  there is  an  accredited program  for                                                               
midwives in Alaska.                                                                                                             
MS.  CROSSEH  said nothing  is  offered  in-state but  accredited                                                               
distance  programs  are available.  The  birth  center where  she                                                               
works in Juneau  offers the internship portion  of the accredited                                                               
training. Many  birth centers and  private midwives  in Anchorage                                                               
also offer apprenticeships.                                                                                                     
1:50:09 PM                                                                                                                    
MADI  NOLAN GRIMES  said she  is a  direct-entry midwife  and the                                                               
director of  a local birth  center in  Juneau who is  speaking in                                                               
support  of  HB  49.  She  echoed  Ms.  Crosseh's  comments  that                                                               
midwives as  a profession  acknowledge that  they are  willing to                                                               
pay down their debt and will continue to pay the elevated fees.                                                                 
SENATOR GARDNER  asked if the  $3,800 fee  is a barrier  to entry                                                               
for starting midwives.                                                                                                          
MS. NOLAN  GRIMES said the hope  is that the licensing  fees will                                                               
even out as the deficit is addressed.                                                                                           
1:51:57 PM                                                                                                                    
DEBORAH  SCHNEIDER,   Chair,  Board  of   Direct-Entry  Midwives,                                                               
Wasilla, said  she is testifying  in support  of HB 49.  She said                                                               
midwives have been licensed in Alaska  for more than 20 years and                                                               
they have worked  hard to provide good, safe  care. The licensing                                                               
fees have fluctuated  up and down over the years  and the current                                                               
licensees are committed  to paying down their  deficit. The board                                                               
is  also   working  with  multiple  state   agencies  to  prevent                                                               
protracted and expensive investigations  that the board has faced                                                               
in the  past. The first  two recommendations from the  audit have                                                               
been  addressed but  the  board  does not  agree  with the  third                                                               
recommendation  to address  the deficit  by merging  with another                                                               
1:54:34 PM                                                                                                                    
SUSAN  TERWILLIGER,  President,  Midwives Association  of  Alaska                                                               
said she  is a certified  direct-entry midwife who has  an office                                                               
in Eagle  River and  does home  births. She  is speaking  for the                                                               
membership in support  HB 49. They agree to pay  the high fees to                                                               
eliminate  the   deficit.  The   uniqueness  of   the  profession                                                               
underscores  the   importance  of   this  board   overseeing  the                                                               
midwifery profession and protecting public safety.                                                                              
CHAIR  COSTELLO asked  if  she knows  the range  of  costs for  a                                                               
hospital birth.                                                                                                                 
MS. TERWILLIGER said no, but  the packets should have information                                                               
showing  how  much  direct-entry   midwives  save  the  state  in                                                               
Medicaid payments.                                                                                                              
1:57:12 PM                                                                                                                    
At ease                                                                                                                         
1:57:28 PM                                                                                                                    
CHAIR  COSTELLO  reconvened  the  meeting and  advised  that  the                                                               
document is online but not in the packets.                                                                                      
MS. TERWILLIGER read  from the document she  referenced. In 2015,                                                               
Medicaid payments per  birth by CDNs was $1,168  and the Medicaid                                                               
payment for a low-risk hospital birth was $3,171.                                                                               
CHAIR  COSTELLO asked  if midwives  have  adjusted their  charges                                                               
based on their licensing fees.                                                                                                  
MS. TERWILLIGER said no.                                                                                                        
1:59:39 PM                                                                                                                    
CHAIR  COSTELLO closed  public testimony  on HB  49 and  held the                                                               
bill in committee for further review.                                                                                           

Document Name Date/Time Subjects
HB 49 - Background Document - MID Fee Analysis.pdf SL&C 4/11/2017 1:30:00 PM
HB 49
HB 49 - Fiscal Note.pdf SL&C 4/11/2017 1:30:00 PM
HB 49
HB 49 - Background Document - Leg. Audit Sunset.pdf SL&C 4/11/2017 1:30:00 PM
HB 49
HB 49 - Leg. Research - Board of Direct Entry Midwives.pdf SL&C 4/11/2017 1:30:00 PM
HB 49
HB 49 - Sponsor Statement.pdf SL&C 4/11/2017 1:30:00 PM
HB 49
HB 49.PDF SL&C 4/11/2017 1:30:00 PM
HB 49
CS SCR 10 (L&C) - Ver. O.PDF SL&C 4/11/2017 1:30:00 PM
SCR 10