Legislature(2021 - 2022)DAVIS 106
03/22/2021 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB117 | |
| HB132 | |
| State Board of Physical Therapy & Occupation Therapy | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 117 | TELECONFERENCED | |
| += | HB 132 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
HB 117-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES
4:02:18 PM
CO-CHAIR FIELDS announced that the first order of business would
be HOUSE BILL NO. 117, "An Act extending the termination date of
the Board of Certified Direct-Entry Midwives; and providing for
an effective date."
4:02:28 PM
REPRESENTATIVE DAN ORTIZ, Alaska State Legislature, introduced
HB 117 as prime sponsor. He explained that the bill would
extend the termination date for the Board of Certified Direct-
Entry Midwives to June 30, 2023, as recommended by the Division
of Legislative Audit (DLA). He said that the board is composed
of five members: two direct-entry midwives, one physician, one
certified nurse midwife, and one public member. Statute
dictates the responsibilities of the board, he said, which
include examining and issuing certificates and permits,
establishing regulations for certification and practice
requirements, ordering disciplinary actions, and approving
curricula and standards for education and training. He noted
that the bill has a nearly $22,000 fiscal note, which would be
paid for by the revenue from license fees.
4:04:33 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
presented the legislative audit [included in the committee
packet] on the Board of Direct-Entry Midwives, titled "A Sunset
Review of the Department of Commerce, Community, and Economic
Development, Board of Certified Direct-Entry Midwives (board)."
She explained that the purpose of the audit is to discover
whether the board is serving the interests of the public and
whether it should be extended. She read the report conclusions
on page i of the audit, which read as follows [original
punctuation provided]:
Overall, the audit concluded that the board served the
public's interest by conducting meetings in accordance
with state laws and effectively certifying midwives.
The board adopted regulatory changes to improve the
profession, but failed to pursue statutory changes due
to concerns over related costs. Additionally, the
audit found the peer review process was not
effectively monitored by the board and improvements
were needed over the Division of Corporations,
Business and Professional Licensing's (DCBPL)
investigative process.
In accordance with AS 08.03.010(c)(8), the board is
scheduled to terminate on June 30, 2021. We recommend
the legislature extend the board's termination date
two years, to June 30, 2023, which is significantly
less than the eight-year maximum allowed in statute.
The reduced extension is due to an issue identified
during the audit that may impact the board's ability
to protect the public and the board's reluctance to
recommend statutory changes in the public's best
interest. The details of the issue are not included in
this report to preserve the confidentiality of an
ongoing investigation. The reduced extension reflects
the need for continued oversight.
MS. CUTRIS then directed attention to page 7 of the audit, which
shows a scheduling of licensing statistics. She noted that
there were 51 certified midwives and apprentices as of January
31, 2020.
MS. CURTIS turned to page 8, which depicted the schedule of
fees. She said that the fees were raised in fiscal year 2017
(FY 17) to address a deficit, and as a result, the board has one
of the highest occupational fees of any occupation.
MS. CURTIS turned to page 9, which included a schedule of
revenues and expenditures showing that the board had a deficit
of just over $19,000 as of January 2020. She explained that at
the time of the audit, the management of the Division of
Corporations, Business and Professional Licensing (DCBPL) was of
the opinion that the deficit would be fully resolved by the end
of FY 21.
MS. CURTIS read excerpts of the recommendations on pages 11 and
12, which read as follows [original punctuation provided]:
Recommendation 1
The board should recommend statutory changes that
benefit the public.
The board identified a need to change certification
statutes to align Alaska's midwifery laws with
national standards. However, due to the legal costs
involved with the project, the board did not recommend
statutory changes.
Recommendation 2
DCBPL's chief investigator should ensure
investigations are completed timely.
Three cases open over 180 days from July 2016 through
January 2020 were evaluated by auditors. All three
were found to have unjustified periods of inactivity
ranging between 54 and 114 days. It was also noted
that supervisory review of two of the three cases was
not documented as required by DCBPL procedures,
indicating review did not occur or did occur and was
not documented. According to DCBPL staff, the
inactivity was the result of turnover and competing
priorities.
Recommendation 3
The board should improve oversight of the peer review
process.
The board delegated peer reviews to the Midwives
Association of Alaska's Action and Accountability
Committee. However, the board did not establish
procedures to provide assurance that reviews were
adequately completed. The board did not consider the
need for or importance of monitoring the peer review
process.
According to AS 08.65.030(b), the board may, by
regulation, require a CDM undergo a uniform or random
period of peer review to ensure quality of care.
Inadequate monitoring of the peer review process
increases the risk that the reviews will be deficient,
which increases the risk to public safety.
MS. CURTIS directed attention to page 23, which discussed
responses to the audit. She noted that the commissioner of the
Department of Commerce, Community and Economic Development
(DCCED) did not respond to Recommendations 1 and three because
these recommendations were directed only to the board. In
response to Recommendation 2, regarding improving the timeliness
of investigation, the commissioner shared that the department
was adding an additional supervisory position to assist with the
caseload.
MS. CURTIS directed attention to page 27, which included the
board chair's response to the audit. She explained that the
chair expressed disappointment with the "short, two-year
extension recommendation." Regarding Recommendation 1, to
pursue statutory changes when needed, she said that the chair
characterized the board's inaction as "justified" because it was
a way to reduce costs, and further noted that the board chair
expressed that the board should not be penalized for practicing
what was characterized as "fiscal responsibility." In response
to Recommendation 2, regarding the timeliness of the
investigative process, Ms. Curtis said the board chair concurred
with the recommendation but was not of the opinion that it
should impact the extension recommendation. She said that the
board chair concurred with Recommendation 3.
4:10:00 PM
BETHEL BELISLE, Chair, Board of Certified Direct-Entry Midwives,
said that the audit caused several concerns and discussed the
peer review process as addressed in Recommendation 3, which the
board delegates to the Midwives Association of Alaska's Action
and Accountability Committee (AAC), composed of members of the
Board of Certified Direct-Entry Midwives who have been voted in
by other members. She explained that when a chart includes
certain circumstances, which could include emergency transport,
care in the Neonatal Intensive Care Unit (NICU), or the death of
a mother and baby, the chart is then submitted to AAC. The
committee reviews the chart to determine whether the midwife
broke any statutes or regulations; if so, AAC sends the charges
to the full board for review. At the time of the audit, she
said, there were no charts being sent to the board. In response
to the determination by the audit that AAC was not "doing its
proper job," the board initiated an audit that called for a
complete review of all charts submitted since 2014. She shared
that, while the review committee has found nothing to indicate
that AAC has failed to do its job, the board has begun the
process of revamping the peer review committee, giving midwives
the ability to have confidential peer review but giving the
board complete oversight over any outcome that requires
emergency services in NICU stay or death.
MS. BELISLE then addressed the Recommendation 1 from the audit,
identified as a need to change certification statutes to align
Alaska's midwifery laws with national standards. She
characterized this change as "difficult" and expressed that
Alaska has always been a leader in the standard of midwifery
care, and that all current statutes meet or exceed the Certified
Professional Midwife (CPM) model. The licensure fee is $3,800
every two years, she said, and the fiscal responsibility of the
board is to pay off debt. She concluded that she would like the
board's sunset audit be changed to four years rather than two
years, due to the progress that the board has already made.
4:13:42 PM
CO-CHAIR FIELDS asked Ms. Belisle to explain the difference
between a certified nurse midwife and a certified direct-entry
midwife. He then asked whether the legislature's action on HB
117 would have any impact on Alaskans who receive care from
certified nurse midwives.
MS. BELISLE responded that certified nurse midwives are nurses
who have gone through higher education and have a larger scope
of practice than certified direct-entry midwives. She said that
CDE midwives go through the process of doing an apprenticeship
followed by a national exam and have a much narrower scope of
practice than certified nurse midwives. She explained that the
standard she referenced earlier is called "certified
professional midwife," which is a national certification that
acknowledges a nurse midwife has met or exceeded a minimal level
of practice standards. She stated that a change in the sunset
date would not impact certified nurse midwives in any way.
4:15:06 PM
CO-CHAIR SPOHNHOLZ asked Ms. Belisle to describe the alignment
of educational standards in Alaska to national standards, and
what would be involved in the changes.
MS. BELISLE explained that certified nurse midwives, until
recently, were required to have taken a course of study approved
by the Board of Certified Direct-Entry Midwives, which was
generally sourced from an online school and did not involve
college credit. In 2020, she said, the standards were changed
to require that, in order to become a midwife, courses be taken
through a school accredited by the Midwife Education
Accreditation Council (MEAC). She expressed that MEAC-
accredited schools limit the ability of practitioners to become
midwives because they're online schools that include components
requiring students to travel for different skills workshops.
She said that the cost of a MEAC-accredited school has limited
the number of apprentices applying for licensure. She said that
the national standard referenced in the audit states "any method
to midwifery," which could mean that the board could return to
what was originally used as an approved course of study.
CO-CHAIR SPOHNHOLZ asked Ms. Belisle whether she is suggesting
that aligning Alaska's standards with MEAC accreditation
standards would be rolling back standards in the state.
MS. BELISLE responded that it would be widening the standards.
She said that every midwife has to take part in the
apprenticeship model and then the national test. She explained
that currently, it is limited to the MEAC schooling in the form
of a "college type" degree, but if expanded to the national CPM
standard, it would allow for either option. She noted that she
recently resumed her training to take the MEAC courses and is of
the opinion that widening the standards would be preferable,
because passing the national test is what really matters.
CO-CHAIR SPOHNHOLZ asked Ms. Belisle to describe the time
commitment by midwives during apprenticeship training in Alaska.
MS. BELISLE responded that the board requires a minimum of 100
prenatal visits, a minimum of 65 births including observing,
assisting, and primary care, and a minimum of 100 post-partum
visits and newborn exams.
4:18:40 PM
REPRESENTATIVE MCCARTY recalled Ms. Belisle's earlier comments
about the fiscal responsibility to pay down debt. He asked what
the debt is and the reason for it.
MS. BELISLE replied that she only recently joined the board and
said that a subsequent testifier could likely answer that
question better. She stated that the debt was incurred about
eight years ago and was "several hundred thousand" dollars in
investigations that were applied to the board.
4:19:39 PM
SARA CHAMBERS, Director, Division of Corporation, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development, responded to Representative McCarty's
question. She said that the board has approximately 50
licensees, which she said is a "small number," but has the same
resources for investigative activity as any other board. She
explained that the reason for this is that AS 08.01.065 requires
all licensing programs to be self-funded. She said that there
is a greater chance of serious investigations in the medical
industry, and licensees will often challenge and appeal board
decisions. There have been significant investigations and
appeals for which the board has incurred legal costs, she said,
and expressed that a board regulating a large number of
licensees would not have incurred that level of debt because
there would be a sufficient number of licensees to pay these
fees.
4:21:52 PM
REPRESENTATIVE MCCARTY asked how many licensees are needed to
make the board self-sustaining.
MS. CHAMBERS replied that the licensee fees were increased
several years ago. She said that the number of licensees
required to make the board self-sustaining isn't known because
there are too many factors that can't be enumerated. She
recalled that there was discussion during a different
legislative audit that it might make sense to merge this board
with another, but the board and the industry shared that it
would strongly prefer to remain autonomous. She concluded that
for the second quarter ending December 31, 2020, the board
posted its first surplus for the year to date.
REPRESENTATIVE MCCARTY expressed his understanding that the
board has enough licensees to exist, but investigations have
caused the debt. He said that his experience lends him the
understanding that investigations have a "cap" in order to
ensure that any individual board is not overburdened by
investigative costs.
MS. CHAMBERS replied that capping investigative costs is an idea
that the department has tried to bring to the attention of the
legislature for years. She alluded to an unsuccessful bill that
would have created a cost equalization model.
4:26:06 PM
REPRESENTATIVE SNYDER asked Ms. Chambers whether she could speak
about the magnitude of the anticipated legal costs associated
with aligning Alaska's midwifery standards with national
standards.
MS. CHAMBERS expressed her belief that there was a
misunderstanding on the part of the previous board about the
cost, and that there would not have been a great legal cost.
She said the claim by the board doesn't make sense to her
because seeking a legislative sponsor would not come with a
cost. She noted that Ms. Belisle, the board chair, was not on
the board at the time of the confusion.
4:27:45 PM
REPRESENTATIVE KAUFMAN asked Ms. Belisle whether there would be
hardship imposed by the two-year extension period proposed under
HB 117, and whether it would have a tangible impact on the
board's ability to operate.
MS. BELISLE replied that it feels very "heavy" to know that
certain actions could potentially change the entire way
certified direct-entry midwives operate. She expressed that
while extending the sunset date by only two years wouldn't have
a tangible impact on the board's ability to operate, she said
that "we'll be right back where we are today."
4:28:55 PM
CO-CHAIR SPOHNHOLZ asked Ms. Belisle whether it's possible that
approving a two-year extension at this time might give the board
the opportunity to document some of the changes being made. She
shared her understanding that the board is in the process of
implementing changes, and she suggested that a two-year
extension could possibly give the board the opportunity to
complete and document those efforts and later seek an eight-year
extension from the committee.
MS. BELISLE replied that it would motivate the board to complete
the changes. She said that the peer review process will be
completed in April 2021, which is also when the statutory
changes will be completed.
4:30:00 PM
REPRESENTATIVE KAUFMAN asked Co-Chair Fields whether there would
be a benefit to hearing HB 117 in the House Health and Social
Services Standing Committee as well.
CO-CHAIR FIELDS responded that board renewals typically go
through the House Labor and Commerce Standing Committee,
notwithstanding the subject matter.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 117 Additional Document 3.19.21.pdf |
HL&C 3/22/2021 3:15:00 PM SFIN 5/14/2021 1:00:00 PM |
HB 117 |
| HB 117 Sponsor Statement version A.pdf |
HL&C 3/22/2021 3:15:00 PM |
HB 117 |
| HB 117 v. A.PDF |
HL&C 3/22/2021 3:15:00 PM |
HB 117 |
| HB 117 Sunset Review DLA 6.19.2020.pdf |
HL&C 3/22/2021 3:15:00 PM SFIN 5/14/2021 1:00:00 PM |
HB 117 |
| HB 117 Fiscal Note DCCED 3.22.21.pdf |
HL&C 3/22/2021 3:15:00 PM |
HB 117 |
| HB 132 Work Draft Committee Substitute v. G 3.19.21.pdf |
HL&C 3/22/2021 3:15:00 PM |
HB 132 |
| HB 132 Amendment #1 3.22.21.pdf |
HL&C 3/22/2021 3:15:00 PM |
HB 132 |
| HB 132 Letter of Support - Ironworkers Business Manager 3.19.21.pdf |
HL&C 3/22/2021 3:15:00 PM SEDC 3/11/2022 9:00:00 AM |
HB 132 |
| HB 132 Letter of Support - Ironworkers Apprenticehsip Training Coordinator 3.19.21.pdf |
HL&C 3/22/2021 3:15:00 PM |
HB 132 |
| HB 132 Letter of Support - PNRCC 3.22.21.pdf |
HL&C 3/22/2021 3:15:00 PM SEDC 3/11/2022 9:00:00 AM |
HB 132 |
| HB 132 Letter of Support - ASPTA 3.22.21.pdf |
HL&C 3/22/2021 3:15:00 PM SEDC 3/11/2022 9:00:00 AM |
HB 132 |