Legislature(1999 - 2000)

02/10/1999 01:35 PM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HOUSE BILL NO. 10                                                                                                               
"An Act extending the termination date of the Board of                                                                          
Certified Direct-Entry Midwives; and providing for an                                                                           
effective date."                                                                                                                
REPRESENTATIVE BILL HUDSON explained that CH.130, SLA 1992                                                                      
established the Board of Certified Direct Entry Midwives                                                                        
(CDM's).  HB 10, if enacted, would extend the board                                                                             
operation for another 4 years to June 30, 2003.                                                                                 
Representative Hudson continued, the duties of the                                                                              
regulating Board include:                                                                                                       
? Examining applicants and issuing certificates to                                                                              
qualified applicants;                                                                                                           
? Issuing permits to apprentice direct entry                                                                                    
? Reporting annually to the Governor and the                                                                                    
Department of Commerce and Economic Development;                                                                                
? Approving curricula and adopting standards for                                                                                
basic education, training, and apprentice                                                                                       
Representative Hudson pointed out Alaska's infant mortality                                                                     
rate is even higher than the national average which ranks                                                                       
22nd among developed nations.  Increasing the use of                                                                            
midwifery services has been shown to improve birth outcomes                                                                     
considerably.  The Legislature, in a strong move of support                                                                     
last session, moved midwifery services up on the Medicaid                                                                       
eligibility list.  The new listing will insure that these                                                                       
important services, which cost less than half of the Medical                                                                    
Model, will be funded.                                                                                                          
Representative Hudson summarized that Alaska is currently                                                                       
among the forerunners in the worldwide movement to establish                                                                    
a Midwifery Model of care as an alternative choice to the                                                                       
Medical Model.  The Board is currently in its wind down                                                                         
year, so if this board is to continue its work, HB 10 must                                                                      
pass this session.                                                                                                              
Co-Chair Therriault asked for further information on the                                                                        
price to each licensee applicant.  Representative Hudson                                                                        
noted that fourteen licensed midwives have been identified                                                                      
in the State and five apprentices.  He agreed that the                                                                          
charge to that Board was heavy, pointing out although that                                                                      
those involved have accepted that fee.  As the number of                                                                        
midwives increase, the individual costs should decrease.  He                                                                    
noted that the legal costs must be shared with collected                                                                        
combined fees, which will drop over time.                                                                                       
Representative J. Davies advised that he had submitted a                                                                        
bill a few years ago which tried to "smooth out" the ups and                                                                    
downs of the cumulative boards.  He proposed reconsideration                                                                    
of that legislation, suggesting that it would be beneficial                                                                     
to small groups such as the Midwifery Board.  Representative                                                                    
J. Davies asked how the use of midwifery improves the                                                                           
birthing process.                                                                                                               
KAYE KANNE, MIDWIVES ASSOCIATION OF ALASKA, JUNEU, stated                                                                       
that there are many reasons why the outcomes for midwives                                                                       
are better than the Medical Model.  Midwives work with their                                                                    
patients from the beginning addressing matters of nutrition,                                                                    
which can prevent complications such as premature labor,                                                                        
toxemia or diabetes from occurring.                                                                                             
MARILYN HOLMES, CITIZENS FOR MIDWIFERY, JUNEAU, advised that                                                                    
when looking at the worldview, the five nations with the                                                                        
best birth outcomes use midwifery for 70% of their births.                                                                      
Their model is to use midwifery for normal births and use                                                                       
physicians for abnormal births, which normally is about 10%                                                                     
of the population.  In the United States, we use midwifery                                                                      
for about 5% of all births.  The norm in our country is to                                                                      
use the Medical Model.                                                                                                          
The Board of Midwifery begins to "break" the pattern of our                                                                     
country.  One of the reasons that we need to break that                                                                         
pattern is that we are 22nd on the list of developed nations                                                                    
in terms of infant mortality and morbidity.  The U.S. does                                                                      
not have great birth outcomes.  Midwifery is the model which                                                                    
is recommended by the World Organization.                                                                                       
Ms. Holmes continued, the kind of care that is received from                                                                    
the midwife is sustained care.  It is from the beginning of                                                                     
the pregnancy, with the mother being monitored for social,                                                                      
psychological and health factors.  The woman receives much                                                                      
more attention and there is continual education regarding                                                                       
breast-feeding and other information that makes for                                                                             
healthier infants.  Ms. Holmes added that midwifery is a                                                                        
less expensive way to birth.  Midwifery takes the birth                                                                         
situation out of the technological realm.  It no longer                                                                         
becomes a medical emergency.                                                                                                    
Co-Chair Therriault asked questions regarding expenses paid                                                                     
for by the licensing individuals.                                                                                               
CATHERINE REARDON, DIRECTOR, DIVISION OF OCCUPATIONAL                                                                           
LICENSING, DEPARTMENT OF COMMERCE AND ECONOMIC DEVELOPMENT                                                                      
commented that the Board did cover its own costs for the                                                                        
fiscal years 1997 and 1998.  The cost was not recouped from                                                                     
outside, and licensee fees did cover those costs.                                                                               
She suggested that it would be difficult to predict what                                                                        
would happen in the coming two years, as the Department is                                                                      
not aware of potential complaints.  She noted that Board                                                                        
pays the second highest fee for a license, while at the same                                                                    
time is a profession that is not highly paid.  Including the                                                                    
indirect costs, all licenses total $15 thousand dollars a                                                                       
year.  Ms. Reardon added that it is expected that the fee                                                                       
will be lowered and costs will be kept down in the coming                                                                       
Representative J. Davies asked if there were ways in which                                                                      
the costs of the Board could be reduced.  Ms. Reardon                                                                           
replied that this Board is very frugal.  In FY97, $700                                                                          
dollars was spent on travel.                                                                                                    
Representative J. Davies asked what drives the costs.  Ms.                                                                      
Reardon explained that there has been an average of $12,600                                                                     
dollars in directed midwifery costs and perhaps $1500 for                                                                       
Department overhead costs.                                                                                                      
Representative J. Davies asked if Ms. Reardon thought that                                                                      
the bill submitted previously would have merit.                                                                                 
Ms. Reardon pointed out that the bill in reference had been                                                                     
presented perhaps three years ago and that enforcement,                                                                         
investigative and legal costs would be spread per capita                                                                        
amongst the 30,000 licensees in the Division.  The                                                                              
Department strongly supported the bill, although, the                                                                           
licensees which have low per capita cost did not want it                                                                        
implemented.  In terms of the over all benefit, she believed                                                                    
that it would be realistic.  Ms. Reardon suggested that with                                                                    
some adjustments, the concerns could work.  She added that                                                                      
Division auditors have recommended that there be strict                                                                         
application of the fee law.  That would mean that each sub-                                                                     
profession within the Board would have to cover its own                                                                         
costs.  She indicated that if such action were applied,                                                                         
there would be more volatile fees.                                                                                              
Co-Chair Therriault pointed out that the bill carried a zero                                                                    
fiscal note, indicating that the fees are covered into the                                                                      
year 2000 budget.                                                                                                               
Co-Chair Mulder MOVED to report HB 10 out of Committee with                                                                     
individual recommendations and with the accompanying fiscal                                                                     
note.  There being NO OBJECTION, it was so ordered.                                                                             
HB 10 was reported out of Committee with a "do pass"                                                                            
recommendation and with a zero fiscal note by the Department                                                                    
of Commerce and Economic Development dated 2/10/99.                                                                             

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