Legislature(1999 - 2000)
02/10/1999 01:35 PM FIN
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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 midwives; ? Reporting annually to the Governor and the Department of Commerce and Economic Development; and ? Approving curricula and adopting standards for basic education, training, and apprentice programs. 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 years. 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.