Legislature(2021 - 2022)DAVIS 106

03/22/2021 03:15 PM LABOR & COMMERCE

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Audio Topic
04:01:33 PM Start
04:02:18 PM HB117
04:31:28 PM HB132
07:29:21 PM State Board of Physical Therapy & Occupation Therapy
07:30:28 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Location Change --
Heard & Held
-- Testimony <Invitation Only> --
Moved CSHB 132(L&C) Out of Committee
-- Invited & Public Testimony --
John Hakala, Alaska State Director, U.S. Dept.
of Labor, Office of Apprenticeship
+ Bills Previously Heard/Scheduled TELECONFERENCED
+ Consideration of Governor's Appointees: TELECONFERENCED
- Alaska Labor Relations Agency
- State Board of Registration for Architects,
Engineers & Land Surveyors
- Workers' Compensation Appeals Commission
- State Physical Therapy & Occupational Therapy
**Streamed live on AKL.tv**
          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                                                                    
     Recommendation 3                                                                                                           
     The board  should improve oversight of  the peer review                                                                    
     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                                                                    
     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                                                               
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                                                               
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                                                               
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
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
HB 132
HB 132 Letter of Support - ASPTA 3.22.21.pdf HL&C 3/22/2021 3:15:00 PM
HB 132