Legislature(2007 - 2008)SENATE FINANCE 532
03/13/2007 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB59 | |
| SB81 | |
| HB18 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 59 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | SB 81 | ||
| = | HB 18 | ||
9:28:01 AM SENATE BILL NO. 81 "An Act extending the termination date for the Board of Certified Direct-Entry Midwives; and providing for an effective date." This was the first hearing for this bill in the Senate Finance Committee. Co-Chair Stedman announced intent to report this bill from Committee. 9:28:57 AM RICHARD BENEVIDES, Staff to Senator Bettye Davis, sponsor of the bill, read the sponsor statement into the record as follows. Senate Bill 81 extends the sunset date of the Board of Certified Direct-Entry Midwives until June 30, 2015, in accordance with the recommendations of the Legislative Auditor. The legislative auditor has concluded the Board of Certified Direct-Entry Midwives meets the statutory requirements of public need and is in compliance with AS 08.01.065(c), which requires occupational licensing fees to cover the regulatory costs of that occupation. The board has served as a means to make people practicing Midwifery aware of the level of experience and education expected of them. It consists of five members appointed by the Governor: one public member, two certified direct-entry midwives (CDMs), one certified nurse midwife, and one physician licensed by the Alaska State Medical Board who is either an obstetrician or who has specialized obstetric training. Their duties include examining and certificating applicants, permitting apprentices, holding hearings and ordering disciplinary sanctions. They maintain all educational records; approve curricula, training, and programs for direct entry midwives and apprentices. They have worked proactively to ensure that public safety has been maintained while improving the profession of Midwives. They have successfully incorporated Certified Professional Midwife standards into Alaska's Certified Direct-Entry Midwives licensing program and worked with the State to establish Medicaid procedures for CDM services, thereby placing Alaska among eight states which both license their traditional midwives and provide Medicaid reimbursement for their services. They continue to work to create and revise regulations that ensure proper training and increase educational requirements. Women seeking an alternative to hospital care for normal pregnancy and birth rely on the diligence of the board to enhance both the quality and accessibility of their healthcare. We urge your support on passage of this bill. 9:30:51 AM Mr. Benevides informed that approximately ten percent of all births in Alaska are done through midwifery. Additionally, membership on this board has the highest licensing fee. 9:31:09 AM Co-Chair Stedman cited a letter to the Division of Legislative Audit from Dana Brown, Chair of the Certified Direct-Entry Midwives Board dated October 26, 2006 and included in the audit report [copy on file] on page 17. The text of the letter reads as follows. This is written in response to the preliminary audit report concerning the Board of Certified Direct-entry Midwives. I concur with the recommendation that the legislature extend the termination date of the board to June 30, 2015. My conclusions are the same as those in the audit report. In the Analysis of Public Need section on page 8, it implies that the board increased certification requirements for apprentice direct-entry supervisors. We tried to do this but were unable to change regulation because of wording in statute. Someday the Midwives Association of Alaska will need to go to the legislature and try to get legislation passed to change wording in statute so that certain regs. can be addressed. I concur with the rest of the report. I am very pleased with the report. AT EASE 9:32:14 AM / 9:32:23 AM Mr. Benevides was unaware of specific regulatory changes sought by the Board. 9:32:44 AM Senator Olson asked the number of licensees in the State. 9:32:51 AM Mr. Benevides deferred to the Division of Legislative Audit. 9:32:59 AM PAT DAVIDSON, Director, Division of Legislative Audit, listed the number of Certified Direct-Entry Midwife (CDM) licensees at the end of 2006 as 28 and the number of registered apprentices at that time as eight. Senator Olson asked the number of births and the number of "bad outcomes". 9:33:34 AM Ms. Davidson did not know the number of births performed or the number of negative outcomes. The Division reviews the investigations conducted by the Board and the outcomes of those investigations. It found that investigations were conducted in a timely manner and with satisfactory outcomes. 9:34:07 AM Senator Olson asked if any disciplinary actions against members were taken in the past year. 9:34:17 AM Ms. Davidson did not know. Senator Olson asked the number of disciplinary actions taken in the history of the Board. 9:34:43 AM Ms. Davidson again did not have the information, but assured she would research the matter. 9:34:54 AM Senator Olson asked if Certified Direct-Entry Midwives have authority to prescribe any medication. 9:35:01 AM Ms. Davidson did not know. 9:35:04 AM Mr. Benevides interjected that midwives are prohibited from practicing unless they are located within a certain number of miles to a practicing doctor. Additionally, midwives are prohibited from performing any "medically difficult" births. The last disciplinary action taken by the Board was against a person practicing without a license. 9:35:59 AM Senator Olson asked about the continuing education requirements and whether those requirements have changed in recent years similar to changes imposed by the State medical board. 9:36:17 AM Mr. Benevides could not speak to the details of continuing education requirements. 9:36:36 AM Co-Chair Stedman asked Ms. Davidson's recommendation on the aforementioned need for statutory changes. 9:36:39 AM Ms. Davidson did not have adequate information to provide a complete answer. The Division determines whether boards or commissions are able to "carry out their business" and "leaves" necessary statutory changes to the board or commission to pursue. 9:37:31 AM Co-Chair Stedman, noting that the Board was operating at a deficit, asked whether the license fee rates should be reevaluated. 9:38:08 AM Ms. Davidson directed attention to Exhibit 1 of the Analysis of Public Need on page 9 of the audit report. Exhibit 1 is a spreadsheet titled, "Board of Certified Direct-Entry Midwives, Schedule of License Revenues and Board Expenditures, FY 03 - FY 06, (Unaudited)". Fees are levied on a two-year basis, with the Board receiving most revenue every second year, including FY 05 and FY 03. The lesser revenue generated in the intervening years should be adequate to sustain the program through that year. The greater amounts collected in subsequent years have been utilized to reduce the cumulative deficit. She highlighted the Ending Cumulative Deficits for FY 03: $8,188; FY 04: $45,026; FY 05: $13,000; and FY 06: $24,395. This pattern of reduction to the deficit would continue as fee rates would be unchanged for 2007. The balance should be zero barring any unforeseen spending increases, and at that time the fee should be reduced. Ms. Davidson informed that expenditures "spiked" in 2002 and 2003 primarily in contractual costs with the Department of Law and for investigations. 9:40:25 AM Co-Chair Stedman asked about the high litigation costs referenced in the audit report. 9:40:37 AM Ms. Davidson pointed out that statute requires that occupational boards must be self financed. Therefore, the board incurs the costs associated with investigations, legal actions and drafting of new legislation. The increased costs incurred by this board do not cause "particular concern". A board with as few members as the Board of Certified Direct-Entry Midwives has high licensing fees. 9:41:34 AM Senator Thomas asked why the personal services and contractual expenses of FY 03 and FY 04 were higher than FY 05 and FY 06. 9:42:03 AM Ms. Davidson responded that the contractual costs are comprised of legal fees involving investigations. She could not address the disparities in the personnel services costs. 9:42:33 AM Senator Thomas, citing page 10 of the audit, noted that the Division of Occupational Licensing, Department of Commerce, Community and Economic Development, opened nine investigative cases during the period of July 2002 and June 2006 pertaining to the Board of Certified Direct-Entry Midwives. He asked if any of these investigations were ongoing at this time and whether additional legal fees associated with the complaints were expected. 9:43:18 AM Ms. Davidson had no direct information. Fees associated with the investigative cases depend on the direction each case takes. Investigation and legal fees concern all boards and commissions because their expense requires license fees to "swing" from one year to the next. However, these boards and commissions must deal with the costs of investigations and be self sufficient. 9:44:20 AM Senator Elton, returning to the letter from the Board Chair on page 17 of the audit report, suggested "cognitive differences" exist between the understanding of the Board and that of the Division of Legislative Audit. He cited a finding on page 12 of the audit, which reads as follows. It appears that the board has effectively and efficiently obtained its objectives and purposes. In proposing regulatory changes, the board has worked to ensure the objective of the regulation is clearly defined. They have provided for consistent language throughout the Certified Direct-Entry Midwives regulations and have updated the regulations and statutes to reflect new changes in the professional environment. Evidence suggests the board establishes and meets its operational objectives annually. Senator Elton surmised that the audit report deems the Board to be solely responsible for drafting legislation, although the Board itself is "complaining" that it could not draft regulations. Senator Elton commented that he supports this Board. Members of the profession have not protested the amount of the licenses. 9:45:59 AM Ms. Davidson would discuss the matter with the Board Chair. The Board claims it could not draft regulations because it does not have statutory authority. However, the Division of Legislative Audit has determined the Board does have sufficient authority. 9:46:34 AM Senator Huggins asked if a "clear message" could be gleaned from the number and types of complaints filed, as listed on page 10 of the audit. 9:46:59 AM Ms. Davidson perceived no clear message. The Division of Legislative Audit reviews the types of complaints and their source. Because most of the complaints were filed by a Peer Review Committee member (67 percent) or by another governmental agency (22 percent), the issues were primarily administrative, such as incomplete applications. 9:47:54 AM Senator Olson pointed out the current licensing fee of $2,088 and asked whether the profession had "any relief in sight" that could encourage more people to enter the midwifery field. Midwifery offered a "nice option" for those physicians unwilling or unable to perform births due to high malpractice insurance rates. 9:48:33 AM Ms. Davidson responded that the license fees could not be reduced because the governing Board must be self sufficient. 9:48:54 AM Mr. Benevides recalled testimony provided in the previous committee of referral on this bill from a CDM expressing willingness to pay the large amount because that person "loved their job". This midwife was reassured that the activities of those in the profession were overseen by the Board. Mr. Benevides informed of two different regulations published the prior month pertaining to reimbursement and facility reimbursement for Certified Direct-Entry Midwives. Those regulations could be the same as those referenced in the letter by the Board Chair. A new set of proposed regulations has also been opened to public comment. 9:50:13 AM Senator Huggins, referring to Senator Olson's statement that some doctor's could be unable to afford malpractice insurance, hypothesized that a "lower profile of litigation" could result in lower insurance rates for midwives. Senator Huggins commented in the irony that the "least qualified" professionals with the "highest risk" would have the lowest profile. 9:51:01 AM Senator Olson corrected any misinterpretation of his earlier remarks asserting that midwives are "very well trained" with skill levels equal to many doctors. Midwives do no have the ability to perform surgery and therefore are unable to perform cesarean section births. 9:51:39 AM Senator Huggins asked the type of insurance carried by Certified Direct-Entry Midwives. 9:51:50 AM Mr. Benevides was unsure. Because of "law structure" midwives are not allowed to participate in high risk pregnancies. 9:52:12 AM Senator Olson shared that CDMs normally participate in group insurance coverage. License fees are often paid by the corporation that employs the midwife or the organization in which the midwife practices. 9:52:37 AM Senator Dyson suggested that the discussion on this bill highlighted a policy issue. The Legislature's determination that all boards and commissions must be financially self sufficient could provide an adverse incentive for these boards to adequately "police" their members. Investigations increase a board's operating costs and licensure fees must subsequently be increased. This issue is most predominant in the mental health boards, as the boards that have prosecuted the most cases also have the highest license fees. As a result new members to the mental health care profession consider joining boards with lower fees. This reduces the membership on the boards that diligently pursue the conduct of its professionals. 9:54:09 AM Senator Huggins offered a motion to report the bill from Committee with individual recommendations and accompanying fiscal note. There was no objection and SB 81 was REPORTED from Committee with zero fiscal note #1 from the Department of Commerce, Community and Economic Development. AT EASE 9:54:53 AM / 9:56:35 AM
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