Legislature(2021 - 2022)ADAMS 519
04/12/2021 09:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB99 | |
| HB117 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 99 | TELECONFERENCED | |
| += | HB 117 | TELECONFERENCED | |
| + | HB 109 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
April 12, 2021
9:03 a.m.
9:03:03 AM
CALL TO ORDER
Co-Chair Merrick called the House Finance Committee meeting
to order at 9:03 a.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Kelly Merrick, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative Bryce Edgmon
Representative DeLena Johnson
Representative Andy Josephson
Representative Bart LeBon
Representative Steve Thompson
Representative Adam Wool
MEMBERS ABSENT
Representative Ben Carpenter
Representative Sara Rasmussen
ALSO PRESENT
Representative Matt Claman, Sponsor; Joey Bosworth, Staff,
Representative Matt Claman; Representative Dan Ortiz,
Sponsor; Kris Curtis, Legislative Auditor, Alaska Division
of Legislative Audit.
PRESENT VIA TELECONFERENCE
Alec Kay, President, Alaska Chapter of the American
Physical Therapy Association; Sabrina Javier, Fiscal
Analyst, Legislative Finance Division; Sharon Walsh, Deputy
Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community
and Economic Development; Bethel Belisle, Chair, Board of
Certified Direct Entry Midwives, Anchorage; Madi Grimes,
President, Midwives Association of Alaska, Juneau.
SUMMARY
HB 99 PHYSICAL/OCCUPATIONAL THERAPY BD/PRACTICE
HB 99 was REPORTED out of committee with a "do
pass" recommendation and with one previously
published fiscal impact note: FN1 (CED).
HB 117 EXTEND BOARD OF DIRECT-ENTRY MIDWIVES
HB 117 was REPORTED out of committee with a "do
pass" recommendation and with one previously
published fiscal impact note: FN1 (CED).
Co-Chair Merrick reviewed the meeting agenda.
HOUSE BILL NO. 99
"An Act relating to the State Physical Therapy and
Occupational Therapy Board; relating to the practice
of physical therapy; and relating to the practice of
occupational therapy."
9:03:42 AM
REPRESENTATIVE MATT CLAMAN, SPONSOR, introduced himself and
shared that he was carrying the bill at the request of the
Alaska physical and occupational therapy associations. He
read from prepared remarks:
House Bill 99 amends the governing statutes for
physical therapists, physical therapy assistants,
occupational therapists, and occupational therapy
assistants practicing in Alaska. The changes it makes
are designed to bring Alaska statutes in line with
national standards and terminology and overall make
the administrative experience of these professionals
more efficient and up to date. This bill is supported
by the state Physical Therapy and Occupational Therapy
Board, which believes House Bill 99 will help the
board in its work to protect the public. A letter
stating their support is in your packet.
Currently, physical therapists, physical therapy
assistants, occupational therapists, and occupational
therapy assistants are represented by the state
Physical Therapy and Occupational Therapy Board. This
board is made up of one physician, three physical
therapists, two occupational therapists, and one
member of the public. The first change made by this
bill is to remove the physician from this board and
replace them with another occupational therapist.
Thereby balancing the representation of the
professionals on the board. There's good reason for
this. When the statute was originally written, the
work of physical and occupational therapists required
referral by a physician. This has not been the case in
Alaska for more than 30 years.
House Bill 99 also enables the board to discipline a
therapist who commits infractions under AS 08.84.120,
such as conviction of a felony, gross negligence, or
abuse of alcohol. Currently, the board has the ability
to revoke or deny a license based on infractions but
has no ability to discipline. This bill also clarifies
the language and the requirements for those therapists
who receive their training outside of the United
States, ensuring that their training is equivalent to
a U.S. professional physical therapy training program
and also exempting therapists trained in an English
language program for having to take an English
proficiency test.
Furthermore, this bill updates language in Alaska
statutes that references an accrediting entity that no
longer exists and makes the language more general,
allowing the state board to designate the appropriate
accrediting entity as needed.
9:06:20 AM
Representative Claman continued reading from a prepared
statement:
Several other updates to terminology are made to
update the language. House Bill 99 does not constitute
a restructuring of the relevant statute, but it
contains a number of long awaited changes. This is a
way to make it easier for professionals to do business
in Alaska.
JOEY BOSWORTH, STAFF, REPRESENTATIVE MATT CLAMAN, stated
his understanding that the committee did not need a review
of the sectional analysis.
Co-Chair Merrick concurred. She OPENED public testimony.
ALEC KAY, PRESIDENT, ALASKA CHAPTER OF THE AMERICAN
PHYSICAL THERAPY ASSOCIATION (via teleconference),
testified in support of the legislation. He discussed that
the bill was primarily language modernization and
improvement for the practice. Additionally, the bill would
provide more clarity for the public. He pointed out that
the bill was supported by several licensees who had written
letters, the state licensing board, and the member
association of chiropractors in Alaska. He hoped the bill
would move forward to improve the practice and protections
of the public. He thanked the committee.
Co-Chair Merrick CLOSED public testimony.
9:08:44 AM
AT EASE
9:09:35 AM
RECONVENED
Co-Chair Merrick asked the Legislative Finance Division
(LFD) to speak to the fiscal note.
SABRINA JAVIER, FISCAL ANALYST, LEGISLATIVE FINANCE
DIVISION (via teleconference), reported that LFD had no
technical issues with the fiscal note. She was available
for questions.
Co-Chair Merrick shared that the committee had been told
the board had sufficient funds to cover the $2,300 fiscal
note. She asked if LFD believed the committee could zero-
out the note.
Ms. Javier answered that based on the FY 20 annual
professional licensing report, the board had a surplus of
over $280,000; therefore, LFD believed the department could
potentially absorb the one-time cost of $2,300.
Representative Josephson agreed the board could afford it,
but he had never seen a fee borne by the Division of
Corporations, Business and Professional Licensing (CBPL)
absorbed by the board itself.
Ms. Javier answered that it was merely a suggestion to
committee members to take into consideration. She deferred
to the Department of Commerce, Community and Economic
Development (DCCED) about absorbing costs in prior fiscal
notes.
9:12:06 AM
SHARON WALSH, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESS AND PROFESSIONAL LICENSING (CBPL) (via
teleconference), believed Representative Josephson was
asking whether costs associated with the program could be
absorbed and whether the fee was for regulation or legal
costs.
Representative Josephson clarified his support for the
bill. He had no problem with the fiscal note. However, he
remarked that he had never seen a board charged with the
cost of a fiscal note.
Ms. Walsh answered that the practice was pretty standard
based on her understanding of fiscal notes.
Co-Chair Foster MOVED to REPORT HB 99 out of committee with
individual recommendations and the accompanying fiscal
note.
There being NO OBJECTION, it was so ordered.
HB 99 was REPORTED out of committee with a "do pass"
recommendation and with one previously published fiscal
impact note: FN1 (CED).
9:13:47 AM
AT EASE
9:18:37 AM
RECONVENED
Co-Chair Merrick noted that Representative Johnson had
joined the meeting.
HOUSE BILL NO. 117
"An Act extending the termination date of the Board of
Certified Direct-Entry Midwives; and providing for an
effective date."
9:18:47 AM
REPRESENTATIVE DAN ORTIZ, SPONSOR, reintroduced the bill
that would extend the Board of Certified Direct-Entry
Midwives. He summarized that committee members had heard
the bill the previous week where there had been good
discussion. He was available for any questions. He listed
others available for questions.
Representative Johnson referenced the audit recommendation
for the board to improve oversight of the peer review
process. She asked how the board intended to improve
oversight.
BETHEL BELISLE, CHAIR, BOARD OF CERTIFIED DIRECT ENTRY
MIDWIVES, ANCHORAGE (via teleconference), answered that the
board had already begun the process to completely revamp
the peer review method. She explained the process that had
been in place since 2014. She detailed that a committee of
midwives unaffiliated with the board received charts of any
outcome listed in statutes and regulations including the
death of the mother of a baby, an emergency transport of
any kind, or if a midwife went outside regulations. For
example, if a midwife attended a woman at a home birth and
the baby was being delivered breached, the midwife was
required to call 911. She elaborated that if emergency
responders did not arrive, the midwife may deliver the baby
and was then required to submit the chart.
Ms. Belisle reported that the board had removed the entire
committee and had brought the entire peer review process
back to the board. She explained that any midwife who had a
birth under the aforementioned categories, was required to
submit the chart to the board for review. The updated
process gave the board the ability to provide discipline as
needed or to send the case to investigation if outside the
board's regulation. She elaborated that currently when the
board received charts, it reviewed paperwork to determine
whether a midwife had followed procedures, obtained signed
consent, and protected the public interest. The board had
moved from a peer review committee back to a board review.
She shared that the process was in the final stage with
legal to ensure it was up to the state standard.
Representative Johnson she asked if in the peer review
process the board was taking responsibility for monitoring
and addressing any problems. She asked how the process
would differ from the former review by a peer review
committee. She asked if the board would have more ability
to directly address issues.
Ms. Belisle replied that the old committee was called an
action accountability committee. The only thing the
committee could do was determine whether a midwife had or
had not followed procedures. She elaborated that if the
committee determined a midwife had not followed procedures,
the chart was sent to investigation. Under the new process,
the board would receive the charts for review. The board
would also be able to tell someone under review they needed
more education on a specific issue. She expounded that in a
scenario where there was no death of a mother or baby. She
explained that the board could determine there had been
numerous pink flags that the midwife should have identified
earlier. The board would have the ability to discipline by
requiring more education, a fine, or accountability under
another midwife.
9:24:28 AM
Representative Wool looked at the two-year extension
recommendation. He noted that an audit took one year. He
asked if two years was enough time to realize changes and
see the impacts.
Ms. Belisle replied in the affirmative related to the peer
review portion. She detailed that the peer review change
should be completed in 2021. The board had already begun a
process to change the statutes to align with national
standards. She stated that while the board may not get all
the way through the process, she believed the auditor would
be able to see the board had made significant changes and
that it was on a trajectory to meet the changes that would
meet or exceed the national standard.
Representative Wool looked at the biennial $3,800 license
fee for a midwife. He wondered at what point a fee would
become cost prohibitive and result in the loss of
practicing midwives. He noted that fewer practicing
midwives would mean a higher fee. He asked if the license
fee was currently at the top end of affordability.
Ms. Belisle responded in the affirmative. She reported that
as the license fee had increased to the current amount in
recent years, the number of licensed midwives had stayed
fairly static at 40. She confirmed that the fee was cost
prohibitive. She considered the $3,800 fee and relayed that
a Medicaid payment for a birth was about $3,400. She
explained that for midwives without large practices it was
difficult to stay licensed due to the high license fee. She
did not believe the fee could go any higher.
9:27:00 AM
Representative Wool provided a hypothetical scenario where
an additional investigation may require the board to raise
fees due to the cost. He thought the current number of
midwives was around 50, but he noted Ms. Belisle had listed
the number at 40. He was concerned an increased fee may
decrease the number of licensed midwives from 40 to 30. He
asked if the number of midwives had been increasing up
until the past several years.
Ms. Belisle confirmed there were 40 licensed direct-entry
midwives and 10 licensed apprentices. She relayed the
apprentice fee was $850 for a two-year license. She stated
that practicing midwives had selected the profession as
their career path and would work diligently to maintain the
fees. She shared that she would not leave her practice
merely because it got more expensive. She noted it was a
difficult procedure to move forward to think about a
potential investigation. She was happy the board was taking
over the peer review process and was hopeful it would
decrease the likelihood of an investigation due to
increased oversight by the board.
9:28:54 AM
Representative Wool referenced Ms. Belisle's statement that
the number of midwives was remaining flat. He asked if the
population of midwives had typically increased in the past.
He asked about the license fee in Washington, Oregon, and
California.
Ms. Belisle answered that the number of midwives in Alaska
had been relatively flat for the past ten years. She shared
that when she received her original license in 1999, her
license had been number 25. She noted that license numbers
had changed, and the number of midwives had fluctuated over
time. The number of licensees was remaining flat,
particularly because some of the education requirements in
regulation had changed, which made it harder for women in
Alaska to become midwives. She reported that the license
fee in Oregon was $600 every two years. She did not know
the fee in Washington.
Representative Johnson asked about the peer review process.
She looked at the audit recommendation to move the peer
review process under the board. She noted that the
documents did not mention the board's plan to have the
process brought back to the board. She asked when the
process would be brought back to the board.
9:30:40 AM
Ms. Belisle answered that the board had started the process
to change its regulations for the new peer review in March
2020. She believed the process had been slowed down due to
COVID, but it was currently under review by legal. She
relayed that the process was not part of the original
audit. She noted she was not the original chair of the
board and the information had not been given to the auditor
at the time the audit had been performed.
Representative Johnson asked about the timeline.
Ms. Belisle believed the process should be done by October.
Co-Chair Merrick OPENED public testimony.
MADI GRIMES, PRESIDENT, MIDWIVES ASSOCIATION OF ALASKA,
JUNEAU (via teleconference), shared that she lived and
worked in Juneau had had been a licensed midwife for seven
years. She spoke in support of the bill and certified
direct-entry midwives. She referenced a document titled
"Midwifery in Alaska" located in members' packets (copy on
file). She read from prepared remarks:
Certified direct-entry midwives have been licensed in
the State of Alaska for nearly 30 years. In that time
more Alaskan constituents are accessing midwifery care
every year and we see the demand for home and birth
center births grow. Midwives are trained through an
accredited education program and are focused on
providing individualized care to low-risk individuals.
We are integrated in the larger healthcare system and
refer high-risk clients to physicians when the need
arises. Our goal as a midwifery group is to provide
the highest quality care while ensuring the safest
outcomes possible.
Midwife-led care has been found to reduce the risk of
costly complications and interventions, such as
cesarean births, preterm births, and low birth weight
incidents. This cost savings can be directly tied back
to the state cost savings as approximately 30 percent
of families receiving midwifery care are Medicaid
recipients.
Some of the supporting documents in your packet
include an epidemiology report outlining the
demographics and outcomes of Alaskan families as well
as a couple studies showing the cost savings and
safety outcomes of families who receive midwifery
care. Highlighting the Strong Start study run by the
Centers for Medicare and Medicaid Innovation - this
study shows a savings of $2,000 per pregnant person
that receives prenatal care with a midwife regardless
of their ultimate location of birth. An interesting
footnote in that study is that we actually had three
Alaskan birth centers participate in this study group
furnishing data. Our association supports the passing
of House Bill 117. Thank you.
9:34:21 AM
Co-Chair Merrick CLOSED public testimony.
Co-Chair Merrick asked the Legislative Finance Division
(LFD) to discuss the fiscal note.
SABRINA JAVIER, ANALYST, LEGISLATIVE FINANCE DIVISION (via
teleconference), reported that LFD had no issues with the
fiscal note put forward by the Division of Corporations,
Business and Professional Licensing (CBPL). She was
available for questions.
Representative Wool referenced the $21,800 designated
general fund cost in the fiscal note. He asked if the cost
was paid by the board and if it was the standard process.
He asked if it would be the process going forward for all
boards.
Ms. Javier answered that the receipt supported services
code 1156 was essentially treated like general fund program
receipts. The department could not spend the $21,800 for FY
22 and FY 23 unless it collected the funds. The fiscal note
was asking for authority to use the funds.
9:36:07 AM
Representative Josephson referenced the $21,800 outlined on
page 2 of the fiscal note. He asked for verification that
the expenses were typical and should not increase the
(already very high) annual fee for a licensee. He surmised
the cost was a reflection of life in the division and the
costs it absorbed for the board.
Ms. Javier responded in the affirmative. She elaborated
that the expenses the department had put forward reflected
a projection and request for spending authority.
Representative Josephson provided his understanding of what
would take place if the board extension were five years
instead of two years. He surmised four years would go by
and the legislature would not know, but the agency would be
requiring the payment of $21,800 from the licensees.
Ms. Javier noted that the division may be able to better
answer the question. She explained that if the program were
going to extend for the next five years, the fiscal note
would show the $21,800 in receipt supported services for
the next five years. She elaborated that the fiscal note
would give the division authority to collect the fees to
fund the program.
9:38:10 AM
Representative LeBon looked at the expenses summarized in
the fiscal note. He observed that about $20,000 was
indicated for travel for five board members and staff to
attend four board meetings per year. He asked if one or two
of the meetings could be held via videoconference or if
there was a requirement to meet in person.
Ms. Javier deferred the question to the department.
SHARON WALSH, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESS AND PROFESSIONAL LICENSING (CBPL), DEPARTMENT OF
COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT (via
teleconference), asked Representative LeBon to repeat the
question.
Representative LeBon restated his question.
Ms. Walsh answered that the department encouraged Zoom
meetings to reduce some of the fiscal costs. She noted the
decision was up to the board. She relayed that the board's
annual report to the department projected any travel for
the year, which had to be approved by the division
director. She detailed that some boards had a statutory
requirement to meet in person (e.g., the medical board),
but most did not. She did not believe the board under
discussion had a requirement to meet in person.
Co-Chair Merrick asked Ms. Belisle if the board had
considered meeting electronically.
Ms. Belisle answered that the board had not met in person
for several years. She expounded that all of the meetings
in the past 1.5 years had been via Zoom. She noted there
had been no travel for a minimum of two years.
Representative LeBon wondered why the licensing fees were
so high when the board was not traveling.
Representative Wool calculated that the 40 licensed
midwives and 10 apprentices brought in $160,000 every two
years or $80,000 annually. He remarked that $20,000 went to
travel. He was surprised the fiscal note had not been
reduced to reflect there had been no travel in recent
years. He thought reducing the amount for travel would
provide the board with more funding to spend on any
investigations. He thought perhaps it would lower the
license fee.
9:42:59 AM
Ms. Javier responded that if the board were doing more Zoom
meetings and did not incur the $20,300, the funding would
sit as hollow authority. She did not know how it would
impact the licensee fees.
Representative Wool highlighted the vast cost difference
between the two board extensions discussed by the committee
during the meeting. He noted the fiscal note for the first
board was $2,300 whereas the fiscal note for the midwifery
board exceeded $20,000. He remarked that a layperson would
question why one board was spending ten times the amount
spent by another board. He thought it would be in the best
interest of the board and CBPL to make the numbers more
accurate.
9:44:57 AM
AT EASE
9:46:39 AM
RECONVENED
Co-Chair Merrick asked the Division of Legislative Audit to
address the committee.
KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF
LEGISLATIVE AUDIT, highlighted that the legislation was a
board extension bill. She elaborated that the licensing
function would remain with the division if the board were
not extended. She clarified that the fiscal note only
reflected the cost of continuing the board itself and did
not reflect the cost of licensing the entire occupation.
She stated that board members were not compensated but
often they were paid per diem, which was coded to travel
even if there was no actual traveling. She did not know
whether it was the case for the midwifery board.
Representative Wool understood that per diem was not
travel. He remarked that a board member doing a Zoom call
from home did not incur the cost of lodging and meals. He
thought per diem was directly relatable to hotels and meals
while traveling.
Ms. Curtis answered that there were five categories
including personal services, travel, services, commodities,
and capital projects that showed up as codes in budgetary
documents. She explained that per diem was part of the
travel code. She thought there could be amounts budgeted
under travel that was used for something other than airfare
or hotel.
Co-Chair Merrick asked if a stipend could be used as
another term for per diem.
Ms. Curtis replied in the affirmative.
Representative Wool surmised that the increment in the
fiscal note was coded travel, but it could reflect a board
member being paid to attend a board meeting, whether in
their living room or a conference room in Anchorage.
Ms. Curtis agreed. She believed the department was
responsible for drafting the fiscal note and could provide
more explanation on the reason for budgeting $20,000 per
year for a board meeting four times.
9:49:38 AM
Ms. Walsh answered that travel was estimated at $20,300
based on five board members and one staff attending four
meetings per year. She added that the amount did not
necessarily reflect what the board would do. She expounded
that if board members wanted to travel, the amount provided
an idea of the cost.
Co-Chair Merrick asked if [midwifery] board members
received a stipend for attending a board meeting
electronically.
Ms. Walsh answered that board members received $16 per day
if they chose to submit the paperwork.
Representative Wool considered that board members received
$16 per day to attend a meeting from home [or elsewhere].
He asked if board members also received per diem or any
other portion of the $20,000 if there was no travel. He
thought it would be more in the board's interest to show a
lower fiscal note. He suggested it may be beneficial to
lower the amount if the board was not using the hollow
receipt authority.
9:51:37 AM
Representative Edgmon thought another way to look at the
fiscal note was that the money not spent would be lapsed to
the subsequent year. He clarified that the amount in the
fiscal note was merely a budget item for a maximum of five
members and four meetings. He asked whether the funds could
lapse to the FY 23 budget if not expended.
Ms. Javier responded that the CBPL allocation had language
in the operating budget allowing the division to carry
forward receipt supported services authority.
Representative Edgmon referenced the license fees coming in
from 40 midwives and 10 apprentices in the amount of $3,800
and $850, respectively. He asked if the approximately
$50,000 per year from fees came into the department via
language in the operating budget.
Ms. Javier answered that there was conditional language in
the numbers section of the budget allowing for the funds to
be carried forward.
Representative Thompson referenced the audit and observed
that the board was in a deficit situation. He assumed if
the board did not spend the $20,000 on travel, its deficit
would be reduced.
Ms. Javier asked Representative Thompson to repeat his
question.
Representative Thompson repeated his question.
Ms. Javier confirmed that it was her understanding.
9:55:01 AM
Representative Johnson considered the audit recommendation
for the board to update the peer review process. She stated
her understanding the board was transitioning to having
peer reviews done by the board. She thought the previous
peer review process was perhaps not carried out to the
level auditors preferred. She asked if the auditors had
recommended a board review. She asked if there had been a
recommendation on how to update the review process.
Ms. Curtis answered that the audit recommendation was very
general. The audit had found the board did not have
internal controls over monitoring the peer review process
it had delegated to the Midwife Association of Alaska's
action accountability committee. The board had delegated
the process and had not been overseeing it or monitoring
it, which increased the risk of deficiency and to public
safety. The audit recommendation was for the board to
improve its monitoring of the process. She understood the
board had taken over the review process. She had no comment
on the change until the Division of Legislative Audit was
able to review the updated process.
9:56:59 AM
Co-Chair Foster MOVED to REPORT HB 117 out of committee
with individual recommendations and the accompanying fiscal
note.
There being NO OBJECTION, it was so ordered.
HB 117 was REPORTED out of committee with a "do pass"
recommendation and with one previously published fiscal
impact note: FN1 (CED).
9:57:26 AM
AT EASE
10:00:05 AM
RECONVENED
Co-Chair Merrick reviewed the schedule for the following
meeting.
ADJOURNMENT
10:00:14 AM
The meeting was adjourned at 10:00 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HFIN HB117 Follow-Up Information from CBPL (4.12.21).pdf |
HFIN 4/12/2021 9:00:00 AM |
HB 117 |
| HB 117 Follow-up Midwoves Assoc 041021.pdf |
HFIN 4/12/2021 9:00:00 AM |
HB 117 |