Legislature(2017 - 2018)BARNES 124

02/01/2017 03:15 PM LABOR & COMMERCE

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Audio Topic
03:16:54 PM Start
03:17:31 PM HB49
04:20:55 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 49 EXTEND BOARD OF DIRECT-ENTRY MIDWIVES TELECONFERENCED
Heard & Held
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                                                                         
                        February 1, 2017                                                                                        
                           3:16 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Sam Kito, Chair                                                                                                  
Representative Adam Wool, Vice Chair                                                                                            
Representative Andy Josephson                                                                                                   
Representative Louise Stutes                                                                                                    
Representative Chris Birch                                                                                                      
Representative Gary Knopp                                                                                                       
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Bryce Edgmon (alternate)                                                                                         
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 49                                                                                                               
"An Act extending the termination date of the Board of Certified                                                                
Direct-Entry Midwives; and providing for an effective date."                                                                    
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 49                                                                                                                   
SHORT TITLE: EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                              
SPONSOR(s): REPRESENTATIVE(s) KITO                                                                                              
                                                                                                                                
01/18/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/17       (H)       L&C, FIN                                                                                               
02/01/17       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
CRYSTAL KOENEMAN, Staff                                                                                                         
Representative Sam Kito                                                                                                         
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 49 on behalf of Representative                                                              
Kito, prime sponsor.                                                                                                            
                                                                                                                                
KRIS CURTIS, Legislative Auditor                                                                                                
Legislative Audit Division                                                                                                      
Legislative Agencies and Offices                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 49.                                                                                      
                                                                                                                                
DEBORAH SCHNEIDER, Chair                                                                                                        
Board of Certified Direct-Entry Midwives                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of HB 49                                                                            
                                                                                                                                
SUSAN TERWILLIGER, President                                                                                                    
Midwives Association of Alaska                                                                                                  
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 49.                                                                           
                                                                                                                                
JANEY HOVENDEN, Director                                                                                                        
Division of Corporations, Business, and Professional Licensing                                                                  
(DCBPL)                                                                                                                         
Department of Commerce, Community & Economic Development (DCCED)                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 49.                                                                                      
                                                                                                                                
MADISON NOLAN GRIMES, Director                                                                                                  
Juneau Family Health and Birth Center                                                                                           
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 49.                                                                           
                                                                                                                                
JOHANNA CROSSETT, Direct-Entry Midwife                                                                                          
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 49.                                                                           
                                                                                                                                
DEBORAH GILLESPIE, Direct-Entry Midwife                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 49.                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:16:54 PM                                                                                                                    
                                                                                                                                
CHAIR  SAM KITO  called  the House  Labor  and Commerce  Standing                                                             
Committee meeting  to order at  3:16 p.m.   Representatives Wool,                                                               
Stutes, Birch, Knopp, Sullivan-Leonard,  and Kito were present at                                                               
the  call to  order.   Representative  Josephson  arrived as  the                                                               
meeting was in progress.                                                                                                        
                                                                                                                                
          HB 49-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES                                                                       
                                                                                                                                
3:17:31 PM                                                                                                                    
                                                                                                                                
CHAIR KITO  announced that  the only order  of business  would be                                                               
HOUSE BILL NO. 49, "An Act  extending the termination date of the                                                               
Board of  Certified Direct-Entry  Midwives; and providing  for an                                                               
effective date."                                                                                                                
                                                                                                                                
3:18:12 PM                                                                                                                    
                                                                                                                                
CRYSTAL KOENEMAN,  Staff, Representative  Sam Kito,  Alaska State                                                               
Legislature,  on behalf  of Representative  Kito, prime  sponsor,                                                               
presented  HB  49,  which  extends   the  Board  of  Direct-Entry                                                               
Midwives  for four  years.   She mentioned  that the  Division of                                                               
Legislative Audit determined  that extending the board  is in the                                                               
best interest  of the  state and  is important  to the  safety of                                                               
Alaska's women  and children.   The  board currently  licenses 52                                                               
licensees and  consists of  two certified  direct-entry midwives,                                                               
one physician, one  certified nurse, and one public  member.  She                                                               
explained that midwives  assist in about 500 births  outside of a                                                               
hospital setting  each year in Alaska  and many more births  in a                                                               
hospital setting.   She asked for the committee's  support of the                                                               
proposed legislation.                                                                                                           
                                                                                                                                
3:19:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KNOPP asked why the board is not permanent.                                                                      
                                                                                                                                
3:20:08 PM                                                                                                                    
                                                                                                                                
CHAIR KITO  stated that  Kris Curtis  could better  address board                                                               
term limits.                                                                                                                    
                                                                                                                                
3:20:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES  asked why  the  board  has such  a  large                                                               
deficit and  whether there have  been approaches to bring  it out                                                               
of the hole.                                                                                                                    
                                                                                                                                
MS.  KOENEMAN  stated  that  the  board  and  the  Department  of                                                               
Commerce,  Community &  Economic  Development  (DCCED) have  been                                                               
working diligently  to reduce the  deficit.  She stated  that the                                                               
investigative costs associated  with the board have  been a large                                                               
contributor to the deficit.                                                                                                     
                                                                                                                                
REPRESENTATIVE STUTES  asked whether the board  has increased its                                                               
fees.                                                                                                                           
                                                                                                                                
CHAIR KITO  responded that either  the department  or legislative                                                               
audit would be better suited to answer that question.                                                                           
                                                                                                                                
3:21:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH stated that  three of his four grandchildren                                                               
were  delivered by  a midwife.   He  stated his  concern for  the                                                               
sunset date and  asked for clarification on  what the distinction                                                               
"direct-entry midwife" means.                                                                                                   
                                                                                                                                
MS.   KOENEMAN   answered   that  direct-entry   midwife   is   a                                                               
classification by  the state, but  other testifiers  could better                                                               
clarify that.                                                                                                                   
                                                                                                                                
3:23:37 PM                                                                                                                    
                                                                                                                                
KRIS  CURTIS, Legislative  Auditor,  Legislative Audit  Division,                                                               
Legislative  Agencies  and  Offices,   testified  on  HB  49  and                                                               
presented  the sunset  audit conducted  on the  Board of  Direct-                                                               
Entry Midwives.   She  mentioned that  a sunset  audit determines                                                               
whether a  board is serving  the public's interest and  should be                                                               
extended.   She informed  the committee  that the  sunset process                                                               
started in the  1970s, and the concept of sunset  is used in many                                                               
states.   The idea  behind sunsetting is  that when  a government                                                               
entity  is created,  there should  be an  analysis of  whether it                                                               
should  continue  in  perpetuity.    Occupational  boards,  other                                                               
boards, and commissions  all have sunset dates.   She stated that                                                               
last year  three audits were  conducted for  entities terminating                                                               
this  year,  and this  year  11  sunset  audits will  happen  for                                                               
entities set to terminate in 2018.                                                                                              
                                                                                                                                
3:25:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL asked about boards that were not extended.                                                                  
                                                                                                                                
MS. CURTIS stated  that the sunset process has been  in place for                                                               
a  long  time, and  it  is  unusual  for  an audit  to  recommend                                                               
termination.   Audits have determined  that there is no  need for                                                               
continuing  some   entities  such  as  the   Alaska  Health  Care                                                               
Commission and the  Board of Barbers and Hairdressers.   She said                                                               
that recommendations  for sunset are  unusual; more often  a term                                                               
is set  for the next review.   She related that  boards cannot be                                                               
extended for more than 8 years.                                                                                                 
                                                                                                                                
3:26:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JOSEPHSON   recalled  that   prior   legislation                                                               
eliminated  statutory  oversight  of midwives  and  instead  left                                                               
regulation  to the  board.   He  asked "what  was  so onerous  or                                                               
improper, and why did we make that change?"                                                                                     
                                                                                                                                
MS. CURTIS stated  that the reason for the change  was that it is                                                               
easier  for  the  board to  change  practice  through  regulation                                                               
without  legislation and  to take  practice  requirements out  of                                                               
statue and into  regulation.  She offered  her understanding that                                                               
the board finalized the regulations in February 2016.                                                                           
                                                                                                                                
3:27:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  BIRCH  restated  his  interest  in  knowing  what                                                               
"direct-entry midwives" means.                                                                                                  
                                                                                                                                
MS.  CURTIS offered  her  opinion  that it  is  a  term based  on                                                               
requirements  to become  a direct-entry  midwife,  but there  are                                                               
also nurse midwives who are certified nurses.                                                                                   
                                                                                                                                
REPRESENTATIVE  BIRCH  asked whether  there  is  a potential  for                                                               
using  the   Legislative  Information  Office  (LIO)   for  board                                                               
meetings to mitigate travel expenses.                                                                                           
                                                                                                                                
MS.  CURTIS  stated   that  the  audit  looks   at  meetings  and                                                               
operations  and determines  if  the costs  are  reasonable.   The                                                               
personal  services reflect  regulatory  and investigative  costs,                                                               
which are the biggest cost fluctuations for the board.                                                                          
                                                                                                                                
3:30:09 PM                                                                                                                    
                                                                                                                                
MS. CURTIS began  her presentation of the audit  [included in the                                                               
committee packet].   In the 2014 audit, there  were concerns that                                                               
investigations that  posed a  public safety  risk were  not being                                                               
actively processed.   Therefore, the board was  only extended two                                                               
years.   She  expressed that  this  year's audit  found that  the                                                               
board is  serving the public's interest  by monitoring licensees,                                                               
licensing  appropriately, and  issuing  regulations that  benefit                                                               
the industry.                                                                                                                   
                                                                                                                                
MS. CURTIS noted  that the audit recommended three  changes.  The                                                               
first  is a  recommendation to  the director  of the  Division of                                                               
Corporations  Business  and  Professional Licensing  (DCBPL),  in                                                               
consultation  with the  board,  to increase  fees  to reduce  the                                                               
deficit.  Between the 2014  and 2016 audits, fees were increased,                                                               
but not  enough to  cover operations  of the  board.   The second                                                               
recommendation  is  to  the  director to  take  steps  in  ensure                                                               
accurate  record keeping  of licenses,  which  reflects that  the                                                               
audit  found  simple  errors  by  the DCBPL  staff.    The  final                                                               
recommendation is to the state  legislature to consider alternate                                                               
forms  of regulating  the midwifery  profession in  light of  the                                                               
large  deficit and  the small  number of  licensees who  bear the                                                               
cost of  the deficit.   She  noted that in  order to  address the                                                               
deficit, DCBPL was  planning on raising fees by  50 percent every                                                               
two years.   By 2020, the  licensing fee would be  around $4,000,                                                               
which  would  pose  a  barrier  to  entry  into  the  profession,                                                               
limiting the number of practicing midwives.                                                                                     
                                                                                                                                
3:33:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH asked how frequently  a critical review of a                                                               
licensee occurs, and whether licenses have been rescinded.                                                                      
                                                                                                                                
MS.  CURTIS stated  that an  investigative  section within  DCBPL                                                               
fields  complaints   to  determine   basis  and   purview  before                                                               
conducting  an investigation.    She noted  that  the 2014  audit                                                               
found that  some investigations had  stalled, but the  2016 audit                                                               
found  that they  had  been addressed.    Licenses are  rescinded                                                               
periodically on this board, like with other boards.                                                                             
                                                                                                                                
3:35:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON  said that "these boards"  are generally                                                               
supposed to pay  for themselves and questioned if  that is always                                                               
good policy.   He referred  to the  recommendation on page  11 of                                                               
the  audit  and asked  whether  it  is  reasonable to  offer  the                                                               
licensees  independence  if  they  pay the  $4,000  fee  or  find                                                               
another mechanism if they decline.                                                                                              
                                                                                                                                
MS.  CURTIS   asked  for  clarification   whether  Representative                                                               
Josephson proposes  that some  midwives would  be regulated  by a                                                               
board and  some would not.   She mentioned that even  without the                                                               
board, licensing and oversight would be handled by DCCED.                                                                       
                                                                                                                                
REPRESENTATIVE   JOSEPHSON  stated   that  at   some  point   the                                                               
institution may refuse  to pay such high fees.   He asked what [a                                                               
licensee] gets out of being in the commission.                                                                                  
                                                                                                                                
MS. CURTIS  stated that  benefits include  being close  enough to                                                               
the industry  to self-regulate through peer  review, having rules                                                               
set  in   place  for  quality   control,  and   having  education                                                               
requirements to  ensure competency.   She urged the  committee to                                                               
ask the testifiers why they see a benefit in being regulated.                                                                   
                                                                                                                                
3:39:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  whether there  has  been                                                               
discussion  with the  nursing  or medical  boards  to assist  the                                                               
Board of  Certified Direct-Entry  Midwives to  stay active.   She                                                               
asked if  the board would  merge with another board  if disbanded                                                               
and if that has been discussed with the other boards.                                                                           
                                                                                                                                
MS. CURTIS stated that the  other individual boards have not been                                                               
spoken  to.    They  were  mentioned due  to  the  similarity  of                                                               
occupations.                                                                                                                    
                                                                                                                                
3:40:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  stated his  understanding that if  the board                                                               
was  not extended,  then  it  would fall  under  the Division  of                                                               
Corporations,  Business,  and   Professional  Licensing  (DCBPL),                                                               
which doesn't  have midwifery  expertise.  He  noted that  a main                                                               
point  of the  audit recommendations  is the  financial loss  the                                                               
board has incurred,  largely due to investigations.   He asked if                                                               
the deficit would exist under  a different department without the                                                               
board.   He  asked  if  the investigations  are  common in  other                                                               
occupations, and  if boards are  always responsible to  cover the                                                               
cost of investigations.                                                                                                         
                                                                                                                                
MS.  CURTIS answered  yes; there  is a  statute stating  that all                                                               
boards  must set  fees  to cover  the cost  of  regulation.   The                                                               
decision goes  back to  the 1990s.   She  noted that  many boards                                                               
have  deficits stemming  from the  fee setting  process; deficits                                                               
are not unique to this board  or the medical area.  She expressed                                                               
that a deficit  is often a reflection of the  number of licensees                                                               
who  bear the  cost of  investigations.   Boards  with a  smaller                                                               
number of licensees  tend to have larger deficits.   She reported                                                               
that many  investigations and big regulation  projects drive high                                                               
costs for boards.                                                                                                               
                                                                                                                                
3:43:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  told of her  personal experience  with the                                                               
Big Game Commercial  Services Board, which had a  huge debt, even                                                               
though its 2014  statement showed it was in the  black.  The next                                                               
year the  budget showed the board  back in the red.   She pointed                                                               
out  that  this  was  clearly   the  result  of  inadequacies  in                                                               
bookkeeping.   She  stated her  concern that  a deficit  could be                                                               
skewed as a result of bookkeeping.                                                                                              
                                                                                                                                
3:45:12 PM                                                                                                                    
                                                                                                                                
CHAIR KITO  stated that the  board investigation fee  issue would                                                               
be discussed by  the House Labor and  Commerce Standing Committee                                                               
later this session.                                                                                                             
                                                                                                                                
REPRESENTATIVE STUTES  commented that increasing fees  may not be                                                               
the  appropriate action  to address  the deficit.   The  money is                                                               
still owed whether or not the board sunsets.                                                                                    
                                                                                                                                
3:46:07 PM                                                                                                                    
                                                                                                                                
MS. CURTIS noted that there  have been problems at the department                                                               
with improper accounting of  indirect individual cost allocation.                                                               
The department received a supplemental  appropriation to make the                                                               
boards whole  and not to  hold them accountable for  the improper                                                               
accounting.   She  noted that  a more  recent review  of the  new                                                               
accounting  procedures showed  that the  problems with  financial                                                               
reporting  to the  boards were  corrected, and  improvements have                                                               
been made in the department.                                                                                                    
                                                                                                                                
3:47:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KNOPP  asked   whether  investigative  costs  are                                                               
associated  with licensing  someone or  are more  of a  follow up                                                               
cost.   He suggested that if  the high costs are  associated with                                                               
qualifying a candidate for licensing,  then the regulations might                                                               
be excessive.                                                                                                                   
                                                                                                                                
MS.  CURTIS  responded that  some  investigative  costs could  be                                                               
associated with licensing, but most  of the more material cost of                                                               
investigations comes  from complaints.  The  audit tests licenses                                                               
to  ensure they  comply with  statutes and  regulations, but  the                                                               
department does not determine if  the regulations are excessive -                                                               
regulations are  passed by  the legislature.   She noted  that if                                                               
the Legislative Audit Division heard  problems and concerns about                                                               
the quality of licensing regulations,  then it would pursue them,                                                               
but that has not been the case with this board.                                                                                 
                                                                                                                                
MS. CURTIS stated, in response  to a follow-up question, that the                                                               
costs largely come  from the investigative section  not having to                                                               
do with licensing and from working  with the department of law to                                                               
get support through reimbursable service agreements.                                                                            
                                                                                                                                
3:49:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES   asked  who   determines  who   does  the                                                               
investigation - the  board or the department  - as investigations                                                               
create a  huge expense.   She referenced her  previous experience                                                               
when  a board  didn't want  to investigate  because investigating                                                               
would cost much more than the fine.                                                                                             
                                                                                                                                
MS. CURTIS  stated that  the board  itself must  stay out  of the                                                               
investigative process,  because the  board's opinion  is rendered                                                               
on the  results.   The investigators can  consult a  board member                                                               
for expertise.   She continued as follows:                                                                                      
                                                                                                                                
     They come  into the division.  The division is  ... the                                                                    
     entity  by statute  that has  the authority  to do  the                                                                    
     investigation.   They come to  the board,  provide them                                                                    
     status  updates.   Ultimately when  they have  a result                                                                    
     from  their  investigation,  they  will  provide  their                                                                    
     suggestion or consent agreements,  and the board itself                                                                    
     has to approve them.                                                                                                       
                                                                                                                                
3:51:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL asked for an  example of an investigation and                                                               
what would be investigated.                                                                                                     
                                                                                                                                
MS.  CURTIS  stated  that one  area  investigated  is  unlicensed                                                               
activity.   She questioned whether  it is  fair for the  board to                                                               
bear the cost of investigating  people that aren't licensed or if                                                               
it  is  more   of  a  criminal  offense.     Another  area  often                                                               
investigated is malpractice, which is a public safety issue.                                                                    
                                                                                                                                
3:52:53 PM                                                                                                                    
                                                                                                                                
CHAIR KITO  stated that testifiers  from other  organizations are                                                               
present.   He stated  that the  cost issue will  be covered  in a                                                               
later  meeting, and  he  urged  the committee  to  focus on  "the                                                               
midwives side of things."                                                                                                       
                                                                                                                                
3:53:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON  added that  the legislature  has looked                                                               
at  the issue,  at length  many  times, and  the committee  might                                                               
benefit from some of that experience.                                                                                           
                                                                                                                                
3:54:06 PM                                                                                                                    
                                                                                                                                
DEBORAH  SCHNEIDER,   Chair,  Board  of   Certified  Direct-Entry                                                               
Midwives, asked  for support to  extend the board through  HB 49.                                                               
She stated  that she has  been part  of the profession  since its                                                               
establishment  in the  1990s.   Midwives  are hoping  to see  the                                                               
industry grow  in Alaska, and the  safest way for that  to happen                                                               
is  under  the   direction  of  a  board   that  understands  the                                                               
industry's specific  difficulties.   She offered  that healthcare                                                               
dollars in  Alaska are being  stretched to cover  Alaskan mothers                                                               
and  babies,  and  midwives  provide  valuable  service  with  an                                                               
incredible cost savings.                                                                                                        
                                                                                                                                
MS.  SCHNEIDER noted  that the  board  has been  working hard  to                                                               
reduce its  deficit.  The  investigation costs are  partially due                                                               
to prolonged  investigations of five or  six years or more.   She                                                               
stated that the  board could not do anything to  reduce the money                                                               
spent on  those prolonged investigations until  changes were made                                                               
in the  investigative division that brought  those investigations                                                               
to a conclusion.                                                                                                                
                                                                                                                                
MS.  SCHNEIDER summarized  that  other  measures will  eventually                                                               
bring the deficit under control.   She remarked that by providing                                                               
midwifery with  a board,  Alaskans will  have the  best midwifery                                                               
practice in  the United  States.  Since  first becoming  a board,                                                               
other  states  have  looked  to  Alaska's  board  and  regulation                                                               
process for help.  She urged the committee's support of HB 49.                                                                  
                                                                                                                                
3:56:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  referred   to  Ms.  Schneider's                                                               
letter, on page 24 of the  audit, and asked for confirmation that                                                               
Ms. Schneider  was in favor  of an increase  in fees in  order to                                                               
help pay off the deficit for the board.                                                                                         
                                                                                                                                
MS. SCHNEIDER answered yes.  She  noted that the board raised the                                                               
fees last year to $3,800 and  she expects midwives will be paying                                                               
that for  the foreseeable future.   She stated that the  board is                                                               
working to  reduce the other areas  of the deficit and  work with                                                               
the investigative groups to make  sure there are not extended and                                                               
protracted cases.                                                                                                               
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD referred  to  her experience  in                                                               
healthcare.   She stated  that when  the board  is "ahead  of the                                                               
game  ...   financially,"  she  hopes  fees   would  be  adjusted                                                               
accordingly.                                                                                                                    
                                                                                                                                
3:58:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH  reiterated his  question about  the meaning                                                               
of "direct-entry."                                                                                                              
                                                                                                                                
MS. SCHNEIDER responded that  direct-entry midwives are non-nurse                                                               
midwives.   There are two  categories: those who have  received a                                                               
nursing degree and those with a  different route of entry [to the                                                               
industry].  She noted that  direct-entry midwives do not practice                                                               
in the  hospital, they  practice in  a home  or birth  center and                                                               
specialize in helping low-risk mothers.                                                                                         
                                                                                                                                
3:58:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH asked if there  is another group of midwives                                                               
out  there  who  went  through  a different  path  and  are  also                                                               
delivering children.                                                                                                            
                                                                                                                                
MS. SCHNEIDER  responded that in  Alaska, midwifery  is practiced                                                               
by certified nurse midwives or certified direct-entry midwives.                                                                 
                                                                                                                                
3:59:46 PM                                                                                                                    
                                                                                                                                
SUSAN  TERWILLIGER, President,  Midwives  Association of  Alaska,                                                               
expressed her support  of HB 49 for herself and  on behalf of the                                                               
membership of  the association.  She  stated that she has  been a                                                               
licensed midwife in  Alaska since 2005 and has 29  total years of                                                               
practice.  She offered that the  profession is best governed by a                                                               
board that  understands the industry's  place in the  health care                                                               
system.    The  profession  provides  comprehensive  care  during                                                               
pregnancy,  birth, and  postpartum to  healthy, low-risk  mothers                                                               
and  babies and  serves all  socio-economic walks  of life.   The                                                               
board  protects public  safety by  developing and  updating clear                                                               
regulations,  keeping  with  national   standards,  and  using  a                                                               
detailed  system of  accountability.   She  stated that  midwives                                                               
have a  close professional working  relationship with  the board;                                                               
there is  a mutual  desire to  have the best  laws in  the nation                                                               
governing  direct-entry midwives.   Alaska  needs midwives  to be                                                               
governed by  their own board.   She added that  some direct-entry                                                               
midwives are  also nurses,  but have chosen  not to  be certified                                                               
nurse midwives  but to be  direct-entry midwives.   She mentioned                                                               
that there are basically two  parallel routes to midwifery: nurse                                                               
midwifery or  going directly  into midwifery  without necessarily                                                               
going through nursing school first.                                                                                             
                                                                                                                                
4:03:08 PM                                                                                                                    
                                                                                                                                
JANEY  HOVENDEN, Director,  Division  of Corporations,  Business,                                                               
and  Professional  Licensing  (DCBPL),  Department  of  Commerce,                                                               
Community &  Economic Development (DCCED), stated  that the costs                                                               
associated with  licensing the profession would  continue without                                                               
the  board -  with  the exception  of  board-specific costs  like                                                               
travel and  meeting costs -  but would fall under  the department                                                               
or an alternative form of regulation such as another board.                                                                     
                                                                                                                                
4:04:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  noted that  a lot  of the  costs are  due to                                                               
investigations  of   non-licensed  persons,  but  the   board  is                                                               
responsible  for paying  for the  investigations.    He  asked if                                                               
paying  for   the  investigation  of  someone   not  licensed  or                                                               
affiliated with the board is common to other boards.                                                                            
                                                                                                                                
MS. HOVENDEN stated  that is correct; it  is statutorily required                                                               
for boards and programs that oversee [professions].                                                                             
                                                                                                                                
4:05:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES asked  how many  department staff  members                                                               
attend the board's meetings.                                                                                                    
                                                                                                                                
MS.  HOVENDEN  answered  typically  one.    She  noted  that  the                                                               
department  has undergone  strict  travel  policy changes,  which                                                               
have  restricted   meetings  to   the  least   costs  associated.                                                               
Typically one person from the  department would fly or attend the                                                               
meetings,  and the  department  has tried  to  have the  examiner                                                               
attend telephonically.                                                                                                          
                                                                                                                                
REPRESENTATIVE STUTES asked if this is a recent policy change.                                                                  
                                                                                                                                
MS. HOVENDEN answered that it has been about a year.                                                                            
                                                                                                                                
4:06:42 PM                                                                                                                    
                                                                                                                                
CHAIR KITO opened public testimony on HB 49.                                                                                    
                                                                                                                                
4:07:05 PM                                                                                                                    
                                                                                                                                
MADISON NOLAN  GRIMES, Director,  Juneau Family Health  and Birth                                                               
Center, testified in  support of HB 49.  She  stated that she has                                                               
been a licensed  direct-entry midwife for three years.   She said                                                               
HB  49   would  support  midwives   to  maintain   safe  practice                                                               
guidelines  and to  provide  safe, up-to-date  care.   The  board                                                               
provides regulatory  support to ensure that  midwives are meeting                                                               
standards of care  and doing the best they can  for Alaskan women                                                               
and families.   Maintaining  the board  is the  best way  to make                                                               
sure  licensees are  practicing in  the safest  way possible  and                                                               
maintaining national standards.                                                                                                 
                                                                                                                                
4:08:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked Ms. Nolan Grimes  how many                                                               
births  happen per  year in  her  practice and  if physicians  or                                                               
nurses assist or oversee the midwives in her practice.                                                                          
                                                                                                                                
MS. NOLAN GRIMES stated that  her practice has three direct-entry                                                               
midwifes licensed on  staff, and the practice  does between 55-60                                                               
births a  year.  She  noted that  there are complications  in the                                                               
course of  care that require  consultation due to  regulations or                                                               
common   sense.     In  such   cases,  there   are  collaborating                                                               
physicians,  but  they   are  not  required  to   have  a  signed                                                               
collaboration  agreement.   She  stated that  her practice  works                                                               
with physicians and advanced nurse practitioners as necessary.                                                                  
                                                                                                                                
4:09:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOSEPHSON asked  if there  is a  code to  bill an                                                               
insurance company.                                                                                                              
                                                                                                                                
MS. NOLAN GRIMES answered yes.                                                                                                  
                                                                                                                                
4:09:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KNOPP   asked  whether  there  is   a  continuing                                                               
education component to the profession.                                                                                          
                                                                                                                                
MS.  NOLAN GRIMES  answered yes.    She added  that within  every                                                               
licensing  cycle  each midwife  is  required  to meet  a  certain                                                               
number of  continuing education  units and  annually have  a peer                                                               
review to ensure regulations are being followed.                                                                                
                                                                                                                                
REPRESENTATIVE  KNOPP asked  who put  in the  requirements -  the                                                               
board or the state.                                                                                                             
                                                                                                                                
MS.  NOLAN  GRIMES  offered  her  understanding  that  there  was                                                               
licensure  before  a  board existed,  so  the  requirements  were                                                               
initially in statute.   A few years ago  requirements were pulled                                                               
from  statute into  regulation for  better adaptation,  which the                                                               
board  now handles.   She  stated that  the continuing  education                                                               
requirements and  peer reviews have  not changed since  they were                                                               
put in place by the legislature.                                                                                                
                                                                                                                                
REPRESENTATIVE  KNOPP  asked if  the  potential  for midwives  to                                                               
practice  "under the  radar" was  discussed with  the recent  fee                                                               
raise.                                                                                                                          
                                                                                                                                
MS. NOLAN  GRIMES stated that there  were extensive conversations                                                               
within the midwifery association  about that potential situation.                                                               
She mentioned  that she  is lucky because  her practice  pays the                                                               
licensing fees.   She stated that there is a  lot of concern that                                                               
apprentices  may not  join the  field due  to the  expense -  the                                                               
licensing fees might equate to a midwife's income in a month.                                                                   
                                                                                                                                
4:12:57 PM                                                                                                                    
                                                                                                                                
JOHANNA CROSSETT,  Direct-Entry Midwife, testified in  support of                                                               
HB 49.   She stated  that she  loves helping babies  and mothers.                                                               
She  noted  that  midwives  save  the  state  money  in  Medicaid                                                               
dollars.   The unique profession  requires having  a direct-entry                                                               
midwifery  board for  proper  regulation.   She  stated that  the                                                               
board understands its  unique niche in the  medical community and                                                               
within  the  state's  healthcare  system.   The  board  expertise                                                               
allows the profession  to continue to adopt  and uphold standards                                                               
of safe practice in Alaska.                                                                                                     
                                                                                                                                
4:14:26 PM                                                                                                                    
                                                                                                                                
DEBORAH GILLESPIE, Direct-Entry Midwife,  testified in support of                                                               
HB  49.   She stated  that  she is  a licensed  naturopath and  a                                                               
direct-entry midwife.                                                                                                           
                                                                                                                                
4:14:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON asked  whether it is legal  to deliver a                                                               
baby without being licensed.  He  stated that it seems unfair the                                                               
licensed midwives should  be "watching the rest  of the Alaskans"                                                               
to see who is practicing midwifery.                                                                                             
                                                                                                                                
MS. GILLESPIE  responded  that  she  agrees  with  Representative                                                               
Josephson's statements.   She offered  her understanding  that is                                                               
not legal to practice without a  license.  She stated that people                                                               
helping to  deliver babies in  the Interior represents  a portion                                                               
of  investigative fees,  but  she is  not sure  how  many of  the                                                               
investigations involved unlicensed individuals.                                                                                 
                                                                                                                                
4:16:54 PM                                                                                                                    
                                                                                                                                
CHAIR KITO speculated that if  an individual helps deliver a baby                                                               
without expectation  of trade  or payment, then  it might  not be                                                               
under a licensing investigation.   If someone solicits payment or                                                               
trade for  such services,  then it is  commerce and  would engage                                                               
the licensing board.                                                                                                            
                                                                                                                                
4:17:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH asked who would  oppose the extension of the                                                               
board, as it seems like a reasonable and necessary extension.                                                                   
                                                                                                                                
4:18:00 PM                                                                                                                    
                                                                                                                                
MS. GILLESPIE  stated that she  cannot think of a  reason someone                                                               
would oppose  the extension.   She stated  that as  a naturopath,                                                               
she has experience in a  profession without a specific board, and                                                               
her fees tripled  this year; she had $3,800 in  fees as a midwife                                                               
and nearly $2,000 as a naturopath.                                                                                              
                                                                                                                                
4:18:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  asked if midwifery is  an exclusively female                                                               
profession and what a male midwife is called.                                                                                   
                                                                                                                                
MS. GILLESPIE stated that there  are male midwives who are called                                                               
midwives.                                                                                                                       
                                                                                                                                
4:19:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KNOPP  asked  if  an  individual  would  continue                                                               
practicing if it got to the  point where a person couldn't afford                                                               
licensing.   He  stated his  belief that  a person  would operate                                                               
underneath the radar if he/she had  been priced out of the market                                                               
but knows himself/herself to be qualified.                                                                                      
                                                                                                                                
MS. GILLESPIE  offered that she  thinks the state stands  to lose                                                               
more midwifes than to have midwifes practice illegally.                                                                         
                                                                                                                              
4:20:43 PM                                                                                                                  
                                                                                                                                
CHAIR KITO announced that HB 49 was held over.                                                                                  
                                                                                                                                
4:20:55 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Labor and  Commerce Standing Committee  meeting was  adjourned at                                                               
4:21 p.m.                                                                                                                       

Document Name Date/Time Subjects
HB049 Fiscal Note DCCED CBPL 1.27.17.pdf HL&C 2/1/2017 3:15:00 PM
HL&C 2/3/2017 3:15:00 PM
HB 49
HB049 Sponsor Statement 01.30.17.pdf HL&C 2/1/2017 3:15:00 PM
HL&C 2/3/2017 3:15:00 PM
HB 49
HB049 Supporting Documents-Full Sunset Audit 01.30.17.pdf HL&C 2/1/2017 3:15:00 PM
HL&C 2/3/2017 3:15:00 PM
HB 49