Legislature(2021 - 2022)BUTROVICH 205
03/03/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB175 | |
| SB192 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 192 | TELECONFERENCED | |
| += | SB 175 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 3, 2022
1:31 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
OTHER LEGISLATORS PRESENT
Representative Ivy Spohnholz
COMMITTEE CALENDAR
SENATE BILL NO. 175
"An Act relating to telehealth; relating to the practice of
medicine; relating to medical assistance coverage for services
provided by telehealth; and providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 192
"An Act relating to midwives and the practice of midwifery;
relating to apprentice midwives; relating to the licensing of
midwives; relating to insurance requirements for the practice of
midwifery; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 175
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH
SPONSOR(s): SENATOR(s) WILSON
02/01/22 (S) READ THE FIRST TIME - REFERRALS
02/01/22 (S) HSS, L&C
02/24/22 (S) HSS AT 1:30 PM BUTROVICH 205
02/24/22 (S) -- Invited & Public Testimony --
03/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 192
SHORT TITLE: BOARD OF LICENSED MIDWIVES
SPONSOR(s): SENATOR(s) KAWASAKI
02/15/22 (S) READ THE FIRST TIME - REFERRALS
02/15/22 (S) HSS, L&C, FIN
03/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JASMIN MARTIN, Staff
Senator David Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 175
on behalf of the sponsor.
RENEE GAYHART, Director
Division of Health Care Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SB 175.
GENNIFER MOREAU, Director
Division of Behavioral Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SB 175.
SARAH CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SB 175.
NANCY MERRIMAN, Executive Director
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on SB 175.
JOHN SOLOMON, Director
Behavior Health
Maniilaq Association
Kotzebue, Alaska
POSITION STATEMENT: Provided invited testimony on SB 175.
SUZANNE ISHII-REGAN, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 175.
SARAH ELIASEEN, representing self
Eagle River, Alaska
POSITION STATEMENT: Testified in support of SB 175.
CODY CHIPP, Director
Alaska Native Tribal Health Consortium (ANPHC)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 175.
JOE HAYS, Staff
Senator Scott Kawasaki
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 192 on behalf of the sponsor.
CHERIE BOWMAN, Intern
Senator Scott Kawasaki
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 192
on behalf of the sponsor.
RACHEL PUGH, Member
Board of Certified Direct-Entry Midwives
Department of Commerce, Community and Economic Development
Eagle River, Alaska
POSITION STATEMENT: Provided invited testimony on SB 192.
BETHEL BELISLE, Chair
Board of Certified Direct-Entry Midwives
Department of Commerce, Community and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on SB 192.
ACTION NARRATIVE
1:31:59 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:31 p.m. Present at the
call to order were Senators Costello, Reinbold, and Chair
Wilson. Senator Begich and Hughes arrived shortly thereafter.
SB 175-HEALTH CARE SERVICES BY TELEHEALTH
1:32:19 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 175
"An Act relating to telehealth; relating to the practice of
medicine; relating to medical assistance coverage for services
provided by telehealth; and providing for an effective date."
1:32:38 PM
SENATOR COSTELLO moved to adopt the committee substitute (CS)
for SB 175, work order 32-LS1421\I, as the working document.
1:32:50 PM
CHAIR WILSON objected for purposes of discussion. He explained
that the CS is a good faith compromise with stakeholders that
will make a better bill.
1:33:40 PM
CHAIR WILSON removed his objection; he found no further
objection, and Version I was adopted as the working document.
1:33:49 PM
SENATOR HUGHES and SENATOR BEGICH joined the meeting.
1:34:04 PM
CHAIR WILSON, speaking as sponsor, paraphrased the following
sponsor statement for SB 175:
[Original punctuation provided.]
The COVID pandemic brought many hardships, but also
inspired innovation. The committee has had extensive
conversations on telehealth, through both SB 56
(Disaster Bill) and SB 78 (Senator Costello's
Telehealth Bill). SB 175 capitalizes on these
innovations and conversations. Access to telehealth
services were broadened temporarily during the COVID-
19 pandemic. We want to continue these telehealth
flexibilities and make them permanent in statute. SB
175:
• Improves access to behavioral health and helps to
address opioid use disorder.
• Reduces bureaucracy.
• Makes health care possible when an in-person
visit doesn't make sense, or just isn't an
option.
1:35:04 PM
There is an extensive packet of letters of support to
this legislation. Some of the supporters are:
Southcentral Foundation, ASHNHA, Alaska Association on
Developmental Disabilities, Alaska Behavioral Health
Association, AARP, Alaska Primary Care Association
Alaska Regional Coalition (TCC, Kawerak, Maniilaq,
Chugachmuit, Central Council Tlingit & Haida), Alaska
Native Health Board, Family Centered Services of
Alaska, Set Free Alaska, and U.S. Renal Care.
SB 175:
1) Creates a new section on telehealth for health care
providers licensed with the State of Alaska that
removes the requirement for an in-person visit and
ensures payment parity for telehealth visit.
2) Allows physicians licensed in another state to deliver
telehealth services within their scope of practice if:
a. There is an established physician-patient
relationship,
b. The non-resident physician has given the patient
an in-person physical exam,
c. And the services are related to ongoing treatment
or follow-up care related to past treatment.
3) Ensures telehealth availability for services related
to opioid use disorder and controlled substances for
certain providers.
4) Increases telehealth access for Alaska Medicaid
beneficiaries by ensuring coverage and ensures payment
parity and Medicaid coverage for virtually any
telehealth modality.
SB 175 does not require anyone to deliver or receive
services through telehealth. Both the provider and the
patient may choose to limit or decline a telehealth
encounter.
1:36:40 PM
CHAIR WILSON noted that Representative Spohnholz sponsored a
companion bill.
1:37:02 PM
JASMIN MARTIN, Staff, Senator David Wilson, Juneau, Alaska,
paraphrased the following sectional analysis on behalf of the
sponsor:
[Original punctuation provided.]
Section 1: Adds a new section (.085 Telehealth) to AS
08 (Business and Professions) .01 (Centralized
Licensing).
(a) Allows a healthcare provider (other than
physician licensed in in another state) to
provide health care services via telehealth
without first conducting an in-person visit.
(b) Allows an out-of-state physician to provide
health care services via telehealth if:
(1) The physician and patient have pre-
established relationship.
(2) There has been an in-person
examination.
(3) The telehealth visits are a follow-up to
previously provided health care
services.
(c) Creates limits for a telehealth appointment.
If a telehealth appointment falls outside a
provider's authorized scope of practice, they
may refer the patient to an appropriate
clinician. Prohibits a healthcare provider
from charging for any portion of the visit
that was beyond their scope of practice.
(d) Requires fees charged for telehealth to be no
more than fees charged for in person visits.
(e) Allows a physician, podiatrist, osteopath, or
physician assistant licensed with the State of
Alaska to prescribe controlled substances via
telehealth if they comply with Alaska Statute
regarding prescribing controlled substances
without a physical examination.
(f) Allows an advanced practice registered nurse
licensed with the State of Alaska to
prescribe controlled substances via
telehealth.
(g) Prohibits a provider from prescribing
controlled substances via telehealth other
than as provided in (e) and (f).
1:39:00 PM
(h) Removes the burden to document barriers to an
in-person visit and clarifies that the board
or department cannot require health care
services to be provided from a certain
location.
(i) Clarifies that nothing in this section re-
quires a provider to provide telehealth
services or a patient to use telehealth
services.
(j) Defines: "health care provider," "licensed,"
and "telehealth."
Section 2: Amends AS 08 (Business and Professions) .64
(Medicine) .364 (Prescription of drugs without a
physical examination).
Removes the in-person requirement in AS 08.64.364(b)
for an appropriate health care provider to assist a
patient during a telehealth appointment with a
physician or physician assistant regarding controlled
substances.
1:39:45 PM
Section 3: Adds a new section (.100 Telehealth) to AS
18 (Health, Safety, Housing, Human Rights, and Public
Defenders) .08 (Emergency Medical Services).
(a) Allows an individual certified or licensed to
provide emergency services to provide
emergency services through telehealth.
(b) Requires a certified or licensed individual to
stay within their scope of practice during a
telehealth visit. Prohibits them from charging
for any portion of the visit that was beyond
their scope of practice.
(c) Requires fees charged for telehealth to be no
more than fees charged for in person visits.
(d) Removes the burden to document attempts at an
in person visit and clarifies that the council
or department cannot require health care
services to be provided from a certain
location.
(e) Clarifies that nothing in this section requires
a provider to provide telehealth services or a
patient to use telehealth services.
(f) Defines "telehealth" as defined in section 1.
1:40:46 PM
Section 4: Adds a new section (.069. Payment for
Telehealth) to AS 47 (Welfare, Social Services, and
Institutions) .07 (Medical Assistance for Needy
Persons).
(a) Requires Medicaid to pay for services by
telehealth at the same rate they would if the
services were provided in person.
(b) Requires the department to adopt regulations
for services provided through telehealth.
Requires these regulations to treat services
provided through telehealth in the same
manners as services provided in person. Allows
the department to limit modes, coverage, and
reimbursement of telehealth only if:
(1) The department specifically excludes or
limits services from telehealth coverage
through regulation.
(2) Determines, through substantial medical
evidence, that a service cannot be safely
provided via telehealth.
(3) Providing a service through telehealth
would violate federal law or render a
service ineligible for reimbursement
under federal law.
(c) Requires all telehealth services comply with
HIPAA.
(d) Defines "federally qualified health center,"
"rural health clinic," "state plan," and
"telehealth."
1:41:23 PM
Section 5: Adds a new section (.585 Telehealth) to AS
47 (Welfare, Social Services, and Institutions) .30
(Mental Health).
Identical to section 3 but applies to entities which
are approved to receive grant funding by the
Department of Health and Social Services to deliver
community health services.
Section 6: Adds a new section (.145 Telehealth) to AS
47 (Welfare, Social Services, and Institutions) .37
(Uniform Alcoholism and Intoxication Act).
Identical to section 3 but applies to public or
private treatment facilities approved by the
Department of Health and Social Services in AS
47.37.140 to deliver services designated under AS
47.37.40 AS 47.37.270 addressing substance use
disorders.
Section 7-10
Amends the uncodified law to instruct the Department
of Health and Social Services to submit an amendment
to the state plan and seek approval from the U.S.
Department of Health and Human Services if needed and
provides immediate effective dates for other areas of
this bill.
1:42:25 PM
MS. MARTIN presented the changes from version A to version
I of SB 175:
[Original punctuation provided.]
Section 1
Replaces any reference to "examination" with "visit,"
and updates corresponding language throughout the
bill, except for providers licensed in another state.
Removes language in subsection (a) of version A
related to the telehealth authority of providers
licensed in another state. This language is replaced
with subsection (b), which creates an exemption for
physicians licensed in another state to deliver health
care services within their scope of practice if there
is an established physician-patient relationship, the
non-resident physician has given the patient an in-
person physical exam, and the services are related to
ongoing treatment or follow-up care related to past
treatment.
Cleans up the provisions regarding medication assisted
treatment by removing subsection (d) in version A,
which pertained to services addressing opioid use
disorder. This language was deemed unnecessary to
ensure the telehealth delivery of medication assisted
treatment to treat opioid use disorder (i.e.,
medication, counseling, and behavioral health
therapies).
Revises the prescribing authority provision by
separating physicians, podiatrists, osteopaths, and
physician assistants in subsection (e) from advanced
practice registered nurses (APRNs) in subsection (f).
Amends the APRN language in subsection (f) to remove
the in-person requirement of prescribing controlled
substances (including buprenorphine) via telehealth.
This does not change the prescribing scope for these
providers.
Creates subsection (h) to remove requirements to
document all attempts for an in-person visit and
prevents the department or board from limiting the
physical setting of a health care provider delivering
telehealth.
Clarifying language is inserted under subsection
(j)(2) defining all providers in this section as
licensed in good standing.
1:43:36 PM
Section 3 Creates subsection (h) under Title 18 to
remove requirements to document all attempts for an
in-person visit. This section replicates the same
provisions on documentation and physical setting for
emergency medical services as Section 1.
Section 4
Amends telehealth services included in Alaska Medicaid
by explicitly including home and community-based
waiver services in subsection (a)(2) and adding
services provided under a state plan option (e.g.,
1915(k) services) in subsection (a)(3). Adds language
in subsection (b), line 13 to ensure the department
must revise regulatory language to include telehealth
in the definition of a "visit."
Section 5-6
These are new sections adding telehealth provisions to
entities in Title 47. These entities represent
grantees which deliver community mental health
services, or facilities approved by the department to
deliver substance use disorder treatment. Their
authority to deliver telehealth was previously
unaddressed in version W because they are not
applicable to the provisions in Title 8 or the Alaska
Medicaid provisions in Title 47. Both sections
replicate the same telehealth provisions on cost,
scope of services, patient protections, documentation,
and physical setting as Section 1.
1:44:23 PM
Section 5 creates AS 47.30.585 to include entities
designated under AS 47.30.520 AS 47.30.620, which
are approved to receive grant funding by the
Department of Health and Social Services to deliver
community mental health services.
Section 6 creates AS 47.37.145 to include public or
private treatment facilities approved by the
Department of Health and Social Services in AS
47.37.140 to deliver services designated under AS
47.37.40 AS 47.37.270 addressing substance use
disorders.
1:45:07 PM
SENATOR REINBOLD stated that when the telehealth bill was
introduced by former Representative Vasquez, Alaska physicians
were adamant about the requirement for an in-person visit before
online visits could occur. She asked for an explanation of what
SB 175 does in that regard that wasn't in that House bill.
MS. MARTIN responded that the bill removes the burden of
documenting an attempted in-person visit. It would also
establish payment parity for telehealth and in-person visits.
1:46:03 PM
SENATOR REINBOLD asked if SB 175 would address prescribing
related to telehealth.
1:46:21 PM
At ease
1:48:52 PM
CHAIR WILSON reconvened the meeting.
1:48:57 PM
SENATOR REINBOLD asked whether HB 275 and SB 175 were identical
because the fiscal notes talk about two different bills.
1:49:12 PM
CHAIR WILSON replied that the bills were the same. He deferred
to the Division of Healthcare Services, Department of Health and
Social Services (DHSS) to address the fiscal notes and the
reason an additional person is needed to provide services the
division is already providing to the public.
1:49:57 PM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health and Social Services (DHSS), Juneau, Alaska,
related that the department would retain some flexibilities for
public health emergency care. It would require regulatory
changes and quality assurance reviews of payments, which would
require additional staff time. The additional staff was to
ensure quality assurance. She noted that the Division of
Behavioral Health and Senior and Disability Services staff were
online.
1:51:34 PM
CHAIR WILSON asked if the department should wait to determine if
there are additional costs to the administration. The fiscal
note does not say how many more patients would use telehealth as
a modality versus in-patient care. According to the fiscal note,
it appears the department adds this as a cost into perpetuity
and not just as a one-time charge. He asked why the department
would not just request temporary funds in the supplemental
budget.
MS. GAYHART responded that the department has been working with
Representative Spohnholz and others on what could be added
through SB 175 and the companion bill. Due to the pandemic, the
flexibilities put in place added many recipients to telehealth.
She indicated that if the changes in the bill are permanent,
they require additional regulations, system edits, and post-
payment claims review. She stated that the Centers for Medicare
and Medicaid Services (CMS) temporarily waived the requirements
because of the pandemic, noting that CMS reimburses the
department for services it provides to recipients through
providers. However, making those changes permanent would require
additional staff.
1:53:40 PM
CHAIR WILSON expressed concern about the ongoing costs in SB
175. He offered his view that the regulation changes would not
happen until FY 2027 and FY 2028.
1:54:05 PM
GENNIFER MOREAU-JOHNSON, Director, Division of Behavioral
Health, Department of Health and Social Services (DHSS),
Anchorage, Alaska, stated that the Division of Behavioral Health
was very interested in supporting access to care. She
highlighted that part of their mission is to ensure effective
care and assurance of quality outcomes. The full-time position
in the division's fiscal note would provide review and
monitoring to assure the clinical appropriateness of the
services and for ongoing review to ensure national best
practices related to telehealth. She envisioned that telehealth
would be a method of delivery that would continue to develop
over time. Thus, the division believes the position should be a
full-time permanent position to stay abreast of national best
practices and ensure quality.
1:55:19 PM
CHAIR WILSON wondered whether the division was currently doing
so.
MS. MOREAU-JOHNSON answered yes. However, this bill proposes
language that would require regulatory changes for the
administration of telehealth, which would require additional
staff support.
1:55:46 PM
SENATOR BEGICH asked what additional work the bill required. He
related that the division would need to develop new regulations
for one year, but she indicated the department currently reviews
and monitors telehealth activities. Thus, he was unsure of the
additional work that SB 175 would require.
MS. MOREAU-JOHNSON answered that language in SB 175 relates to
substantial medical evidence, and because telehealth is an
emerging platform, the division wants to ensure patients receive
quality telehealth care. She said the bill focuses on providing
behavioral services through telehealth, and the division
supports that access but wants to ensure adequate services are
provided. She highlighted that the division is small and has
taken on substantial work to implement the [Medicaid Section]
1115 waiver.
1:57:02 PM
SENATOR BEGICH stated he could understand up to a five-year
follow-up; however, SB 175 should reduce documentation once
enacted, so he was not comfortable with the fiscal note. He
offered his view that the fiscal note is inflated by half a
million dollars. He surmised that it would likely take a year or
18 months at most. He said he did not see the need for an
ongoing full-time position over time and suggested that the
division clearly assess the time required to determine quality
telehealth delivery.
1:58:08 PM
SENATOR HUGHES expressed concern about the cost of SB 175 for
Alaskans because it allows fees for a telehealth visit at the
same rate as an in-person visit. She recalled stipulating years
ago that telehealth would reduce health care costs in the state,
especially for villages. She stated that the costs associated
with telehealth are less than for a clinic. For example, no
medical assistant takes the patient's blood pressure and
performs other duties, resulting in lower overhead. She
highlighted that Alaska has a problem with high health care
costs, so she questioned why the medical fees for telehealth and
in-person visits would be the same.
CHAIR WILSON commented that his office worked with other
telehealth providers during a Medicaid Policy conference and
found that there were two reasons for including payment parity
in SB 175. One reason was that it helps incentivize the use of
telehealth since most doctors prefer in-patient visits for the
profitability of their practice. He offered to distribute
information from the National Conference of Legislatures (NCSL)
on this. NCSL researched the issue and found it also related to
the initial cost for some of the rural community health
providers in the nation to provide telehealth. Thus, payment
parity allows providers to recoup the initial costs of setting
up private and secure telehealth communications equipment. This
is particularly important for small practices in underserved
communities because they may not have the financial means to
offer telehealth if the reimbursement rates are substantially
lower. He noted that he was working with stakeholders and the
sponsor of the companion bill to consider an amendment for a
sunset date for payment parity.
2:01:52 PM
SENATOR HUGHES opined that telehealth costs affect individuals
and will also be reflected in savings to the Medicaid budget.
She referred to page 6, line 9 of Version I, that says the
Department of Health and Social Services (DHSS) has the
responsibility to decide what will be covered, excluded,
limited, or reimbursed for services provided by telehealth. She
offered her belief that the medical board decides what doctors
can do, and the nursing board decides what nurse practitioners
can do. She wondered how DHSS would determine what is
appropriate for telehealth. She suggested that the medical board
would want to determine what is suitable for telehealth.
CHAIR WILSON replied that this section was addressing
reimbursable services. It allows the department to determine
which provided services will be reimbursed. For example, certain
case management providers may not be covered through Medicaid
for in-patient visits, but the visit may be covered through
another private insurance. This provision would allow them to
say which service modalities will be reimbursed. It would allow
the state to set the regulations accordingly for current
procedural terminology (CPT) codes and determine which ones
would be set for reimbursable services in Alaska.
2:04:29 PM
MS. MOREAU-JOHNSON agreed that the language in SB 175 provides
the department the authority to establish regulations for
reimbursement and to maintain like reimbursement for like
services to the extent possible.
2:04:51 PM
SENATOR HUGHES referred to Section 1, which states that in-state
providers may use telehealth without conducting a patient's
physical exam. In contrast, out-of-state providers must have an
in-person medical exam before providing service. She questioned
the constitutionality of having different telehealth
requirements for using non-Alaskan licensed physicians.
CHAIR WILSON replied that he did not believe it caused any
constitutional issues. He explained that Section 1 relates to
licensing requirements for doctors, creating parity for Alaska
and out-of-state physicians.
2:05:55 PM
SARAH CHAMBERS, Director, Division of Corporations, Business,
and Professional Licensing, Department of Commerce, Community
and Economic Development (DCCED), Juneau, Alaska, related her
understanding that Section 1 eliminates licensure for out-of-
state providers. Out-of-state providers must be licensed in
Alaska to provide care in the state. SB 175 would allow out-of-
state physicians licensed in another jurisdiction to practice in
Alaska via telehealth, but they must follow Alaska's laws. She
related that during the pandemic, some Alaskans had a Seattle
doctor for specialty care but had health restrictions and could
not travel to Seattle. Their provider had limited access to in-
patient services, or it was cost prohibitive.
2:07:32 PM
SENATOR HUGHES stated the explanation makes sense. She wondered
if this was opening the door to allow out-of-state physicians to
live in the state and provide telehealth services indefinitely
without obtaining an Alaska license.
CHAIR WILSON opined that the requirements would make that
difficult and deferred to Ms. Chambers.
MS. CHAMBERS replied that the intent is to have a bifurcated
system where a physician practicing in Alaska must have an
Alaska license. She offered to research when out-of-state
physicians would need an Alaska license to clarify the bill's
intent for the future.
2:09:19 PM
CHAIR WILSON stated he would add the suggestion to his list of
potential amendments.
2:09:38 PM
NANCY MERRIMAN, Executive Director, Alaska Primary Care
Association, Anchorage, Alaska, paraphrased her testimony as
follows:
[Original punctuation provided.]
The Alaska Primary Care Association (APCA) supports
the operations and development of Alaska 29 federally
qualified health centers, also known as community
health centers, or FQHC. Health centers provide
comprehensive whole person care which includes
medical, dental, behavioral, pharmacy and care
coordination services. A PCA and Alaska's health
centers support SB 175 because it increases access to
primary care and behavioral health services, and it
expands telehealth in this space. This legislation
does several things that are important to help
centers. First, it includes a range of telehealth
modalities, including audio only, both now and into
the future. Second, it allows patients and providers
to engage in telehealth services outside of clinic
setting if they so choose. And third, it provides
adequate reimbursement for telehealth visits,
providing new points of access to whole person care,
including behavioral health and substance use disorder
treatment.
In 2020, health centers served 105,000 patients
through 450,000 visits. Telehealth and substance use
disorder services are our fastest growing area of
service, and of those visits 40 percent were
accommodated via telehealth. In the subspecialty area
of substance use disorder services, 45 percent of
visits were via telehealth. The temporary telehealth
policy changes have benefited health centers because
they have allowed health centers to be recognized as
telehealth treating providers to furnish some
behavioral health services via audio only technology,
and to be paid for telehealth services furnished to
Medicaid beneficiaries under the health centers
bundled payment reimbursement model.
2:11:47 PM
MS. MERRIMAN continued her testimony:
Health centers serve hard to reach community. The
majority of health center patients experienced
challenges in accessing health care that include long
distances to reach local providers, cost of care,
transportation, language, and cultural barriers. In
Alaska, over half of our patients are from racial or
ethnic minorities, a majority are low income, and most
patients live in rural communities. Health centers
best serve their patient populations if they have the
ability to use technology to meet their patients where
they are at. Additionally, workforce shortages,
particularly in behavioral health providers, impact
health centers uniquely as nonprofit safety net
providers. And telehealth allows health centers to use
their clinical workforce most nimbly.
In 2021, a cohort of health centers reported that of
their telehealth interactions 59 percent occurred by
phone and 40 percent by audio or video. Through the
pandemic demand for tele behavioral health now
represents 35 percent of all telehealth usage. Health
centers have witnessed how telehealth has provided a
stronger continuity of care for patients, reduced
travel costs, and has resulted in fewer dropped
visits, and less delayed and more costly care. And we
understand that delivering quality whole person care
ultimately leads to better health outcomes, saves
lives, and in the long run saves on cost. So, on
behalf of the Alaska Primary Care Association and
health centers across the state, I urge you to support
SB 175. And we appreciate your support.
2:13:39 PM
SENATOR REINBOLD stated she made a commitment when she supported
telehealth six years ago to support Alaska's physicians. She
said she is pleased that SB 175 requires physicians to have an
established patient relationship before offering telehealth
services. She expressed concern that SB 175 might mean more
patients would seek medical care from physicians in the Lower
48, which could be difficult for local providers who established
small clinics. She wants to ensure that patients do not turn to
out-of-area telemedicine and leave local doctors without
patients.
CHAIR WILSON asked Ms. Merriman whether Alaskan providers would
have that concern.
MS. MERRIMAN opined that SB 175 seeks to establish and protect
the patient-provider relationship.
2:15:17 PM
SENATOR REINBOLD stated she supports SB 175 because it prevents
providers from requiring patients to be vaccinated before
receiving treatment. She is concerned about the opioid crisis in
Alaska and whether SB 175 would increase access to opioids in
Alaska.
CHAIR WILSON responded no. He stated that SB 175 would not
increase access because there are still state statutes that out-
of-state providers must follow. He said he would follow up to
ensure that all entities are required to follow Alaska's
prescribing rules.
SENATOR REINBOLD recalled that opioid prescriptions were limited
to a 7-day maximum prescription.
2:16:22 PM
SENATOR REINBOLD asked if SB 175 mirrors or complements HB 172
related to psychotropic medication use in sub-acute medical
facilities.
CHAIR WILSON answered no.
2:17:09 PM
SENATOR REINBOLD related her understanding that the local
physicians, physician's assistants, and nurse practitioners were
represented by APCA. She acknowledged that APCA testified in
support of SB 175, but she would like to know if Alaska's
healthcare providers support SB 175.
CHAIR WILSON replied that other invited testimony would speak to
her concern.
2:17:37 PM
JOHN SOLOMON, Director, Behavior Health, Maniilaq Association,
Kotzebue, Alaska, stated that Maniilaq is the only association
serving the Northwest Arctic area villages on the North Slope.
Before becoming an administrator, he was a counselor who flew to
villages to see patients, carrying his backpack and sleeping
bag. He emphasized the importance of telehealth to his region,
which he hopes was happening in other rural Alaska areas.
MR. SOLOMON explained that previously many logistical barriers
prevented patients from obtaining treatment. Still, once
restrictions were removed, the flexibilities allowed telehealth,
which brought about an explosion in the number of clients asking
for and receiving care. Telehealth for substance abuse groups
went up 800 percent in six months. People had been waiting and
wanting care but lacked access to providers. The substance abuse
program grew from five to 70 ongoing clients. He emphasized the
importance of the telephonic provision in SB 175 for rural
Alaskans. The Northwest Arctic has clinics that do not have
behavioral health aides (BHAs) and organizations with clinics
that are not staffed. The telephonic option provides access to
obtain care. In rural Alaska, telehealth is not about better or
best practices but about care or no care for rural Alaskans.
MR. SOLOMON highlighted that Maniilaq has worked to develop the
local workforce in villages, so village BHA's can provide care
to other villages. The hope is to fill the remaining BHA
positions. In closing, he stated that the Maniilaq Association
is a strong advocate for SB 175.
2:20:23 PM
CHAIR WILSON related that BHA stands for behavior health aide.
MR. SOLOMON agreed and elaborated that in the tribal health
organizations, a behavior health aide works as a village-based
counselor.
2:20:43 PM
CHAIR WILSON opened public testimony on SB 175.
2:21:09 PM
SUZANNE ISHII-REGAN, representing self, Anchorage, Alaska, said
she is a member of a family who has benefited from telehealth.
She thanked the state for a quick pivot to provide the
flexibility of telehealth during the pandemic, which helped
protect many vulnerable citizens. She said she has a male family
member who uses a ventilator and has a primary immune
deficiency. She noted that telehealth helped the family stay
connected to doctors and avoid exposure to illnesses and
infection, so they did not bring them home. Telehealth provided
an opportunity for first-time access to services when he needed
to transition to a new provider. It also reduced barriers that
allowed him to continue receiving medical care. Telehealth was
beneficial during extreme cold and icy weather, which further
complicate mobility issues. She said it was easier to
communicate since masks did not have to be worn during the
telehealth appointments.
2:23:40 PM
SARAH ELIASEEN, representing self, Eagle River, Alaska, stated
she is a 96-year-old retired schoolteacher who appreciated being
able to stay home and receive medical care. She has been
declared legally blind and must use a walker. She can no longer
use public transportation but would like to remain as
independent as possible. She surmised that she is not the only
person who finds transportation to Anchorage difficult. She
mentioned that while visiting with her doctor online, an
assistant kept records and facilitated the call. She asked the
committee to make telehealth a permanent option for the elderly,
disabled, those in rural areas, and anyone else who needs it.
She thanked members and urged them to pass SB 175.
2:27:30 PM
CODY CHIPP, Director, Alaska Native Tribal Health Consortium
(ANPHC), Anchorage, Alaska, stated that the telehealth
flexibility that came about through COVID created a greater
ability to provide greater access to care. ANPHC launched a
telehealth behavioral health clinic to address COVID-related
distress. He stated that ANTHC uses OQ 45, the gold standard of
patient-reported outcome measures, to measure clinical outcomes.
Telehealth was found to be accessible, safe, and effective. The
clinical outcomes were equal to or greater than the national
averages. Client surveys expressed patient gratitude for easy
access to services previously not available. Alaska's fiscal
analysis has shown that telehealth could also save the state
money, as noted in the Medicaid Reform report in response to SB
74. Telehealth also saves individuals time and money because it
eliminates driving time.
2:29:32 PM
CHAIR WILSON held SB 175 in committee with public testimony
open.
2:30:17 PM
At ease
SB 192-BOARD OF LICENSED MIDWIVES
2:31:16 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 192 "An Act relating to
midwives and the practice of midwifery; relating to apprentice
midwives; relating to the licensing of midwives; relating to
insurance requirements for the practice of midwifery; and
providing for an effective date."
2:31:49 PM
JOE HAYS, Staff, Senator Scott Kawasaki, Alaska State
Legislature, Juneau, Alaska, paraphrased the sponsor statement
for SB 192:
[Original punctuation provided.]
Senate Bill 192 would establish licensing of certified
professional midwives in Alaska and create a governing
board to develop licensing procedures and review
licensing applications and renewals.
Currently Alaska only has legislation regarding the
certification of direct-entry midwives. This bill
would institute licensing requirements and regulations
for certified professional midwives to be formed in
conjunction with a nationally recognized midwife
organization. The bill also requires that licensed
midwives have basic life support certification for
health care providers and certification in neonatal
resuscitation, and knowledge of and experience with
non-hospital-based births. These requirements would be
in addition to a required background in a health-
related field other than nursing and graduation from a
master's level midwifery education program.
2:33:18 PM
This bill would also create a Board of Licensed
Midwives from the current Board of Certified Direct-
Entry Midwives. The new Board will adopt standards and
regulations for licensed midwives that are in the
public interest and in compliance with the
Administrative Procedure Act. The Board will review
license applications and renewals for midwives in the
State of Alaska and establish insurance provisions.
The Board will help to develop future legislation
specific to licensed midwives that will clarify these
standards and regulations.
SB 192 is important for ensuring safer at-home births
and improving prepartum and postpartum care for
mothers and infants.
I ask for your consideration and support of Senate
Bill 192 to allow the State licensing of certified
professional midwives and the formation of a governing
board to oversee the standards and regulations for
licensed midwives.
2:34:15 PM
CHERIE BOWMAN, Intern, Senator Scott Kawasaki, Alaska State
Legislature, Juneau, Alaska, read the sectional analysis for SB
192:
[Original punctuation provided.]
Section 1. Uncodified law providing legislative Intent
to preserve right of women to deliver children at home
with licensed midwives.
Section 2. Amends AS 08.01.017(17) to change board
name form (certified direct - entry) to licensed
midwives.
Section 3. Amends AS 08.02.010(a) to explain who can
practice and what type of professional letters or
title shall appear on.
Section 4. Amends AS 08.03.010(c)(8) to change the
name certified direct entry to licensed midwives and
adds an effective date of June 30, 2023.
2:35:20 PM
Section 5. Amends AS 08.64.370 to explain how licensed
midwives are recognized with or without compensation
and how licensed midwives are defined in AS 08.65.190
Section 6. Amends AS 08.65.010(a) to establish the
board of licensed midwives.
Section 7. Amends AS 08.65.010(b) to define who can be
members of the licensed midwife board.
Section 8. Amends AS 08.065.030 to address the powers
and duties of the board of midwives
Section 9. Amends AS 08.065.040 to add a new
subsection on activities the board cannot adopt by
regulations to include: (b) and (c). Subsection B
includes
1. Requires a person to have a nursing degree or
diploma to be licensed under this chapter
2. Requires a licensed midwife to practice midwifery
under the supervision of or collaboration with
another health care provider or a health care
facility
3. Requires a licensed midwife to enter into an
agreement, whether written, oral, or in another
form, with another health care provider or a health
care facility.
4. Limits the location where a licensed midwife may
practice midwifery.
2:36:43 PM
Subsection C. adds definitions of health care facility
and health care provider as identified in AS 18.35.399
and AS 09.65.300 respectively.
Section 10. Amends AS 08.65.050 to address the
qualifications needed to be a licensed midwife in
Alaska.
1. Line 1 reads "holds a valid certified
professional midwife certificate, if the
certificate is issued by a nationally recognized
midwife organization recognized by the board and
the requirements for the certificate are consistent
with this chapter."
2. Line 2 is added and reads "applies on a form
provided by the board".
3. Lines 2 and 3 are renumbered as 3 and 4.
4. Line 4 is renumbered as line 5 and adds "is a
certified in basic life support for health care
provider" and adds the word "and".
5. Line 5 is renumbered as line 6 and adds "is
certified in the interventions used at the time of
birth to support the establishment of breathing and
circulation of the newborn."
Section 11. Amends AS 08.65.080 to explain
procedures for renewal of midwifery license.
2:38:08 PM
Section 12. Amends AS 08.65.090(a) to allow the
midwifery board to issue permits to midwife
apprentices who have satisfied the education, training
and apprenticeship that is deemed by the board to be
in the public interest and recognized by a nationally
commissioner to adopt regulations to implement and
interpret the Act.
Section 13. Amends AS 08.65.110 to address grounds of
discipline, suspension or revocation of certification
for licensed midwives.
Section 14. Amends AS 08.65.120(a) to give the board
the authority to impose discipline to include
revocation or suspension of midwives' licenses for
those who broke any code of conduct.
Section 15. Amends AS 08.65.120(d) to give the board
the ability to reinstate a licensed after appeal if a
person proves to able to practice with reasonable
skill and safety.
Section 16. Amends AS 08.65.140 to allow the board to
adopt regulations to licensed midwives after
consultation with a nationally recognized midwife
organization. The regulations would have to conform to
the public interest.
Section 17. Amends AS 08.08.65.150 to add a new
subsection to read:
(b) A licensed midwife may practice midwifery without
being under the supervision of, or collaborating with,
another health care provider or a health care
facility.
2:39:50 PM
(c) A licensed midwife may practice midwifery without
entering into a written or other form of agreement
with another health care provider or a health care
facility.
(d) A licensed midwife may provide services using
audio, video, or other electronic media for the
purpose of diagnosis, consultation or treatment.
Section 18: Amends AS 08.65.150 to give specification
that a non-licensed midwife recognized under AS
08.65.150 cannot receive compensation.
Section 19: Amends AS 08.65.160 to address who can be
called a licensed midwife and the penalties
established for a person who uses the title illegally.
Section 20: Amends AS 08.65.170 to exclude licensed
physicians and advanced practiced registered nurses.
Section 21: Amends AS 08.65.180 to explain the
responsibility of care is not transferred from a
licensed midwife to a licensed physician until the
patient is physically within the physician's care.
Section 22: Amends AS 08.65.190(1) to explain what
board is being discussed licensed midwives.
Section 23: Amends AS 08.65.190(3) to define the
practice of midwifery to include preconception
pregnancy, the first postpartum year and well-baby
care for the infant through the age of six weeks.
2:41:41 PM
Section 24: Amends AS 08.65.190 by adding a new
paragraph to read:
1. "licensed midwife" means a midwife who is licensed
under this chapter to practice midwifery.
2. "midwife" means a person who practices midwifery.
Section 25: Amends AS 09.65.300(c)(1) to add licensed
midwives as a health care provider.
Section 26: Amends AS11.42.470(1) to add licensed
midwives as a health care worker.
Section 27: Amends AS 18.20.095(e)(2) to add licensed
midwives as a licensed staff member under AS 08.64.
Section 28: Amends AS 18.50.165(b) to add licensed
midwives to the responsibilities of the registrar to
distribute information to.
Section 29: Amends AS 21.36.090(d) to add licensed
midwives as a person who cannot practice or permit
unfair discrimination against a person who provides
services covered under a group health insurance that
extends coverage on an expense incurred basis.
2:43:12 PM
Section 30: Amends AS 21.42.355 by adding a new
subsection that reads:
(c) If a health care insurance plan or an excepted
benefits policy or contract provides indemnity for the
cost of services of a physician provided to women
during preconception, pregnancy, childbirth and the
period after childbirth up to one year, indemnity in a
reasonable amount shall also be provided for the cost
of a midwife licensed in AS 08.65 who provides the
same services. Indemnity may be provided under this
subsection only if the licensed midwife is practicing
as a licensed midwife within the scope of the license.
(d) If a health care insurance plan or an excepted
benefits policy or contract provides for furnishing
those services required of a physician in the care of
women during preconception, pregnancy childbirth and
the period after childbirth, and the period after
childbirth up to one year, the contract shall also
provide that a midwife licensed under AS 08.65 may
furnish those same services instead of a physician.
Services may be provided under this subsection only if
the licensed midwife is practicing as a licensed
midwife as a licensed midwife in accordance with the
regulations adopted under AS 08.65.030(a)(7), and the
services provided within the scope of practice of the
license.
2:44:57 PM
At ease
2:45:50 PM
CHAIR WILSON reconvened the meeting.
2:45:52 PM
MS. BOWMAN continued reading the sectional analysis for SB
192:
Section 31: Amends AS 21.84.335(b)(15) to add AS
21.42.355(a) and (b).
Section 32: Amends AS 25.20.055(a) to add licensed
midwives to the protocol that hospitals must follow to
assist a single parent and coupled parents regarding
their rights and responsibilities and the forms and
statements that must be filled out.
Section 33: Amends AS 25.20.055(b) to add licensed
midwives to the list of medical professionals who must
adhere to the same duties described in (a)(2) (6) of
this section or ensure that an agent performs those
duties.
Section 34: Amends AS 44.62.330(a)(36) to rename board
of certified direct entry to licensed midwives.
Section 35: Amends AS 47.07.900 to explain what
midwife services are for a licensed midwife.
Section 36: Amends AS 47.20.320(d) to add licensed
midwives in this section explaining who shall not be
criminally or civilly liable for providing information
in good faith to the department or its designee.
Section 37: Repeals AS 08.65.060, 08.65.070 and
08.65.090(b).
2:47:36 PM
Section 38: Amends uncodified law by adding a new
section that reads:
Transition: Continuation of Board. (a)
Notwithstanding AS 08.65.030, as amended by
sec 8 of this Act, the members of the Board of
Certified Direct-Entry Midwives, as that board
is constituted under AS 08.65.030 as that
section reads on December 31, 2022, shall
operate as the Board of Licensed Midwives from
January 1, 2023, until the new members of the
Board of the Licensed Midwives are appointed
by the governor un sec 39of this Act and
confirmed by the legislature under AS
08.65.010, as amended by secs. 6 and 7 of this
Act.
(b) in this section, "Board of Licensed Midwives"
means the Board of Licensed Midwives
established by AS 08.65.010 as amended by secs
6 and 7 of this Act.
Section 39: Amends uncodified law by adding a new
section that reads:
Transition: Current Direct Entry Midwives and
Apprentice Midwives. (a) Notwithstanding AS
08.65.050, as amended by sec 10 of this Act, a
person who holds on December 31, 2022, an unexpired
certificate to practice direct-entry midwifery
issued under AS 08.65.050, as that section reads on
December 31, 2022, is licensed on the effective date
of secs. 1 40 of this Act to practice midwifery
under AS 08.65, as amended by secs. 6 24 of this
Act, for a two - year period.
(b) Notwithstanding AS 08.65.090, as amended by sec 12
of this Act, a person who holds on December 31,
2022, an unexpired permit to practice as an
apprentice direct-entry midwife issued under AS
08.65.090, as that section reads on December 31,
2022, is permitted on the effective date of secs. 1
40 of this Act to practice as an apprentice
midwife under AS 08.65.090, as amended by sec. 12 of
this Act, for a two-year period.
2:50:21 PM
Section 40. The uncodified law of the State of Alaska
is amended by adding a new section that reads:
TRANSITION: NEW BOARD MEMBERS. (a) Within 60 days
after the effective date of secs. 1 40 of this
Act, the governor shall appoint an advanced practice
registered nurse licensed under AS 08.68 to be a
member of the board to replace the physician member
of the board for the remainder of the term of the
physician member.
2:50:53 PM
(b) Within 60 days after the effective date of secs. 1
40 of this Act, the governor shall appoint an
advanced practice registered nurse licensed under AS
08.68 to be a member of the board to replace the
certified nurse midwife member of the board for the
remainder of the term of the certified nurse midwife
member.
(c) The board, as constituted under (a) and (b) of
this section, shall begin operating as the board
when the legislature has confirmed the members
appointed under (a) and (b) of this section.
(d) In this section, "board" means the Board of
Licensed Midwives established by AS 08.65.010, as
amended by secs. 6 and 7 of this Act.
2:51:49 PM
Section 41. The uncodified law of the State of Alaska
is amended by adding a new section to read:
TRANSITION: REGULATIONS. The Board of Direct-Entry
Midwives established by AS 08.65.010, as that
section reads on December 31, 2022, shall adopt,
repeal, or amend regulations as necessary to
implement the changes made by secs. 1 40 of this
Act. The regulations take effect under AS 44.62
(Administrative Procedure Act), but not before
January 1, 2023.
Section 42. Reads "Section 41 of this Act takes effect
immediately under AS 01.10.070(c)."
Section 43. Reads "Except as provided in sec. 42 of
this Act, this Act takes effect January 1, 2023."
2:52:53 PM
CHAIR WILSON opened invited testimony on SB 192. He stated that
public testimony would be heard at a later date.
2:53:45 PM
RACHEL PUGH, Member, Board of Certified Direct-Entry Midwives,
Department of Commerce, Community and Economic Development,
Eagle River, Alaska, stated she strongly supports SB 192. She
said she was directly involved in writing the proposed statute
changes for over a year. The changes are necessary to comply
with state audit recommendations and eliminate many outdated
statutes that make it challenging to access midwifery care in
Alaska.
MS. PUGH related one issue: the lack of legal recognition and
insurance coverage for certified direct-entry midwives (CDMs)
and certified professional midwives (CPMs), based on current
statutes, is creating insurmountable financial barriers for
many.
MS. PUGH reported that a nationwide study revealed that only 3.4
percent of hospital births were paid out of pocket. In contrast,
67.9 percent of planned out-of-hospital births and 32.3 percent
of birth center births were self-pay. Seven and nine-tenths
percent of all births in Alaska are planned out of hospital
births, whereas the national average is 1.6 percent.
MS. PUGH stated that SB 192 would provide greater access to
midwifery. It would allow midwives to practice to the full
extent of their competencies and education and ensure that
Alaska midwives have nationally recognized credentials. They
would be paid the same rate as certified nurse midwives and
physicians for identical procedures. She said studies provide
clear evidence that midwifery care, birth center, and home birth
settings provide improved birth outcomes and are highly
effective at improving maternal and infant health.
MS. PUGH said not passing SB 192 limits freedom of medical
choice and available medical options to families in more than 35
states.
2:55:42 PM
MS. PUGH offered her view that the changes in SB 192 do not
endanger the health and safety of a single woman in Alaska. SB
192 would not affect how a midwife currently practices or the
type of care they provide. It would not limit or restrict women
from choosing their providers or where to give birth.
MS. PUGH emphasized that she was fighting for the rights of
women and families in Alaska to have more options and better
access to the type of maternity care that they deserve, not
less. She stated that witnessing women being denied medical
coverage for home births was frustrating. She said she was tired
of explaining to women that bureaucracy dictates their limited
maternity care in Alaska, but if they lived in many other
states, they would have more freedom in their medical choices.
2:56:36 PM
MS. PUGH said she was also tired of providing medical care for
free, such as postpartum care beyond six weeks, which she is
trained and licensed to provide. She highlighted that other
medical providers are reimbursed when providing these services.
However, due to the current statute, she cannot do so.
MS. PUGH highlighted another issue in Alaska: some women choose
to have an unassisted birth because Alaska's current statutes
and regulations prevent them from hiring a licensed midwife,
most often due to insurance coverage and financial barriers. She
stated SB 192 addresses a human rights issue. She urged members
to pass the bill as written.
2:57:56 PM
BETHEL BELISLE, Chair, Board of Certified Midwives, Department
of Commerce, Community and Economic Development, Anchorage,
Alaska, stated that she is a certified direct-entry midwife in
Alaska and a professional midwife, a nationally recognized
designation. She has been a midwife since 1999, with a home and
birth center practice. She related that she has served on the
board since 2020.
MS. BELISLE thanked Senator Kawasaki for introducing the bill to
preserve the rights of Alaska women to have access to safe, out-
of-hospital providers, high-quality care, and guaranteed
insurance coverage.
MS. BELISLE indicated that SB 192 resulted from a legislative
audit that began in 2016. The audit recommended that the Board
of Certified Direct-Entry Midwives pursue statutory changes that
benefit the public. However, due to a perceived financial
concern, the previous board did not make the recommended
changes. She said the 2020 audit noted, "The board identified a
need to change certification statutes to align Alaska's
midwifery laws with national standards."
2:59:24 PM
MS. BELISLE stated that the first legislative audit
recommendation indicated that the board identified a need to
change certification statutes to align Alaska's midwifery laws
with national standards. However, due to the legal costs
involved with the project, the board did not recommend statutory
changes.
MS. BELISLE stated she joined the board and became chair in
2020, and the board worked on that recommendation. The board
also reviewed the peer review process and fiscal responsibility.
The legislature passed a peer review bill in 2021. The board now
operates "in the black."
MS. BELISLE stated that SB 192 provides the final piece to
complete the 2020 audit recommendations because the bill would
align Alaska's law with national standards, which are currently
the Certified Professional Midwife Standards. SB 192 would
increase fiscal responsibility by requiring applicants to be
vetted by a national organization, thereby streamlining the
licensure process in Alaska.
MS. BELISLE listed numerous ways SB 192 will benefit midwives
and patient health. It would extend well-baby visits from four
weeks to six weeks, thus helping to reduce neonatal morbidity.
It would extend postpartum care to one year, reducing maternal
morbidity and mortality by having a trusted provider helping
with maternal mental health concerns and providing referrals as
needed. It would allow for preconception counseling, which could
increase the health of the next generation of Alaskans. She
offered her view that this bill would stand for women's rights
to choose where and with whom they feel most comfortable
birthing, knowing that their midwifery providers are trained to
national standards. She related that the bill would complete the
legislative audit and provide lower costs, including that
midwifery births have a 40 percent lower cesarean rate, fewer
low birthweight babies, and babies were 26 percent less likely
to be born prematurely. At a recent board meeting, the board
gave unanimous approval for SB 192. The board acknowledges that
change is hard but emphasizes the importance of protecting
public safety and abiding by the legislative audit. She urged
members to support SB 192.
3:01:27 PM
CHAIR WILSON held SB 192 in committee.
3:02:29 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 192 Sponsor Statement 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Supporting Doc Why We Need CPM 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Audit Recommendations DLA 6.19.2020.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 FN DCCED CBPL 2.25.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 FN DCCED IO 2.25.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Leg Legal Memo 1.18.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Leg Legal Memo 2.11.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 Letters 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 192 NARM letter of Support 3.23.21.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |
| SB 175 Sectional Analysis v. I 3.1.2022.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 Sponsor Statement v. I 3.1.2022.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 Explanation of Changes v. A-I 3.2.2022.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 v.I Work Draft 3.2.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 175 |
| SB 175 FN DOH MS 2.18.22.pdf |
SHSS 3/3/2022 1:30:00 PM |
SB 175 |
| SB 175 FN DOH BH 2.18.22.pdf |
SHSS 3/3/2022 1:30:00 PM |
SB 175 |
| SB 175 FN DOH HCS 2.18.22.pdf |
SHSS 3/3/2022 1:30:00 PM |
SB 175 |
| SB 175 FN DCCED 2.18.22.pdf |
SHSS 3/3/2022 1:30:00 PM |
SB 175 |
| SB 175 (HB 265) Letters 03.02.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HB 265 SB 175 |
| SB 192 Sectional Analysis 3.3.22.pdf |
SHSS 3/3/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
SB 192 |