Legislature(2017 - 2018)BELTZ 105 (TSBldg)
04/11/2017 01:30 PM Senate LABOR & COMMERCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB49 | |
| SCR10 | |
| SB85 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 49 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 85 | TELECONFERENCED | |
| += | SCR 10 | TELECONFERENCED | |
HB 49-EXTEND BOARD OF DIRECT-ENTRY MIDWIVES
1:31:59 PM
CHAIR COSTELLO announced the consideration of HB 49. She stated
that the intent is to hear from the sponsor, take questions and
public testimony, and hold the bill for further consideration.
[CSHB 49(FIN) was before the committee.]
1:32:19 PM
CRYSTAL KOENEMAN, Staff, Representative Sam Kito, Alaska State
Legislature, explained that HB 49 extends the Board of Direct-
Entry Midwives for six years, to 2023. Legislative Audit
recommended a four-year sunset extension and the House Finance
Committee recommended a six-year sunset. The sponsor is
comfortable with the finance recommendation with the
understanding that the board's deficit will be paid off. Also,
extending the audit the additional two years will reduce costs
to the state.
1:33:28 PM
KRIS CURTIS, Legislative Auditor, Division of Legislative Audit,
Legislative Agencies and Offices, stated that the division
conducted a sunset audit of the Board of Direct-Entry Midwives
to determine whether it is serving the public interest and
should be extended. The last sunset audit of this board was
conducted in 2014. At that time the division found that the
investigative staff of the Division of Corporations, Business
and Professional Licensing (DCBPL) was not actively pursuing
investigations. This posed a public safety risk and the board
was given a two-year extension. The 2016 audit found that the
board was serving the public interest and was effectively
licensing and regulating direct-entry midwives. A four-year
extension was recommended.
She said Legislative Audit made three recommendations in the
last audit.
Recommendation 1: The Division of Corporations, Business and
Professional Licensing, in consultation with the board, should
increase licensing fees to address the operating deficit.
Ms. Curtis noted that in 2014 the deficit was about $115,000 and
in 2016 the deficit had grown to just over $183,000. Fees were
increased during this time but were insufficient to cover the
board's operating costs.
Recommendation 2: The director of the Division of Corporations,
Business and Professional Licensing should take steps to ensure
that license records are accurate.
Ms. Curtis explained that audit test work found two errors. The
wrong license was listed as on probation in the online database,
and a consent agreement that the board had approved had the
wrong year listed.
Recommendation 3: The legislature should consider alternate
forms of regulating the midwifery profession.
She said this is an unusual recommendation that is made in light
of the rising deficit and the small number of licensees. To
address the deficit DCBPL management plans to increase licensing
fees significantly. By 2020 fees are expected to be about $4,000
for direct-entry midwives and about $2,000 for apprentice
midwives. Legislative Audit believes this fee structure poses a
barrier to entry into the profession and could result in a lower
number of midwives available to the public.
1:36:51 PM
CHAIR COSTELLO asked if this was the first time Legislative
Audit the legislature look at alternate forms of licensing a
profession.
MS. CURTIS said they have made that recommendation in the past
and have also recommended terminating due to a large deficit.
She directed attention to the Department of Commerce, Community
and Economic Development (DCCED) response on page 21 of the
audit. DCCED concurred with the first two recommendations and
had no position on the third recommendation but did acknowledge
that merging the board with a similar profession would improve
its fiscal situation. The board's response is on page 23. They
concur with recommendations 1 and 2, but strongly disagree with
recommendation 3. They point out that midwifery is a unique
profession and other boards would have difficulty regulating it.
The suggestion to combine with the Board of Nursing or the
Physician's Board would be problematic because those boards are
in direct competition with the CDM profession. They fear being
regulated out of practice and strongly believe that neither of
these boards would want midwives to have any role in regulating
their profession.
1:37:31 PM
SENATOR HUGHES joined the committee.
1:38:38 PM
CHAIR COSTELLO said she understands that similar suggestions
have not been successful.
1:38:59 PM
SENATOR STEVENS joined the committee.
CHAIR COSTELLO asked if it is unusual for a board to carry a
deficit for a decade, as this board has.
MS. CURTIS said she can't confirm that this board has been in
deficit for a decade, but prior audits indicate that licensing
fees have been a consistent problem. The board has also
experienced investigative costs.
CHAIR COSTELLO asked Ms. Chambers to comment on the audit and
anything else the committee should know.
1:40:47 PM
SARA CHAMBERS, Deputy Director, Division of Corporations,
Businesses and Professional Licensing, Department of Commerce,
Community and Economic Development (DCCED), Juneau, said the
division concurred with the first two recommendations and has
been working with the board to eliminate the deficit. Statute
requires all licensing programs to cover their expenses,
including investigations of unlicensed activity. This is a very
sensitive public health profession and their investigative and
legal costs are quite high relative to the number of licensees.
Licensing fees have been increased to about $3,800 to cover
costs going forward and to eliminate the debt.
CHAIR COSTELLO asked what the licensing fees are for nurses,
physicians and chiropractors.
MS. CHAMBERS said a physician's license is $300 a nurse's
license is $165, and a chiropractor's license is $450. The fees
generally reflect the number of people who support the overhead
and costs. Physicians and nurses have large boards whereas the
chiropractor board is smaller.
SENATOR GARDNER commented that if the board objects to being
merged with either the Board of Nursing or the State Medical
Board, it is deciding that its membership will pay the high
fees.
MS. CHAMBERS acknowledged the comment.
SENATOR HUGHES asked if there had been any conversations with
either the Board of Nursing or the State Medical Board. She
surmised that those boards wouldn't support the merge.
MS. CHAMBERS said there have been no formal conversations but
anecdotally the top concern is how the fees would be managed if
the program is bringing in a deficit. She added that it isn't
unprecedented for multiple professions to be housed under one
board.
1:45:52 PM
SENATOR MEYER joined the committee.
SENATOR GARDNER asked if the committee will hear from members of
the board.
CHAIR COSTELLO said yes.
1:46:22 PM
CHAIR COSTELLO opened public testimony on HB 49.
1:46:45 PM
JOHANNA CROSSEH, representing herself, said she is a direct-
entry midwife in Juneau who is testifying in support of HB 49.
She stated, "We like our board so much that we're willing to pay
the $3,800 licensing fee in an effort to get us out of this debt
situation we've gotten ourselves into."
CHAIR COSTELLO asked her to comment further on the board's
willingness to address the deficit within the current
membership.
MS. CROSSEH maintained that she and other midwives are willing
to pay the fees because they understand how unique their
profession is. Anecdotal reports from nurses and doctors
indicate a lack of support for merging with a board that is
operating in a deficit, she said.
CHAIR COSTELLO asked the cost of a home birth.
MS. CROSSEH said most midwives in Juneau charge $3,500 and
Medicaid pays about $1,200 for the same home birth.
CHAIR COSTELLO asked what a hospital birth costs.
MS. CROSSEH said she didn't have exact figures, but the midwife
option certainly saves the state money.
SENATOR GARDNER asked if there is an accredited program for
midwives in Alaska.
MS. CROSSEH said nothing is offered in-state but accredited
distance programs are available. The birth center where she
works in Juneau offers the internship portion of the accredited
training. Many birth centers and private midwives in Anchorage
also offer apprenticeships.
1:50:09 PM
MADI NOLAN GRIMES said she is a direct-entry midwife and the
director of a local birth center in Juneau who is speaking in
support of HB 49. She echoed Ms. Crosseh's comments that
midwives as a profession acknowledge that they are willing to
pay down their debt and will continue to pay the elevated fees.
SENATOR GARDNER asked if the $3,800 fee is a barrier to entry
for starting midwives.
MS. NOLAN GRIMES said the hope is that the licensing fees will
even out as the deficit is addressed.
1:51:57 PM
DEBORAH SCHNEIDER, Chair, Board of Direct-Entry Midwives,
Wasilla, said she is testifying in support of HB 49. She said
midwives have been licensed in Alaska for more than 20 years and
they have worked hard to provide good, safe care. The licensing
fees have fluctuated up and down over the years and the current
licensees are committed to paying down their deficit. The board
is also working with multiple state agencies to prevent
protracted and expensive investigations that the board has faced
in the past. The first two recommendations from the audit have
been addressed but the board does not agree with the third
recommendation to address the deficit by merging with another
board.
1:54:34 PM
SUSAN TERWILLIGER, President, Midwives Association of Alaska
said she is a certified direct-entry midwife who has an office
in Eagle River and does home births. She is speaking for the
membership in support HB 49. They agree to pay the high fees to
eliminate the deficit. The uniqueness of the profession
underscores the importance of this board overseeing the
midwifery profession and protecting public safety.
CHAIR COSTELLO asked if she knows the range of costs for a
hospital birth.
MS. TERWILLIGER said no, but the packets should have information
showing how much direct-entry midwives save the state in
Medicaid payments.
1:57:12 PM
At ease
1:57:28 PM
CHAIR COSTELLO reconvened the meeting and advised that the
document is online but not in the packets.
MS. TERWILLIGER read from the document she referenced. In 2015,
Medicaid payments per birth by CDNs was $1,168 and the Medicaid
payment for a low-risk hospital birth was $3,171.
CHAIR COSTELLO asked if midwives have adjusted their charges
based on their licensing fees.
MS. TERWILLIGER said no.
1:59:39 PM
CHAIR COSTELLO closed public testimony on HB 49 and held the
bill in committee for further review.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 49 - Background Document - MID Fee Analysis.pdf |
SL&C 4/11/2017 1:30:00 PM |
HB 49 |
| HB 49 - Fiscal Note.pdf |
SL&C 4/11/2017 1:30:00 PM |
HB 49 |
| HB 49 - Background Document - Leg. Audit Sunset.pdf |
SL&C 4/11/2017 1:30:00 PM |
HB 49 |
| HB 49 - Leg. Research - Board of Direct Entry Midwives.pdf |
SL&C 4/11/2017 1:30:00 PM |
HB 49 |
| HB 49 - Sponsor Statement.pdf |
SL&C 4/11/2017 1:30:00 PM |
HB 49 |
| HB 49.PDF |
SL&C 4/11/2017 1:30:00 PM |
HB 49 |
| CS SCR 10 (L&C) - Ver. O.PDF |
SL&C 4/11/2017 1:30:00 PM |
SCR 10 |