Legislature(2023 - 2024)BARNES 124
03/13/2024 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB285 | |
| HB175 | |
| HB200 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 378 | TELECONFERENCED | |
| += | HB 200 | TELECONFERENCED | |
| += | HB 285 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| *+ | HB 271 | TELECONFERENCED | |
| += | HB 175 | TELECONFERENCED | |
HB 175-BOARD OF LICENSED MIDWIVES
3:49:42 PM
CHAIR SUMNER announced that the next order of business would be
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 175, "An Act relating to
midwives and the practice of midwifery; relating to apprentice
midwives; renaming the Board of Certified Direct-Entry Midwives
as the Board of Licensed Midwives; relating to the Board of
Licensed Midwives; extending the termination date of the Board
of Licensed Midwives; relating to insurance; and providing for
an effective date."
3:50:08 PM
REPRESENTATIVE PRAX moved to adopt Amendment 1 to SSHB 175,
labeled 33-LS0601\S.1, Gunther, 3/9/24, which read:
Page 1, line 4:
Delete "relating to insurance;"
Page 1, line 11, following "hospitals,":
Insert "and"
Page 1, line 12:
Delete ", and to guarantee insurance coverage for
home births"
Page 13, line 18, through page 14, line 14:
Delete all material.
Renumber the following bill sections accordingly.
Page 16, line 7:
Delete "sec. 44"
Insert "sec. 39"
Page 16, line 31:
Delete "sec. 42"
Insert "sec. 37"
Page 17, line 12:
Delete "6 - 42"
Insert "6 - 37"
Page 17, line 18:
Delete "Section 47"
Insert "Section 42"
Page 17, line 20:
Delete "secs. 48 and 49"
Insert "secs. 43 and 44"
REPRESENTATIVE FIELDS objected.
3:50:22 PM
The committee took a brief at-ease at 3:50 p.m.
3:51:44 PM
REPRESENTATIVE FIELDS asked how home births attended by
certified direct-entry midwives (CDM) are treated now under
insurance statutes and how that would change under Amendment 1.
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community, and Economic Development (DCCED), asked
whether Amendment 1 would delete "relating to insurance" from
the title of the bill.
3:52:43 PM
REPRESENTATIVE PRAX said Amendment 1 would delete page 13, line
8, through page 14, line 14, which would require insurance
companies that provide pregnancy related coverage to offer the
same coverage for midwifery services.
MS. WING-HEIER suspected that Amendment 1 would not be feasible
under the Affordable Care Act (ACA) because [the state] cannot
pick and choose which providers receive certain insurance
coverage. She offered to follow up with Representative Prax
after further research.
3:55:01 PM
REPRESENTATIVE RUFFRIDGE shared his understanding that the
purpose of Amendment 1 was to clean up the bill by removing
unnecessary language, as it's already understood that licensed
midwives would be covered if the healthcare insurer provided
coverage for the costs associated with childbirth.
REPRESENTATIVE ALLARD said part of the issue is that she
received letters from insurance companies stating, "if you put
it state statute, we will follow the law." Consequently, the
intent is to codify that language.
3:56:26 PM
REPRESENTATIVE CARRICK sought to confirm that the intent of
Amendment 1 is to provide, in statute, that insurance providers
are required to cover home births and midwife procedures.
3:57:00 PM
REPRESENTATIVE FIELDS sought to further understand what is
required under current law with respect to midwife services, and
how the bill, in addition to Amendment 1, would change that.
MS. WING-HEIER explained that home births are considered an
insured event. She emphasized that the services and location of
a delivery should not be debatable.
3:58:06 PM
REPRESENTATIVE PRAX shared his understanding that there were
statutory restrictions on the conditions under which a midwife
could provide home births, and SSHB 175 removes those
restrictions. He asked how that affected the insurance
companies' ability to calculate the (indisc.)
MS. WING-HEIER said Representative Prax was most likely
referring to when the ACA first required that certain
professions, including midwifery, be licensed.
REPRESENTATIVE PRAX directed attention to page 10, line 7, which
states that CDMs may not knowingly deliver a woman with certain
types of health conditions, prior history, or complications, as
specified by the Board of Certified Direct-Entry Midwives ("the
board"). He shared his belief that the bill would remove that
restriction.
MS. HEIER did not know the answer.
REPRESENTATIVE PRAX withdrew amendment 1.
4:01:38 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 2 to SSHB 175,
labeled 33-LS0601\S.2, Gunther, 3/11/24, which read:
Page 9, line 28, through page 10, line 1:
Delete "(1) [RECOMMEND, BEFORE CARE OR DELIVERY
OF A CLIENT, THAT THE CLIENT UNDERGO A PHYSICAL
EXAMINATION PERFORMED BY A PHYSICIAN, PHYSICIAN
ASSISTANT, OR ADVANCED PRACTICE REGISTERED NURSE WHO
IS LICENSED IN THIS STATE;
(2)]"
Insert "(1) recommend, before care or delivery
of a client, that the client undergo a physical
examination performed by a physician, physician
assistant, or advanced practice registered nurse who
is licensed in this state;
(2)"
Page 10, line 2:
Delete "(2) [(3)]"
Insert "(3)"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS explained that Amendment 2 would reverse
the deletion in statute that says a woman preparing to give
birth must have a visit with a physician, physician's assistant
(PA), or advanced practice registered nurse (APRN), prior to
delivery or care by a midwife to ensure that women are aware of
any pre-existing health conditions and how those might affect a
pregnancy.
4:02:46 PM
REPRESENTATIVE SADDLER asked whether the examination described
in Amendment 2 are covered by health. In addition, he inquired
as to the benefits of that examination and the risks of not
having it.
REPRESENTATIVE ALLARD said part of the benefit of having a
midwife is that they are there from start to finish and taking
that ability away from some women may be traumatizing. She
shared her understanding that midwives are licensed to perform
examinations and that if a pregnant woman does not have
insurance, requiring her to see an independent physician may
require her to cover the cost out of pocket, which the bill
seeks to avoid.
4:04:12 PM
REPRESENTATIVE FIELDS asked Ms. Wing-Heier whether these
procedures are covered by insurance.
MS. HEIER answered yes, if a woman has insurance, then the
procedures would be covered.
REPRESENTATIVE FIELDS noted that federally qualified health
centers can offer this kind of service on a sliding scale fee
for woman who are uninsured or lack sufficient income.
4:05:18 PM
REPRESENTATIVE PRAX said there are women who do want to avail
themselves to services provided by physician. He said he would
not be in favor of requiring a pre-checkup.
4:06:03 PM
REPRESENTATIVE RUFFRIDGE said that he would be interested to
know whether the national midwife examination requires a
physical medical examination component.
4:07:45 PM
RACHEL PUGH, Member, Board of Certified Direct-Entry Midwives,
said midwives are trained on preconception and "well women"
care, so the examinations can be done by a midwife.
4:08:01 PM
REPRESENTATIVE SADDLER said the law requires that a midwife
recommend an examination by an obstetrician-gynecologist (OB-
GYN) or APRN; however, it's not a requirement. He questioned
whether the examinations performed by nationally certified
midwives is sufficient and suggested that deference should be
given to the patient.
REPRESENTATIVE FIELDS agreed that it's not a requirement.
4:09:04 PM
REPRESENTATIVE RUFFRIDGE asked what Ms. Pugh would do if she
came across something serious during the examination and how she
would proceed with prenatal and delivery care.
MS. PUGH said through the examination and risk assessment tools,
women fall out of a midwife's scope of practice and require a
higher level of care.
4:09:58 PM
A roll call vote was taken. Representatives Fields, Saddler,
Carrick voted in favor of Amendment 2. Representatives
Ruffridge, Wright, Prax, and Sumner voted against it.
Therefore, Amendment 2 failed by a vote of 3-4.
4:10:51 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 3 to SSHB 175,
labeled 33-LS0601\S.3, Gunther, 3/11/24, which read:
Page 10, lines 6 - 9:
Delete "[;
(4) NOT KNOWINGLY DELIVER A WOMAN WITH
CERTAIN TYPES OF HEALTH CONDITIONS, PRIOR HISTORY, OR
COMPLICATIONS AS SPECIFIED BY THE BOARD]"
Insert ";
(3) [(4)] not knowingly deliver a woman
with certain types of health conditions, prior
history, or complications as specified by the board"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS explained that Amendment 3 would reverse a
recent regulatory deletion by the board that specified a list of
patient conditions, prior history, or complications for which
midwives should avoid delivering a baby. While the specific
conditions are not listed, the amendment would revert to the
status quo ante in state law and regulations, which states that
home births are appropriate for situations in which there are
not complications. Complications could include breach, twins,
or vaginal birth after a previous cesarean delivery. He noted
that he is a proponent of midwifery; however, in the event of
complications, it does not make sense to allow for home births
in statute.
REPRESENTATIVE PRAX said by removing this provision, the state
would be leaving the decision to the discretion of the mother
and the midwife.
4:12:59 PM
REPRESENTATIVE SADDLER opined that women should be able to seek
the care they want. With respect to individual autonomy, he
said he would oppose Amendment 3.
4:13:36 PM
REPRESENTATIVE RUFFRIDGE recalled that Ms. Pugh had stated that
women would be referred to a clinical environment if a problem
was found upon examination. He questioned the mechanism by
which that happens.
MS. PUGH stated that midwives may only operate within their
scope of practice, as outlined in state regulations, which match
the national standards.
REPRESENTATIVE RUFFRIDGE sought to confirm that removal of this
section would not change the regulation under which midwives
operate.
MS. PUGH confirmed that this section is redundant.
4:16:29 PM
REPRESENTATIVE WRIGHT asked for the bill sponsor's opinion on
Amendment 3.
REPRESENTATIVE ALLARD agreed with Ms. Pugh.
4:16:56 PM
REPRESENTATIVE PRAX shared his belief that midwives know their
limitations. He expressed his opposition to Amendment 3 due to
its redundancy.
4:18:03 PM
A roll call vote was taken. Representative Fields voted in
favor of Amendment 3. Representatives Prax, Ruffridge, Saddler,
Wright, Carrick, and Sumner voted against it. Therefore,
Amendment 3 failed by a vote of 1-6.
4:18:39 PM
REPRESENTATIVE FIELDS said he would not be offering Amendment 4.
4:18:47 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 5 to SSHB 175,
labeled 33-LS0601\S.5, Gunther, 3/12/24, which read:
Page 5, lines 2 - 3:
Delete "[APPROVE CURRICULA AND ADOPT STANDARDS FOR BASIC
EDUCATION, TRAINING, AND APPRENTICE PROGRAMS"
Insert "approve curricula and adopt standards for basic
education, training, and apprentice programs"
Page 5, line 4:
Delete "PROVIDE"
Insert "[PROVIDE"
Page 5, lines 7 - 10:
Delete "(9) APPROVE EDUCATION, TRAINING, AND
APPRENTICE PROGRAMS THAT MEET THE REQUIREMENTS OF THIS
CHAPTER AND OF THE BOARD, AND DENY, REVOKE, OR SUSPEND
APPROVAL OF THOSE PROGRAMS FOR FAILURE TO MEET THE
REQUIREMENTS"
Insert "(9)] approve education, training, and
apprentice programs that meet the requirements of this
chapter and of the board, and deny, revoke, or suspend
approval of those programs for failure to meet the
requirements"
Page 5, line 11:
Delete "(10)]"
Insert "(9) [(10)]"
Page 14, line 9:
Delete "AS 08.65.030(a)(7)"
Insert "AS 08.65.030(a)(9)"
Page 15, line 30:
Delete ", 08.65.070, and 08.65.090(b)"
Insert "and 08.65.070"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS said Amendment 5 would restore the
components of the current apprenticeship program for new
midwives; reverses the deletion of the board's authority to
approve education, protocol, and standards for continuing
education in apprenticeship programs. The proposed amendment
would further allow mentors to be experienced midwives, OB-GYNs,
or certified nurse midwives.
4:20:01 PM
REPRESENTATIVE ALLARD, in response to Representative Saddler,
asked Ms. Pugh to speak to Amendment 5.
4:20:37 PM
MS. PUGH explained that education standards are qualified by the
national certifying organization, not the state board. In order
to receive a state license, midwives are required to receive a
CPM credential. She said the board used to dictate which
education pathways are accessible for an Alaska license, but now
national standards of education are used.
4:23:37 PM
REPRESENTATIVE FIELDS said Amendment 5 would maintain the
board's authority to follow the national standards or implement
higher standards.
4:24:05 PM
REPRESENTATIVE SADDLER shared his understanding that the purpose
of the bill is to have midwifery in Alaska governed according to
the North American Registry of Midwives (NARM). He said he
would defer to the intent of the bill and oppose Amendment 5.
4:24:45 PM
A roll call vote was taken. Representative Fields voted in
favor of Amendment 5. Representatives Carrick, Prax, Ruffridge,
Saddler, Wright, and Sumner voted against it. Therefore,
Amendment 5 failed by a vote of 1-6.
4:25:15 PM
REPRESENTATIVE FIELDS move to adopt Amendment 6 to SSHB 175,
labeled 33-LS0601\S.6, Gunther, 3/12/24, which read:
Page 5, line 19:
Delete "or diploma"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS explained that Amendment 6 would delete
"or diploma" from the section that says the board may not adopt
a regulation that requires a person to have nursing degree or
diploma to be licensed under this chapter. He pointed out that
previous regulations required a minimum of a high school diploma
for certification of certified CDMs and opined that a high
school diploma is not an onerous requirement for a medical
professional.
4:26:17 PM
REPRESENTATIVE SADDLER asked the bill sponsor to speak to
Amendment 6.
REPRESENTATIVE ALLARD said many people who do not have high
school diplomas go to college and become successful. She opined
that individuals who want to further their career later I life
should not be punished.
4:27:05 PM
REPRESENTATIVE CARRICK asked whether a diploma includes a GED.
REPRESENTATIVE FIELDS answered yes.
4:27:24 PM
REPRESENTATIVE FIELDS, in response to a question from
Representative Saddler, clarified that should Amendment 6 pass,
a high school diploma or GED would be "the floor."
REPRESENTATIVE SADDLER asked Ms. Pugh to specify difference
between a nursing degree and a nursing diploma.
MS. PUGH said a nursing degree is obtained by someone who goes
to college and becomes a registered nurse, and a diploma could
be received by a certified nursing assistant (CNA). She said
the section in question refers to a nursing degree or diploma,
not a high school degree.
4:30:23 PM
REPRESENTATIVE RUFFRIDGE it seems that the word "diploma" may be
duplicitous if it refers to a nursing diploma. For that reason,
he said he would be supporting the proposed amendment.
4:30:59 PM
REPRESENTATIVE FIELDS clarified that Amendment 6 would restore
the status quo ante, or "floor," for a high school diploma or
equivalent. He said it would not require a nursing degree, as
the whole point of a certified CDM program is to become a
midwife by apprenticeship.
4:31:25 PM
REPRESENTATIVE SADDLER shared his understanding that "diploma,"
as stated on page 5, line 19, does not refer to a high school
diploma. Instead, per Ms. Pugh's testimony, he said "diploma"
refers to a nursing diploma.
4:31:58 PM
REPRESENTATIVE FIELDS clarified that a CNA is a short-term
certificate, not a two-year degree.
4:32:20 PM
REPRESENTATIVE ALLARD shared her understanding that "diploma"
refers to a nursing diploma.
4:33:10 PM
REPRESENTATIVE CARRICK echoed her support for Amendment 6. She
agreed that the bill language is unclear as to whether "diploma"
refers to a nursing diploma or high school diploma.
CHAIR SUMNER opined that "degree or diploma" referred to
nursing.
4:34:29 PM
REPRESENTATIVE SADDLER moved to adopt Conceptual Amendment 1 to
Amendment 6 to insert "nursing" after the word "or" on page 5
line 19.
REPRESENTATIVE CARRICK objected. She said she is unclear as to
the definition of "nursing diploma."
4:35:47 PM
MS. PUGH, in response to a series of questions by Representative
Prax, agreed that the bill is focused on passing the nationally
certified course. She confirmed that a high school diploma or
equivalent is required by NARM.
REPRESENTATIVE PRAX shared his understanding that the concern
about requiring a high school diploma is already addressed.
MS. PUGH agreed.
4:37:05 PM
REPRESENTATIVE SADDLER asked Ms. Pugh to offer further
clarification.
MS. PUGH defined a diploma in nursing as "an entry level nursing
credential" that requires two to three years of training prior
to graduation. She reiterated that the language on page 5, line
19 refers to a nursing diploma.
4:38:13 PM
A roll call vote was taken. Representatives Fields, Ruffridge,
Saddler, Wright, Carrick, Prax, and Sumner voted in favor of
Conceptual Amendment 1 to Amendment 6. No members voted against
it. Therefore, Conceptual Amendment 1 to Amendment 6 passed by
a vote of 7-0.
4:39:04 PM
A roll call vote was taken. Representatives Wright, Carrick,
Fields, Ruffridge, Saddler, Sumner voted in favor of Amendment
6, as amended. Representatives Prax voted against it.
Therefore, Amendment 6, as amended, passed by a vote of 6-1.
4:39:53 PM
The committee took an at-ease from 4:39 p.m. to 4:43 p.m.
4:43:03 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 7 to SSHB 175,
labeled 33-LS0601\S.8, Gunther, 3/13/24, which read:
Page 4, line 10:
Delete "four"
Insert "three"
Page 4, lines 12 - 16:
Delete "[, ONE PHYSICIAN LICENSED BY THE STATE
MEDICAL BOARD IN THIS STATE WHO HAS AN OBSTETRICAL
PRACTICE OR HAS SPECIALIZED TRAINING IN OBSTETRICS,
ONE CERTIFIED NURSE MIDWIFE LICENSED BY THE BOARD OF
NURSING IN THIS STATE,]"
Insert ", one member who is either a physician
licensed by the State Medical Board in this state who
has an obstetrical practice or has specialized
training in obstetrics or a [, ONE] certified nurse
midwife licensed by the Board of Nursing in this
state,"
Page 16, line 4:
Delete "reads"
Insert "read"
Page 16, lines 5 - 8:
Delete "shall operate as the Board of Licensed
Midwives, established by AS 08.65.010, as amended by
secs. 7 and 8 of this Act, from September 1, 2023,
until the new members of the Board of Licensed
Midwives are appointed by the governor under sec. 44
of this Act and confirmed by the legislature under
AS 08.65.010(b), as amended by sec. 8 of this Act"
Insert "shall continue to serve on the Board of
Licensed Midwives, established by AS 08.65.010, as
amended by secs. 7 and 8 of this Act, for the
remainder of the member's term under AS 08.65.010(b),
as that section read on August 31, 2023, and until a
successor is appointed and confirmed under
AS 08.65.010(b), as amended by sec. 8 of this Act"
Page 16, lines 9 - 22:
Delete all material.
Renumber the following bill sections accordingly.
Page 17, line 18:
Delete "Section 47"
Insert "Section 46"
Page 17, line 20:
Delete "secs. 48 and 49"
Insert "secs. 47 and 48"
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE FIELDS explained that Amendment 7 would change
the board requirements to one member who is either a state
licensed physician who has an obstetrical practice or
specialized training in obstetrics, or a certified nurse midwife
licensed by the Board of Nursing. He said he had worked on the
amendment with Ms. Pugh and deferred to her for further comment.
4:43:45 PM
MS. PUGH said she believed Amendment 7 would be an acceptable
change.
4:44:28 PM
REPRESENTATIVE WRIGHT asked to hear from Representative Allard
on Amendment 7.
REPRESENTATIVE ALLARD said she found the proposed amendment to
be a friendly one.
4:44:52 PM
REPRESENTATIVE SADDLER shared his understanding that Amendment 7
would shorten the board members' term from four years to three
years. He questioned the effect of that change.
REPRESENTATIVE FIELDS clarified that "three to four" references
the number of board members not the length of the term.
4:46:10 PM
REPRESENTATIVE WRIGHT remove objection. There being no further
objection, Amendment 7 was adopted.
4:46:21 PM
REPRESENTATIVE SADDLER directed attention to page 4, lines 9-10,
of the bill, which addressed the term length. He reiterated
that Amendment 7 would indeed change the length of terms from
four years to three years.
4:46:53 PM
REPRESENTATIVE FIELDS pointed out that "line 10" on page 1 of
Amendment 7 should be "line 11," otherwise, the intent of the
amendment is clear. He suggested that given the authority to
make technical and conforming changes, Legislative Legal Service
could clean up the language.
4:47:35 PM
REPRESENTATIVE RUFFRIDGE moved to report to SSHB 175, as
amended, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, CSSSHB
175(L&C) was reported from the House Labor and Commerce Standing
Committee.