03/13/2024 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB285 | |
| HB175 | |
| HB200 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 378 | TELECONFERENCED | |
| += | HB 200 | TELECONFERENCED | |
| += | HB 285 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| *+ | HB 271 | TELECONFERENCED | |
| += | HB 175 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
March 13, 2024
3:19 p.m.
MEMBERS PRESENT
Representative Jesse Sumner, Chair
Representative Justin Ruffridge, Vice Chair
Representative Mike Prax
Representative Dan Saddler
Representative Stanley Wright
Representative Ashley Carrick
Representative Zack Fields
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 285
"An Act relating to insurance; relating to mammograms; and
providing for an effective date."
- HEARD & HELD
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."
- MOVED CSSSHB 175(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 200
"An Act relating to pull-tabs; relating to persons prohibited
from involvement in gaming; and relating to the duties of the
Department of Revenue."
- HEARD & HELD
HOUSE BILL NO. 378
"An Act relating to theft; relating to organized retail theft;
establishing a statewide marketplace facilitator sales tax;
establishing the organized retail theft fund in the general
fund; and providing for an effective date."
- BILL HEARING RESCHEDULED TO 3/15/24
Presentation: Pacific Health Coalition
- HEARING POSTPONED TO 3/18/24
HOUSE BILL NO. 271
"An Act relating to social media and minors; and providing for
an effective date."
- BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: HB 285
SHORT TITLE: MAMMOGRAMS: INSURANCE COVERAGE
SPONSOR(s): REPRESENTATIVE(s) FIELDS
01/22/24 (H) READ THE FIRST TIME - REFERRALS
01/22/24 (H) HSS, FIN
01/29/24 (H) L&C REFERRAL ADDED AFTER HSS
01/29/24 (H) BILL REPRINTED
02/14/24 (H) HSS REFERRAL MOVED TO AFTER L&C
02/21/24 (H) L&C AT 3:15 PM BARNES 124
02/21/24 (H) -- MEETING CANCELED --
02/28/24 (H) L&C AT 3:15 PM BARNES 124
02/28/24 (H) -- MEETING CANCELED --
03/04/24 (H) L&C AT 3:15 PM BARNES 124
03/04/24 (H) Heard & Held
03/04/24 (H) MINUTE(L&C)
03/13/24 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 175
SHORT TITLE: BOARD OF LICENSED MIDWIVES
SPONSOR(s): REPRESENTATIVE(s) ALLARD
04/24/23 (H) READ THE FIRST TIME - REFERRALS
04/24/23 (H) L&C, FIN
04/26/23 (H) SPONSOR SUBSTITUTE INTRODUCED
04/26/23 (H) READ THE FIRST TIME - REFERRALS
04/26/23 (H) L&C, FIN
02/21/24 (H) L&C AT 3:15 PM BARNES 124
02/21/24 (H) -- MEETING CANCELED --
02/23/24 (H) L&C AT 3:15 PM BARNES 124
02/23/24 (H) Scheduled but Not Heard
03/08/24 (H) L&C AT 3:15 PM BARNES 124
03/08/24 (H) Heard & Held
03/08/24 (H) MINUTE(L&C)
03/11/24 (H) L&C AT 3:15 PM BARNES 124
03/11/24 (H) Heard & Held
03/11/24 (H) MINUTE(L&C)
03/13/24 (H) L&C AT 3:15 PM BARNES 124
BILL: HB 200
SHORT TITLE: GAMING; ELECTRONIC PULL-TABS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
05/10/23 (H) READ THE FIRST TIME - REFERRALS
05/10/23 (H) L&C, FIN
02/09/24 (H) L&C AT 3:15 PM BARNES 124
02/09/24 (H) -- MEETING CANCELED --
02/12/24 (H) L&C AT 3:15 PM BARNES 124
02/12/24 (H) Heard & Held
02/12/24 (H) MINUTE(L&C)
02/16/24 (H) L&C AT 3:15 PM BARNES 124
02/16/24 (H) -- MEETING CANCELED --
02/26/24 (H) L&C AT 3:15 PM BARNES 124
02/26/24 (H) Heard & Held
02/26/24 (H) MINUTE(L&C)
03/13/24 (H) L&C AT 3:15 PM BARNES 124
WITNESS REGISTER
EMILY NEIMAN, Alaska Government Relations Director
American Cancer Society Cancer Action Network
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 285.
DOROTHY MCGRATH, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 285.
JESSICA IVANOFF, representing self
Nome, Alaska
POSITION STATEMENT: Testified in support of HB 285.
LOIS EPSTEIN, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 285.
DON ENSLOW, Volunteer
Providence Alaska Hospital
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 285.
PENNY PALMQUIST, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 285.
BECKY ZAVERL, representing self
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 285.
KELLY MARRE, representing self
Soldotna, Alaska
POSITION STATEMENT: Testified in support of HB 285.
REBECCA LIBAL, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 285.
PAM VENTGEN, Executive Director
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of 285.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on
SSHB 175.
RACHEL PUGH, Member
Board of Certified Direct-Entry Midwives
Eagle River, Alaska
POSITION STATEMENT: Answered questions during the hearing on
SSHB 175.
ACTION NARRATIVE
3:19:50 PM
CHAIR JESSE SUMNER called the House Labor and Commerce Standing
Committee meeting to order at 3:19 p.m. Representatives
Saddler, Prax, Wright, Carrick, Fields, and Sumner were present
at the call to order. Representative Ruffridge arrived as the
meeting was in progress.
HB 285-MAMMOGRAMS: INSURANCE COVERAGE
3:20:53 PM
CHAIR SUMNER announced that the first order of business would be
HOUSE BILL NO. 285, "An Act relating to insurance; relating to
mammograms; and providing for an effective date."
3:21:14 PM
CHAIR SUMNER opened public testimony on HB 285.
3:21:36 PM
EMILY NEIMAN, Alaska Government Relations Director, American
Cancer Society Cancer Action Network, testified in support of HB
285. She provided the committee with historical context on the
issue and shard information on what constitutes increased risk
[for breast cancer]. She added that even though the bill would
only affect a small percentage of insured plans in Alaska, the
other insured plans have followed precedent.
3:25:09 PM
DOROTHY MCGRATH, representing self, testified in support of HB
285. She shared that she and her mother are cancer survivors
and described their experience receiving scans. She urged the
committee to pass the bill to ensure that this life saving,
early detection measure is fully covered to keep families from
having to decide on getting a potentially life-saving scan given
the high cost.
3:27:13 PM
JESSICA IVANOFF, representing self, testified in support of HB
285, given the high cost of medical care. She said she wants
everyone to live as long as possible and to take preventative
measures.
3:28:10 PM
LOIS EPSTEIN, representing self, testified in support of HB 285.
She shared a personal anecdote about the cost of additional
diagnostic scans. She said she should not be penalized due to
the characteristics of her body that cause her to require
additional imaging, or issues with the imaging center where her
mammography is performed.
3:30:34 PM
DON ENSLOW, Volunteer, Providence Alaska Hospital, testified in
support of HB 285. He said HB 285 would eliminate the cost
sharing for diagnostic imaging procedures for breast cancer,
which are critical. Although mammogram screenings are free
under federal law, additional imaging tests are not included in
that. He urged the committee to consider passing the bill
because early screening and diagnostic tests are critical for
patients, specifically those at high risk.
3:33:10 PM
PENNY PALMQUIST, representing self, testified in support of HB
285. She shared that she is a cancer survivor, and due to her
high-risk factors, she requires additional screenings every
year. She urged passage of the legislation.
3:34:27 PM
BECKY ZAVERL, representing self, testified in support of HB 285
as a three-time cancer survivor. She stressed the importance of
diagnostic screening and shared her story. She said cancer
makes a person feel out of control, and that screenings and
knowledge become power. She explained that eliminating cost
sharing would provide more equal access to care and ensure a
timelier diagnosis of breast cancer, improving the health
outcomes for those diagnosed with breast cancer and reducing
overall costs to the healthcare system. She urged the committee
to move any roadblocks to keep families and loved ones healthy.
3:38:48 PM
KELLY MARRE, representing self, testified in support of HB 285.
As an oncology social worker, she discussed the high cost of
follow-up screenings. She reported that cancer patients are
refusing to receive breast MRIs and diagnostic tests because
they can't afford it. She urged the committee to support the
bill because it would help people live longer.
3:41:15 PM
REBECCA LIBAL, representing self, testified in support of HB
285. She detailed the importance of annual imaging with
screening mammography and contrast enhanced breast MRIs for
women at high risk for breast cancer. She said the out-of-
pocket costs for such exams can be prohibitive, leading to
patients declining the tests due to financial burden. She
thanked members for hearing HB 285, which would help save the
lives of Alaskan women and decrease the financial burden to
society with early detection.
3:43:54 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, testified during the hearing on HB 285. She said a
fellow board member relayed the following concerns about the
bill: firstly, the diagnostic imaging after an abnormal
screening should be covered by insurance and easier to afford;
secondly, the supplemental breast exam for risk factors. She
explained that the goal of supplemental screening is to catch
cancer early, and in addition to an increased survival rate,
early detection could decrease treatment costs because the more
advanced surgeries and treatments may not be needed. She
reiterated the Alaska State Medical Association's support for
the bill.
3:49:23 PM
CHAIR SUMNER closed public testimony on HB 285 and announced
that the bill would be held over.
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.
4:48:06 PM
The committee took an at-ease from 4:48 p.m. to 5:51 p.m.
HB 200-GAMING; ELECTRONIC PULL-TABS
4:51:09 PM
CHAIR SUMNER announced that the final order of business would be
HOUSE BILL NO. 200, "An Act relating to pull-tabs; relating to
persons prohibited from involvement in gaming; and relating to
the duties of the Department of Revenue." [Before the
committee, adopted as the working document on 2/12/24, was the
proposed committee substitute (CS) for HB 200, Version 33-
GH1054\S, Wallace, 2/8/24 ("Version S").]
The committee took an at-ease at 4:51 p.m.
4:51:16 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 1 to Version
S, labeled 33-GH1054\S.2, Wallace, 3/8/24, which read:
Page 2, following line 3:
Insert a new bill section to read:
"* Sec. 3. AS 05.15.115(b) is amended to read:
(b) The contract between an authorizing
permittee and an operator must include the amount and
form of compensation to be paid to the operator, the
term of the contract, the activities to be conducted
by the operator on behalf of the permittee, the
location where the activities are to be conducted, the
name and address of the member in charge, and other
provisions the department may require. A contract
between an authorizing permittee and an operator may
allow the operator to pool permittees and divide the
gaming income and payouts among permittees on a
percentage basis. A contract for paper pull-tabs must
require the operator to pay an authorizing permittee a
minimum of 30 percent of the ideal net. A contract for
electronic pull-tabs must require the operator to pay
an authorizing permittee a minimum of 30 percent of
the gross receipts minus prize payouts monthly."
Renumber the following bill sections accordingly.
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE RUFFRIDGE explained that Amendment 1 is intended
to set a minimum of 30 percent of adjusted gross income (AGI).
He said it would be helpful to put side boards on some of the
payments that are associated with these processes.
4:52:03 PM
REPRESENTATIVE RUFFRIDGE moved Conceptual Amendment 1 to
Amendment 1, which would delete "ideal net" and insert "adjusted
gross income" on page 1, line 12, and delete "gross receipts
minus prize payouts monthly" and insert "adjusted gross income"
on lines 14 and 15.
REPRESENTATIVE PRAX objected. He shared his understanding that
"ideal net" means something specific to the industry. He said
he did not understand AGI as it applies to pool tabs.
REPRESENTATIVE RUFFRIDGE explained that ideal net is only
functional once the entire batch of game has been sold.
Alternatively, electronic pool tabs are purchased by the play
and in many cases, operators could be taking a "massive hit"
with the term "ideal net."
REPRESENTATIVE PRAX shared his understanding that the risk of
not selling the whole batch of pool tabs was borne by the
operator rather than the permittee.
4:55:22 PM
A roll call vote was taken. Representatives Saddler, Wright,
Carrick, Fields, Ruffridge, and Sumner voted in favor of
Conceptual Amendment 1 to Amendment 1. Representative Prax
voted against it. Therefore, Conceptual Amendment 1 to
Amendment 1 passed by a vote of 6-1.
4:56:01 PM
A roll call vote was taken. Representatives Ruffridge, Saddler,
Wright, Carrick, Fields, and Sumner voted in favor of Amendment
1, as conceptually amended. Representative Prax voted against
it. Therefore, Amendment 1, as amended, passed by a vote of 6-
1.
4:56:35 PM
REPRESENTATIVE RUFFRIDGE move to adopt Amendment 2 to Version S,
labeled 33-GH1054\S.3, Wallace, 3/8/24, which read:
Page 5, following line 23:
Insert a new subsection to read:
"(i) A pull-tab manufacturer or an agent of a
manufacturer may not provide to a vendor, operator,
permittee, distributor, municipality, or qualified
organization compensation or a gift, gratuity,
premium, or other thing of value in an amount greater
than $25 annually, including the value of a gift,
gratuity, premium or other thing of value provided to
an individual employee or agent of the vendor,
operator, permittee, distributor, municipality, or
qualified organization."
Reletter the following subsections accordingly.
Page 6, following line 23:
Insert a new subsection to read:
"(g) A distributor may not provide to an
employee or agent of a licensed vendor, operator,
permittee, municipality, or qualified organization
compensation or a gift, gratuity, premium, or other
thing of value in an amount greater than $25 annually,
including the value of a gift, gratuity, premium, or
other thing of value provided to an individual
employee or agent of the vendor, operator, permittee,
municipality, or qualified organization."
Reletter the following subsection accordingly.
REPRESENTATIVE WRIGHT objected.
REPRESENTATIVE RUFFRIDGE explained that Amendment 2 follows up
on concerns regarding manufacturers that may use a kickback or
rebate in order to incentivize vendors, operators, or permittees
to utilize their program. He opined that leveling the playing
field by making kickbacks of more than $25 annually illegal
would be a good sideboard on electronic pool tabs.
4:58:08 PM
REPRESENTATIVE SADDLER expressed concern about the use of the
term "kickback" and its potentially negative connotation.
Nonetheless, he opined that Amendment 2 would provide reasonable
reassurance to the public that there's no extra rebate.
4:59:02 PM
REPRESENTATIVE WRIGHT removed his objection. There being no
further objection, Amendment 2 was adopted.
4:59:12 PM
CHAIR SUMNER announced that Version S, as amended, would be held
over.
4:59:21 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
4:59 p.m.