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 |
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.
| 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 |