Legislature(2017 - 2018)HOUSE FINANCE 519

03/06/2017 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 49 EXTEND BOARD OF DIRECT-ENTRY MIDWIVES TELECONFERENCED
Heard & Held
+ HB 56 COMMERCIAL FISHING LOANS TELECONFERENCED
Heard & Held
+ HB 81 AK ENERGY EFFICIENCY LOANS: ELIGIBILITY TELECONFERENCED
Heard & Held
+ HB 106 CIVIL LEGAL SERVICES FUND TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
HOUSE BILL NO. 49                                                                                                             
                                                                                                                                
     "An Act extending the termination date of the Board of                                                                     
     Certified Direct-Entry Midwives; and providing for an                                                                      
     effective date."                                                                                                           
                                                                                                                                
2:48:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SAM KITO,  SPONSOR,  introduced himself  and                                                                    
the bill.                                                                                                                       
CRYSTAL KOENEMAN, STAFF, REPRESENTATIVE SAM KITO, shared                                                                        
the sponsor's statement (copy on file):                                                                                         
                                                                                                                                
     House  Bill 49  extends  the termination  date for  the                                                                    
     Board  of Certified  Direct-Entry  Midwives until  June                                                                    
     30, 2021.                                                                                                                  
                                                                                                                                
     Legislative Audit conducted their  review of this board                                                                    
     and determined that "The board  is serving the public's                                                                    
     interest  by   effectively  licensing   and  regulating                                                                    
     certified   direct-entry    midwives   and   apprentice                                                                    
     midwives.  The board  monitors licensees  and works  to                                                                    
     ensure    only    qualified    individuals    practice.                                                                    
     Furthermore,  the board  adopts regulations  to improve                                                                    
     the  practice  of  midwifery.  In  accordance  with  AS                                                                    
     08.03.010(c)(8),  the board  is scheduled  to terminate                                                                    
     on  June 30,  2017. We  recommend that  the legislature                                                                    
     extend the board's termination date to June 30, 2021."                                                                     
                                                                                                                                
     The board  currently oversees  52 active  licensees and                                                                    
     is  composed of  five  members:  two certified  direct-                                                                    
     entry  midwives, one  physician licensed  by the  State                                                                    
     Medical Board, one certified  nurse midwife licensed by                                                                    
     the Board of Nursing, and one public member.                                                                               
                                                                                                                                
     The continuation of the Board of Certified Direct-                                                                         
     Entry Midwives  is important to  the health  and safety                                                                    
     of  Alaska's  women  and  children,  as  it  serves  an                                                                    
     important   role  in   protecting  the   well-being  of                                                                    
     Alaskans by identifying individuals  who are willing to                                                                    
     pursue technical training  and meet specified technical                                                                    
     qualifications  necessary  for   license  as  midwives.                                                                    
     Thank you for your support of House Bill 49.                                                                               
                                                                                                                                
2:50:18 PM                                                                                                                    
Co-Chair Foster noted there were individuals available for                                                                      
questions.                                                                                                                      
                                                                                                                                
Representative Wilson queried the cost of the audit,                                                                            
relative to the size of the group the board oversaw. She                                                                        
wondered whether the board paid for the audit.                                                                                  
                                                                                                                                
Representative Kito deferred the question to the division.                                                                      
He answered that the four-year extension had been                                                                               
recommended by the division.                                                                                                    
                                                                                                                                
Co-Chair Foster  recognized that Vice-Chair Gara  had joined                                                                    
the meeting.                                                                                                                    
                                                                                                                                
Co-Chair Seaton  noted the fee  increase of 169  percent and                                                                    
the one-time surcharge of $2000.                                                                                                
                                                                                                                                
Representative  Kito explained  that  the audit  recommended                                                                    
that licensing  fees should be  increased to cover  the cost                                                                    
of board operations.                                                                                                            
                                                                                                                                
2:52:42 PM                                                                                                                    
                                                                                                                                
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE AUDIT, testified that  the previous sunset audit                                                                    
conducted on the  board had been in 2014, and  at that point                                                                    
the  division  found  that  the  Division  of  Corporations,                                                                    
Businesses and Professional  Licensing (DCBPL) investigative                                                                    
staff had  not been actively processing  investigations that                                                                    
posed a public safety risk. She  said that at that point the                                                                    
board was extended only 2  years; the division had conducted                                                                    
a  2016 follow-up  sunset review.  The  latest review  found                                                                    
that  the  board is  serving  in  the public's  interest  by                                                                    
effectively licensing and  regulating certified direct-entry                                                                    
midwives (CDM) and apprentice midwives.  She stated that the                                                                    
division  recommended   that  the  legislature   extend  the                                                                    
board's  termination date  to June  30,  2021, provided  the                                                                    
board  execute  the   following  recommendations  [from  the                                                                    
Performance Audit  of the Department of  Commerce, Community                                                                    
and Economic  Development, State Board of  Certified Direct-                                                                    
Entry Midwives (board) April 30, 2016(copy on file)]:                                                                           
                                                                                                                                
     Recommendation  1:  DCBPL management,  in  consultation                                                                  
     with  the  board,  should increase  licensing  fees  to                                                                  
     eliminate the board's operating deficit.                                                                                 
                                                                                                                              
     High  regulatory costs  relative to  the low  number of                                                                    
     licensees  has  led to  high  license  fees. The  board                                                                    
     primarily  receives   its  revenue  from   license  and                                                                    
     renewal  fees. Renewals  are  conducted  on a  biennial                                                                    
     basis,  creating a  two-year cycle  in board  revenues.                                                                    
     Fee levels were  increased in FY 15, but  fees were not                                                                    
     high  enough  to cover  operating  costs.  As shown  in                                                                    
     Exhibit 3, the  board's deficit grew to  $183,081 as of                                                                    
     February  29, 2016,  the second  year  of its  biennial                                                                    
     licensing period (see Recommendation 1.)                                                                                   
                                                                                                                                
     Recommendation 2: The DCBPL  director should take steps                                                                  
    to ensure license records are accurately recorded.                                                                        
                                                                                                                                
     Audit test  work identified  two instances  where DCBPL                                                                    
     staff provided  insufficient support  to the  board. In                                                                    
     one instance,  division staff  noted the  wrong license                                                                    
     as on  probation in the  online licensing  database. In                                                                    
     another instance,  a consent agreement approved  by the                                                                    
     board had  the wrong year.  Both instances were  due to                                                                    
     administrative error by DCBPL staff.                                                                                       
                                                                                                                                
     Recommendation  3:  The   legislature  should  consider                                                                  
     alternate   forms    of   regulating    the   midwifery                                                                  
     profession.                                                                                                              
                                                                                                                                
     In order  to address the deficit,  licensing fees would                                                                    
     need to  be significantly increased. Fees  are expected                                                                    
     to  be  upwards  of  $4,000 for  CDMs  and  $2,000  for                                                                    
     apprentice  permits   by  the   year  2020.   The  high                                                                    
     licensing fees could limit entry into the profession.                                                                      
                                                                                                                                
Ms. Curtis  noted the  department's response  on Page  21 of                                                                    
the  audit. She  shared that  the department  concurred with                                                                    
recommendation's   1  and   2,  but   did  not   respond  to                                                                    
recommendation 3, as it was  not directed to the department.                                                                    
However, the department acknowledged  that merging the board                                                                    
could  result  in  economies  of scale.  She  spoke  to  the                                                                    
board's  response  on  Page  23  of  the  audit.  The  board                                                                    
concurred  with  recommendations  1   and  2,  but  strongly                                                                    
disagreed with recommendation 3:                                                                                                
                                                                                                                                
     Midwifery is  a unique profession that  any other board                                                                    
     would  have difficulty  regulation.  The suggestion  of                                                                    
     the Board  of Nursing  and the Physician's  Board would                                                                    
     be problematic  on several different levels.  These two                                                                    
     boards have  historically been  competitive to  the CDM                                                                    
     profession and  often oppose  legislation that  we have                                                                    
     introduced to  improve the standard of  care and safety                                                                    
     of  our  clients.  I  am concerned  that  we  would  be                                                                    
     regulated  out  of  practice  or   to  a  very  minimal                                                                    
     practice,  which is  what the  majority of  the Alaskan                                                                    
     population clearly does not want.  Also, I believe that                                                                    
     the  doctor's and  nurse's board  would  not want  CDMs                                                                    
     sitting on  their Board (which  we would need to  do if                                                                    
     we  were to  have proper  representation) and  having a                                                                    
     voice  in  decisions  regarding their  regulations  and                                                                    
     practices.                                                                                                                 
2:57:27 PM                                                                                                                    
                                                                                                                                
Representative   Wilson  asked   who  decided   which  cases                                                                    
warranted investigation.                                                                                                        
                                                                                                                                
Ms. Curtis responded that the  division had an investigative                                                                    
section  that had  the statutory  responsibility to  conduct                                                                    
investigations. The  board was removed from,  but eventually                                                                    
weighed in on, the decision.                                                                                                    
                                                                                                                                
Representative  Wilson  asked  whether  unlicensed  midwives                                                                    
were charged with reimbursing the board for any fines.                                                                          
                                                                                                                                
Ms. Curtis  deferred to DCCED.  She offered that  there were                                                                    
no dedication of  fines to any particular  board; any levied                                                                    
fines went to the General Fund.                                                                                                 
                                                                                                                                
Representative  Wilson  thought  that   there  should  be  a                                                                    
mechanism  that could  protect  midwives  from having  their                                                                    
licensing  fees  increased  because of  acts  of  unlicensed                                                                    
midwives.                                                                                                                       
                                                                                                                                
Ms. Curtis  asked whether  Representative Wilson  was asking                                                                    
if the board's deficit was the result of investigations.                                                                        
                                                                                                                                
Representative Wilson replied in the affirmative.                                                                               
                                                                                                                                
Ms. Curtis stated  that the schedule on Page 6  of the audit                                                                    
highlighted   the  board's   expenditures.  She   said  that                                                                    
historically  the  problem  with deficit  had  stemmed  from                                                                    
investigations;  however,   not  only   unlicensed  activity                                                                    
generated investigations.                                                                                                       
                                                                                                                                
3:00:20 PM                                                                                                                    
                                                                                                                                
Representative Wilson surmised that  the board would have to                                                                    
pay the fee  even though the fee was already  in the general                                                                    
fund.                                                                                                                           
                                                                                                                                
Ms. Curtis explained  that the cost of  regulating was borne                                                                    
by licensees,  and any  fees that  were collected  went into                                                                    
the general fund.                                                                                                               
                                                                                                                                
Representative  Wilson asserted  that  any money  collected,                                                                    
based  on an  investigation, had  to be  paid by  the board,                                                                    
even if it went into the general fund.                                                                                          
                                                                                                                                
Ms. Curtis  answered that  the revenues  from the  fines did                                                                    
not offset the costs of investigations.                                                                                         
                                                                                                                                
Representative Wilson  felt that the fees  should offset the                                                                    
costs of investigations.                                                                                                        
                                                                                                                                
3:02:04 PM                                                                                                                    
                                                                                                                                
Representative  Kawasaki   asked  why  there  had   been  an                                                                    
extension of 2  years had been recommended, rather  than a 4                                                                    
year, 6 year, or 8 year.                                                                                                        
                                                                                                                                
Ms. Curtis replied she had  never seen a one-year extension.                                                                    
They  had  received  recommendations  for  termination.  She                                                                    
spoke to boards  with significant deficit such  as the Board                                                                    
of  Game with  a $1  million  deficit, which  resulted in  a                                                                    
short  recommendation  for  extension.  She  explained  that                                                                    
problems  that posed  a public  safety risk  could prompt  a                                                                    
short recommendation. She  said that it was  very unusual to                                                                    
have  2 year  recommendation for  extension. She  added that                                                                    
the number and nature of  the findings would be weighed when                                                                    
considering  the length  of  extension; housekeeping  issues                                                                    
would not impact the  extension recommendation, but deficits                                                                    
would reduce the number of years recommended.                                                                                   
                                                                                                                                
Representative Kawasaki wondered  whether the extension were                                                                    
always even numbered years.                                                                                                     
                                                                                                                                
Ms. Curtis  answered that  extensions seemed  to be  made in                                                                    
even  numbers.  She  said  that workload  was  a  factor  in                                                                    
determining sunset timelines.                                                                                                   
                                                                                                                                
3:04:11 PM                                                                                                                    
                                                                                                                                
Representative  Kawasaki preferred  longer sunset  timelines                                                                    
because it meant less work  for auditors. He asked about the                                                                    
long  sheet (copy  on file)  in the  packet, created  by the                                                                    
division  and  the  board,  related to  ways  in  which  the                                                                    
deficit could be erased.                                                                                                        
                                                                                                                                
Ms. Curtis replied that she had not seen the document.                                                                          
                                                                                                                                
Representative Pruitt thought that  the deficit was the crux                                                                    
of the  problem. He spoke of  the differing views of  all of                                                                    
the  involved parties.  He wondered  whether  the board  had                                                                    
offered a  proposal of how  to eliminate the debt.  He asked                                                                    
when the  legislature should  expect action  to be  taken on                                                                    
the third recommendation.                                                                                                       
                                                                                                                                
Ms.  Curtis clarified  that the  intent of  recommendation 3                                                                    
had been  to acknowledge  that direct  entry midwives  had a                                                                    
board  that was  serving the  public's interest,  and should                                                                    
exist. She  said that  the division's  concern was  that the                                                                    
number  of  midwives would  decline  because  of barrier  to                                                                    
entry  due to  increased licensing  fees. She  stressed that                                                                    
the  recommendation  had  not   been  made  to  address  the                                                                    
deficit, but to ensure that  the public's interest was being                                                                    
served  by the  board. She  felt  that it  was a  management                                                                    
decision as to  how the deficit would be  addressed, but the                                                                    
increase in licensing fees had seemed extreme.                                                                                  
                                                                                                                                
3:09:50 PM                                                                                                                    
                                                                                                                                
Representative   Pruitt   requested   to   hear   from   the                                                                    
department.                                                                                                                     
                                                                                                                                
Vice-Chair Gara asked whether Ms.  Curtis could speak to the                                                                    
investigation   costs  for   violations   that  had   proved                                                                    
unfounded.                                                                                                                      
                                                                                                                                
Ms. Curtis answered in the negative.                                                                                            
                                                                                                                                
Vice-Chair  Gara  worried  about  people being  put  out  of                                                                    
business  for   minor  violations.   He  noted   that  often                                                                    
traditional  medical  professionals and  midwives  disagreed                                                                    
about each  other's practices, and  wondered if  having them                                                                    
share a board would be practical.                                                                                               
                                                                                                                                
3:11:46 PM                                                                                                                    
                                                                                                                                
Representative  Wilson  asked about  the  cost  of the  most                                                                    
recent audit and how it was paid for.                                                                                           
                                                                                                                                
Ms.  Curtis thought  the  audit had  taken  about 450  hours                                                                    
which was approximately  $38,000. She said that  a follow up                                                                    
review  had been  conducted by  the  request of  Legislative                                                                    
Budget and Audit to look into  the public safety risk of not                                                                    
following up on the investigations.                                                                                             
                                                                                                                                
Representative Wilson asked who paid for the audit.                                                                             
                                                                                                                                
Ms. Curtis  answered the audit  was part of the  Division of                                                                    
Audit's  operating budget  that was  approved annually,  and                                                                    
was not paid for by the boards that were audited.                                                                               
                                                                                                                                
Representative  Wilson thought  the  boards had  to pay  the                                                                    
costs.                                                                                                                          
                                                                                                                                
Ms. Curtis answered that the  statute that dictated that the                                                                    
boards would  pay the operational costs  was the operational                                                                    
cost  of  regulation  the  board  and  not  the  legislative                                                                    
oversight process of sunsets.                                                                                                   
                                                                                                                                
3:14:00 PM                                                                                                                    
                                                                                                                                
Representative  Thompson spoke  to the  investigation costs.                                                                    
He lamented  that investigators  assigned to  certain boards                                                                    
may not  understand certain aspects  to the work  the boards                                                                    
oversee, adding to the investigating costs.                                                                                     
                                                                                                                                
Ms.  Curtis said  that she  did  not know.  She stated  that                                                                    
there  were some  boards that  had dedicated  investigators,                                                                    
such as the medical board.                                                                                                      
                                                                                                                                
3:15:30 PM                                                                                                                    
                                                                                                                                
JANEY   HOVENDEN,   DIRECTOR,  DIVISION   OF   CORPORATIONS,                                                                    
BUSINESS   AND   PROFESSIONAL   LICENSING,   DEPARTMENT   OF                                                                    
COMMERCE,  COMMUNITY  AND ECONOMIC  DEVELOPMENT,  introduced                                                                    
herself.                                                                                                                        
                                                                                                                                
Representative Pruitt  asked about  the denial of  the board                                                                    
to carry a surplus budget forward.                                                                                              
                                                                                                                                
Ms. Hovenden  answered that there  had been concerns  by the                                                                    
Department of  Law about incorporating the  $2000 surcharge,                                                                    
instead the  $2000 had been incorporated  into the licensing                                                                    
fee, raising  the fee  to the current  level of  $3,800. She                                                                    
said that  she would not  be able  to speak to  changes that                                                                    
were made to the fees before she took her position.                                                                             
                                                                                                                                
Representative  Pruitt  asked how  long  it  would take  the                                                                    
board  to get  to a  place where  the fees  would cover  the                                                                    
debt.                                                                                                                           
                                                                                                                                
Ms.   Hovenden  referred   to  a   handout  with   an  Excel                                                                    
spreadsheet  chart titled  "Board of  Direct-Entry Midwives"                                                                    
dated September 7, 2016 (copy  on file), which offered a fee                                                                    
analysis. She noted  where the board had  recommended a one-                                                                    
time  surcharge  of $2000,  over  to  biennium. Due  to  the                                                                    
concerns of  the Department  of Law, the  fee of  $3,800 was                                                                    
recommended.  She  said  that  the  fee  increase  would  be                                                                    
stretched out to 2021.                                                                                                          
                                                                                                                                
Representative  Pruitt   spoke  to  the  challenge   of  the                                                                    
continued cost  of investigating unlicensed  individuals. He                                                                    
asked about the department's suggestion  to make sure it did                                                                    
not penalize individuals working  within the proper confines                                                                    
of  the law.  He  felt that  individuals  who were  properly                                                                    
licensed should not be penalized.                                                                                               
                                                                                                                                
3:20:57 PM                                                                                                                    
                                                                                                                                
Ms. Hovenden  answered that the department  did not breakout                                                                    
the  information  in  investigations  between  licensed  and                                                                    
unlicensed individuals.                                                                                                         
                                                                                                                                
Representative Pruitt asked if a breakdown could be done.                                                                       
                                                                                                                                
Ms. Hovenden answered  that it would not  be that difficult,                                                                    
but   the  department   did  not   currently  look   at  the                                                                    
information down to that level.                                                                                                 
                                                                                                                                
Representative  Pruitt  recalled  that the  issue  had  been                                                                    
brought up a couple of  years earlier. He believed the issue                                                                    
had been brought up by midwives a couple of years earlier.                                                                      
                                                                                                                                
3:22:58 PM                                                                                                                    
                                                                                                                                
Ms.  Koeneman  relayed  that civil  penalties  for  licensed                                                                    
midwives were  set under Alaska Statute  08.08.075. She said                                                                    
that there  was another statute for  unlicensed activity, AS                                                                    
08.01.082, and  did not delineate  any civil penalty  or any                                                                    
monetary amount. She said that it  would be a policy call by                                                                    
the committee  to open the  unlicensed activity  statutes to                                                                    
modify the  language. She  noted there  was another  bill in                                                                    
the  finance  committee  that  would  address  investigative                                                                    
costs.                                                                                                                          
                                                                                                                                
Representative  Pruitt understood  that currently  there was                                                                    
no penalty for being unlicensed.                                                                                                
                                                                                                                                
Ms.  Koeneman answered  that  under Title  8  there were  no                                                                    
fines other  than the $5,000  civil penalty. She  added that                                                                    
criminal charges could be applied under Title 11.                                                                               
Representative Pruitt  asked how  to discourage  people from                                                                    
practicing without a license.                                                                                                   
                                                                                                                                
Ms.  Koeneman thought  that  the answer  could  be found  by                                                                    
reading the statute.                                                                                                            
                                                                                                                                
Representative  Kawasaki  referred   to  the  fee  proposals                                                                    
intended to erase  the deficit by 2021.  He wondered whether                                                                    
the timeline had been spurred by the audit.                                                                                     
                                                                                                                                
3:25:38 PM                                                                                                                    
                                                                                                                                
Ms. Hovenden  answered in the  affirmative. She  stated that                                                                    
the board  had been  active and  engaged in  increasing fees                                                                    
for that particular reason.                                                                                                     
                                                                                                                                
Representative Kawasaki  spoke to the conflicting  nature of                                                                    
recommendations  one   and  three.  He  was   supportive  of                                                                    
extending the  board for  a longer time  period and  did not                                                                    
believe  that the  deficit had  to be  completely erased  by                                                                    
2021. He agreed with recommendation 3.                                                                                          
                                                                                                                                
Ms.  Koeneman  answered  that  the  statutory  authority  to                                                                    
collect fees did  not give the legislature or  the board any                                                                    
additional  authority  to  collect  outside  of  the  annual                                                                    
review. She said  that stretching the payment out  over 3 or                                                                    
4 biennium would go against the statutory intent.                                                                               
                                                                                                                                
Representative Kawasaki referred to  the Division of Audit's                                                                    
recommendation  to  extend  the  board four  years,  and  he                                                                    
wondered whether  the existing  deficit, plus the  high fees                                                                    
would be problematic.                                                                                                           
                                                                                                                                
Ms. Koeneman understood  that it the board did  not have the                                                                    
fees paid  up within 4  years, legislative audit  would have                                                                    
no  choice but  to make  another recommendation  stating the                                                                    
board and the department needed  to modify the fees on order                                                                    
to eliminate the deficit.                                                                                                       
                                                                                                                                
3:28:35 PM                                                                                                                    
                                                                                                                                
Co-Chair Seaton thought  payment of the deficit  was tied to                                                                    
the four-year sunset.                                                                                                           
                                                                                                                                
Ms. Curtis  responded there was  no term recommended  by the                                                                    
Division of Audit for fixing  the issue. She stated that the                                                                    
law specified the  cost of regulation must  be covered every                                                                    
time rates were  set. She said that the  four year extension                                                                    
was  made  in order  to  understand  whether the  number  of                                                                    
midwives  in the  state were  serving the  public's interest                                                                    
and had nothing to do with the fee setting process.                                                                             
                                                                                                                                
Representative   Kawasaki    noted   that    the   step-down                                                                    
calculations  that  the  division proposed  would  have  the                                                                    
board outside  of the  deficit by  2021, but  a drop  in the                                                                    
deficit over  the next four  year could result in  a cleaner                                                                    
audit.                                                                                                                          
                                                                                                                                
3:30:45 PM                                                                                                                    
                                                                                                                                
Ms. Curtis replied that she  would revisit the issue in four                                                                    
years to provide an answer.                                                                                                     
                                                                                                                                
Representative Wilson  requested the cost  of investigations                                                                    
in  the  past  several   years.  She  wondered  whether  the                                                                    
legislature could be equally at fault for the deficit.                                                                          
                                                                                                                                
Ms.  Koeneman answered  that investigative  costs for  FY 16                                                                    
was $31,000;  FY 14 and FY  15, $41,522 total; FY  12 and FY                                                                    
13, $45,457;  FY 10  and FY  11, $8,034.  She said  that the                                                                    
figures  did   not  include  some  of   the  indirect  costs                                                                    
associated with  the department's cost allocation  plan. She                                                                    
agreed the department  was getting in the way  of the board.                                                                    
She said that in FY  09, licensing costs dropped from $2088,                                                                    
down  to   $500,  and  rose   as  the   investigative  costs                                                                    
increased.                                                                                                                      
                                                                                                                                
Representative   Wilson  requested   why  the   increase  in                                                                    
investigative costs had jumped significantly.                                                                                   
                                                                                                                                
3:33:59 PM                                                                                                                    
                                                                                                                                
Co-Chair Foster OPENED public testimony.                                                                                        
                                                                                                                                
JOHANNA  CROSSET,  CERTIFIED DIRECT-ENTRY  MIDWIFE,  JUNEAU,                                                                    
she expressed  gratitude for  the current  conversation. She                                                                    
hoped for a  solution to prevent deficit in  the future. She                                                                    
explained it  had been  a surprise to  hear of  the proposal                                                                    
for the  fee increase. She  asked the committee  to continue                                                                    
conversing. She directed a  comment to Representative Wilson                                                                    
about looking  into the investigative costs,  penalties, and                                                                    
fees going to the general fund as opposed to the board.                                                                         
                                                                                                                                
SUSAN   TERWILLIGER,    PRESIDENT,   MIDWIVES   ASSOCIATION,                                                                    
ANCHORAGE  (via teleconference),  spoke  in  support of  the                                                                    
legislation. She shared that each  member of the association                                                                    
had  endured  the  large  hit related  to  the  increase  in                                                                    
licensing. The  board wanted  to pay  down the  deficit. She                                                                    
said  that HB  90  would deal  with  investigation costs  to                                                                    
correct  the  issue  over time.  She  shared  that  midwives                                                                    
provided high quality  care to low-risk women  for less cost                                                                    
and were  regulated by  a board that  was familiar  with the                                                                    
nature of their work. She  referred to a handout in members'                                                                    
packets that  detailed the cost  savings that  resulted from                                                                    
midwife  assisted   births.  Many  women  and   babies  were                                                                    
thankful for the extension of the board.                                                                                        
                                                                                                                                
3:38:08 PM                                                                                                                    
                                                                                                                                
DEBORAH SCHNEIDER,  CHAIR, BOARD  OF CERTIFIED  DIRECT ENTRY                                                                    
MIDWIVES, ANCHORAGE (via  teleconference), urged the passage                                                                    
of the bill.  She had been involved  crafting regulations to                                                                    
protect  mothers and  babies. She  was very  appreciative of                                                                    
the conversation supporting the  continuation of the board's                                                                    
cost-effectiveness.  She referred  to the  issue related  to                                                                    
investigations, and the high  cost of investigations covered                                                                    
in the audit,  and shared that there had  been several cases                                                                    
that  had  been  under  investigation  for  4  to  6  years,                                                                    
generating  enormous cost.  She stressed  that the  midwives                                                                    
were  committed  to  paying  down  the  debt.  She  believed                                                                    
midwifery could  be expanded  in Alaska  if the  issues were                                                                    
addressed. She  expressed appreciation for the  work done by                                                                    
the committee.                                                                                                                  
                                                                                                                                
Co-Chair Foster CLOSED public testimony.                                                                                        
                                                                                                                                
HB  49  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
Co-Chair Foster discussed housekeeping.                                                                                         
                                                                                                                                

Document Name Date/Time Subjects
HB049 Sponsor Statement 1.30.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 49
HB049 Supporting Documents-Letters of Support 2.2.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 49
HB049 Supporting Documents-Full Sunset Audit 01.30.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 49
HB0056 Sponsor Statement 01.23.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB0056 Supporting Document-Constituent 01.24.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB0056 Sectional Analysis 01.23.17 .pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB056 Support SEAFA.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB056 Support USAG.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB056 Supporting Document - Decker 02.23.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB056 Supporting Document CED 2016 Annual State Loan Report.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB056 Supporting Document CED 2016 FE Term Ext Report.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
HB081 Additional Documents Guide AEERLFP 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Additional Documents Memo Legal 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Sectional Analysis 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Sponsor Statement 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Summary of Changes 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Support Document Letter AAHA 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Supporting Documents Letter CCS, Catholic Diocese of Juneau 1.27.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Supporting Documents Letter Denali Commission 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Supporting Documents Letter SFAC 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Supporting Documents Letter TCC 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB081 Supporting Documents Report Rural Retrofits 2.14.2017.pdf HFIN 3/6/2017 1:30:00 PM
HB 81
HB 106 Supporting Document - Letters ACOA-ACT 2.14.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Additional Document-2017 Civil Legal Services Fund Overview 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Additional Document-2017 Fact Sheet 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Additional Document-ALSC statement on Case Restrictions 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Additional Document-Civil Funds filing fee info 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Additional Document-FY2016 ALSC Fact Sheet 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Additional Document-FY2016 ALSC Pro Bono Program 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Sponsor Statement 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB106 Sectional Analysis ver A 2.8.17.pdf HFIN 3/6/2017 1:30:00 PM
HB 106
HB 49 Medicaid Cost Savings_CDMs 2015_word (002).pdf HFIN 3/6/2017 1:30:00 PM
HB 49
HB 49 Supporting Doc 2016 MID Fee Analysis.pdf HFIN 3/6/2017 1:30:00 PM
HB 49
HB56 Support UFA to HFin SB71 to SLC 030317.pdf HFIN 3/6/2017 1:30:00 PM
HB 56
SB 71
HB 56 Supporting Documents-letters.pdf HFIN 3/6/2017 1:30:00 PM
HB 56