Legislature(2013 - 2014)BARNES 124
04/15/2014 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB156 | |
| SB166 | |
| SB167 | |
| SB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 156 | TELECONFERENCED | |
| + | SB 166 | TELECONFERENCED | |
| + | SB 167 | TELECONFERENCED | |
| + | SB 183 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 156-DIRECT-ENTRY MIDWIVES
3:26:01 PM
CHAIR OLSON announced that the first order of business would be
SENATE BILL NO. 156, "An Act relating to direct-entry midwives."
3:26:06 PM
HEATHER SHATTUCK, Staff, Senator Pete Kelly, Alaska State
Legislature, stated the concept for SB 156 was brought to the
sponsor by the Midwives Association of Alaska. The statutes
pertaining to the practice of midwifery were put into place in
1992 but have not been updated since. Placing specific
practices of a profession in statute stymies growth and
management of the profession. These initial required practices
were placed into statute prior to a functioning board of
certified direct-entry midwives
MS. SHATTUCK said the Board of Certified Direct-Entry Midwives
(BCDM) has tried to establish and develop a comprehensive
regulatory framework through practice regulations and guidelines
crafted to ensure public safety and professional discipline.
However, the outdated statute cements certain obsolete practice
requirements in place and can only be updated by an act of the
legislature. This bill will update the statutes and place the
certified direct-entry midwives into regulation rather than
statute. The proposed changes in the bill will also ensure
greater public safety in the field of midwifery. This enables
the Board to oversee the profession more effectively and
incorporate current nationally-recognized best practices. This
type of authority is granted to most professional boards in
order to develop and maintain professional practice standards.
The public safety provisions are addressed in a few ways. The
midwives association requested a higher threshold of training in
order for a licensed certified direct-entry midwife (CDM) to act
as a supervisor to an apprentice midwife. In addition to the
requirement to be licensed and practicing for two years, the
bill further requires a licensed CDM to attend 50 or more births
as a primary or assistant midwife in order to supervise an
apprentice direct-entry midwife. The proposed changes to the
threshold will ensure a greater level of expertise prior to
providing supervision. The also would help ensure greater
public safety in the field of midwifery.
3:28:28 PM
MS. SHATTUCK related that under SB 156 well-baby care will also
be covered under the scope of CDM practice for up to four weeks
after birth. This helps to ensure that the delivering midwife
can properly follow up with both mother and baby, and it helps
ensure the baby will thrive while midwives can maintain an
ongoing relationship with the patient. Additionally, some
required tests for newborns are performed after the current
seven-day set-off in statute. This has put midwives in the
situation of providing services without being reimbursed, where
applicable, by Medicaid.
MS. SHATTUCK said that SB 156 also repeals the cultural midwives
exemption, requiring all CDMs in the state to be licensed and
under the disciplinary regulation of the BCDM. Currently, an
individual whose cultural traditions have included, for at least
two generations, the attendance of midwives at birth, and has
assisted in at least 10 births does not fall under regulation of
the board. As noted in a letter in members' packets from the
Division of Corporations, Business, and Professional Licensing
(DCBPL), state licensing exemptions exist for employees of
tribal health programs. She discussed the exemption with the
Alaska Native Tribal Health Consortium (ANTHC) and the
organization agreed with the provision being removed.
3:29:44 PM
MS. SHATTUCK offered her belief that midwives provide a good
option for women with low-risk pregnancy in Alaska. She pointed
out that these services represent a lower financial impact on
Medicaid eligible patients under Denali Kid Care. She
emphasized the sponsor's intent to make the BCDM as effective
and efficient as possible in the oversight of this field.
3:30:14 PM
REPRESENTATIVE JOSEPHSON asked whether the expansion of the
practice for the first four weeks after birth is the period in
which babies would receive inoculations.
MS. SHATTUCK acknowledged that is her understanding. She
referred to last year's bill [SB 87] by Senator Micciche that
required newborn testing. Currently, midwives can only receive
reimbursement from Medicaid for services provided up to seven
days for newborns, but some testing is provided after two weeks.
She deferred to midwives available to testify.
3:31:08 PM
MS. SHATTUCK provided a section-by-section analysis of the bill.
Section 1 would provide conforming language to remove an
exemption that Section 6 repeals relating to cultural traditions
exclusions. Section 2 would clarify the board's authority to
adopt regulations necessary for establishing practice
requirements and guidelines. Section 3 would add the
requirement for a licensed CDM to attend 50 or more births as a
primary or assistant midwife in order to supervise an apprentice
midwife. Section 4 would update the required practices and
directs the board to adopt regulations regarding the practice of
direct-entry midwifery. Section 5 would update the definition
of the "practice of midwifery" and includes well baby care
through the age of four weeks and preventative measures for the
infant. Section 6 would repeal the cultural traditions
exclusion allowing a person to practice midwifery for
compensation without meeting the education and practice
requirements for practicing midwifery.
3:32:18 PM
CHERYL CORRICK, Certified Direct-Entry Midwife and Chair of
BCDM, stated that she is a certified direct-entry midwife (CDM)
in Alaska and a certified professional midwife with the National
Association of Registered Midwives. She has over 20 years of
experience in the field of midwifery and has worked at a birth
center in a group practice in Fairbanks. Additionally, she
currently serves as the chair of the Board of Certified Direct-
Entry Midwives (BCDM). She explained that SB 156 would increase
the requirements for CDMs by requiring the experience of 50
births as the primary or assisting midwife in addition to the
current requirement of two years of experience. This would
require preceptors with experience closer to the national
standards. This bill would also remove the cultural midwife
exemption that allows an individual who meets the definition to
practice as a midwife and receive compensation with the only
required training to have assisted another cultural midwife with
10 births. This level of training is extremely inadequate and
is simply not safe for our mothers and babies. The practices
have been in statute for over 20 years during which time health
care practices have greatly changed. She said she has served on
the BCDM for six years, during which time the board's goal has
been to support legislation to remove the required practices
from statute and allow the board to update and revise
regulations to maintain current state and national standards of
care. On February 21, 2014 the BCDM unanimously voted to
support SB 156 and the companion bill, HB 311, and sent a letter
of support [in members' packets]. She urged members to support
SB 156.
3:34:28 PM
REPRESENTATIVE JOSEPHSON wondered how CDM's would ensure that
newborns receive vaccinations if they cannot administer them.
MS. CORRICK responded that the initial vaccine would be for
Hepatitis B, which is given at the hospital or by their
pediatrician at one month visit. Other vaccines are given at
two months, and midwives do not administer the vaccinations;
however, they are required by regulation to recommend that
parents and newborns see a physician within the first seven days
of life.
3:35:48 PM
REPRESENTATIVE JOSEPHSON asked whether any historic problems
have arisen since 1992 in terms of the certified direct-midwife
practice or if things have gone relatively smoothly in the past
22 years.
MS. CORRICK offered her belief that they have gone relatively
smoothly, although midwifery has had occasional problems as all
professions experience. She reported that the latest data set
from the U.S. Centers for Disease Control and Prevention (CDC)
actually shows that Alaska has the highest rate of "out of
hospital" births and the lowest rate of [Caesarean sections].
3:36:47 PM
SUSAN TERWILLIGER, Certified Direct-Entry Midwife (CDM);
President, Midwives Association of Alaska (MAA), stated she is
also a certified professional midwife with the national registry
of midwives and the president of Midwives Association of Alaska
(MAA). She reported that she has been in practice for 17 years
in Texas and for the past 9 years in Alaska with a small home
birth practice. She related that the MAA supports SB 156. She
urged members to support the bill so the standards for midwives
can be updated. Initially, the CDMs did not have a board, but
the BCDM has been in place for a number of years, and doctors,
CDMs, public members serve on the board.
3:38:39 PM
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on SB 156.
3:38:52 PM
REPRESENTATIVE CHENAULT referred to page [4], lines 3-4, Section
5, to the well-baby care of infant and preventative measures.
He asked who pays for this.
MS. SHATTUCK answered that infant care up to four weeks is
covered by Denali Kid Care. She related her understanding that
it would move the scope from the pediatrician to the midwives.
Otherwise, private insurance would cover it, she said.
3:40:53 PM
REPRESENTATIVE CHENAULT asked whether [CDMs] currently provide
this service or would it be an increased workload for the
midwives.
MS. SHATTUCK suggested that this provision was requested with
respect to children covered by Denali Kid Care. She explained
that the midwives are currently providing the care but are not
eligible for reimbursement.
REPRESENTATIVE CHENAULT related his understanding that this
language would allow [CDMs] to be reimbursed. He asked what
happens if the child cannot qualify for Denali Kid Care.
3:41:30 PM
MS. CORRICK answered that Denali Kid Care and Medicare have
typically covered midwifery services through six or eight weeks
but last year after conducting a massive audit decided not to
cover CDMS since the care was not in their scope of practice.
The CDMs argued for coverage, which was extended until January
2014; however, currently the Denali Kid Care doesn't cover CDM
care beyond seven days [after birth]. Part of the problem
results because CDMs are required to provide services by
regulation for the [phenylketonuria] PKU screening. The second
screening is traditionally done between two and three weeks.
Thus, midwives must provide the care per regulation but are not
reimbursed. This language would allow the midwives to be
reimbursed. In response to an earlier question, she said if
Medicaid or Denali Kid Care did not cover the care, it would be
covered by the parents through private insurance, just as they
receive coverage for their pediatricians.
3:42:55 PM
REPRESENTATIVE CHENAULT understood this language would extend
coverage that has not been allowed since January 2014 for
services beyond seven days.
MS. CORRICK answered that is correct. She added that prior to
January 2014, midwives did receive reimbursement for providing
these services.
REPRESENTATIVE CHENAULT noted a lack of a fiscal note, and
although this is not a new charge since Denali Kid Care
previously picked up the costs, but he anticipated an increase.
3:44:04 PM
REPRESENTATIVE HERRON moved to report SB 156 out of committee
with individual recommendations and the accompanying fiscal
note. There being no objection, SB 156 was reported from the
House Labor and Commerce Standing Committee.