Legislature(2023 - 2024)BARNES 124

03/13/2024 03:15 PM House LABOR & COMMERCE

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

Document Name Date/Time Subjects
S.2 for HB 200.pdf HL&C 3/13/2024 3:15:00 PM
HB 200
S.3 for HB 200.pdf HL&C 3/13/2024 3:15:00 PM
HB 200
6 HB 285 - Nat'l Cancer Institute.pdf HL&C 3/13/2024 3:15:00 PM
HB 285
5 HB 285 - Komen Report.pdf HL&C 3/13/2024 3:15:00 PM
HB 285
4 HB 285 - Preventing Chronic Disease.pdf HL&C 3/13/2024 3:15:00 PM
HB 285
HB378 220329_OrganizedRetailTheft_Congress_NGA_NCSL_NDAA.pdf HL&C 3/13/2024 3:15:00 PM
HB 378
HB378 231212_OrganizedRetailCrimeHearing_HouseHomeland_2023-12-12-144642_ipii.pdf HL&C 3/13/2024 3:15:00 PM
HB 378
HB378 The fight against stolen products on Amazon and Facebook Marketplace - CNBC.pdf HL&C 3/13/2024 3:15:00 PM
HB 378
HB378 ASIS Article - Megan Gates - Organized Retail Crime - Oct 2023.pdf HL&C 3/13/2024 3:15:00 PM
HB 378
HB 378 ver. B Sectional Analysis 2.26.2024.pdf HL&C 3/13/2024 3:15:00 PM
HB 378
HB 378 Sponsor Statement.pdf HL&C 3/13/2024 3:15:00 PM
HB 378
HB271 Sectional Analysis Version B.pdf HL&C 3/13/2024 3:15:00 PM
HB 271
HB271 Sponsor Statement.pdf HL&C 3/13/2024 3:15:00 PM
HB 271
HB200 Concerns.pdf HL&C 3/13/2024 3:15:00 PM
HB 200
HB200 Opposition Letters.pdf HL&C 3/13/2024 3:15:00 PM
HB 200
ltr support HB 285 mammogms.pdf HL&C 3/13/2024 3:15:00 PM
HB 285
HB 285 Committee Questions.pdf HL&C 3/13/2024 3:15:00 PM
HB 285
SJ response to HB 285.docx HL&C 3/13/2024 3:15:00 PM
HB 285
CLEAR letter re HB 378.pdf HL&C 3/13/2024 3:15:00 PM
HB 378