Legislature(1999 - 2000)
02/10/1999 01:35 PM House FIN
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
HOUSE FINANCE COMMITTEE
February 10, 1999
1:35 P.M.
TAPE HFC 99 - 19, Side 1.
CALL TO ORDER
Co-Chair Therriault called the House Finance Committee
meeting to order at 1:35 P.M.
PRESENT
Co-Chair Therriault Representative G. Davis
Co-Chair Mulder Representative Grussendorf
Vice-Chair Bunde Representative Kohring
Representative J. Davies Representative Williams
Representatives Foster, Moses and Austerman were not present
for the meeting.
ALSO PRESENT
Representative Bill Hudson; Melinda Hofstad, Aid,
Representative Bill Hudson; Catherine Reardon, Director,
Division of Occupational Licensing, Department of Commerce
and Economic Development; Kaye Kanne, Midwives Association
of Alaska, Juneau; Marilyn Holmes, Citizens for Midwifery,
Juneau.
SUMMARY
HB 10 An Act extending the termination date of the Board
of Certified Direct-Entry Midwives; and providing
for an effective date.
HB 10 was reported out of Committee with a "do
pass" recommendation and with a zero fiscal note
by the Department of Commerce and Economic
Development dated 2/10/99.
HOUSE BILL NO. 10
"An Act extending the termination date of the Board of
Certified Direct-Entry Midwives; and providing for an
effective date."
REPRESENTATIVE BILL HUDSON explained that CH.130, SLA 1992
established the Board of Certified Direct Entry Midwives
(CDM's). HB 10, if enacted, would extend the board
operation for another 4 years to June 30, 2003.
Representative Hudson continued, the duties of the
regulating Board include:
? Examining applicants and issuing certificates to
qualified applicants;
? Issuing permits to apprentice direct entry
midwives;
? Reporting annually to the Governor and the
Department of Commerce and Economic Development;
and
? Approving curricula and adopting standards for
basic education, training, and apprentice
programs.
Representative Hudson pointed out Alaska's infant mortality
rate is even higher than the national average which ranks
22nd among developed nations. Increasing the use of
midwifery services has been shown to improve birth outcomes
considerably. The Legislature, in a strong move of support
last session, moved midwifery services up on the Medicaid
eligibility list. The new listing will insure that these
important services, which cost less than half of the Medical
Model, will be funded.
Representative Hudson summarized that Alaska is currently
among the forerunners in the worldwide movement to establish
a Midwifery Model of care as an alternative choice to the
Medical Model. The Board is currently in its wind down
year, so if this board is to continue its work, HB 10 must
pass this session.
Co-Chair Therriault asked for further information on the
price to each licensee applicant. Representative Hudson
noted that fourteen licensed midwives have been identified
in the State and five apprentices. He agreed that the
charge to that Board was heavy, pointing out although that
those involved have accepted that fee. As the number of
midwives increase, the individual costs should decrease. He
noted that the legal costs must be shared with collected
combined fees, which will drop over time.
Representative J. Davies advised that he had submitted a
bill a few years ago which tried to "smooth out" the ups and
downs of the cumulative boards. He proposed reconsideration
of that legislation, suggesting that it would be beneficial
to small groups such as the Midwifery Board. Representative
J. Davies asked how the use of midwifery improves the
birthing process.
KAYE KANNE, MIDWIVES ASSOCIATION OF ALASKA, JUNEU, stated
that there are many reasons why the outcomes for midwives
are better than the Medical Model. Midwives work with their
patients from the beginning addressing matters of nutrition,
which can prevent complications such as premature labor,
toxemia or diabetes from occurring.
MARILYN HOLMES, CITIZENS FOR MIDWIFERY, JUNEAU, advised that
when looking at the worldview, the five nations with the
best birth outcomes use midwifery for 70% of their births.
Their model is to use midwifery for normal births and use
physicians for abnormal births, which normally is about 10%
of the population. In the United States, we use midwifery
for about 5% of all births. The norm in our country is to
use the Medical Model.
The Board of Midwifery begins to "break" the pattern of our
country. One of the reasons that we need to break that
pattern is that we are 22nd on the list of developed nations
in terms of infant mortality and morbidity. The U.S. does
not have great birth outcomes. Midwifery is the model which
is recommended by the World Organization.
Ms. Holmes continued, the kind of care that is received from
the midwife is sustained care. It is from the beginning of
the pregnancy, with the mother being monitored for social,
psychological and health factors. The woman receives much
more attention and there is continual education regarding
breast-feeding and other information that makes for
healthier infants. Ms. Holmes added that midwifery is a
less expensive way to birth. Midwifery takes the birth
situation out of the technological realm. It no longer
becomes a medical emergency.
Co-Chair Therriault asked questions regarding expenses paid
for by the licensing individuals.
CATHERINE REARDON, DIRECTOR, DIVISION OF OCCUPATIONAL
LICENSING, DEPARTMENT OF COMMERCE AND ECONOMIC DEVELOPMENT
commented that the Board did cover its own costs for the
fiscal years 1997 and 1998. The cost was not recouped from
outside, and licensee fees did cover those costs.
She suggested that it would be difficult to predict what
would happen in the coming two years, as the Department is
not aware of potential complaints. She noted that Board
pays the second highest fee for a license, while at the same
time is a profession that is not highly paid. Including the
indirect costs, all licenses total $15 thousand dollars a
year. Ms. Reardon added that it is expected that the fee
will be lowered and costs will be kept down in the coming
years.
Representative J. Davies asked if there were ways in which
the costs of the Board could be reduced. Ms. Reardon
replied that this Board is very frugal. In FY97, $700
dollars was spent on travel.
Representative J. Davies asked what drives the costs. Ms.
Reardon explained that there has been an average of $12,600
dollars in directed midwifery costs and perhaps $1500 for
Department overhead costs.
Representative J. Davies asked if Ms. Reardon thought that
the bill submitted previously would have merit.
Ms. Reardon pointed out that the bill in reference had been
presented perhaps three years ago and that enforcement,
investigative and legal costs would be spread per capita
amongst the 30,000 licensees in the Division. The
Department strongly supported the bill, although, the
licensees which have low per capita cost did not want it
implemented. In terms of the over all benefit, she believed
that it would be realistic. Ms. Reardon suggested that with
some adjustments, the concerns could work. She added that
Division auditors have recommended that there be strict
application of the fee law. That would mean that each sub-
profession within the Board would have to cover its own
costs. She indicated that if such action were applied,
there would be more volatile fees.
Co-Chair Therriault pointed out that the bill carried a zero
fiscal note, indicating that the fees are covered into the
year 2000 budget.
Co-Chair Mulder MOVED to report HB 10 out of Committee with
individual recommendations and with the accompanying fiscal
note. There being NO OBJECTION, it was so ordered.
HB 10 was reported out of Committee with a "do pass"
recommendation and with a zero fiscal note by the Department
of Commerce and Economic Development dated 2/10/99.
ADJOURNMENT
The meeting adjourned at 1:55 P.M.
H.F.C. 4 2/10/99
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