Legislature(2021 - 2022)BUTROVICH 205

03/10/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HCR 10 AMERICAN HEART MONTH TELECONFERENCED
Moved HCR 10 Out of Committee
<Above Item Added to Agenda>
+= SB 175 HEALTH CARE SERVICES BY TELEHEALTH TELECONFERENCED
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
+= SB 192 BOARD OF LICENSED MIDWIVES TELECONFERENCED
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 10, 2022                                                                                         
                           1:32 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Mia Costello                                                                                                            
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE CONCURRENT RESOLUTION NO. 10                                                                                              
Proclaiming February 2022 as American Heart Month.                                                                              
                                                                                                                                
     - MOVED HCR 10 OUT OF COMMITTEE                                                                                            
                                                                                                                                
SENATE BILL NO. 175                                                                                                             
"An Act relating to telehealth; relating to the practice of                                                                     
medicine; relating to medical assistance coverage for services                                                                  
provided by telehealth; and providing for an effective date."                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 192                                                                                                             
"An  Act relating  to  midwives and  the  practice of  midwifery;                                                               
relating  to apprentice  midwives; relating  to the  licensing of                                                               
midwives; relating to insurance  requirements for the practice of                                                               
midwifery; and providing for an effective date."                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HCR 10                                                                                                                  
SHORT TITLE: AMERICAN HEART MONTH                                                                                               
SPONSOR(s): REPRESENTATIVE(s) GILLHAM                                                                                           
                                                                                                                                
02/09/22       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/09/22       (H)       RLS                                                                                                    
02/16/22       (H)       TRANSMITTED TO (S)                                                                                     
02/16/22       (H)       VERSION: HCR 10                                                                                        
02/22/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/22/22       (S)       HSS                                                                                                    
03/08/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/08/22       (S)       Heard & Held                                                                                           
03/08/22       (S)       MINUTE(HSS)                                                                                            
03/10/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 175                                                                                                                  
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH                                                                                 
SPONSOR(s): SENATOR(s) WILSON                                                                                                   
                                                                                                                                
02/01/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/01/22       (S)       HSS, L&C                                                                                               
02/24/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/24/22       (S)       -- Invited & Public Testimony --                                                                       
03/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/03/22       (S)       Heard & Held                                                                                           
03/03/22       (S)       MINUTE(HSS)                                                                                            
03/10/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 192                                                                                                                  
SHORT TITLE: BOARD OF LICENSED MIDWIVES                                                                                         
SPONSOR(s): SENATOR(s) KAWASAKI                                                                                                 
                                                                                                                                
02/15/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/15/22       (S)       HSS, L&C, FIN                                                                                          
03/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/03/22       (S)       Heard & Held                                                                                           
03/03/22       (S)       MINUTE(HSS)                                                                                            
03/10/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE RONALD GILLHAM                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor HCR 10.                                                                                           
                                                                                                                                
POLLY-BETH ODOM, represent self                                                                                                 
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 175.                                                                           
                                                                                                                                
JON ZESEDA, Policy Integration Director                                                                                         
Alaska Primary Care Association                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 175.                                                                           
                                                                                                                                
JESSICA ESTES, Member                                                                                                           
Advanced Practice Registered Nurses (APRN) Alliance                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 175.                                                                           
                                                                                                                                
SENATOR SCOTT KAWASAKI                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of SB 192.                                                                                        
                                                                                                                                
KRIS CURTIS, Legislative Auditor                                                                                                
Legislative Audit Division                                                                                                      
Legislative Agencies and Offices                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 192.                                                                             
                                                                                                                                
SARA CHAMBERS, Director                                                                                                         
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered question on SB 192.                                                                              
                                                                                                                                
JOHANNA CROSSETT, representing self                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 192.                                                                           
                                                                                                                                
RACHEL PUGH, Member                                                                                                             
Board of Certified Direct-Entry Midwives                                                                                        
Department of Commerce, Community and Economic Development                                                                      
Eagle River, Alaska                                                                                                             
POSITION STATEMENT: Testified in support of SB 192 and answered                                                               
questions.                                                                                                                      
                                                                                                                                
IDA DARRAGH, CPM, Executive Director                                                                                            
North American Registry of Midwives (NARM)                                                                                      
Little Rock, Arkansas                                                                                                           
POSITION STATEMENT: Testified in support of SB 192.                                                                           
                                                                                                                                
KATHRYN AULT, Nurse Practitioner; President,                                                                                    
American College of Nurse Midwives; Member                                                                                      
APRN Alliance                                                                                                                   
Homer, Alaska                                                                                                                   
POSITION STATEMENT: Testified with concerns on SB 192.                                                                        
                                                                                                                                
MARY YANAGAWA, Certified Direct-Entry Midwife; President                                                                        
Midwives Association of Alaska                                                                                                  
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Provided invited testimony for SB 192.                                                                    
                                                                                                                                
BETHANY KIRILLOV, representing self                                                                                             
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 192                                                                            
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:32:45 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:32 p.m.  Present at the                                                               
call to order  were Senators Reinbold, Begich,  Hughes, and Chair                                                               
Wilson.                                                                                                                         
                                                                                                                                
                  HCR 10-AMERICAN HEART MONTH                                                                               
                                                                                                                                
1:33:31 PM                                                                                                                    
CHAIR  WILSON announced  the  consideration  of HOUSE  CONCURRENT                                                               
RESOLUTION  NO. 10  Proclaiming February  2022 as  American Heart                                                               
Month.                                                                                                                          
                                                                                                                                
He asked  the sponsor whether he  had any final comments  on [HCR
10].                                                                                                                            
                                                                                                                                
1:33:44 PM                                                                                                                    
REPRESENTATIVE RONALD GILLHAM,  Alaska State Legislature, Juneau,                                                               
Alaska,  speaking as  sponsor HCR  10, stated  that HCR  10 would                                                               
bring cardiovascular health to the  forefront every year. He said                                                               
he looks  forward to  bringing this resolution  up every  year in                                                               
hopes of saving lives by promoting heart health.                                                                                
                                                                                                                                
1:35:06 PM                                                                                                                    
SENATOR HUGHES asked  if this resolution would start  a new state                                                               
program regarding heart health.                                                                                                 
                                                                                                                                
1:35:27 PM                                                                                                                    
REPRESENTATIVE  GILHAM  answered  no,  it  would  not  start  new                                                               
programs, but would raise  awareness about cardiovascular health.                                                               
He stated  that the  American Red  Cross and  other organizations                                                               
teach people  how to perform cardiopulmonary  resuscitation (CPR)                                                               
but this resolution promotes preventative heart health.                                                                         
                                                                                                                                
1:36:00 PM                                                                                                                    
SENATOR  HUGHES stated  that  she is  pro-life.  She said  during                                                               
public  testimony,  someone  commented about  abortions,  so  she                                                               
wanted to indicate that her support  for HCR 10 has nothing to do                                                               
with that issue.                                                                                                                
                                                                                                                                
1:36:32 PM                                                                                                                    
REPRESENTATIVE  GILHAM agreed  he  is pro-life,  and  HCR 10  has                                                               
nothing to do with overshadowing  abortion. He said he introduced                                                               
HCR 10 to provide information and raise awareness.                                                                              
                                                                                                                                
1:37:04 PM                                                                                                                    
SENATOR REINBOLD thanked him for bringing this issue forward.                                                                   
                                                                                                                                
1:38:40 PM                                                                                                                    
REPRESENTATIVE GILHAM stated  that he had a  heart attack related                                                               
to his genetics.                                                                                                                
                                                                                                                                
1:38:55 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
1:38:57 PM                                                                                                                    
SENATOR HUGHES  moved to report  HCR 10, work  order 32-LS1478\I,                                                               
from  committee  with  individual  recommendations  and  attached                                                               
fiscal note(s).                                                                                                                 
                                                                                                                                
CHAIR WILSON  found no  objection, and HCR  10 was  reported from                                                               
the Senate Health and Social Services Standing Committee.                                                                       
                                                                                                                                
1:39:20 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
           SB 175-HEALTH CARE SERVICES BY TELEHEALTH                                                                        
                                                                                                                                
1:41:37 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration  of  SENATE  BILL  NO.  175  "An  Act  relating  to                                                               
telehealth;  relating to  the practice  of medicine;  relating to                                                               
medical assistance coverage for  services provided by telehealth;                                                               
and providing for an effective date."                                                                                           
                                                                                                                                
1:41:42 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 175.                                                                                 
                                                                                                                                
1:41:58 PM                                                                                                                    
POLLY-BETH ODOM,  representing self, Palmer, Alaska,  stated that                                                               
she provides  case management services for  adults who experience                                                               
long-term mental  illness and traumatic  injury in  Anchorage and                                                               
the  Mat-Su Valley.  She spoke  in support  of SB  175. She  said                                                               
telehealth  provides an  alternative  to  in-person services  for                                                               
people  without  reliable  transportation.   She  noted  that  in                                                               
January  2022,  the  Mat-Su   Valley  experienced  a  devastating                                                               
windstorm that caused her to  close her brick-and-mortar business                                                               
[Daybreak]. She  had to turn  to telehealth to  provide continued                                                               
services quickly.  She was able  to help people connect  to their                                                               
behavioral   health  providers.   She  offered   her  view   that                                                               
telehealth is an  essential tool in behavioral  health. She urged                                                               
members to support SB 175.                                                                                                      
                                                                                                                                
1:43:25 PM                                                                                                                    
SENATOR BEGICH  thanked his high  school classmate for  coming to                                                               
Juneau to testify.                                                                                                              
                                                                                                                                
1:43:55 PM                                                                                                                    
JON  ZESEDA, Policy  Integration  Director,  Alaska Primary  Care                                                               
Association,  Anchorage,  Alaska,  stated that  Alaska  Community                                                               
Health Centers asked him to convey  their support for SB 175. The                                                               
vast majority of health centers  operate using a team care model,                                                               
where the  provider, nurse, care  coordinator, lab,  and pharmacy                                                               
can be involved  in a telehealth visit. He related  that they had                                                               
used chronic disease  telehealth calls as a  gateway for strongly                                                               
encouraging patients to  come to the clinic to follow  up on labs                                                               
and  other  services.  He  offered   support  for  the  range  of                                                               
modalities  that  include  audio  only  and  the  flexibility  to                                                               
introduce future modalities. Patients  who currently experience a                                                               
lack of bandwidth  and other challenges have  grown accustomed to                                                               
accessing care over the phone.                                                                                                  
                                                                                                                                
MR. ZESEDA stated  that many Alaskans had  used telehealth during                                                               
the   pandemic,  especially   receiving  care   from  home   when                                                               
necessary. He strongly encouraged members to pass SB 175.                                                                       
                                                                                                                                
1:45:35 PM                                                                                                                    
SENATOR REINBOLD stated that she  doesn't want Alaskan physicians                                                               
undermined.                                                                                                                     
                                                                                                                                
1:45:59 PM                                                                                                                    
MR.  ZESEDA responded  that  the vast  majority  of providers  in                                                               
Alaska provide  services at federally-qualified  Community Health                                                               
Centers, providing primary care  services in the communities they                                                               
serve.  He explained  that APCA  was primarily  focused on  pain,                                                               
parity,  telehealth modalities,  and patients  and on  providers'                                                               
ability  to  work  flexibly  and   not  just  within  the  clinic                                                               
building.                                                                                                                       
                                                                                                                                
1:46:53 PM                                                                                                                    
SENATOR REINBOLD asked for the name of the movement.                                                                            
                                                                                                                                
MR. ZESEDA answered that Community  Health Centers are federally-                                                               
qualified health centers in Alaska.                                                                                             
                                                                                                                                
CHAIR  WILSON asked  how many  Community Health  Centers were  in                                                               
Alaska.                                                                                                                         
                                                                                                                                
JON  ZESEDA  answered that  29  organizations  operate 220  sites                                                               
across the state.                                                                                                               
                                                                                                                                
SENATOR REINBOLD asked for a list of the sites.                                                                                 
                                                                                                                                
1:47:51 PM                                                                                                                    
JESSICA  ESTES,  Member,   Advanced  Practice  Registered  Nurses                                                               
(APRN) Alliance, Anchorage,  Alaska, spoke in support  of SB 175.                                                               
She  stated  that  she  is  a  psychiatric  mental  health  nurse                                                               
practitioner. She  said that her  current role is serving  as the                                                               
Chief  Nursing Officer  at  Alaska  Behavioral Health,  [formerly                                                               
Anchorage  Community Mental  Health Services].  She related  that                                                               
telehealth  presents an  opportunity  for  providers to  maintain                                                               
continuity  of care.  She  highlighted that  SB  175 would  allow                                                               
APRNs to serve clients no matter  where they reside in Alaska and                                                               
for  patients with  limited ability  to come  to the  clinic. She                                                               
emphasized the importance  of telehealth for those  in hospice or                                                               
seeking mental health services.                                                                                                 
                                                                                                                                
1:49:23 PM                                                                                                                    
CHAIR WILSON closed public testimony on HB 175.                                                                                 
                                                                                                                                
1:49:24 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:50:47 PM                                                                                                                    
CHAIR  WILSON  reconvened   the  meeting  and  held   SB  175  in                                                               
committee.                                                                                                                      
                                                                                                                                
               SB 192-BOARD OF LICENSED MIDWIVES                                                                            
                                                                                                                                
1:51:09 PM                                                                                                                    
CHAIR WILSON announced  the consideration of SENATE  BILL NO. 192                                                               
"An  Act relating  to  midwives and  the  practice of  midwifery;                                                               
relating  to apprentice  midwives; relating  to the  licensing of                                                               
midwives; relating to insurance  requirements for the practice of                                                               
midwifery; and providing for an effective date."                                                                                
                                                                                                                                
1:51:28 PM                                                                                                                    
SENATOR  SCOTT   KAWASAKI,  Alaska  State   Legislature,  Juneau,                                                               
Alaska, sponsor of  SB 192, stated that he introduced  SB 192, on                                                               
behalf  of  midwives,  to institute  licensing  requirements  and                                                               
regulations   for  certified   professional  midwives,   using  a                                                               
nationally  recognized midwife  organization.  He anticipated  an                                                               
amendment.  The bill  aims  to ensure  safer  at-home births  and                                                               
improve prepartum  and postpartum  care for mothers  and infants.                                                               
He indicated  his willingness to consider  suggestions to improve                                                               
the bill.                                                                                                                       
                                                                                                                                
1:52:52 PM                                                                                                                    
SENATOR  REINBOLD suggested  he  consider combining  it with  the                                                               
naturopath bill.                                                                                                                
                                                                                                                                
1:53:28 PM                                                                                                                    
SENATOR BEGICH  related his understanding  that part of  the bill                                                               
was in  response to a limited  renewal of the Board  of Certified                                                               
Direct-Entry Midwives. He  asked Ms. Curtis how much  of the bill                                                               
resulted from the scope of  the legislative audit. He offered his                                                               
support for ensuring safe practices with births.                                                                                
                                                                                                                                
1:55:30 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:56:33 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
1:56:55 PM                                                                                                                    
SENATOR BEGICH recalled that two  years ago the legislative audit                                                               
led to  a truncated  renewal for the  Board of  Certified Direct-                                                               
Entry Midwives.  He asked how  much of  this bill was  related to                                                               
the audit findings and recommendations.                                                                                         
                                                                                                                                
1:57:34 PM                                                                                                                    
KRIS  CURTIS, Legislative  Auditor,  Legislative Audit  Division,                                                               
Legislative Agencies and Offices,  Juneau, Alaska, responded that                                                               
the  report  for the  sunset  audit  of  the Board  of  Certified                                                               
Direct-Entry  Midwives [Audit  Control Number  08-20123-20] dated                                                               
June 19,  2020, recommended a  two-year extension. She  said this                                                               
is six  years less  than the  maximum of  eight years  allowed in                                                               
statute. The  division's recommendation  for a  reduced extension                                                               
was  due  to   an  issue  related  to   an  ongoing  confidential                                                               
investigation that  could potentially impact the  board's ability                                                               
to protect the public. The  audit made three recommendations that                                                               
did not  affect the extension,  but another issue did.  The board                                                               
had identified a  need to change certification  statutes to align                                                               
Alaska's midwifery  laws with national  standards. Still,  it had                                                               
not proceeded  to do  so due  to a concern  that it  might impact                                                               
their  fees.  The  auditors  did  not believe  that  was  in  the                                                               
public's best  interest and made Recommendation  [1]. She related                                                               
her understanding that  this bill was attempting  to remedy that,                                                               
which is how it links to the audit.                                                                                             
                                                                                                                                
1:58:56 PM                                                                                                                    
SENATOR BEGICH related that based  on conversations, there seemed                                                               
to  be a  difference  of  opinion as  to  the  best approach.  He                                                               
indicated that  he would  like to  craft a  simplified definition                                                               
related to  the national organizations with  different standards.                                                               
He noted that two or  three national organizations have different                                                               
standards.  He wondered  if  that would  be  consistent with  the                                                               
audit recommendation.                                                                                                           
                                                                                                                                
MS. CURTIS answered that she  had no comment because the auditors                                                               
did not look at the organizations  nor identify if there was more                                                               
than one organization.                                                                                                          
                                                                                                                                
2:00:03 PM                                                                                                                    
SENATOR BEGICH  recalled she had mentioned  a confidential issue,                                                               
which cannot be  discussed. He asked whether the  matter had been                                                               
resolved or if a path to resolution existed.                                                                                    
                                                                                                                                
2:00:25 PM                                                                                                                    
MS. CURTIS  answered that  auditors are about  to start  the next                                                               
sunset  audit on  the board  since the  audit recommended  only a                                                               
two-year   extension.  This   means   the   division  will   have                                                               
legislative oversight  of that issue,  and the audit  report will                                                               
be completed this year.                                                                                                         
                                                                                                                                
2:00:44 PM                                                                                                                    
CHAIR WILSON  related his understanding that  midwives will still                                                               
be a licensed  entity, at least until the completion  of the next                                                               
audit.                                                                                                                          
                                                                                                                                
2:01:03 PM                                                                                                                    
MS.  CURTIS clarified  that the  Board of  Certified Direct-Entry                                                               
Midwives was  extended and will  not sunset until June  2023. She                                                               
stated  that  the board  would  have  a  year  to wind  down  its                                                               
affairs.  She  noted that  if  the  board  is not  extended,  the                                                               
Division  of Corporations,  Business, and  Professional Licensing                                                               
would conduct the licensing process.                                                                                            
                                                                                                                                
2:01:31 PM                                                                                                                    
SENATOR  HUGHES   asked  whether  the  board   would  technically                                                               
continue until June 30, 2024.                                                                                                   
                                                                                                                                
2:01:49 PM                                                                                                                    
MS. CURTIS deferred to Ms. Chambers.                                                                                            
                                                                                                                                
2:01:54 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic Development,  Juneau, Alaska,  responded that  the board                                                               
would sunset on  June 30, 2023, but the one  year wind down would                                                               
allow it a grace period to wrap up its affairs until June 2024.                                                                 
                                                                                                                                
2:02:24 PM                                                                                                                    
SENATOR HUGHES noted Ms. Curtis  mentioned a pending confidential                                                               
investigation   and  three   audit  recommendations.   The  board                                                               
identified  a  need to  change  certification  statutes to  align                                                               
Alaska's midwifery  laws with national  standards. She  asked for                                                               
the other two audit recommendations.                                                                                            
                                                                                                                                
2:02:39 PM                                                                                                                    
MS.  CURTIS  stated that  Recommendation  1  was that  the  board                                                               
should recommend  statutory changes that benefit  the public. She                                                               
noted that  the board identified  a need to  change certification                                                               
statutes  to   align  Alaska's   midwifery  laws   with  national                                                               
standards. Recommendation  2 was that DCBPL's  chief investigator                                                               
should ensure investigations are  completed timely. She noted the                                                               
auditors found three investigations  that had unjustified periods                                                               
of  inactivity   due  to   turnover  and   competing  priorities.                                                               
Recommendation 3 was  that the board should  improve oversight of                                                               
the peer review process.                                                                                                        
                                                                                                                                
2:03:16 PM                                                                                                                    
SENATOR  HUGHES acknowledged  that  she must  remain neutral  and                                                               
could not likely offer her opinion  on the bill. She asked if the                                                               
three items were in the bill.                                                                                                   
                                                                                                                                
2:03:33 PM                                                                                                                    
MS. CURTIS stated that she had not reviewed SB 192.                                                                             
                                                                                                                                
2:02:35 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:05:56 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
2:06:02 PM                                                                                                                    
SENATOR BEGICH  said he has a  copy of the legislative  audit for                                                               
the board.                                                                                                                      
                                                                                                                                
2:06:12 PM                                                                                                                    
SENATOR HUGHES asked for the third recommendation.                                                                              
                                                                                                                                
MS.  CURTIS  said Recommendation  3  was  that the  board  should                                                               
improve oversight of the peer review process.                                                                                   
                                                                                                                                
2:06:26 PM                                                                                                                    
SENATOR  HUGHES noted  that the  bill changes  the makeup  of the                                                               
board. She  asked whether that  would benefit the public  and the                                                               
peer review process.                                                                                                            
                                                                                                                                
2:06:41 PM                                                                                                                    
MS. CURTIS answered that she was unsure.                                                                                        
                                                                                                                                
2:07:11 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 192.                                                                                 
                                                                                                                                
2:07:30 PM                                                                                                                    
JOHANNA CROSSETT, representing self,  Juneau, Alaska, stated that                                                               
she  was  a licensed  midwife.  She  said  she is  curious  about                                                               
changes   that  the   committee   may  make.   She  related   her                                                               
understanding  that the  intent of  the bill  was to  address the                                                               
audit recommendations.                                                                                                          
                                                                                                                                
2:08:24 PM                                                                                                                    
RACHEL PUGH,  Member, Board  of Certified  Direct-Entry Midwives,                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED),  Eagle River,  Alaska, stated  that she  is a  certified                                                               
direct-entry  midwife. She  stated that  Recommendations 2  and 3                                                               
have already been addressed by the  board. She stated that SB 192                                                               
was  designed  to address  Recommendation  3.  She expressed  her                                                               
interest in any  proposed amendments. The board  spoke in support                                                               
of  SB  192, as  written.  She  pointed  out  there is  only  one                                                               
certifying organization, the North  American Registry of Midwives                                                               
(NARM).  The  other organizations  are  associations  but do  not                                                               
certify midwives. She  related that she consulted  with NARM when                                                               
working on  the language in  SB 192  to ensure that  the statutes                                                               
fulfilled national standards.                                                                                                   
                                                                                                                                
2:10:50 PM                                                                                                                    
SENATOR  HUGHES  characterized  the profession  of  midwifery  as                                                               
important.  She stated  that she  has a  family member  under the                                                               
care of a midwife. She asked  Ms. Pugh to identify any provisions                                                               
in the bill that were not the result of audit recommendations.                                                                  
                                                                                                                                
MS. PUGH  offered her view  that the  entire bill is  designed to                                                               
meet  national  standards.  She  did  not  believe  anything  was                                                               
outside of that scope.                                                                                                          
                                                                                                                                
2:11:34 PM                                                                                                                    
SENATOR  HUGHES related  her understanding  that the  board would                                                               
remove  seats  on  the  board  for  the  physician  and  advanced                                                               
practice  nurse  that works  in  a  hospital setting.  She  asked                                                               
whether that was part of the sunset audit recommendation.                                                                       
                                                                                                                                
2:11:50 PM                                                                                                                    
MS. PUGH  stated that it  relates to the national  standards. She                                                               
explained  that  the board  went  through  the proposed  statutes                                                               
line-by-line [during a board meeting].  She related that four [of                                                               
five]   board   members   participated  online.   Those   members                                                               
unanimously supported the proposed  language, including the board                                                               
member  serving  in the  Physician/OB  practice  position on  the                                                               
board.  The board  supported changing  the  board composition  to                                                               
consist of two members who  are licensed midwives and two members                                                               
who  are Advanced  Practice  Registered  Nurses (APRN).  Midwives                                                               
work  closely with  advanced practice  registered nurses  (APRNs)                                                               
because  they understand  the scope  of practice.  She said  that                                                               
Certified  Nurse   Midwives/APRNs  who  work  in   hospitals  and                                                               
Obstetricians   (OB)  physicians   do   not  understand   midwife                                                               
practices outside  the hospital realm.  She stated that  it could                                                               
make  the Board  of  Certified  Direct-Entry Midwives'  decisions                                                               
difficult  because  it  requires  the midwife  board  members  to                                                               
explain how  they conduct  their jobs. She  related that  she had                                                               
worked  with  counterparts CNMs  and  APRNs  working outside  the                                                               
hospital and collaborating  with the rest of the  midwives in the                                                               
state. She  noted that  she is  not the  only midwife  that works                                                               
closely with  out-of-hospital CNMs  and APRNs.  She characterized                                                               
their working relationship as very  good, so they would know more                                                               
about  the scope  of practice,  which would  be an  asset to  the                                                               
board.                                                                                                                          
                                                                                                                                
2:13:47 PM                                                                                                                    
SENATOR HUGHES  pointed out that  changing the  board composition                                                               
was  not in  the audit  recommendation but  it was  something the                                                               
board decided would be beneficial.                                                                                              
                                                                                                                                
2:14:06 PM                                                                                                                    
SENATOR BEGICH stated that the  audit said the board identified a                                                               
need  to   change  certification   statutes  to   align  Alaska's                                                               
midwifery  laws  with  national   standards.  It  says  certified                                                               
direct-entry midwife (CDM) certification  statutes are defined in                                                               
AS 08.65.060 through AS 08.65.080.  It pointed out that the board                                                               
has   the   authority   to   establish   regulations   over   the                                                               
certification process. He stated  that the audit recommended that                                                               
the  board  pursue statutory  changes  that  benefit the  public,                                                               
which is somewhat vague.                                                                                                        
                                                                                                                                
SENATOR  BEGICH  stated  that  the  bill  is  lengthy  and  makes                                                               
numerous suggestions.  He wondered if  it would be  sufficient to                                                               
just focus on  AS 08.65.050, which relates  to the qualifications                                                               
for licensure. He read a  portion of Sec. 08.65.050. The language                                                               
proposed [on page 5, lines 21-25 reads:                                                                                         
                                                                                                                                
     (1) holds  a valid certified  professional certificate,                                                                    
     if   the  certificate   is  issued   by  a   nationally                                                                    
     recognized  midwife  organization   recognized  by  the                                                                    
     board  and the  requirements  for  the certificate  are                                                                    
     consistent with this chapter.                                                                                              
                                                                                                                                
SENATOR  BEGICH   noted  that   the  board  could   identify  the                                                               
nationally  recognized  midwife  organization. He  asked  whether                                                               
that was sufficient to meet the audit requirement.                                                                              
                                                                                                                                
2:15:45 PM                                                                                                                    
MS.  PUGH said  it was  not because  midwives currently  practice                                                               
under  a  restriction of  trade.  She  noted  that CDMs  are  not                                                               
recognized by  insurance companies,  and Alaskan midwives  do not                                                               
practice as Certified Professional  Midwives (CPMs), which is the                                                               
national standard.  She pointed  out that  it was  challenging to                                                               
make proposed statutory  changes because one change  would have a                                                               
ripple effect.  She noted that  the enabling statute is  30 years                                                               
old and is not up to national standards.                                                                                        
                                                                                                                                
2:16:47 PM                                                                                                                    
SENATOR BEGICH asked how many  certified midwives in Alaska would                                                               
lose their certification if this bill were adopted.                                                                             
                                                                                                                                
2:17:20 PM                                                                                                                    
MS. PUGH  offered her  view that  there would  be less  than five                                                               
midwives in Alaska without CPM certification.                                                                                   
                                                                                                                                
2:17:32 PM                                                                                                                    
SENATOR REINBOLD thanked her for serving.                                                                                       
                                                                                                                                
2:18:07 PM                                                                                                                    
IDA DARRAGH, CPM; Executive Director,  North American Registry of                                                               
Midwives (NARM), Little  Rock, Arkansas, stated that  NARM is the                                                               
national organization  that issues the credentials  for Certified                                                               
Professional Midwives (CPM). She spoke  in support of SB 192. She                                                               
said the CPM credential is  nationally accredited by the National                                                               
Commission for  Certifying Agencies  (NCCA), providing  the basis                                                               
for  licensure  in 37  states  that  license midwives  to  attend                                                               
births outside  the hospital.  She said it  is the  only national                                                               
credential  that  requires  training and  experience  in  out-of-                                                               
hospital  births.  Alaska  has recognized  Direct-Entry  Midwives                                                               
since  at least  1999.  She  indicated that  SB  192 would  bring                                                               
Alaska up  to the  national standard for  the licensure  of CPMs.                                                               
She related  that passing the  bill would  change the title  to a                                                               
licensed midwife.  The term  certified was  based on  meeting the                                                               
national  certification  standards   of  the  national  midwifery                                                               
credential, but each state does  licensure. The current system in                                                               
Alaska already  functions as  a licensure  program, so  the title                                                               
should reflect that, even though it  is not a change to the legal                                                               
path to practice in Alaska.  She characterized it as a refinement                                                               
and improvement to the current system.                                                                                          
                                                                                                                                
MS. DARRAGH  stated that SB 192  would bring licensure up  to the                                                               
national  standard. All  currently  holding  the title  Certified                                                               
Direct  Entry   Midwife  in  Alaska  have   passed  the  national                                                               
certification   exam,  but   some  have   not  applied   for  the                                                               
credential. Those  who are not  CPMs but hold a  state credential                                                               
can  easily   obtain  the  CPM   credential  with   a  simplified                                                               
application and a $50 fee.  The credential would also verify that                                                               
they  had met  the  continuing  education, recertification,  peer                                                               
review, and CPR training.                                                                                                       
                                                                                                                                
2:21:07 PM                                                                                                                    
KATHRYN AULT, Nurse Practitioner;  President, American College of                                                               
Nurse-Midwives; Member APRN Alliance,  Homer, Alaska, stated that                                                               
she  also serves  as the  President  of the  American College  of                                                               
Nurse-Midwives.  She said  that  she was  speaking  on behalf  of                                                               
herself  and  for  the  APRN Alliance.  She  offered  that  APRNs                                                               
support  Direct-Entry Midwives  and  changed  their licensure  to                                                               
licensed midwives.  However, APRN has issues  and opposition with                                                               
some  parts  of the  bill,  so  they do  not  support  SB 192  as                                                               
currently  written. She  expressed concern  about the  changes to                                                               
the board  composition and the  difference for the  nurse midwife                                                               
to be  actively practicing out  of the hospital. They  think this                                                               
would  erode   some  important  relationships   with  in-hospital                                                               
providers  because sometimes  home  births must  transfer to  the                                                               
hospital,   and   those   relationships   are   meaningful   when                                                               
transferring the patient.                                                                                                       
                                                                                                                                
2:22:20 PM                                                                                                                    
MS. AULT stated that the Division  of Public Health has a quality                                                               
improvement measure that midwives  and obstetricians are part of,                                                               
which strives to improve the  transfer process from the community                                                               
to the  hospital. She offered  her view  that this bill  does the                                                               
opposite.                                                                                                                       
                                                                                                                                
2:22:50 PM                                                                                                                    
MARY   YANAGAWA,  Certified   Direct-Entry  Midwife;   President,                                                               
Midwives Association  of Alaska (MAA), Wasilla,  Alaska, provided                                                               
invited  testimony  for  SB  192.   She  read  prepared  remarks,                                                               
beginning with the mission statement.                                                                                           
                                                                                                                                
     The Midwives  Association of  Alaska exists  to promote                                                                    
     midwifery  in  Alaska   through  continuing  education,                                                                    
     support, and  structure for  Direct Entry  Midwives. We                                                                    
     are  committed   to  the   midwifery  model   of  care,                                                                    
     providing choices in childbirth for women and babies.                                                                      
                                                                                                                                
     The Midwifery Model  of Care is based on  the fact that                                                                    
     pregnancy  and birth  are  normal  life processes.  The                                                                    
     Midwifery  Model   of  Care  includes   monitoring  the                                                                    
     physical, psychological,  and social well-being  of the                                                                    
     mother in a child-bearing  cycle. We provide the mother                                                                    
     with   individualized  education,   counseling,  female                                                                    
     care,  and continuous  hands-on  assistance during  the                                                                    
     labor   and  delivery,   and  postpartum   support.  We                                                                    
     specialize  in  minimizing technological  intervention,                                                                    
     identifying  and referring  women who  require physical                                                                    
     attention, and  we know the application  of this woman-                                                                    
     centered model  of care has  been proven to  reduce the                                                                    
     incidence  of  birth   injury,  trauma,  and  caesarean                                                                    
     section.                                                                                                                   
                                                                                                                                
     As an organization made up  of fiercely independent and                                                                    
     strong women,  it is  understood that  we will  not all                                                                    
     agree on every detail of  everything. We each come from                                                                    
     differing perspectives  based on our  individual lives,                                                                    
     practices, and  callings. There is a  midwife out there                                                                    
     for   everyone,  for   every  personality,   and  every                                                                    
     individual.                                                                                                                
                                                                                                                                
2:25:09 PM                                                                                                                    
     We have  heard from  a small  group of  midwives within                                                                    
     our  organization that  the  language  of our  statutes                                                                    
     today  were not  to their  liking. We  understand these                                                                    
     viewpoints that  are shared with us  and also recognize                                                                    
     that the majority of our  midwives have expressed their                                                                    
     support with these statute updates.                                                                                        
                                                                                                                                
MS.  YANAGAWA added  her  personal comment.  She  said as  a                                                                    
woman who  spent all of  her child-bearing years  in Alaska,                                                                    
her voice matters.  As a pregnant woman and  new mother, she                                                                    
felt  mistreated by  the  mainstream medical  hospital-based                                                                    
system providers in Alaska.                                                                                                     
                                                                                                                                
MS.  YANAGAWA stated  that she  had  restricted options  for                                                                    
childbirth due  to the practices  and policies  of hospital-                                                                    
based  providers in  this state.  Her treatment  led her  to                                                                    
seek  the  midwifery  profession, including  the  education,                                                                    
advocacy,  and Midwifery  Model of  Care that  she currently                                                                    
espouses.  She stated  that her  search for  a flexible  and                                                                    
compassionate provider within the hospital was fruitless.                                                                       
                                                                                                                                
MS. YANAGAWA stated  that she drove the  ALCAN when pregnant                                                                    
with  her  sixth child  to  be  under  the care  of  out-of-                                                                    
hospital  community-based care  in California.  The midwives                                                                    
were no  different than the  licensing and  credentialing of                                                                    
the CPMs  in Alaska. She said  she would have liked  to have                                                                    
used an  Alaskan midwife if Alaska  statutes and regulations                                                                    
had not  restricted their  trade. She  detailed some  of her                                                                    
trials and tribulations during her time in California.                                                                          
                                                                                                                                
2:27:30 PM                                                                                                                    
MS.  YANAGAWA  noted that  the  audit  recommended that  the                                                                    
board pursue statutory changes that  benefit the public. She                                                                    
offered  her   view  that  numerous  families   support  the                                                                    
legislation.                                                                                                                    
                                                                                                                                
MS.  YANAGAWA  stated that  midwives  do  more than  provide                                                                    
care.  They  provide   a  safe  space  for   women  to  feel                                                                    
empowered.  Midwives provide  compassion, access  to quality                                                                    
care, and the ability to  refer families when necessary. She                                                                    
said midwives  provide community-based  care that  is proven                                                                    
to grow strong families with great outcomes.                                                                                    
                                                                                                                                
2:28:55 PM                                                                                                                    
BETHANY KIRILLOV,  representing self,  Wasilla, Alaska,  spoke in                                                               
support of  SB 192.  She stated  that she  is a  licensed Direct-                                                               
Entry  Apprentice  Midwife.  She  said   she  has  worked  as  an                                                               
apprentice and  is also  a mother of  four children.  She offered                                                               
her  support for  SB 192,  as written,  because it  would benefit                                                               
mothers and  midwives and fulfill the  audit recommendations. She                                                               
expressed  concern that  some mothers  have  indicated they  will                                                               
give  birth  without  a caregiver  present  because  of  Alaska's                                                               
statutes that limit midwifery care.                                                                                             
                                                                                                                                
MS. KIRILLOV  stated that midwives  exercising their  training is                                                               
in the  interest of Alaskans.  She said women choose  midwives to                                                               
have control  over their  care. She  further stated  that billing                                                               
private  insurance will  lessen the  out-of-pocket expenses.  She                                                               
stated that  the current statutes  are restrictive.  She attended                                                               
the  Via  Vita  School  of Midwifery,  which  is  acceptable  for                                                               
licensure in  Alaska. She  said she  supported NARM  because they                                                               
issue the  CPM credentials to midwives  nationwide and administer                                                               
the national exam.  NARM is an excellent choice  to set standards                                                               
for Alaska's  licensure. She expressed  concern that  the current                                                               
statutes  limit midwifery  education  to a  very  narrow list  of                                                               
schools.                                                                                                                        
                                                                                                                                
2:33:03 PM                                                                                                                    
CHAIR WILSON closed public testimony on SB 192.                                                                                 
                                                                                                                                
2:33:27 PM                                                                                                                    
SENATOR BEGICH  stated his questions  had been answered.  He said                                                               
he  would like  to  pare down  the  bill to  focus  on the  audit                                                               
recommendations.                                                                                                                
                                                                                                                                
2:34:05 PM                                                                                                                    
SENATOR KAWASAKI thanked  the committee for hearing  the bill. He                                                               
welcomed working with Senator Begich on amendments.                                                                             
                                                                                                                                
2:34:26 PM                                                                                                                    
CHAIR WILSON held SB 192 in committee.                                                                                          
                                                                                                                                
2:35:36 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 2:35 p.m.                                                                                         

Document Name Date/Time Subjects
SB 192 APRN 3.3.22.pdf SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Midwives Assoc. of AK Letter.pdf SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Testimony 3.8.22.pdf SHSS 3/10/2022 1:30:00 PM
SB 192
SB 175 Letters 3.9.22.pdf SHSS 3/10/2022 1:30:00 PM
SB 175
HCR 10 - CDC Heart Disease Facts.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HCR 10
HCR 10 Sponsor Statement.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HCR 10
HCR 10 2021 AMA 2021 Update.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HCR 10
SB 175 Sectional Analysis v. I 3.1.2022.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 Sponsor Statement v. I 3.1.2022.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 v.I Work Draft 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 Explanation of Changes v. A-I 3.2.2022.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 175
SB 175 (HB 265) Letters 03.02.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HB 265
SB 175
SB 192 NARM letter of Support 3.23.21.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Sectional Analysis 3.2.22.pdf SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Sponsor Statement 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Supporting Doc Why We Need CPM 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Audit Recommendations DLA 6.19.2020.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 FN DCCED CBPL 2.25.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 FN DCCED IO 2.25.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Leg Legal Memo 1.18.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Leg Legal Memo 2.11.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Letters 3.2.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192
SB 192 Sectional Analysis 3.3.22.pdf SHSS 3/3/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
SB 192