CS FOR SENATE BILL NO. 55(FIN) "An Act extending the termination date of the Board of Certified Direct-Entry Midwives; extending the termination date of the State Medical Board; and providing for an effective date." 2:09:51 PM MERCEDES COLBERT, STAFF, SENATOR BILL WIELECHOWSKI, SPONSOR, thanked the committee for hearing the bill. She explained that the bill would extend the termination date of the Board of Certified Direct-Entry Midwives and the termination date of the State Medical Board. She relayed that the state auditor recommended a four-year extension date through June 30, 2027 for the Board of Certified Direct-Entry Midwives and an eight-year extension through June 30, 2031 for the State Medical Board. She deferred to Kris Curtis, legislative auditor for details on the audits. Additionally, the Department of Commerce, Community and Economic Development (DCCED) was available to address the fiscal note. Co-Chair Foster asked for a review of the audit. KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF LEGISLATIVE AUDIT, began with the audit findings for the State Medical Board (copy on file). The audit concluded that the board developed and adopted regulations to protect the public, improve the licensing process, and expand access to healthcare during the pandemic. Further, the board served the public's interest by effectively licensing physicians, osteopaths, and podiatrists; however, emergency courtesy licenses for physician assistants were not always issued in accordance with law. The audit also found that the board's workload had increased substantially during the audit period. The board met frequently, sometimes weekly, to consider pandemic-related regulations and the number of license applications considered by the board increased 28 percent compared to the pre-pandemic period. She explained the increase was a result of physicians traveling to the state to help meet the need for healthcare services during the pandemic and out of state practitioners providing services via telehealth. Ms. Curtis relayed that board turnover and vacancies were common during the audit period, but even with the challenges, the audit found the board operated effectively. The audit recommended an eight-year extension, which was the maximum allowed in statute. She directed members to page 8 of the audit report showing licensing information. As of March 2022, there were 5,878 active licenses and permits for the board. Page 10 showed the schedule of revenues and expenses, showing that as of March 2022, the board had a surplus of approximately $506,000. Ms. Curtis directed members to page 14 of the audit report and highlighted two recommendations. First, the audit recommended that the board's executive director ensure all board meetings were adequately public noticed. The audit found that six of 32 meetings were not publicly noticed or not publicly noticed accurately. Second, the audit recommended that the board ensure emergency regulations comply with statute. The audit found that when the board established the physician assistant emergency courtesy license regulation, they did not ensure that the applicant had a collaborative plan with a supervising physician, which was a statutory requirement. She relayed that management's response to the audit began on page 25. She reported that the governor, commissioner, and board chair concurred with the findings and recommendations. She stated that overall, it was a fairly clean audit. 2:14:29 PM Ms. Curtis addressed the audit findings for the Board of Certified Direct-Entry Midwives (copy on file). The audit concluded that the board served the public's interest by conducting its meetings in an effective manner, by supporting statutory changes when deemed necessary, and by actively working towards amending its regulations. The audit also concluded that the board and the Division of Corporations, Business and Professional Licensing (CBPL) staff did not consistently certify midwives and apprentice midwives in accordance with the law. Further, an investigation that concerned a potential threat to public safety was not addressed by CBPL investigators in an efficient manner. The audit recommended the legislature extend the board four years, which was half of the eight- year maximum allowed in statute. The reduced extension recommendation was based on a need for more timely oversight of the board and on the fact that the board had some draft regulations that would significantly change how it licensed midwives in the future. Ms. Curtis turned to page 5 of the audit report and relayed that there were 47 certified midwives and apprentice midwives as of June 2022. Page 7 showed a schedule of revenues and expenses showing a surplus of approximately $68,000 as of March 2022. The audit made four recommendations for improvement beginning on page 9. In regard to the investigations that were not done timely, the audit recommended that the commissioner consult with the governor's office and other policy makers to improve the recruitment and retention of investigators. She stated that because recruitment and retention was a statewide problem, it should be addressed at a statewide policy level. The second recommendation was similar in regard to improving the recruitment and retention of licensing staff, which contributed to the licensing errors discovered in the audit. Ms. Curtis turned to page 11 of the audit report and addressed the audit recommendation for the director to work with the board to ensure the online renewal licensing application form was sufficient to monitor compliance with continuing education. Additionally, the license referenced incorrect regulations, which should be cleaned up. The fourth recommendation, located on page 12, recommended that the Office of the Governor's Boards and Commissions director work with the board to identify interested applicants to fill board vacancies in a timely manner. She detailed that the board was composed of five members and for 20 months it was down two positions and for two months it was down three positions. She shared that the commissioner, board chair, and governor's office concurred with the findings and recommendations. She highlighted that on page 26, the chair asked for an eight-year extension as opposed to a four-year extension. The request was made because the recommendations were mainly addressed to the department and governor's office. 2:17:46 PM Representative Hannan noted that the audit recommendations did not really pertain to actions by the board. She considered various extension options including four, six, and eight years. She reasoned it was incumbent on the agency to ensure the board was adequately staffed and [investigations] were done in a timely manner. She considered herself to be a fairly new legislator, but she recalled renewing the board once before. She thought it seemed there would always be a sort of panic to get on step when they were down on staff and the concerns were timeliness but not actions of the board. She asked if she was missing something. Ms. Curtis replied it was a common question whenever there were recommendations addressed to the division and not the board. She stated it was a legislative oversight mechanism. She recommended taking a look at the board again earlier rather than later because the board planned to significantly change how it licensed midwives. Additionally, she believed it was important to keep an eye on the investigations for a board that impacted public safety. She noted it was the second time there had been issues with the investigations. Representative Hannan asked Ms. Curtis to elaborate on any communications the auditors had with the department about their focus and ability to address the concerns raised in the audit. She asked if the department had more investigators. She wondered if the deficits [in the division] would remain in four years. She did not recall an increase in the division's budget for an investigator. She believed the positions were unfilled. She wondered about filling or addressing the positions and turning licenses and investigations around in a timelier fashion. 2:20:22 PM Ms. Curtis answered that the licensing issue was not necessarily about timing but about not having the appropriate documentation in the files or not following up on certain things. She stated it was attributed to turnover and vacancies. She stated the same was true with the investigations. She relayed that the particular case was a threat to public safety and had been identified in the audit three years earlier. She reported that no progress had been made on the issue. She detailed that the chief investigator stated the division had an untenable workload due to a high number of cases and a high number of vacant positions and that efforts to hire had been unsuccessful. She relayed it was a statewide issue. She explained that it may not be a budgetary situation if the division could not find someone to apply for a position or remain in a position. She considered it may indicate a need for more statewide policy pertaining to recruitment and retention. Representative Josephson asked if the board and midwives had to pay the audit fees if they had to come back in four years. Ms. Curtis answered that there was no cost to the department for a sunset; it was just the department's time and energy dealing with the auditors. She explained that sunset audits were part of the Division of Legislative Audit's budget. She explained that if there were seven sunsets in a given year, more of the division's resources would go towards the audits as opposed to doing special audits at the request of the committee. Representative Josephson asked from the perspective of the midwives and board chair why it was so important for the board to receive a seven-year extension versus four. He asked if it felt insulting to the board and licensees. Ms. Curtis answered that the individuals were passionate about their work and the volunteers worked very hard. She stated that time and time again she saw that the individuals felt like it was like a grade on their report. She stated they wanted an "A" and did not feel that a four- year extension indicated an A. She acknowledged that the individuals were doing a wonderful job, they worked very hard, and the recommendation was not a reflection of their time. Co-Chair Foster noted that both of the boards would expire June 30, 2023 if the bill was not passed. He asked Ms. Colbert if she had anything to add prior to the review of the fiscal note. Ms. Colbert thanked the committee for hearing the bill and thanked the senator's intern for carrying the bill in the other body. Co-Chair Foster asked for a review of the fiscal note. 2:23:43 PM SYLVAN ROBB, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, highlighted that the total annual cost to extend both boards was $25,200 from FY 25 through FY 29. She noted there were no costs shown for FY 24 because per statute, if boards were not extended, there was a one-year wind down period; therefore, the division would pay for the board in FY 24 regardless of the status of the bill. Representative Hannan asked how the department was doing in hiring the investigative position and filling the vacancies that had created some demerits on the audit. Ms. Robb responded that the division had been successful in staffing its investigations unit. She detailed that the unit had been fully staffed until the end of March with 23 filled positions. An individual had retired at the of March and the position had been filled with an internal promotion meaning there would still be a vacancy. She stated the division was doing much better in terms of having the investigation positions filled. Representative Hannan asked if the department believed it would be able to support the board to fully comply with statute for the next four years if the sunset was extended. Ms. Robb replied affirmatively. Co-Chair Edgmon MOVED to REPORT CSSB 55(FIN) out of committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. CSSB 55(FIN) was REPORTED out of committee with a "do pass" recommendation and with one previously published fiscal impact note: FN2 (CED).