CS FOR HOUSE BILL NO. 49(FIN) "An Act extending the termination date of the Board of Certified Direct-Entry Midwives; and providing for an effective date." 1:58:49 PM REPRESENTATIVE SAM KITO, SPONSOR, introduced the legislation. He stated that the bill provided an extension of Board of Certified Direct-Entry Midwives through 2021, which was the recommended extension from Legislative Audit. 1:59:53 PM KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF LEGISLATIVE AUDIT, shared that there was an audit available dated 2016 (copy on file). The last sunset audit of the board was conducted in 2014. At that time the Division of Corporation, Business, and Professional Licensing (DCBPL) investigative staff had not actively processed investigations that posed a public safety risk. After that audit was released, the board was only extended two years. The most recent audit found that the board was effectively licensing and regulating certified direct entry midwives and midwife apprentices, and she recommended a four-year extension. He stated that there were four recommendations located in the audit document. 2:04:28 PM Senator Olson queried the reasons for the deficits. Ms. Curtis replied that the board had struggled with investigative fees. Senator Olson wondered whether there were lawsuits related to malpractice of midwives. Ms. Curtis replied that there were four cases involving two individuals that were not moving forward and resulted in additional costs. She stressed that the audit did not typically go into detail on investigative cases. Senator Olson wondered whether did not pursue a license because of the high fee. Ms. Curtis deferred to the department. Senator Olson asked whether there were any mergers of the boards for economic reasons in the state or other states. Ms. Curtis replied that there were no recent board mergers. Senator Hughes wondered whether the investigations were of licensed individuals or fraudulent midwives. Ms. Curtis that, historically, there was a mixture of both. 2:07:48 PM SARA CHAMBERS, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS, AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, shared that the department concurred with the first two findings in the audit regarding administrative errors and fees. She stated that there was a fee increase to $3800 for fully authorized midwives, and under $2000 for apprentices. She stated that there were no documented departures from the industry because of the fees, but it was a fairly new fee. She stated that the board only have approximately 50 licensees, so there was an economy of scale issue with unlicensed practice and some standard of care investigations. Co-Chair MacKinnon shared that Senator Olson had valuable medical expertise. Senator Olson wondered whether the licensees included the apprentices. Ms. Chambers responded in the affirmative. She stated that the latest numbers for the fee analysis indicated that there were 43 fully licensed midwives and approximately 20 apprentices. Senator Olson wondered whether the investigations were for midwives or apprentices. Ms. Chambers agreed to provide that information, but midwives had fiduciary responsibility over apprentices. Senator Hughes queried the licensure fees for physicians, nurses, and nurse practitioners. Ms. Chambers replied that the physician fee was $300, physician assistant's fee was $200, nurse's fee was approximately $200. Senator Hughes noted that midwives paid a significantly larger license fee, and thanked them for their dedication. 2:13:54 PM Co-Chair MacKinnon wondered whether the department could advance the concern that was listed from the officer to either the presiding officers, Labor and Commerce, or the appropriate chairman. She remarked that there was a liability for choosing to use a midwife. Co-Chair Hoffman remarked that the bill only dealt with the extension. He felt that addressing the third recommendation in the audit may require work from the Senate Health and Social Services Committee. Co-Chair MacKinnon agreed. Senator Micciche wondered how long it took to build an operation deficit of $183,083. Ms. Chambers replied that the board has had a deficit since 2012 of $65,000 and had grown annually until the most recent renewal cycle. The deficit began to reduce because of the increased fees. She remarked that the fees were dropped in 2009, but did not know the rationale for lowering the fee at that time. Senator Micciche wondered whether the four-year sunset renewal was too long, because the board should continue to be investigated. Senator Olson supported keeping independent midwives. He queried the estimated forecast. Ms. Chambers replied that there was a fee analysis to address the issues with setting fees. She stated that, assuming that the fees remain the same, the board's deficit would be eliminated by FY 21. 2:22:31 PM DEBORAH SCHNIDER, BOARD OF MIDWIVES, ANCHORAGE (via teleconference), testified in support of the bill. 2:24:21 PM JOHANNA CROSSETT, MIDWIFE, JUNEAU, spoke in support of the bill. Senator Micciche queried whether there was support of the licensees covering the deficit. Ms. Crossett replied in the affirmative. Vice-Chair Bishop wondered whether the midwives might not want to pay the fee, and stop licensing. Ms. Crossett replied that the initial proposed licensing fee was $4700. The reduction to $3800 was a good compromise. She hoped that there would not be another fee increase. 2:26:25 PM MADI NOLAN-GRIMES, MIDWIFE, JUNEAU, spoke in support of the bill. 2:27:21 PM SUZANNE TREWILLIGER, PRESIDENT, MIDWIVES ASSOCIATION OF ALASKA, EAGLE RIVER (via teleconference), testified in support of the bill. Senator Micciche wondered whether the number of midwives was changing. Ms. Trewilliger replied that that there was a reduction of thirteen midwives, and did not know the number of apprentices. Co-Chair MacKinnon CLOSED public testimony. 2:31:03 PM Vice-Chair Bishop addressed the fiscal note: FN 1(CED). 2:32:01 PM AT EASE 2:32:48 PM RECONVENED Vice-Chair Bishop MOVED to REPORT SCS CSHB 49(L&C) out of committee with individual recommendations and attached fiscal note. SCS CSHB 49(L&C) was REPORTED out of committee with a "do pass" recommendation and with one previously published fiscal impact note: FIN 1(CED). 2:33:51 PM AT EASE 2:40:39 PM RECONVENED