HB 26-EXTEND CERT. DIRECT-ENTRY MIDWIVES BOARD  CHAIR COSTELLO announced the consideration of HB 26. "An Act extending the termination date of the Board of Certified Direct- Entry Midwives; and providing for an effective date." 1:31:53 PM LAURA STIDOLPH, Staff, Representative Kurt Olson, on behalf of the prime sponsor, stated that HB 26 would extend the sunset date for the Board of Certified Direct-Entry Midwives to June 30, 2017. She explained that the Division of Legislative Audit conducts audits each year to determine if state boards and commissions should be reestablished. The division reviewed the activities of the Board of Certified Direct-Entry Midwives to determine if there is a demonstrated public need for the board's continued existence and whether it has been operating in an effective manner. The auditors recommended that the board be extended two years until June 30, 2017. 1:32:27 PM SENATOR MEYER joined the committee. MS. STIDOLPH related that auditors found the Board of Certified Direct-Entry Midwives has been serving the public's interest by effectively licensing certified direct-entry midwives (CDM) and apprentices. In addition, it was found that the board continues to improve the profession by modifying and adopting midwifery regulations to conform to current standards of care. MS. STIDOLPH highlighted that the auditors had four findings and recommendations: 1) the Department of Commerce, Community and Economic Development (DCCED) should immediately pursue disciplinary sanctions for CDM cases when warranted; 2) increase licensing fees to eliminate the board's operating deficit; 3) the board should communicate certificate requirements to continuing education providers to facilitate compliance with centralized licensing regulations; and 4) the board should approve apprentice permit applications in accordance with statute. 1:34:02 PM KRIS CURTIS, Legislative Auditor, Legislative Audit Division, Legislative Agencies and Offices, stated that the Audit Division conducted an audit of the Board of Certified Direct-Entry Midwives to determine whether it was serving the public purpose and concluded overall that the board is serving the public's interest by effectively licensing certified direct-entry midwives. However, the audit found that the Division of Corporations, Business, and Professional Licensing (DCBPL) staff failed to operate in the public's interest by not pursuing timely disciplinary sanctions related to midwife investigations. Because of this serious deficiency, the audit recommends the board's termination date be extended only two years to June 30, 2017. The audit made four recommendations. The first and most serious was to the commissioner of DCCED to take immediate action to pursue disciplinary sanctions for midwife cases when warranted. The audit found that disciplinary sanctions were not actively pursued for four investigations that were completed during the audit period. The investigations of two people concluded that disciplinary sanctions were needed. However, DCBPL investigative staff did not actively pursue sanctions to protect the public safety. The respondents in all four cases refused to sign a consent agreement. Rather than file an accusation and pursue an administrative hearing, DCBPL staff followed alternate procedures. Two of the four cases were forwarded to the Department of Law Office of Special Prosecution and Appeals (OSPA) without a sufficiency of evidence reviewed by the assistant attorney general. Those two cases remained at OSPA for over a year without action. According to OSPA those class B misdemeanor cases are the lowest priority. The other two cases were held by DCBPL investigators with the understanding that they would be forwarded to OSPA once the other two cases were resolved. Due to staff turnover, the audit could not determine why DCBPL staff did not pursue civil licensing action as required by their standard operating procedures. At a minimum, licensing action should be pursued concurrently with criminal action to ensure that the public is protected. By not pursuing licensing action, the respondents were allowed to continue to practice and the public's safety was at risk. MS. CURTIS said the audit makes three additional recommendations for operational improvements: 1) DCBPL and the board should consult and increase licensing fees to eliminate the board's $115,000 operating deficit; 2) the board should communicate certificate requirements to continuing education providers to facilitate compliance with centralized licensing recommendations; and 3) the board should approve apprentice permits in accordance with statutes. The audit found that permits were being approved by DCBPL staff but statutes only allow the board to issue the permits. 1:37:31 PM SENATOR STEVENS asked what the usual extension would be. MS. CURTIS replied the maximum allowed in statute is an eight- year extension. SENATOR STEVENS asked what has to be done in the next two years for the board to receive another extension. MS. CURTIS explained that the next audit would focus on what has been done with the investigative aspects of the board. 1:38:50 PM SENATOR GIESSEL expressed concern that 4 of 48 licensees had deficiencies. MS. CURTIS clarified that some of the investigations could be related to unlicensed activity. SENATOR GIESSEL questioned how 48 licensees could make up the deficit. She asked if the auditors have a plan, or if it will be left to the division. MS. CURTIS replied the plan will be left to the division, but it is an ongoing problem. The 2006 audit of the board identified that that midwives had the highest fees of any occupation. 1:40:11 PM SENATOR STEVENS asked what the fees are. MS. CURTIS reviewed the fees identified on page 15 of the audit. For FY 14, the Midwife Initial Certification and Renewal Fee was $1,450. The fee was over $2,000 when the 2006 audit was done. SENATOR STEVENS asked what happens when someone practices midwifery without a license. MS. CURTIS replied that falls under the purview of the division of to pursue. 1:41:48 PM JANEY HOVENDEN, Director, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), introduced herself. 1:42:13 PM SARA CHAMBERS, Operations Manager, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), offered to answer questions related to HB 26. SENATOR STEVENS asked what happens when someone practices midwifery without a license. MS. CHAMBERS explained that the division goes through a process of investigation and discovery that involves either a board member or subject matter expert to review the facts. If there is sufficient cause for a violation the division would pursue a consent agreement that acknowledges a violation and how the person plans to correct it. That may include licensure, license probation, or fines. In many cases of unlicensed activity the person is not willing to work toward an amicable agreement. In those cases the division works with the Department of Law to file an accusation of violation of law and pursue the sanctions available to that licensing program. CHAIR COSTELLO asked what the division's plan is to address board deficits. MS. CHAMBERS explained that the fees for midwives and apprentices have been increased since the audit was initiated. The board is aware of the historical deficit and is working with the division to raise all the license fees within the program. The division has prescribed a stair step program to try to chip away at the debt without it becoming overly burdensome to midwives. She said the board recognizes that it is responsible for the deficit, but it is difficult because investigations of licensed and unlicensed practice can be a very expensive. 1:46:39 PM SENATOR GIESSEL offered her understanding is that the deficit stems from a large legal case that cost the board a significant amount. MS. CHAMBERS agreed. SENATOR GIESSEL pointed out that it would help if boards could retain the penalties that are levied against their licensees, but they go into the general fund. She clarified that these licensees are direct-entry midwives not certified nurse midwives. CHAIR COSTELLO recalled the discussion that if the penalties were retained by the board it might stimulate interest in pursuing more penalties. SENATOR STEVENS asked if midwives work fulltime. MS. CHAMBERS replied there are both fulltime and part time midwives. Responding to a further question, she confirmed that the licensing fee is the same regardless of how much the midwife works. 1:50:07 PM MS. CHAMBERS reported that since the division met with the auditors, DCBPL has reviewed its quality control measures and investigative protocols with the new chief investigator. They have worked to tighten the standards and timeframes and have been working with the Department of Law and OSPA to use the audit as a tool for further quality improvement agency wide. The cases that the audit identified are now in full compliance with the stated protocols. She expressed optimism about standing the test of compliance per auditing standards. CHAIR COSTELLO asked her to review of the fiscal note. 1:52:20 PM MS. CHAMBERS explained that the fiscal note speaks to the sunset of the board and reflects the changes that are anticipated if the board dissolves. "Since the sunset assumes that the board sunsets, this would reinitiate what we're currently expending for travel," she said. SENATOR GIESSEL asked Ms. Curtis if she considered a shorter extension, say one year. MS. CURTIS replied she worked with Ms. Chambers on the appropriate timeframe and two years seemed sufficient. She noted that the division appears to have addressed the issues more quickly than anticipated. CHAIR COSTELLO asked Senator Giessel if she wanted an update in a year. SENATOR GIESSEL said she would like an interim report, if possible. MS. CURTIS said the direction has to come from the Legislative Budget and Audit (LB&A) Committee, but that has been done. SENATOR GIESSEL asked if that is best done through intent language in the sunset bill or an informal request to the LB&A. MS. CURTIS said she is only aware of it being done through an informal request to the LB&A. 1:55:42 PM CHAIR COSTELLO found no public testimony and closed it. 1:56:12 PM At ease 1:57:05 PM CHAIR COSTELLO reconvened the meeting and recognized Senator Giessel. SENATOR GIESSEL offered a conceptual amendment to capture legislative intent to request an interim one-year status update from the Legislative Audit Division on the Board of Certified Direct-Entry Midwives. 1:57:41 PM CHAIR COSTELLO found no objection and announced that conceptual Amendment 1 is adopted. 1:57:55 PM SENATOR GIESSEL moved to report HB 26, 29-LS 0171\A as amended, from committee with individual recommendations and attached fiscal note(s). CHAIR COSTELLO announced that without objection, SCS HB 26(L&C) is reported from the Senate Labor and Commerce Standing Committee.