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, sponsor of 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 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 likely could not 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 expressed appreciation that Senator Begich offered to work together 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.