Vermont Legislature SmartTranscripts:

[Matthew Birong (Chair)]: Hello, everyone. Welcome back from lunch, government operations military affairs on January 16. And we're gonna start work on h five eighty eight, and we are joined by counsel to do a walk through of the bill. How are you counsel?

[Tim Dublin (Legislative Counsel)]: Doing very well, Chea. Thank you very much for having me. It's nice to be back in the seat.

[Matthew Birong (Chair)]: Record,

[Tim Dublin (Legislative Counsel)]: my name is Tim Dublin, legislative counsel. And for you, you have h five eight eight. This is, what we general virtue as the OPR miscellaneous bill. OPR is the office of professional regulation. And, actually, what the committee, has available to them online is the bill is introduced, the proposed committee amendment, which is what I'll, be working off of, as well as a bill overview. And I apologize for any typos. I just kind of finished

[Matthew Birong (Chair)]: that quickly.

[Tim Dublin (Legislative Counsel)]: You can ignore any different colored texts or anything like that. And you can assume that will be updated where appropriate and as the amendment evolves well.

[Lisa Hango (Vice Chair)]: Tim, sorry, you said you're going to be working off from the amendment, not the overview?

[Tim Dublin (Legislative Counsel)]: Actually, probably both. Maybe it's best to work from the overview, but it's up to Let's start

[Matthew Birong (Chair)]: with the overview and then we can get more detailed later on. I think that's a good start.

[Tim Dublin (Legislative Counsel)]: Okay. So let's see. Just for those, who have done some of my overviews before, the purpose section is broken down at the beginning, which will not appear in the amendments. And then we have essentially seven large elements. And so those are bold there with the sections underneath. And then I tried to provide hyperlinks to the statutes in case, committee members want to pull up the language to see for themselves real quick. And then includes annotations, I think, might either help distill or the issues being amended via statute amendment that is, or provide additional context. So this bill proposes to do various things, explicitly enable the office professional regulation to rescind licenses and enforce against attempted fraudulent or deceptive procurement or use of a license, require professional regulation, sorry, require board members to be adults, It will correct terminology in for license denials, foreign applicants. It will create a limited academic dentist license. It will modify regulations for massage therapist establishments. It will, let's see, eliminate an advisory committee on midwifery, and change, license renewal requirements for midwives, to move the requirement that they file, individual practice data. It will modify recommendations, recommendation requirements from pharmacists, as well as pharmacist technicians, in regard to prescribing vaccinations. It will modify the definition of the practice of funeral services to include, disposing of dead human bodies by cremation, aquiline hydrolysis, or natural organic reduction. And finally, it will enable the director to create temporary policies to supplement psychologist licensure education requirements, notwithstanding any contrary rules. And you can ignore that. The question is

[Matthew Birong (Chair)]: Right there.

[Lisa Hango (Vice Chair)]: Okay. Is it supposed to be psychologists? Yes. Not physiologists. Apologize. So

[Tim Dublin (Legislative Counsel)]: starting in part one of the bill, this is sections one through five to orient us where we are in the statutes. This is entitled three, and this is essentially the body of law that will, control the office in general and, therefore, kind of applies to all of the regulated professions that OPR has under its purview. So section one will amend the duties of the office founded three VSA 01/2023. And this will enable the office to now rescind licenses in addition to the office's existing ability to revoke or suspend licenses. And, I'll defer to, when this is coming up, next to the OPR as to, any additional context needed in that regard.

[Lisa Hango (Vice Chair)]: Can you tell us the difference between rescind and revoke in a legal setting?

[Tim Dublin (Legislative Counsel)]: Great question. Right now, there's not a distinction in definition. The term isn't defined. Generally speaking, and there's not really an established necessarily established legal term of art when it comes to what is precision can be treated the same as revoke. It can be treated the same as invalidated. So that's a consideration for the committee right there is that if there is, in the absence of kind of defining case law or definitions elsewhere, there could be cross referenced, is it appropriate to kind of flush that out? It's a decision we can get to. And as far as to why and how they'll be using rescission, again, I'll refer to the witnesses that come in and they'll have more detail on. Section one will also add new subdivision A14 enabling the office to adopt rules to establish a program essentially diversionary program for individuals, with substance use disorders, so they can avoid certain misconduct procedures and I just put in a cross reference so this will come up in the next section too. So moving to section two, this will amend statute regarding disciplinary actions to be reported to the office. That's three VSA 128 And this rephrases subdivision A3 for clarity by removing a double negative. Before, it had read, the section shall not apply to cases that are unrelated to. And so, this provided some clear verbiage reading this section shall apply to cases that are related to and just for context section 128 requires healthcare institutions to report disciplinary action that limits a licensee's privilege to practice or leads, to suspension or expulsion. Section three will amend a unprofessional conduct statute, three VSA one twenty nine a specifically, and it will amend subdivision a one to add the definition of what constitutes sorry add to the definition of what already constitutes unprofessional conduct so that it will not only include fraudulent or deceptive procurement and use of a license but also the attempt to do so now will also be considered a professional conduct. We'll add a new subsection g enabling a licensee with substance use disorder to voluntarily enter into a diversion program as an alternative disciplinary proceed process and this again kind of goes hand in hand with that element in section one amending three vsa 1.3 secondtion four will, amend three VSA one twenty nine b and this has to do with board members and advisory appointments. And the amendment will put effects to that, all board members must be adults and we use the term age of majority, which in Vermont is 18 on the end it does change depending on the state. Section five will amend three VSA once 37. This is the uniform process for foreign credential verification and Subdivision D in particular is being amended and this has to do with license denial for foreign applicants. Importantly, this incorporates by a cross reference the standard license denial procedure found in 3BSA 01/1929. And few years ago, in 2023, 120 '9 was amended to eliminate preliminary denial process. And so that term still occurs here in 01/1937. So it's just cleaning that up by removing the term preliminary before it appears in two different places for license denials. So we'll just pause there. Those are the adjustments to general powers. Any questions about those? So now we move into title 26 where we have, our profession specific chapters. First one being dentists here, we'll look at it in sections six and seven. And section six will create a new section, to be six zero three, limited academic license, dentist license, which will create a limited academic dentist license. And that is for teaching in an accredited dental program under the general supervision of a fully licensed dentist. The license is available to full time dental instructors who hold a sufficient dental degree and complete necessary courses. Upon termination of employment, the licensee must report to OPR. And then section seven will amend the already existing fee structure and just state explicitly that fee is zero or there's no fee really for the stamp of license. Questions there? Okay. Part three of the bill has to do with massage therapists, body workers, and touch professionals. This is sections eight and nine of the amended bill, to be amended bill. And section eight amends the entire chapter, which has various, sections being amended starting at 5401 through 5427, and I've broken them out here. Going to sub paragraphs, and I'll just, I guess, quickly go through them. There's a lot here, so feel free to stop and ask questions. We can refer to the language that they all wanted. So in 5,401, definitions, the definition of establishment is amended, changing the meaning from a place of business to a location where the practice is regularly engaged, and then also removes the definition of place of business.

[Matthew Birong (Chair)]: So actually, let's stop here right now because we have, like, a component of conversation last year. And so, can you just give a little background on why that change is occurring? Or maybe it's better conversation. I would Okay. Actually, you're you're you are correct with that. So we'll hold that question for.

[Tim Dublin (Legislative Counsel)]: So, 5403, unauthorized practice will be amended. So, let's see, adding, to who may be found, to be conducting unauthorized practice, individuals who own or operate unregistered establishments. 5,404 is the exemption section as amended so that a massage therapist bodyworker or touch professional is allowed to practice in a location that is not a registered establishment if the licensee and client agree in advance that that location is acceptable. It'll also under subsection D, see added for clarity. And establishment registrations are required. See if practices undertaken by either, oh, if, sorry, it's not required if practices undertaken by either a person exempt from registration or solo licensee. 5411 having to do with the duties of the director is amended to add new subdivision five enabling the director to adopt rules limiting the applicability of this chapter as applied to establishments operated within private homes. Fifty four twenty three, things do with establishments, designee inspection. This will be amended through acquired establishments, let's see, to be registered, then ensure that it's being operated lawfully regardless of whether or not the owner is on-site or as whether or not they have personal knowledge of the operation. And then we'll provide the director the ability to demand certain ownership information as, as well as make inspections prior to registration being granted that is. And as well as granting the director the power to deny registration based on, if the location, if at that location there have been prior unprofessional conduct points, regardless of whether ownership is the same or if there's new ownership. 5426, something to do with the display of registration will be amended, to add see, to require display of both as the conspicuous display of both the establishment's registration as well as those of the documentation of any practicing licensees operating. And 26, we have safe, fifty four twenty seven having to do with unprofessional conduct is amended to add to what constitutes unprofessional conduct, as see, engaging with a client in a sexual sexual conduct as defined criminal statutes there. And then similarly in section nine, this will we go take a quick detour into the criminal provisions, specifically immunity from liability, and we add a safe harbor for victims of unauthorized practice of massage or bodywork so that they can report crimes of prostitution and human trafficking without themselves being prosecuted for that unauthorized practice of bodywork. Pause there for a moment.

[Lisa Hango (Vice Chair)]: This may be just me thinking too much into this, but definitions. Some of the techniques used by a bodyworker, if you look it up, include some techniques that are used by physical therapists. This may not be your wheelhouse. It may be more OPR. But I'd like to know more about whether physical therapy statutes cover them so they don't have to be covered under this statute for body workers.

[Tim Dublin (Legislative Counsel)]: That's a great question. And I would have to look into.

[Lisa Hango (Vice Chair)]: Okay, great. Thank you.

[Matthew Birong (Chair)]: Representative.

[Tim Dublin (Legislative Counsel)]: Part four of the bill, section 10 has to do with midwives, and this will amend 26, VSA forty one eighty five, director of duties, as well as twenty six forty one eighty seven having to do with license renewals, remove the requirement that licensed, midwives submit individual practice down, and it will also dissolve the midwife, advisory committee to the director and to the commissioner of health. Part five of the bill having to do with sections, this is sections eleven and twelve having to do with pharmacists. These sections will add to the pharmacists and pharmacy technicians immunization protocols having to do with adding recommendations from the Commissioner of Health in addition to ACIP recommendations. I apologize, this part of the overview has not really been fully fleshed out yet, but happy to, ask any question or answer any questions about the language in here and all the bill that is and I'll be happy to update this and provide that updated overviews to the committee for today's testimony. Okay, and see part six has to do with funeral services. This is just section 13. This will amend 26 USA twelve eleven the definitions here under funeral services, and adding it to, the definition of what constitutes practice of funeral services. A new subdivision g, so it's kind of a list of items, and then the new item sub item will be the disposing of dead bodies by cremation, alkaline hydrolysis, or natural organic reduction. And, again, I'll, defer to OPR as to, policy asked behind that. Thank you. Part seven has to do with psychologists, not physiologists, sorry. This is section 14. This will create a session law that will enable OPR to make temporary policies for a three year period regarding supplementation of educational requirements for psychologist licensure. These policies will control and that is notwithstanding any contrary rules or, other procedure demanded elsewhere in statute, and will also require OPR to adopt updated rules regarding supplementation by the end of that period, so three years. So they'll have these temporary policies, for three years and then in the meantime, before they expire, they are directed to, implement a rule via the regular rulemaking procedure. Bringing us to part eight, final part of the bill effective dates in section 15. There are basically three different rollout periods. The first being, those sections that will take effect upon passage. These are the general powers as well as the sections having to do with midwives, pharmacists, funeral services, and psychologists. Let's see. And then 09/01/2026, the dentist provisions become effective. And then on 12/01/2026, we will have the massage therapist, body workers, and touch professionals provision take effect.

[Matthew Birong (Chair)]: Oh, computer's overheating. That would explain that sound. That's a little warm. Okay. That was just a little audio distraction there. Let's turn it into a fire accident. Any questions from counsel on that quick run through? We're gonna do a lot of work on this bill. So that was just the they give you the summary. Those are very helpful as a first.

[Tim Dublin (Legislative Counsel)]: And I should also know before I forget the amendment, the highlighted portions of it just indicate what has been changed from the text introduced. Thank you.

[Matthew Birong (Chair)]: And that was the stuff that we went over just, because it was post tracking deadline of all that we hit, right? Yep. And everything, in the amendment is, in the overview. Do we have any questions for counsel before we shift over to our friends from OPR?

[Tim Dublin (Legislative Counsel)]: Okay. We'll do the canoggle.

[Matthew Birong (Chair)]: Oh, we have full tables. Found it, it's the second shift. Awesome.

[Tim Dublin (Legislative Counsel)]: That's

[Lauren Hibbert (Deputy Secretary of State)]: so weird. Chen and I are just laughing because for the one time, I'm not taller than her.

[Matthew Birong (Chair)]: Oh, okay. I was like, what did I miss there? I'm

[Lauren Hibbert (Deputy Secretary of State)]: always the tallest.

[Matthew Birong (Chair)]: Gotcha. Gotcha. Gotcha. Gotcha. Okay. Welcome back.

[Lauren Hibbert (Deputy Secretary of State)]: Thank you. Sorry for the immediate humor about

[Jennifer Hall (Director, Office of Professional Regulation)]: I see. There we go.

[Lauren Hibbert (Deputy Secretary of State)]: Sorry. For the record, Lauren Hibbert, Deputy Secretary of State, and I have with me Jennifer Hall and Director of the Office of Professional Regulation.

[Matthew Birong (Chair)]: Great to have you back.

[Lauren Hibbert (Deputy Secretary of State)]: Thank you for having such a warm reception that we can whip each other in front of you, and to the whole public, apparently.

[Tim Dublin (Legislative Counsel)]: Thank

[Lauren Hibbert (Deputy Secretary of State)]: you so much for having us. We're really excited about this year, the OPR bill. We did speak to the committee about our objectives earlier this session. And just as a brief overview for the committee and for anyone who's watching, OPR at this moment regulates over 80,000 licensees in the state of Vermont on a wide range of occupations, really anything from tattooists to dentists, architects to real estate, nurses. You'll see some of these professions in this bill. Our core mission is to protect the public, to make sure that the public has professionals that provide services that are qualified. We help, with the help of the legislature, set those qualifications, make sure that people are adequately licensed to do the activity. And then if somebody commits on professional conduct, to remove them from the practice of the profession or restrict them from the practice of the profession, ultimately with the goal of rehabilitating them so that they can return to the profession. So you'll see those themes in this bill. We're really focused on creating new professional pathways this year, removing barriers, regulatory barriers that we've determined are unnecessary, and strengthening our core function, which is public protection.

[Jennifer Hall (Director, Office of Professional Regulation)]: And I also wanted to, we filed some testimony for you all today. My mistake, I was working off a previous draft of this bill. So you will see that I brought up some things that have actually already been addressed in the new draft. So apologies. No, no, no.

[Matthew Birong (Chair)]: Sorry, I've been not just speedy and government work out yet.

[Lauren Hibbert (Deputy Secretary of State)]: It's awesome. Tim's a wish. Council's on it.

[Jennifer Hall (Director, Office of Professional Regulation)]: Okay, so in the Title III general provisions, these are provisions that relate to the administration of OPR, and they're general statutes that apply to all of our professions. So, in Section one, 3VSA 123, the duties of the Office of Professional Regulation, We would like to include rescission, rescinding a credential, as one of the duties of the office. And that was a good astute question from Representative Hango about what is the difference between rescission versus revocation. Revocation is a disciplinary measure that takes place after a specification of charges is filed against someone for engaging in unprofessional conduct. Rescission is an administrative action that doesn't involve misconduct on the part of a licensee, but it can happen where, let's say, we issue a license and then the payment for the license doesn't go through. So the credential has not been, know, OPR hasn't received funds for the credential, we might rescind in that case. Or in a case where, let's say, someone is an APRN in the state of Vermont and they received their RN through a compact license issued by another state. If there's some circumstance where that RN license, that compact license is turned off, which can happen just immediately, then that means their APRN license issued by Vermont, that they were not qualified for that because they didn't have the underlying RN license was turned off. And that happens in the nursing compact sometimes. So that means that we've given an APRN credential to someone who is no longer a licensed registered nurse. So rescission would be appropriate there. So it's an administrative action, and it's something where we're not taking disciplinary action so that there would be a ding on someone's license. It's really just an administrative tool for us. So, the next section, A14, that includes language establishing a voluntary alternative to discipline program for all professions through administrative rules. We currently do have an alternative to discipline program. We spoke about that a couple weeks ago. We have that in the profession of nursing and it's been a great program and it's a really good tool for public protection. So, that program has two paths. One, for professionals who have engaged in deficient practice in a minor way, not in a major way where it's harmed somebody, but in a minor way where maybe they did a procedure not quite right. And we've gotten a complaint about that. If it's a kind of minor deficiency that can be remediated through coursework or training, we want to give someone the opportunity to remediate that without, again, having to go through the whole disciplinary process and having a permanent ding on their license. So that's one pathway. And something that's important to note here is that we'll have to develop administrative rules around this process. And one of the things that will be included in those administrative rules is licensees don't have a right to go through this program. It's something where our office determines whether to offer this to someone. So I just wanted to make that note about that. And then the second of arm of this program is for professionals who have substance or alcohol use issues, who have not had a complaint filed against them. With approval from our office, they could self report to us and engage in or submit to monitoring for an agreed upon period of time. And that would require the practitioner to get an evaluation, to agree to a treatment plan, engage in that treatment plan, stick with it, engage in UAs, and OPR is kind of monitoring the person's adherence to that program. And if they fail to adhere to the program or if they withdraw from the program without completing it, then potentially a disciplinary complaint could be filed against them. So it really is someone who is ready to take that step of getting treatment and wants the accountability of the office overseeing or monitoring their compliance with their program. In the next section, section two of the bill, 3VSA 128. Healthcare facilities in the state of Vermont are required to report to the Office of Professional Regulation when they have limited or conditioned a licensee's privilege to practice in their facility. And usually that happens because somebody's engaged in misconduct. So they have to report it to us. And there was a double negative in the statute that kind of made it unclear as to the circumstances of when that should be reported to us. So, we just wanted to clarify that so that facilities won't have a question about when they need to do that. The next section, 3BSA 129 A, our unprofessional conduct statute, we would like in A1 to amend that language to add an attempted fraudulent or deceptive procurement or use of a license. Right now, attempted is not in there, so it's a little unclear about our authority to prosecute somebody when they've tried to falsify credentials or education or something like that to try to get a license. Subsection G, the revision there allows the director to adopt rules permitting licensees to enter a voluntary alternative to discipline program. So, it's just echoing that program in the unprofessional conduct statutes. Section four, 3VSA 129 Board Members and Advisor Appointments. Yes, we think having legal adults on our boards and as our advisors is the way to go. Being the age of majority, board members and advisors have to take an oath. They have to sign a code of ethics. They're acting as jurors on cases that involve some really hard subject matters. So board members also engage in a confidential process where they're in deliberate obsession that's not part of the open meeting. So, for those reasons, we think those are duties that should be conducted by legal adults. And then, in Section five(three) VSA 137, again, this was just a little bit of cleanup that was left over from a previous session where we deny licenses and applicants have the ability to appeal those denials. And we used to have a step in that process called a preliminary denial So that the process had numerous steps and the preliminary denial ultimately was, we kind of realized it was unnecessary and duplicative of the next step in the process. So a couple of years ago, that preliminary denial process was taken out, and now it's just a license denial. So we wanted to change the language of this statute to just remove the preliminary references to preliminary.

[Lauren Hibbert (Deputy Secretary of State)]: Any questions on that section that Jen just covered? I'm going to now turn our attention to the dental professional. I'm going to jump into Title 26. The high level awesome thing is that we have a dental school who wants to set up a pilot Satellite. Satellite dental school in Vermont. If you have been following dental professionals and the lack thereof in Vermont, this is really, really exciting news. And so this satellite dental school will train dentists in Vermont. Hopefully, they'll stay in Vermont. And this is a really important thing for the dental profession. So as part of this, we didn't have an academic dental license. And what a limited academic dental license would do is offer a faster, limited scope practice of dentistry to people who are coming here with the primary purpose of teaching those dental students. The facility, the way that this credential is set up, they would be limited to work in a facility that's been accredited by the American Dental Association. And the practice of dentistry would be under a dentist who has a full license. And we are asking for an addition here that I don't know whether is in the amendment. But our request is that that requirement have that there's general supervision of a dentist who's fully licensed in good standing in Vermont. So Vermont dentist. So that there's some accountability and making sure that everything's going well. The qualifications for this new license would be that you're appointed as a full time dental instructor at that program, that you hold a dental decree sufficient for licensure by examination as set forth in our dental statutes, and that you've completed a course in emergency office procedure. You'll see that our other requirements for dentists do not have that CPR emergency office procedure in it, but it is in our rules. And so we would like for this profession to put that requirement in statute so that we don't have to immediately go at it in rulemaking. Essentially, of the meat of the program that we otherwise might do in rules, we're asking to put right into statute so that we don't have to immediately update the rules related to this profession. This new credential would be limited. They wouldn't be able to get specialties related to sedation and anesthesia. We have specialties for dentists, different levels of training that you have to do in order to do those different levels of sedation. Sedation is probably the most dangerous thing that occurs in dental offices and requires additional training. Then there is a requirement that we would need to be notified if you're terminated within forty eight hours. Of course, the facility would also need to notify us, just like that statute that Jen was just talking about. And then to renew the license, you would have to complete the renewal requirement in statute, renew every two years, meet active practice requirements, and complete thirty or more continuing education hours. And you would have to continue to be an instructor at that school. There's a lot of excitement in the dental profession for this new credential. We would not charge this new credential. It's very limited in what they can do. They're really teaching. But the way that dental school, dentistry is taught, is you're teaching on a human at a certain point. So you're practicing dentistry, which is why we need this credential. And that's a really important part of the training.

[Jennifer Hall (Director, Office of Professional Regulation)]: I'll turn it over to you, Jen. Great.

[Matthew Birong (Chair)]: Hand off.

[Jennifer Hall (Director, Office of Professional Regulation)]: Yes. So next, we have Section eight, which is 26 VSA Chapter 105, Massage Therapists, Body Workers, and Touch Professionals. From that last legislative session, the General Assembly gave OPR the task of working with specified stakeholders to determine what would be the best form of regulation for massage establishments. We did that work. And the recommendation that we have, the ask that we have coming out of that work is that it be a registration. So you'll see that section 54.1 defines a massage establishment as any location where the practice of massage or bodywork is regularly engaged. It struck the of a more specific definition that included place of business, since an establishment is broadly defined. And I think that was the goal, was just to be a little broader about that if that regulated activity is occurring at a location, that that's considered a massage establishment. So that's why we wanted to change to that language. Section 5,403 includes the unauthorized practice language. That includes an individual owner who owns or operates an unregistered establishment. That's also an authorized practice. Yes. Representative. Can you explain to me what the difference between a massage therapist and a touch professional is? That is a great question. Yeah, Lauren's going to help us with So

[Lauren Hibbert (Deputy Secretary of State)]: massage therapists, as we generally understand them, have a certification from a national body. They've gone through formal education. As we did our sunrise for this profession, something that really came to light is there's many massage therapists who have the formal education and training and are certified at the national level, but there's also a lot of people in this space who practice in Vermont doing a wide variety of other methodologies. So Reiki, there's many different ones. Ralph and yeah. And with a better name than touch professionals. I was

[Matthew Birong (Chair)]: Let them explain the as to why.

[Lauren Hibbert (Deputy Secretary of State)]: I also have felt some discomfort with touch professionals. And I just, I'm gonna ask for a leap of faith and trust that that was the best we could come up with. This whole title was a compromise and a large discussion. There's a lot of discussion about wanting full licensure for massage therapists, but that would exclude a lot of people who have access to touch people's body and may do unprofessional things, which is why we wanted to regulate the profession. We wanted this whole group of people to be under the umbrella of OPR and under our jurisdiction. Touch professionals was the best we could do. And I understand. It's such a wide job. It does. And I wanted to answer Representative Hango's question. In the massage therapy bodyworkers and touch professionals, bodyworkers is a good addition, too. I just want to add that that's an important word there. There are express exemptions, and almost every healthcare professional, including physical therapists, are exempted from needing to register as massage therapists. Because as indicated, there is a lot of crossover. But physical therapists really have a very defined, very established educational pathway. What they do is very much within their scope of practice. And there is some crossover in what a massage therapist or otherwise bodyworker or touch practitioner

[Jennifer Hall (Director, Office of Professional Regulation)]: might do. Thank you.

[Matthew Birong (Chair)]: As much as the word being utilized for the purpose of this definition is kind of unhelpful, it's also, like, or awkward at points. It is also a result of nefarious and alarming illegal activity that has us addressing this. So, I want to be very honest with that.

[Lauren Hibbert (Deputy Secretary of State)]: The reason why we needed to regulate this profession was to protect the public. And the reason why we're coming before you now to establish registration really is because of the conduct that's been reported to us as we've regulated. And I'm going to ask Jen to just tell you, I know we talked about this last session, but since we've registered massage, Jen, can you just talk to us about the type Sure. Of contact that we

[Jennifer Hall (Director, Office of Professional Regulation)]: Yes, we receive a lot of complaints about massage. The kind of complaints that we are not receiving, we don't get complaints from people that they feel that their practitioner was not qualified to give them a massage. We are not receiving complaints from people who have been injured by a massage. So we're not seeing a public protection issue around qualifications for massage. What we're seeing is a lot of complaints about sexual conduct and inappropriate touching in massage. And we receive a lot of complaints about human trafficking, like a new place opened up and it's across the road from my house, and I can tell that there's men going in constantly, and it's open late at night, and women are never in there. So we get a lot of human trafficking complaints, and we kind of viewed regulation of establishments as giving us a tool to be able to do some inspection, go in and determine whether it's a legitimate business, and if it's not, to be able to take enforcement action. So that was important.

[Matthew Birong (Chair)]: Thank you, Eric. Just Very much

[Lauren Hibbert (Deputy Secretary of State)]: for this committee's knowledge, as the stakeholder group met, there is not a county in the state that does not have some form of human trafficking. And unfortunately, our staff went through back channels to see where these places are. And there are reviews telling people all over the internet where to go in Vermont for these services. Vermont's not alone, this isn't a national problem. But it's very much here, and it is in all of our communities across the state.

[Jennifer Hall (Director, Office of Professional Regulation)]: Also in the exemptions, you'll see that we exempted solo practitioners from having to get an establishment license. So we knew that would be important to folks working in the profession. Next, in 5411, the duties of the director. We see some changes in there that were just to change the gendered pronouns to neutral terms. And also, Section B5 authorizes OPR to adopt rules limiting the applicability of the chapter as to establishments operated within private homes. And we see in 5423 establishments designee an inspection. Again, an establishment is required to register with the Office of Professional Regulation. Unauthorized practice, if you're not registered, that constitutes unauthorized practice that can be prosecuted through our office. That also could be prosecuted through a criminal case as well. Section 5,423 allows OPR to prosecute the establishment itself for unprofessional conduct for unauthorized practice. And Section C allows OPR to include in an application for a massage establishment the name and ownership of the business and the management of the establishment, the location of the establishment, and any licensing history, past or present, for establishments under the same ownership, which is important in the human trafficking space because these places pop up and they'll switch people around and they might change a name, but it's the same entity that's acting in the location. So the physical location and ownership of the premises, proof of business registration with the Secretary of State's office, which is an important piece, and any other information that we require by rule. Then in D, you'll see it authorizes OPR to deny registration for an establishment located where unprofessional conduct has previously occurred. And again, we're talking about these illicit places that just keep popping up in the same locations. Then there was a minor change, and I don't know if it made it into I'm guessing it did. It made it into the the current draft. Yes, it is in there. So just the statutory reference in subsection D appropriately references three BSA 129 with respect to denials of applications. And then subsection E authorizes OPR to inspect an establishment, including prior to registration. So before, it required when a complaint had been filed with the office. But at this point, we would not need a complaint to be able to conduct an inspection. And then display of registration in section 5,426. Revisions require an establishment to conspicuously display registrations of the establishment and of the individual professionals that are working in the establishment. Section 5,427, unprofessional conduct. In addition to the Title III general provisions for unprofessional conduct, This section has profession specific definitions of what unprofessional conduct is, including engaging in sexual conduct defined in the criminal statutes. And it references a very specific criminal statute that explicitly defines what kind of touching is sexual conduct. And then meeting a client at an establishment for the purpose of sexual conduct, engaging in the practice of massage or bodywork at an unregistered establishment. Those are all profession specific inclusions into that unprofessional conduct definition. Then in section nine, this is a revision to the criminal statutes in '13 CSA 2638, immunity from liability. And again, this provision provides immunity from criminal prosecution for specified crimes for individuals who are victims of crimes of human trafficking or who are involved in prostitution, but they're reporting a crime. You you don't want the idea of being prosecuted to have a chilling effect on people reporting crimes or being witnesses and testifying as witnesses. So, added to the list of specified crimes that they would be immune from prosecution for is unauthorized practice of massage or body works included in that.

[Lauren Hibbert (Deputy Secretary of State)]: And then I think I'm turning it back to the Deputy Secretary. Any questions about massage? All right.

[Matthew Birong (Chair)]: With what we went over last year leading up into this and seeing this work, it's actually been a really seamless transition into it. I just want to say again, that was a heavy engagement we had with stakeholders at the end of last session to get to this point. So thank you very much for that.

[Lauren Hibbert (Deputy Secretary of State)]: It's an issue that we care a lot about. And just to be clear, mean, I think we've said this to every stakeholder. I know we said this to this committee last year. We don't think this is going to resolve this issue, and we don't want to give anyone false hope that it will. But what we do know is this gives our law enforcement, our investigation unit, additional tools that then we can use to coordinate with both federal law enforcement, state law enforcement, and local law enforcement. And that is a very powerful tool. I also think there's possibility in the future for towns to start to require a license in order to do massage therapy in their perimeters, changes to the way that they allow businesses to start. So this just gives a seal of approval from the state that appropriate behavior is occurring in the facility. I think it's a win. So moving on to midwives. As you all know, we license midwives who oversee and help women give birth outside of the traditional hospital setting. And when that profession was established, there was a requirement that midwives report to our office every birth that they attend. This is very administratively cumbersome for both midwives and our office. And that report has been intended to go to the Commissioner of Health. Our understanding is that the commissioner is not really doing anything with that data at this point. When a midwife attends and assists with the labor, she does or he does a birth certificate, which goes to the Department of Health. But this additional reporting is duplicative at this point, and is not being used, I think, as was attended when this profession was established. I think it's fair to say that there was concern about this profession when it was established. There was wanting there to be appropriate state oversight. We think that the way that OPR is structured, way that we license and receive complaints, that this profession is adequately supervised by our state. We no longer need this data of every birth. And one of the reasons why we don't need this data of every birth is midwives have a requirement to provide a report to us if there's anything adverse that happens during a birth, including obviously infant death, all the way to transfer to a hospital, which could be out of no misconduct or harm or fault of the midwife. It just is an unanticipated outcome of what was a planned home birth. And so we receive reports all the way from infant death to transport to a hospital. And those are reviewed by a peer council of midwives. And then if there is an issue, we prosecute those cases. So a good change. The next is clinical pharmacy. This is an important thing because when we expanded the scope of pharmacists, the way that the statute is structured, it allows for pharmacists and pharmacy technicians to administer vaccinations under a commissioner of health protocol. It allows pharmacists to prescribe vaccinations under a commissioner of health protocol. But that protocol was limited to vaccinations that were on the recommended list from the CDC Advisory Council on Immunization Practices, ACIP. That is something that has really shifted. When we established these procedures, that was a very steady list. It hadn't changed in an extremely long time, and that is no longer true. So what this is doing removing the requirement that it only be recommended by the CDC ASAP, but allows the commissioner to establish protocols for vaccinations that aren't on that recommended list. When in real life circumstance, ASIP removed the recommendation for the COVID vaccine for anyone who was 65, including pregnant people, and the mumps, rubella and varicella vaccine for everybody. Were able to, under the COVID protocol, we were able to modify that fairly quickly. But for other vaccinations, we don't have that flexibility. COVID, that protocol wasn't tied to ACIP. So our office worked with the Commissioner of Health and his department and modified that protocol and the span of time that pharmacists and pharmacy technicians could not provide COVID vaccination was a very narrow window. That is not true with other vaccinations because the part of the statute that we're referring to is tied to ACIP. So this provides more flexibility for the commissioner to not rely only on that, but to look at other scientific resources. And this is really important to our office. What this committee likely knows from their own experience, but we can certainly say, pharmacists provide quite a substantial amount of vaccinations in the state. The majority of people getting flu and COVID vaccinations in the state are getting them at their pharmacy. This is a benefit to Vermonters. Most Vermonters have contact with their pharmacists and pharmacies more than they have with their primary care. This is a benefit to primary care, which is very stretched in the state, to have that burden off of their practice. So this is an important thing for public health and for primary care. There is a bill that's moving in House Human Services. It's H545. Correct. And that will have this exact same provisions in it. We obviously defer to legislative counsel for both bills, but it would be our preference to have this language in both bills until one of them passes. Five forty five at this moment, as currently drafted, would be effective upon passage. Another thing is we have asked for an amendment in that bill because there's a sunset provision that would affect this change in statute. We don't think that was intentional for that specific portion of the statute. So we're asking for clarity and an amendment on that. We think these changes should remain for the duration of time, not a sunset. And that Vermonters can trust the process that's set out, that the Commissioner of Health can create these protocols, that there's adequate safeguards around that and adequate accountability around that as well.

[Matthew Birong (Chair)]: Heard clearly, and I have already spoken with Chair Wood about these pieces, with the understanding that we need to coordinate with one another. So that conversation is ongoing and active. But thank you very much for flagging that.

[Lisa Hango (Vice Chair)]: Commissioner approving or setting these protocols, does that have to go through any other type of regulatory body? Or is it just the commissioner themselves? The commissioner is required. I don't have

[Lauren Hibbert (Deputy Secretary of State)]: the statute directly in front of me, Representative Hango, but my understanding is that the commissioner is required to consult with a variety of stakeholders in creation of the protocol. And then the director of the Office of Professional Regulation also reviews it with their respective boards of authority. So there's a lot of professional interaction on these protocols, the Board of Medical Practice, the associations, the pharmacy board. But in terms of external outside of the universe, the Commissioner of Health and OPR, no, not at this time. It really was created at a time, well, was in the early onset of COVID. And there was clearly a need for pharmacists who have extensive training in pharmacology to be able to provide more services. And a lot of the protocols are things where there is a very black and white diagnosis. So smoking cessation is something that pharmacists can do. There's just black and white, very necessary clinical decision making, but limited clinical decision making. And the protocol is designed to really be based on national standards, although I just told you the national standards are shifting, and what is scientifically backed.

[Lisa Hango (Vice Chair)]: I probably wasn't very clear. Thank you for that. I wasn't specifically concerned about pharmacists administering vaccination. It's the actual availability of the vaccinations themselves for an individual who comes in and wants something that ACIP is no longer advocating for or no longer has on their list. And it's one of those shared decision making vaccines. So does the commissioner have the sole authority to decide which ones?

[Lauren Hibbert (Deputy Secretary of State)]: Those shared decision making vaccinations, what this does is allow the Commissioner of Health to create a standing order for those shared decision making. And then pharmacists and pharmacy technicians will be able to prescribe, pharmacy technicians will be able to administer, both will be able to administer. And that's filling that current loophole or problem. What I will say is, with COVID vaccinations in particular, this committee and Vermonter should be really proud. There was a lot of collaborative work between the Office of Professional Regulation, the Department of Financial Regulation, the Department of Health. So that's overseers of health care insurers and overseers of health care professionals to ensure that there would be coverage, insurance coverage and availability, and practitioners who would be able to prescribe and administer. So we were able to, as a collective, really problem solve COVID vaccinations. The shared decision making vaccinations, we need the protocols. Then I'm confident that that stakeholder group will work together to make sure that those vaccinations are available in pharmacies as quickly as possible.

[Lisa Hango (Vice Chair)]: That was a good refresher on something some of us lived through in real time when we were making those decisions. My original question was, does the commissioner establish the protocol for shared decision making on those particular vaccines, which ones they are with any other regulatory body, or is it the

[Lauren Hibbert (Deputy Secretary of State)]: commissioner themselves? With the Office of Professional Regulation. And there's some follow-up clarification on what is required for pharmacy technicians to get registered, again, related to that ACIP change. And

[Jennifer Hall (Director, Office of Professional Regulation)]: with that, I'll turn it over to Jen. So Section 13, we're looking at funeral services again. And 26 VSA twelve eleven adds into the practice of funeral service, disposing of dead bodies by cremation, alkaline hydrolysis, or natural organic reduction. We just included that in the practice of funeral services because there was confusion after those disposition methods were added into the funeral statutes. Funeral directors were not sure if they needed another license, a disposition facility operator license. So we just put that into their definition of practice so they know they don't need another license. And then on Section 14, so part of the written testimony is really not necessary because I was commenting on the first draft of the bill. But OPR has gotten a petition for rulemaking under 3VSA eight zero six to allow for more opportunity for postgraduate supplementation of coursework for master psychologists and doctoral psychologist graduates. And the current allowance restricts supplementation quite a bit. You can only supplement very few courses. And our mental health licensing study report that we did last year really highlighted the idea that what substantial barrier it is for us to get mental health practitioners in the state if we have such stringent, limited requirements allowing coursework supplementation. That means that somebody can go through a psychology program I'm seeing nods. Yeah, you can go through a psychology program at an accredited university, and it might not include the specific name of a course, and you might not be able to count that towards your licensure. So you might have to supplement a class or two when you're going to get licensed. Well, we only allow supplementation of six credit hours total. And so that means that you could have gone through your whole master's program and doctoral program and need to supplement more classes than that to satisfy the requirements, and you're going to be out of luck. So we've gotten this application, this petition for rule making, and we are going to be moving forward with mental health licensure reform in the next legislative session. In the meantime, we'd like the ability to come up with supplementation policies with the Board of Psychological Examiners to kind of be able to allow more supplementation than what's currently allowed. So that's the language that's included in Section 14. And let's get that right in front of me here. So the policies developed pursuant to this section will be developed in consultation with the board consistent with 26 VSA Chapter 57 and made available to the public. They'll be on our website. And again, it's a bit of a stopgap measure. So you see that by 07/01/2029, the board's either going to have to adopt rules regarding supplementation, allowing more supplementation, or this is going to sunset and this provision won't be in effect. So that is the change that we want for psychologists. And was that the conclusion? Yes, I think that was our That's

[Matthew Birong (Chair)]: a close. All right.

[Jennifer Hall (Director, Office of Professional Regulation)]: Thank you so much for having us and happy to answer any questions. If not here in the moment, if you want to send us an email, happy to get back to you and give you more information.

[Matthew Birong (Chair)]: Yeah. Any questions, or else, from the committee right now? No, I mean, yeah. So, representative Nugent is gonna be the lead on this with me. So, we'll be working together on moving this forward. And guess our next step is to start identifying people who write for testimony section by section or subject matter by subject matter through that. So, I guess if you have any questions within that context, we'll let you know. Great. Just to maybe kick your brain off, yeah, who you work with on these PCs over time. Great. Thank you. Thank you. Appreciate it. Yeah. No, thank you. Thank you. I gotta be in Sears office in twenty minutes, so that's a wrap for the week. We started teeing up some of the denser stuff. So we're gonna keep working on those things as identified. We're looking at public records for this, the treasurer's bill. And then I really want to start focusing on those pieces of work to get these bigger things built and moving. And then also, we're going to identify a couple of charges to work on. I want to see Essex get out of here soon and work on that component of five zero eight that had to do with word boundaries and whatnot. I would like to see, hopefully, the end of next week, maybe build something out of here. Anything for me before I sign off?

[Jennifer Hall (Director, Office of Professional Regulation)]: What is the protocol? I got an email sent to me from somebody that would like to testify regarding the fraudulent land on the title company.

[Matthew Birong (Chair)]: We can, we can talk to Nick because we're going to start scheduling that work. I want to do, that's a good point. That's one standalone bill I want to keep working on as well. And we already have that on next week's agenda, so we can close that loop when we go off.

[Jennifer Hall (Director, Office of Professional Regulation)]: Perfect.

[Matthew Birong (Chair)]: Go offline. Alright, with that, I guess that wraps