Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Hi, welcome everybody. It is 11:30 on April 17, House Healthcare, and we have everybody in the room. This is incredibly exciting. And nobody else. And what's that? And nobody else. Yeah, actually nobody else. Can all get together. No one cares what we do. Jen, if you want to come on up, we're going to look at the latest draft of 01/1942, any sort of committee discussion. And just to let everybody know we were we are expecting BDH to join us, Lauren Lueders, but we're a little early. So if we have questions, we'll kind

[Jen Carvey (Office of Legislative Counsel)]: of open for her when she gets here. Alright. Good morning. Jen Carvey from the Office of Legislative Council. I will put some language up on the screen. Before I do, I'll just remind us where we are and what we're about to look at. So we're on S142, which is the pathway to licensure for internationally trained physicians. Yesterday, you looked at, a new proposal from the Department of Health. I have taken sort of those concepts and put them into a new draft. And so what I'm showing you is sort of a hybrid of, as far as the markup goes, of the draft I walked you through yesterday, which was the previous department proposal. And there's some language that is actually added back in from the bill that came over from the Senate. So I'm trying to show you sort of what's actually different from any version you've looked at before. So that's that's what the highlighting means. We have a couple of different versions floating on, so I wanted to try to give you a sense of what's new. So this is a strike all amendment. It starts out with the same report that we have looked at. Think the language is the same as it was yesterday. So by 01/15/2027, the health department in collaboration with the Board of Medical Practice would provide to this committee and other committees a report detailing a pathway to licensure for internationally trained physicians. The report would include the same information that we've looked at, looking at other states' processes for licensing these physicians and any info on outcomes, description of the resources needed to evaluate the qualifications and the availability of those resources, a proposal for the licensure, and then including adding in that proposed requirements for recency of practice, and then anything else the department thinks is relevant, and the same list of stakeholders. Then we get to section what is now two. This is hopped back and forth between being two and three. I put it back in two, partly because it comes first numerically and partly because there were references to it in the rulemaking section and it seemed confusing for you not to know what it says in this section first. So this Section two, which you'll see from the Effective Date section would take effect in 2028, 07/01/2028. This is adding to the qualifications for Medical Licensure Statute, this new subsection on internationally trained physicians, allowing the Board of Medical Practice to issue, and now we have two different things, a provisional license to practice at a participating healthcare facility, as you'll see defined coming up, to an internationally trained physician who meets the requirements for provisional licensure established by the Board by rule, pursuant to the next section we will look at, and a full license to an internationally trained physician who has successfully completed the pathway to licensure established by the board by rule. Pursuant to 1396. So the six in 1396 is highlighted because I changed this from being in 1393 to 1396. And that was really just because I put all of these pieces just into two sections for the pathway piece, the rulemaking and the participating healthcare facilities. There were a couple of available sections back to back, and they fit a little bit better, I think, where I've put them here. So this is the Pathway to Licensure with the rulemaking provisions. And it starts out saying, Pursuant to the authority of the Commissioner, that's the Commissioner of Health, in subsection 1351E of this chapter, which is the provision in this chapter on medical licensure that has the Commissioner as the one adopting, amending and repealing rules. So pursuant to the commissioner's authority, the board, and that's the Board of Medical Practice, and now we would say, shall adopt rules in accordance with 3VSA Chapter 25 as needed to enable the rights to ensure of internationally trained physicians as set forth in this previous section. And the rules adopted by the board, you remember Lauren used this phrase yesterday, shall reflect the least restrictive form of regulation necessary to protect the public interest and shall include, and then it would say, the qualifications necessary for an internationally trained physician to obtain a provisional license to practice and participate at a participating healthcare facility, which is defined in the next session. And

[Unidentified Committee Member]: then I'm going

[Jen Carvey (Office of Legislative Counsel)]: to put in language about scope of practice, which wasn't the direction people wanted to go. So the standards for participating healthcare facilities to use for the evaluation and assessment of the holder of a provisional license and the additional qualifications necessary for an internationally trained physician to get a full license to practice in this state following successful completion of the provisional licensure period. And we have a new Section four. And so I've put this language back in on participating healthcare facilities. And I made some changes to the definitions because the definition in the bill that came over from the Senate had a very broad definition of healthcare facility and then said a participating healthcare facility was a hospital, FQHC, or community health center that did certain things. That didn't make a lot of sense as I was looking at how that applied. So instead, will say, as used in this section, healthcare facility means a hospital, FQHC, or community health center. And a participating healthcare facility means a healthcare facility, so one of these, that meets the requirements of this section and has the capacity to provide an assessment and evaluation program designed, and this would add in accordance with rules adopted by the Board pursuant to Section thirteen ninety six of this chapter, to evaluate an internationally trained physician, and it would add holding a provisional license issued pursuant to Section thirteen ninety one(one) of this chapter. So some of these are just kind of tightening up the internal references and the And then in order to be eligible to be a participating healthcare facility for purposes of, and just referring more specifically to those two subdivisions, that subdivision in the section again, a healthcare facility shall, and much of this is the same as what was in what came over from the Senate, agree to provide medical mentoring, assessment and support in navigating The U. S. Healthcare system by one or more fully licensed physicians employed by the healthcare facility through a provisionally licensed physician using an evaluation and assessment system. And then instead of saying, developed under protocols approved by the Board, it would say that meets the standards established by the Board by rule, pursuant to that rulemaking provision. Also, they must ensure that the mentoring, evaluation, assessment and support of a provisionally licensed physician is provided by one or more. And now instead of saying fully licensed physicians, we're specifying that it can be a physician licensed either under this chapter or as an osteopathic physician. So by one or more physicians who are licensed under 26 VSA Chapter 33, that's the osteopathic physicians, or this chapter and who are physically located in Vermont and that the provisionally licensed physician provides services only to patients physically located in Vermont. They must carry medical malpractice insurance, this again is language that was in the Senate bill and continues here, covering the Provisionally Licensed Physician for the duration of that physician's employment by the participating health care facility and that they not retaliate against or discipline a provisionally licensed physician for making a complaint or pursuing enforcement of an employment related claim. Finally, have the Effective Dates. So the report section and this effective date section would take effect on passage. And then what is now section three, the rulemaking part would take effect on 07/01/2027. And sections two, and I've added in the descriptions of what these are just for ease of reference, qualifications for medical licensure and four, participating healthcare facilities, will take effect on 07/01/2028. And then I have suggested that the title of the bill change to an act relating to a pathway to licensure for internationally trained physicians taking out that medical graduates language. So that's what we got. Don't know if you want to hear from the health department at all. I'll send it to you in this morning. Lauren's on. Can't see it. Just

[Allen "Penny" Demar (Member)]: a question. I think you're on page five, line 12, carrying medical malpractice. The or Participate in Algebra, yeah. The individual have to have it also?

[Jen Carvey (Office of Legislative Counsel)]: Not based on this language, And I don't know the extent to which they would be likely to receive a policy in their own name before they are fully licensed. So I would book to some of

[Alyssa Black (Chair)]: our provider representatives. Did we get any malpractice info after yesterday?

[Jessica Barnett]: Jessica Barnett, I don't say, I think this language is fairly covers the situation, which is that as long as the facility is covering that position for the duration of their

[Allen "Penny" Demar (Member)]: employment He's unemployed, but they don't have coverage needed. Upon leaving that

[Jessica Barnett]: Leaving that, they would have to that is a whole area. The employer can sometimes provide insurance that includes deal coverage, it covers you, it depends on the type of coverage. But this is I think way too much it's covered.

[Allen "Penny" Demar (Member)]: I sought that, but I was just curious about the other thing.

[Jen Carvey (Office of Legislative Counsel)]: And I would imagine it depends on the practice setting that they go through as well. Thank you. That same question? Yes? Would that

[Alyssa Black (Chair)]: be parallel to what other employed physicians get, or could it be something different?

[Jessica Barnett]: This language sounds like what is typically offered to any physician working for a practice. This is just saying to make sure this individual is also covered in the

[Jen Carvey (Office of Legislative Counsel)]: same way. Okay, it'll ask

[Alyssa Black (Chair)]: the same way, because that wouldn't put a tail, I think,

[Jen Carvey (Office of Legislative Counsel)]: right? Typically it would. For

[Alyssa Black (Chair)]: people that don't know what a tail is,

[Jen Carvey (Office of Legislative Counsel)]: I don't know what is.

[Jessica Barnett]: Covering after you've left, like if a claim arises after you've left an employer, but it relates to the carrying case, you're with that employer, you have a policy that covers that situation. This claim can arise in years after a year it's provided.

[Alyssa Black (Chair)]: Three, if it's an adult.

[Jen Carvey (Office of Legislative Counsel)]: Hi, Lauren. How are you? How does this version looks

[Alyssa Black (Chair)]: to you? Lauren Lueders, General Counsel for

[Lauren Lueders (General Counsel, Vermont Department of Health)]: the Department of Health. Thank you. We support this version of the bill. And we've spoken with Mike Zimmer this morning, and he had no comments. He's with the World Education Service. Diana Wall seems to be out of town at this point, so we weren't able to run the language quickly by her. But she this is very similar to the language we all discussed on Wednesday and submitted, just technical changes. Thank you.

[Jen Carvey (Office of Legislative Counsel)]: Great. Yeah. Did you have a question?

[Daisy Berbeco (Ranking Member)]: Oh, yep. Well, can we just talk about number four, nine fifteen? Just be very simply,

[Jen Carvey (Office of Legislative Counsel)]: just break that down. Page five. Look at me. Yes, this is the language. So that language has been in the bill since it was introduced. I'm not an employment law expert, so I don't know quite how that fits with anything else, but I think there was just concern about protecting the internationally trained physician while they're in the learning process from any retaliation or discipline based on making a complaint or pursuing enforcement of an employment related claim. So basically, so they can protect their rights. I don't think there's more to it than that. Any thoughts, questions about the bill? Any discussion?

[Allen "Penny" Demar (Member)]: I've got one more. Of course.

[Alyssa Black (Chair)]: Thank you. You can have as many as you can, Allen.

[Allen "Penny" Demar (Member)]: I just remembered the other day talking about, and it's the first page, I think, line three and four, an act relating to pathway licensure for international trained physicians and medical grads.

[Jen Carvey (Office of Legislative Counsel)]: Right, and so that's why we're changing the name at the end of the bill, because right now that is what it's called. But at the end of the bill, I propose changing the name to just a pathway to licensure for internationally trained physicians without the medical graduates. We've taken the medical graduates out of the rest. But this lead in language for your amendment says, this committee to which was referred Senate Bill 142 entitled an act relating to It medical has this stay there because that's what it's currently called. Since we have the hospitals and practitioners in the room, do you each support the language in this bill as a member? Yes.

[Alyssa Black (Chair)]: You want to give your names on records?

[Jessica Barnett]: I'm excited you're also supportive of this chapter. Great. Thank you.

[Alyssa Black (Chair)]: I'm going to assume everybody else is in support of it because nobody cared enough. It's like one of the days nobody cares what we're doing.

[Daisy Berbeco (Ranking Member)]: I just want to note, I did get an email from both Diana and Mike Zimmerman confirming that they are both supportive of it, and they apologize if we couldn't be here, but they're fine with the language and thank us for our efforts. Can you just tell me who they We took testimony from them, and they worked on the original bill. Was their

[Jen Carvey (Office of Legislative Counsel)]: Did you submit it to the World Education Service, and Diana O'Reilly was from the Windham County. The

[Alyssa Black (Chair)]: One that did like the surveys. She did the interviews. Yeah. Which I found like her written testimony that she submitted fascinating. I keep looking up all these med schools these people went to, and they're like some of the world's best med schools.

[Unidentified Committee Member]: Anyways, so That's a good question.

[Daisy Berbeco (Ranking Member)]: Yeah, of course. Daisy, you worked on this I

[Unidentified Committee Member]: just have a question. How did this come to you? Would this come to you?

[Daisy Berbeco (Ranking Member)]: So Senator Harrison downstairs, the lead sponsor of the bill, reached out because they were doing interviews with CEOs from some of the Vermont hospitals and UHCs just in order to gauge well, to gather more information. And so I joined those calls, and that's how I learned a lot more about Chittenden.

[Unidentified Committee Member]: And how do you envision this working? Were the institutions the one who were asking for this? So if somebody did come in, an international kind of position, were to come in, they seemed enthusiastic about taking them on. Absolutely.

[Daisy Berbeco (Ranking Member)]: I mean, Diana, again, is with the NAACP. And one of my constituents, Ruth Steinmetz, who is with Oh, forgive me, Ruth. I believe she works with AELV as well. Okay. And so I think it's folks who work with immigrant populations that know that there's this untapped resource sitting here for us. And they know that this committee is interested in addressing access and also health equity and making sure that we're delivering culturally appropriate care and high quality care.

[Unidentified Committee Member]: Awesome. I just want to

[Allen "Penny" Demar (Member)]: Question to add. Somebody brought up the other day about visas. I see nothing in here about anybody that's here must be in good standing citizenship.

[Alyssa Black (Chair)]: You wouldn't be able to have an employment arrangement unless you had an immigration status that allowed you I think

[Allen "Penny" Demar (Member)]: somebody said a lot of these people are already here in Vermont that are interested, but there might be some that's not here that might be interested. But they have to go through the whole process.

[Daisy Berbeco (Ranking Member)]: They have to be here legally eligible for work and have to have an offer of employment from a Vermont health care facility. So it's not, this doesn't do anything with immigration, this is for people who live in Vermont.

[Alyssa Black (Chair)]: So let's say, like, UBM wanted to come into an employment with one of these people, they would have to have an immigration status that would allow them to actually be an employee at UBM. Leslie, so just in response to what you were thinking, I'm looking at what Alyssa just alluded to, which was Diana's

[Jen Carvey (Office of Legislative Counsel)]: written testimony,

[Alyssa Black (Chair)]: because I think your question's a good one. And some of them have US citizenship already. Some have green cards. So you can go deep into each person if you're curious to know, but they're all already in the media.

[Allen "Penny" Demar (Member)]: But I was thinking that maybe UBM is big enough, they might get some information from somebody that say, I want to come to The United States and practice medicine. There's a process for those people to come here?

[Daisy Berbeco (Ranking Member)]: This bill doesn't address that. It's not an immigration bill.

[Allen "Penny" Demar (Member)]: It doesn't have to be an immigration bill.

[Daisy Berbeco (Ranking Member)]: I'll let Jim speak to, I think, if there's any what you're looking for is related to the mechanism of eligibility for Of international assistance. Jen, can you say what the new language includes that's related to that?

[Jen Carvey (Office of Legislative Counsel)]: So can you repeat that?

[Allen "Penny" Demar (Member)]: Well, I'm just thinking, if somebody at UVM gets a letter from somebody in another country, and I'm interested in practicing medicine or surgery in The United States. Is there a process for that person to come here and be a physician?

[Jen Carvey (Office of Legislative Counsel)]: I think so. There is a process for them to obtain licensure when they are here. This bill does not address getting them here, getting them citizenship or other authorization to work in The US. It just deals with how to get them their medical license when when all of the other qualifications have been met.

[Alyssa Black (Chair)]: Lauren, did you have anything you wanted to

[Lauren Lueders (General Counsel, Vermont Department of Health)]: No. I completely agree with Jen that there's obviously layers of immigration and authorization to work in The United States and the bill doesn't address that. There are other states that have included in their statutes language specific to that, but if we need any more specificity, there have been variation in that. So if we need any more specificity in the rules or in statute, we would bring that back to you in the report next January. However, as representative Berbeco has also testified, this is not an immigration bill. And so we would hopefully just work on the bottom line of if you're here and eligible to work, we wouldn't create any additional barriers or get involved beyond that.

[Alyssa Black (Chair)]: Version is this version 1.1, Jen?

[Jen Carvey (Office of Legislative Counsel)]: Yes. Mhmm. And it says,

[Alyssa Black (Chair)]: Right call. Look back at the Senate for their last recall, and they only changed a few things. I guess I would, if there's no more discussion or questions, I would entertain a motion.

[Jen Carvey (Office of Legislative Counsel)]: I make a motion that people in public

[Alyssa Black (Chair)]: S142. For the

[Unidentified Committee Member]: 1.1.

[Alyssa Black (Chair)]: And Brian. Debra, do you

[Jen Carvey (Office of Legislative Counsel)]: want to call them on? Brian Cina. Yes. Yes. Luedemara?

[Allen "Penny" Demar (Member)]: Yes. Leslie

[Jen Carvey (Office of Legislative Counsel)]: Goldman? Yes. Lori Houghton? Yes. Karen Lueders? Yes. Debra Powers, yes. David

[Allen "Penny" Demar (Member)]: Sousaun? Yes.

[Jen Carvey (Office of Legislative Counsel)]: About Taylor. Is he regretful? Yes. Alyssa Black. Yes.

[Alyssa Black (Chair)]: Alyssa Black. Alyssa You have an accent. How exciting. The reporter of this bill is going to be Representative Taylor.

[Jen Carvey (Office of Legislative Counsel)]: Oh, thank

[Alyssa Black (Chair)]: you. We're gonna give her lots of support. This is this will be Val's first bill report. And I particularly, Daisy, I know you've worked on this bill a lot. Daisy will work with you. Alright. With that, we are done for the week.

[Jen Carvey (Office of Legislative Counsel)]: And we'll do other and right in strike call. It's just favorable with amendment.

[Alyssa Black (Chair)]: And thank you, Lauren. Thank you for all your work on this. Really appreciate it.

[Unidentified Committee Member]: Stay in touch. Bye. Thank you. Seeing you an awful lot

[Alyssa Black (Chair)]: in our room this A little

[Lauren Lueders (General Counsel, Vermont Department of Health)]: flurry of activity. Thank you.

[Jen Carvey (Office of Legislative Counsel)]: Have a good weekend.

[Daisy Berbeco (Ranking Member)]: Thank you.

[Allen "Penny" Demar (Member)]: Thank you.

[Alyssa Black (Chair)]: Alright. Thank you. We're all the gents and may have a great weekend.