Vermont Legislature SmartTranscripts:

[Senator Ann Cummings (Chair)]: I thought we are live. Why are gonna hold my head? Oh. Everything is going down. What happened? Here she goes. Getting her doctor. No. Okay. We are here. Oh, We are here. Yeah. Yes. Central. So, we're back to H230, Stephanie. This is prescribing by doctoral level, by college. And Jim Collin is here from the office of professional regulation. Jen, the floor is yours, and then we get a couple questions, which if you can't answer, we'll have it by the other channel.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Great, well I will do my best. Jennifer Pullen, Director of the Office of Professional Regulation. I'm joined by Caledonia Bart, who's our General Counsel. We're here to testify in support of H237, an accolade prescribing by Doctor. Olavu's psychologist, and also just talk a little bit about the fee that would be involved in this credential. OKR did a sunrise review of whether doctoral level psychologists should have the opportunity for an expanded scope of practice to be able to prescribe medications used to treat DSM diagnoses. The Vermont Psychological Association a few years back had introduced legislation to allow the scope expansion. We did our Sunrise study and ultimately concluded in our Sunrise study that we didn't agree with the exact way that the BPA had proposed the scope expansion, but that with some modifications that we would be supportive of that. OPR's mission is public protection and in our regulatory programs, we want practitioners who can practice at the very top of their licensure safely and confidently as demonstrated by their experience, their education. That just gets us more practitioners in the state and more access to healthcare. We like allowing scope expansions when we feel confident based upon the evidence that we see of training, education, and experience that practitioners could safely do that. We did make that determination that with some modifications, doctoral level psychologist could safely prescribe mental health medications to treat DSM diagnoses. Some of the features of H237 that provide this assurance of competency and place I don't want to say guardrails, that's the wrong word, but kind of place the courts around this expansion of scope, is that there's a collaborating practitioner who is a licensed osteopath or physician who specializes in psychiatry. They would have to be a collaborator with the psychologist, doctoral level psychologist. There would be advanced training and education with the doctoral level psychologist that have to complete to get the specialty, and they would have to participate in a clinical rotation in different settings. The clinical rotation would be not less than fourteen months, and there would be five different practice settings that they would do that rotation in. With those supports around the scope expansion, OKR does does support it. Mhmm. And this would be offered through a specialty credential at the Office of Professional Regulation on top of the license for the doctoral level psychologist. So you may recall from testimony last week that specialty credentials that are offered by the Office of Professional Regulation cost $100 That's under, That's a fee that's already built into statute of three DSA 125. That's just an initial application fee for that specialty, and there is currently no renewal fee for that specialty. So, it would be a one time $100 fee for these folks. They would have to renew the specialty, but there's no fee associated with that renewal at this time. There's a

[Senator Ann Cummings (Chair)]: renewal fee on there psychology wise? Correct. Okay. So, this would just be But in not

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: on the speciality. That is right. Not at this time. I'm gonna keep saying that not at this time. Okay.

[Senator Ann Cummings (Chair)]: That doesn't stop secretary of the senate from seeing into the future. Attention for future peace. Senator Brock, you had a question? And I'm trying to find the wording on my bill.

[Senator Randy Brock (Member)]: There is a spot on the bill that lists age limits for the practice. It indicates that they're not dealing with juveniles or persons 80 or people who are pregnant. I understand the juvenile, can understand pregnancy is a medical issue, but where did the 80 come from?

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Yeah, my understanding is that these kind of criteria are criteria that you have in other states where this is offered. And when you're looking at folks in all of these categories 18, 80, or pregnant, I think the concern is just co I'm not sure what the right medical term Co occurring. Co occurring conditions, other conditions, medical conditions and medications that the folks may be on for folks 80 or potential complications that could arise. I think it's just

[Senator Randy Brock (Member)]: Is there any evidence supporting this? It seems like in many ways it's kind of an arbitrary number because there are people who are 60 who have all kinds of medical conditions and there are people who are 90 who don't. We're concerned on professional regulation. We're concerned about issues such as we see about judges. Judges have retired at age 70. Why? And we've been attacking those kinds of things. So where did this over 80 come from? Is there any evidence to support the justification for it?

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Yeah. We like I said, we did a sunrise study. And so I can get back to you on that specific question because I'm not recalling, I'm sure that issue was looked at, and I'm sure

[Senator Randy Brock (Member)]: that If there's some basis, a logical basis based on evidence, I can understand it. But if we're simply following what other states are doing, other states have done some very dumb things.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Right. No, I hear you. So I will take a look at that. Thank

[Senator Ann Cummings (Chair)]: you. Does anyone spectators gallery have an answer?

[Magni Lewandowski, Lobbyist, Downs Rachlin Martin (representing Vermont Psychological Association)]: I do. Hi, I'm Magni Lewandowski, the DRM. We represent the Vermont Psychological Association and that age, age 80, was put in place as a result of compromise between the stakeholders. This has been an issue that we've been working on for, I think, eight years at this point and finally gotten to a bill, a proposal that is a worker compromise with BMS, psychiatrists, other stakeholders. OPR has been a great partner in crafting this bill. The Psychological Association doesn't want any cap, do not want any upper limit cap, and we do have the geriatric rotation in there as well. I saw that. These psychiatrists were more comfortable with things in the evening.

[Senator Randy Brock (Member)]: Oh, example, that again would raise another question because I've seen that one of the disciplines that a person could engage in, in terms of training, was geriatrics and then not being able to provide anything to someone who's geriatric didn't seem to make a lot of sense.

[Magni Lewandowski, Lobbyist, Downs Rachlin Martin (representing Vermont Psychological Association)]: Correct. It was the result of compromise.

[Senator Randy Brock (Member)]: Compromise, not evidence.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: One thing I can also add is that there's a report back required in this legislation. On or before 11/15/2032, we have to report back on how many people are taking advantage of the specialty, the status of collaborative practitioners, whether there should be any updates to qualifications and prescribing psychologists to expand access to care. And so I can see that maybe in that last category, the idea of looking into whether 80, is an appropriate cap on that and revisiting those compromised issues with

[Senator Randy Brock (Member)]: Moving in there that requires any revisit. And so how would you do that other than the way you're doing it now by compromise? I think this applies almost to any criteria used to justify who can perform in a certain profession who can't. I think that there is a sane interest in doing that and having a basis for it that is based on evidence.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: It does sound like Vermont Medical Society may have some information about that as well.

[Senator Randy Brock (Member)]: I mean, there's some basis then I think we should look at it, but if there's not any basis other than compromise or looking at what some other state is doing. I don't think that makes a lot of sense.

[Senator Ann Cummings (Chair)]: Yeah, I think the folks in the medical society may be contacting people if they're watching this. I'm pretty sure they have reason, not just because I feel like it, knowing how you know, these are professionals and they don't usually do things just What

[Senator Randy Brock (Member)]: was the professional who said you can't be a judge after 70? That didn't make sense either.

[Senator Ann Cummings (Chair)]: Well, there was a It's

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: now 90 in statute, by the way. But

[Senator Martine Larocque Gulick (Member)]: the so I just wanna make sure I understand your your concern in terms of would you prefer to see no age in there or a different age

[Senator Randy Brock (Member)]: in there? Would prefer no age workers or faces for age having some evidence to support how the basis was arrived at as opposed to quote a compromise, or an arbitrary decision. That's what one Do you want to hear the Because it really is practice of an individual relative to the profession that he or she is

[Senator Ann Cummings (Chair)]: in.

[Senator Martine Larocque Gulick (Member)]: Yeah, I mean I hear you in terms of sort of having arbitrary, so I'm wondering, did you suggest, someone, I heard somebody suggest Well, a reply

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: the Medical Society just texted me, just so

[Senator Martine Larocque Gulick (Member)]: you know. And I think that they have a very different perspective on this,

[Senator Ann Cummings (Chair)]: and I know that there was

[Senator Martine Larocque Gulick (Member)]: a compromise. So I'm wondering if if, like, having because this wouldn't go into effect until 2029. Is that right? There's still time to work out this little issue because this is relatively speaking, this is small compared to the rest of it. We could ask for, you know, a report back with recommendations for how to deal with age restrictions for senior citizens or GRA after however, nobody's disputing the pediatrics thing. So it's just the

[Senator Randy Brock (Member)]: Or not in terms of the age of the funeral. I

[Senator Ann Cummings (Chair)]: can understand

[Senator Randy Brock (Member)]: the reason with again, there there could be complications there in terms of approval.

[Senator Ann Cummings (Chair)]: We will start by asking the medical society, whoever represents the psychiatric profession, to come in and talk to us about their reservations. Psychological. Yeah. Yeah. Yeah. Well, no. This would be it's the psychiatrist that that this was a compromise with.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Well, I mean, I think

[Senator Martine Larocque Gulick (Member)]: if we're gonna ask one, then we should

[Senator Ann Cummings (Chair)]: have both of them. But We'll have both of them. Okay.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: We did pick a lot of testimony in health and welfare, and there's a lot of information on the page, and I wish we could keep it restricted to fees in this committee because there's just been a lot of work for many years on this bill. I'm feeling discouraged right now that we're sort of going to relitigate and go over it again.

[Senator Ann Cummings (Chair)]: We are. That's why we're going to hear if there's a simple your brain chemistry changes at the age of 79, then that's fine. If it's a compromise, there are lots of compromises in this building, and we will move forward with the fees or not. But our jurisdiction really is the fees, but I am feeling some of this may filter across the hall. So if there's a single answer, we will try again. Okay. And then the

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: other just piece of this, which was what senator Gulick just mentioned, or yeah. Think senator Gulick. That the effective date of this is 07/01/2029 because OTR does need some time to do rule making and and get ready to offer this specialty. So it would not go into effect with them.

[Senator Ann Cummings (Chair)]: And then I assume the psych yeah. It would go into effect. The psychologist would have to take the additional courses, so it won't actually be in effect for a while.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Well, some may already be I mean, this this coursework is already offered. Okay. So, some may be in programs and maybe prescribing in other states. So, but but we won't be able to issue licenses until 2021. Okay.

[Senator Ann Cummings (Chair)]: Okay. Okay. Other questions? Thank you.

[Jennifer Pullen, Director, Vermont Office of Professional Regulation]: Thank you so much. Thank you.

[Senator Ann Cummings (Chair)]: Okay. And our next set of witnesses, As soon as we get them, we can take time right now. The report from the cannabis board is on our website, so we can all take a chance to look at that. Yeah. Also, And I suppose we can go