Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: Good luck. Okay, we're back, Senate Health and Welfare, and we are looking at H237 with Legis Council, so we're going ahead. Thank you, let

[Legislative Counsel (unidentified)]: me pull it up on my screen.

[Sen. Virginia "Ginny" Lyons (Chair)]: There we go.

[Legislative Counsel (unidentified)]: So, unlike the other bills we're looking at this morning, which are the bills introduced, this is a bill that has already passed the House. This is related to prescribing by a doctoral level psychologist. This creates a new specialty to authorize prescribing by these professionals. They would prescribe prescription drugs for conditions listed in the Diagnostic Statistical Manual for mental health conditions. This adds definitions of prescribing psychologists, prescriptive authority, so again, the definitions matter. We should take a look at those. This amends the powers of the Board of Psychological Examiners to include oversight of this new specialty. It allows these doctoral psychologists to apply to the board for the specialty, and it outlines all of the requirements for the specialty, including criteria for prescribing the medications themselves, not just for obtaining the specialty. You can take a look. It's a strike off. I love it when the house

[Sen. Virginia "Ginny" Lyons (Chair)]: is sore. Okay. So start. This is why this Start. This? Is as in, oh, has Pathway House. That has Pathway House.

[Legislative Counsel (unidentified)]: Yeah, usually when we look at them, we do the unofficial version, then you don't have the mark through and it looks more like what you're used to seeing in the middle of the truce, but this definitely works. So we have a definition section. We're adding to an existing definition section in the chapter on psychologists within the OPR title of 26. So we're adding definitions of a collaborating practitioner, what the DSM means, when we talk about being able to prescribe a drug, what do we mean by drug? What is the definition of a prescribing psychologist? What is a prescription drug? What do we mean by somebody having prescriptive authority? So that's all handled by adding definitions. And then we have in section two, the powers and duties of the board. And we're adding to their powers and duties the regulation of prescribing by psychologists with this specialty. And there's some language, there's also adding language about regulating a collaborative practice agreement between the prescribing psychologist and another practitioner. So that is all governed by the board. We're kind of amending the board's duties to have oversight over this new specialty. And then within the chapter on psychologists, we're adding a new section about the prescribing specialty. So this creates the specialty and it says that somebody, a prescribing psychologist doctorate, may apply to the board for this specialty. And then we have language that the psychologist doctorate can be eligible for prescribing the specialty if certain criteria are met. And then we have a list of what those criteria are. So they already hold a licensed practice psychology at the doctoral level, successful completion of a post doctoral training program, and psychopharmacologically, psychology designated by the American Psychological Association or its successor completed clinical rotations over a total of not less than fourteen months and not less than nine practice settings to include psychiatry, pediatrics, geriatrics, family medicine, internal medicine, emergency medicine, obstetrics and gynecology, surgery, and one elective. This person has completed a national certifying exam and meets other requirements for obtaining this specialty as determined by the board and rule. Under subsection C, have the actual criteria for doing the prescribing of medication by these professionals once they have their, specialty. There has to be a written collaborative agreement that is required for all prescribing psychologists practicing under a prescribing psychologist, psychologist specialty issued pursuant to this section. So there is a collaborative practice agreement with another professional who already prescribes in this area. The issuance of prescribing authority by a collaborating practitioner to this psychologist, doctoral psychologist shall only include prescription drugs for the treatment of mental health conditions that the collaborating practitioner generally provides to their patients. So, the doctoral level psychologist is only prescribing to the extent that the collaborating practitioner they're working with is already sort of prescribing those types of medications. At the top of page 11, the collaborating practitioner is to file the collaborative agreement with the board, and they have to provide a board notice of any termination of that agreement. Issuance of prescribing authority for schedule two through five controlled substances is to identify the specific controlled substance by brand name or generic name. Prescription or administration of a controlled substance by injection is not to be allowed, that the prescribing authority doesn't extend to injections. And then we have this language about the specialty by endorsement that director of the board of psychological examiners may, upon payment of any required fee, grant a prescribing specialty without examination if certain parameters apply, including that the applicant holds active psychologist prescribing authority in another US or Canadian jurisdiction, and the requirements for psychologist prescribing authority in that jurisdiction are in the judgment of the director, substantially equivalent to their apartments under this section. So we have tiered effective dates. This section, the effective date section, and section two, the powers and duties of the board take effect a year before the rest of the bill takes effect. So, were you to move this? We would need to update these effective dates. The idea being that the board has a year to get the oversight structure in place before the program authorizes prescribing by doctoral level psychologists.

[Committee Member (unidentified)]: I'm missing something, Madam Chair.

[Legislative Counsel (unidentified)]: Doctoral level psychologist has to have a prescribing relationship with, they are a physician licensed to practice medicine with a specialty in psychiatry. It has to be a psychiatrist that they're working with. And the doctoral level person is prescribing sort of within the scope of what the psychiatrist generally provides. Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: Sorry about that. No. No. No. No. It's me. Yeah.

[Committee Member (unidentified)]: So that brings me to my question, which is if in fact they have to collaborate with an individual who already has that authority Mhmm. Why not just allow the individual who already has the authority to prescribe as opposed to I I don't see the big advantage because there's still this two step process.

[Sen. Virginia "Ginny" Lyons (Chair)]: You're trying to sort out what the problem is. Yeah. Yeah. So we'll we need to get to that. We'll we'll have folks come in and tell us what the problem is. Yeah. That's good. One problem are we solving. Yeah. I I I probably most of the effort. So Yeah. This is why the this is this is exactly why the sponsor is so important. You know? So when senator Gulick and senator Bahowski came in, we saw, oh, we see the problem. Now we can look at the bill. And so now we're looking at the bill and we don't know what's what I saw so we'll have to look at that. But they're good questions. We'll get folks in to help us understand. And is there anyone around the room who would like to raise their hand and make a comment on this bill? Because we haven't had time at this point. I should return. Yes, Pam. Becky Lewandowski, I'm with DRM and we work with Vermont Psychological Association And we have witnesses ready to come in and testify to answer some of these questions. But the purpose is to sort of increase access to mental health services by allowing the psychologist with this expanded training with a collaborative agreement to be able to prescribe themselves so there's not as many steps as it may appear. So it's really the patient that's not making an opportunity. Right. Just more addicts. Oh, yes. I find

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: a small voice. Stephanie Winters, I represent the Vermont Medical Society, but also the Vermont Psychiatric Association with both VPA, So change our I represent the physicians who have the current prescribing authority. We do appreciate a lot of the safeguards that were put in in the house, including the collaboration with psychiatry, the clinical rotations. I think some psychiatrists still have some concerns about whether this is needed, because a lot of primary care physicians and APRNs and physician assistants can already prescribe these medications. So do we need more medications in the system versus the real expertise and care that psychologists provide. So I think you will hear from some psychiatrists who have concerns, but also that we do appreciate the safeguards in the current version. Okay, so we'll get folks in from

[Sen. Virginia "Ginny" Lyons (Chair)]: both associations, DPAs. Terrible DPAs too. I know, I know. Okay, good. Thank you. Thank you both. Well, it sets up and began to answer the question. Yeah, that's good. Alright. Anything else there? Okay. Good. Thanks. How are you doing, Katie? I have not gotten an email yet. Oh, no. I know.

[Legislative Counsel (unidentified)]: I don't know what they're doing up there. A lot of announcements. A lot

[Sen. Virginia "Ginny" Lyons (Chair)]: of people up there. So I'm I'm somewhat hesitant to dive into 206, but why don't we? Okay. And then Yeah. Let's do it. So, know, so far I haven't heard from the committee a no on any of these bills, so I'm just assuming that as time goes on we'll take testimony and sort out what's there and we can decide to vote on Okay. Thank you.

[Legislative Counsel (unidentified)]: I want to share my screen.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So, that's Oh, they got knowledge.

[Legislative Counsel (unidentified)]: No, thank you. This relates to the licensure of early childhood educators by OPR. This is, there was a variation of this bill that was in, where was it, Gulick? Gulick. Last year. And it ultimately was not adopted. So this is, like I said, it's a variation of that bill. Just to sort of give the landscape, because I think it can be a little confusing, right now, the Department for Children and Families licenses childcare programs, both programs that are like a center based program and, programs that are

[Sen. Virginia "Ginny" Lyons (Chair)]: in

[Legislative Counsel (unidentified)]: folks' home, receive a license for, from DCF. Those licenses are for the program themselves and not for the individual provider. So what this bill does is it creates a license for the individual provider who's working maybe in a child care center, for example. So this, you'll see that it creates a new chapter in Title 26, which is our professional regulation title for the licensure of early childhood educators. It creates four categories of licensure that are dependent on the individual's education and experience and where they are working, whether they're in a center based program or in a family childcare home program. It creates a board of early childhood educators to govern and provide oversight over the profession, sort of the same, similar structure for other professions under OPR that there's a board that provides that oversight, like what we just looked at with the board for psychologists. Oh, I'm not finished. Let me finish the overview and will walk through the language.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, we need to get up there. I need to go up.

[Legislative Counsel (unidentified)]: Okay, it distinguishes this language, this chapter distinguishes early childhood educators working in a childcare environment from teachers who are licensed under Title 16, the education title, who have endorsements in early childhood education, early childhood special education, or elementary education. It creates a fee structure for that licensure, it also waives the first set of fees during the first round of licensing. It offers a transitional license for two categories of providers for up to eight years to give folks time to get their credentials in place before this takes place. It appropriates funds to set up the program and it creates a few new positions to manage and operate the program. And the program itself was under this draft, but we stood out by 2028. So I will bring you through the language, hopefully in maybe '10 to Schmidt.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So we will go offline and we're gonna take a break till quarter after ten. Okay.

[Legislative Counsel (unidentified)]: And do you want me to pass this note to Top or something?