Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: You're live. All right, we're live. This is Senate Health and Welfare. It's February 11, and it's recovery day in the state house. At 09:45, we're going to have a joint meeting with House Human Services and listen to some of the recovery testimony that relates to one of our bills, S-one 157. But right now we're going to hear from Katie on H237 and look at what we have for that bill. And before we do that, I'm gonna just say welcome to our two medical student guests. Thanks for being here. Thank you. And why don't you introduce yourselves? My

[Kim (Medical Student guest)]: name is Kim, and I'm going into radiology.

[Jennifer Coleman (Director, Office of Professional Regulation)]: And my name is Nina. I'm going into OBGYN.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: AP OBN for mom. Alright. I know you've been working hard outside the committee on this bill and communicating with people.

[Katie McGinn (Office of Legislative Counsel)]: Really appreciate that. No problem. Katie McGinn, Office of Legislative Counsel. So, I know the committee has had multiple requests for proposed changes. And at this point, my instructions have been to sort of wait and have the committee hear those proposals before they're integrated into a draft. Yes. So we could look through the bills introduced. Yep. There was one small amendment that had been asked to, you know, start in a a strike all. We could look at that, or you could look at some of the language you're getting from other folks. Where would you like to start? Let's start with what we have in

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: the bill. Okay. And the strike all. And then I know that BMS had some comments and I know OPR had comments back and I know that the psychologists are here in the room so maybe we can get into that level of completion on the bill. Okay. Because we're ready to finish the bill.

[Katie McGinn (Office of Legislative Counsel)]: So, I'm gonna pull up a draft amendment that has one small change that was, I believe, requested by EMS, and then you have other changes that have been

[Sen. John Morley III (Member)]: requested. Okay,

[Katie McGinn (Office of Legislative Counsel)]: so here is a strike all amendment. This is mostly reflecting the Bill of Litchust. So, we have our chapter on psychology. We have a definition section, and this is adding definitions of collaborating practitioners, the person who's working with the prescribing doctoral level psychologist. You have definitions of drug DSM, prescribing psychologist, and prescription drug, and prescriptive authority as related to prescribing psychologists. Do you wanna go over any of those definitions more slowly or? No, okay. In section two, you have the powers and duties of the board, and there are some changes here. First, a strike through on the duty to explain complaint and appeal procedures to licensees' applications in the public, and then new language around prescribing psychologist licenses pursuant to 3,019, which is a section further on from the bill specific to prescribing doctoral level psychologists, including the settings of clinical rotations. Here is the proposed edition. The minimum requirements for the curriculum of a designated post doc oral psychopharmacology program and prescriptive authority, including the designation of conditions and drugs excluded from that authority, as well as requirements for the prescribing of follicular drugs. So the question is,

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: where does this language come from?

[Katie McGinn (Office of Legislative Counsel)]: I believe this language came from Stephanie. Stephanie So

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: this is VMS language. Okay, let's go through it all and then we'll come back and we'll open up for comments from folks around the room. We won't bring you into the witness chair, but we'll have a discussion about what's here. First of all, me ask a question of, I don't know whether it's VMS, the psychologist, or OPR, and I'll go back to that one first change, if that's that. What are the minimum requirements of a designated postdoctoral psychopharmacology program?

[Dr. Rick Barnett (Vermont Psychological Association)]: I can answer that.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Okay. The

[Dr. Rick Barnett (Vermont Psychological Association)]: minimum requirement For

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: the record.

[Dr. Rick Barnett (Vermont Psychological Association)]: For the record, my name is Doctor. Rick Barnett with the Vermont Psychological Association. Thank you. American Psychological Association has a very formal designation process for Master's degrees, Master's of Science in Clinical Psychopharmacology. It's a designated two year Master's degree in Clinical Psychopharmacology. That is what's in the bill, that's what's required. No one can get prescribing authority about going through that designated Masters of Science program.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So are you agreeing with this?

[Dr. Rick Barnett (Vermont Psychological Association)]: I don't understand, I would have to understand from VMS what they are changing here. It looks like, it looks consistent with what we had before, so I'm not sure what was changed.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Okay, how is it different? Can we assess for you? How is this? This isn't new language.

[Katie McGinn (Office of Legislative Counsel)]: It's not replacing something else in the bill, so it's adding a new subdivision in the bill.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So then I'll turn to Stephanie for some records. Stephanie Wichter, Deputy Director of Vermont Medical Society. In looking at training programs across The United States, we did not see a standardized training or uniformity between all of them. Understanding that the American Psychological Association does have a list of training programs, we wanted to give OPR rule making authority to deem even above that, which met our Vermont standard of minimum training. Okay, so then I turn to OPR. This is about rule making for minimum requirements for cycle cross college. And we had intended

[Jennifer Coleman (Director, Office of Professional Regulation)]: to go through the rule making process for implementation of this chapter, so

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: that could be part of the process. It shows minimum requirements of four

[Jennifer Coleman (Director, Office of Professional Regulation)]: It looks like four of the proposed

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: I know, but Grammatic. Grammatic. Grammatic. Grammatic. Okay, let's just flag that. Okay. But the question I will have you is how this fits with the rule making process. It seems psychopharmacology, as you said, underlies what you would be doing anyway, so it's how this fits in. Alright, let's go.

[Katie McGinn (Office of Legislative Counsel)]: I'm sitting here looking at this. I'm wondering about the word designated. Designated postdoctoral pharma psychology program. So, don't know if we use a designated program. I'll take out a designated. Okay, let me take a closer look and see if we use designated anywhere And else in the

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: does it have to be programmed? I'm just thinking it's the underlying content that's important. Any thought there? We'll come back to this. Okay.

[Katie McGinn (Office of Legislative Counsel)]: And then, last item on the rule making. It strikes out, Explain how the board shall investigate suspected unprofessional conduct, and instead have the language regulate collaborative practice agreements pursuant to section thirty nineteen of this title, including collaborating practitioner qualifications and annual competency evaluations. So, that is all in sections of the chapter on psychology. Within that chapter, section three creates a new section that is specific to prescribing by a doctoral level psychologist. So, subsection A, there's the creation of a specialty allows a psychologist doctor to apply to the board for prescribing specialty. The application shall be made in a manner approved by the board, payment of Chart Fees. And subsection B allows for specialty by examination. So the psychologist doctorate shall be eligible for prescribing the specialty if that individual holds a current license practice psychology at the doctoral level in Vermont, if the person has successfully completed a post doctoral training program in psychopharmacology designated by the American Psychological Association or its successor, And three, has 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. He's completed national certifying exam as determined by our rule and meets all other requirements for obtaining a prescribing psychologist's specialty as determined by our rules. So one thing to think about is we have the program here, psychopharmacology, and there's this redundant way of rulemaking.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Maybe not,

[Sen. John Morley III (Member)]: Yeah. One of the big questions that I keep seeing coming in from medical people, and I'm not sure who answers this question, but do we feel confident that abiding by this section, which sort of sets the stage of training, meets that competency level for actually prescribing medication? Because that's one of the big questions that cited by Martine Larocque Ginny and I just want to hear from the experts whether or not you believe the way this is written actually protects the hospital.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: That's the question. So we'll look, I'm going to look to OPR because they're the ones who have recommended this.

[Jennifer Coleman (Director, Office of Professional Regulation)]: That's right and we did a summarized report on this psychologist prescribing scope expansion. And we think with this level of training along with things like the collaborative practice agreement that that provides sufficient adequate training for prescribing psychologists to do this safely,

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: OPR supports themselves. And there is oversight in here with the collaborative review, yes.

[Sen. John Morley III (Member)]: And just one follow-up on that because the other part of the question that again, it's just how many things we get sent in on the whole and copied on these is when you're dealing generally with your primary, they know all the different prescriptions that somebody is receiving and understand, you know, if I add something, how that interacts with the other prescriptions that that individual may be taking. And so how are we covered in that aspect, so that when the psychologist basically prescribes, they understand what are the other medications that that patient might be under and how what they're prescribing interacts with those other prescriptions.

[Jennifer Coleman (Director, Office of Professional Regulation)]: I think we have the answer to that, but I want to refer back to our report real quick, and then I can

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So we'll keep going. Great. This is a question on the table. Go back. Okay, keep going. So

[Katie McGinn (Office of Legislative Counsel)]: next in subsection C we have the actuals criteria for prescribing medication. So that includes a written collaborative agreement for all prescribing psychologists who are practicing under a prescribing psychologist specialty issue pursuant to this session. So they have to have a collaborative agreement. And this second subdivision, the issuance of the prescriptive authority by a collaborating practitioner to a prescribing psychologist shall only include the prescription drugs for the treatment of mental health conditions that the collaborating practitioner themselves generally provides to patients in the normal course of practice. Third, the collaborating practitioner has to file a collaborative agreement with the board and any notice of termination of that agreement. And fourth, the issuance of prescribing authority for schedule two through five controlled substances shall identify the specific controlled substance by brand name or generic name, and the prescription or administration of a controlled substance by injection is not to be allowed. Subsection D is the specialty by endorsement, the director of the board, upon payment of a required fee, is to grant a prescribing specialty without examination if the applicant holds an active psychologist prescribing authority in another US or Canadian jurisdiction, and the requirements for psychologist prescribing authority in that jurisdiction are on the judgment of the director substantially equivalent to the requirements of this section.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So, part of the answer to your question is under the collaboration, where the collaborating physician or practitioner understands the overall And I think given the training, psychologists should also I guess that was my question last week, then psychologists didn't have access to the continued medical grade than right now. Well, at least if you're in the UVM system, everybody knows everything. And it wasn't that long ago that they didn't know what to do practices within the same hospital prescribing. But if you did know that this patient had kidney disease or liver disease or something, that could be involved. And I guess it's the time to get the collaborative agreement says before the person goes out and takes this new med that it should be been seen by somebody who does have access, or if you're going to give access to the And we did hear testimony from the psychologists that they do look at the patient data. Correct. We did hear that initially. But do they have where do they get that information? They get it

[Dr. Rick Barnett (Vermont Psychological Association)]: With the collaborative agreement, there's bound to be some rule making around, you know, how information is shared between providers and the primary care physician would not approve a psychologist prescribing without having shared those medical records. Whether it's through shared electronic health record, which is very possible, just needs some coordination, or it's through the old phone, or fax, or something, that's what's protective about it, the collaborative agreement with the provider.

[Jennifer Coleman (Director, Office of Professional Regulation)]: And manager, one thing also that I would add is, patients are obtaining prescriptions from pharmacies, those pharmacists, pharmacy professionals have also the entire menu of drugs that the patient is on, and they are also doing a drug utilization review so that they can also alert if there's potential drug interaction between alcohol because of the patient's name. Okay.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Oh, go ahead. I guess if it wasn't that long ago you did pharmacy shopping. Yes, we did. If I get one prescription at Ketty's and the next prescription at Walgreens two towns over, Is that a universal? No. They're saying, well, probably can know. Okay. So, if I go to the state of pharmacy, they know everything I want, but if I might, I move around. I've been in Colchester this week and I go to the pharmacy and I But get it to that would be the case where the records of the physician and the psychologist are sharing what he was working. I don't know if we could cover every single condition because what you're talking about is it could be for any prescription. Not simply related to this one.

[Sen. John Morley III (Member)]: Sounds like we're in the line on the collaboratives. Yeah. Agreed that Yeah. Somebody with oversight over the overall condition of the pages. Yeah. So now that this is a. Yeah. Yeah. I can Yeah.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: That's a front nerve dealer position you've been.

[Sen. John Morley III (Member)]: Yeah. Well, I don't know who's the who's the you're going to split.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: I see Katie pondering something. You know?

[Katie McGinn (Office of Legislative Counsel)]: I just got like an eye feeler. I think a malicious activity blocker, I don't know, think I have to get in touch with the IT department. I'm not sure what's happening.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Uh-oh, what's happening?

[Katie McGinn (Office of Legislative Counsel)]: I don't know.

[Sen. John Morley III (Member)]: Frozen up?

[Katie McGinn (Office of Legislative Counsel)]: Is it showing on that screen? No. Yeah. I'm gonna stop sharing and let you continue this conversation, and I will come back to IT.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Well, what's happening? I'm not We went through the whole bill we brought. We're we're on page we're almost on page

[Katie McGinn (Office of Legislative Counsel)]: six of six. We did get to the effective dates, which is

[Sen. John Morley III (Member)]: the end of the month.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: We changed the effective date.

[Katie McGinn (Office of Legislative Counsel)]: I don't know if you want to change them, yeah, so this updates them by one year because you've had the bill, healthcare passed the bill out last year. So, this has only been updated by year. Is there any, are there any other proposals of amendments that we have had? Yes, you received proposals from OPR, you've received a proposal from DRM, so you have those to look through. Okay. Is it

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: '28 instead of '27? Is that like a two year? Yes. Okay. So OPR has a recommendation and DRM, are you representing some psychologists? So I don't know if they're different or the same. They're the They're the same. We can just go with Let's go to OPR and look at that. We look at DMS's, and we've made some wordsmith in there. And I think we just leave that with the paper. Are you ready?

[Jennifer Coleman (Director, Office of Professional Regulation)]: That's short.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Alright. We won't even come up with presenting something?

[Jennifer Coleman (Director, Office of Professional Regulation)]: I'm Jennifer Coleman, director of

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: the Office of Professional Regulation. Good morning.

[Jennifer Coleman (Director, Office of Professional Regulation)]: Testimony from a couple of weeks ago that we filed on January 21 that had some proposed change event. Yes, you did. So I think very importantly, we would request that collaborating practitioner that the definition include another prescribing provider as approved by the board. We have site ATRNs that are highly specialized in mental health care and we want those folks to be allowed to be collaborating providers. There may be others, I can't think of any off the top of my head, but there may be others that

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: the board would want to designate who have that substantial mental health. Do you have language for that? Yes. I know we have it, but can you share? I

[Jennifer Coleman (Director, Office of Professional Regulation)]: don't have a lot. Sorry.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Oh, I thought that was a lot of that. So we have it. What was the date of that? And Calista, maybe you can pull it up before.

[Jennifer Coleman (Director, Office of Professional Regulation)]: I emailed that to Calista last night, but the date that we gave that to somebody was 01/21/2020.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So I have it right here. Alright. We have it. Yes, sir. We have it.

[Sen. John Morley III (Member)]: You said if you want.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Yeah. No.

[Jennifer Coleman (Director, Office of Professional Regulation)]: Me using him thought you never I a good really appreciate it. We have it right here.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So, or another prescribing provider as approved by the board. That

[Sen. John Morley III (Member)]: gets us back to the other question. Yes, sir. Which is, does that individual have the knowledge and ability oversee the overall condition of a patient because we're talking about more than just mental health, we're talking about their overall physical health and how the prescriptions interact with the rest of their health, and so I want to be sure that collaboration occurs with somebody who has knowledge, skills, background, and training to look at the overall health of the individual and how the prescriptions interact.

[Jennifer Coleman (Director, Office of Professional Regulation)]: Absolutely, as do we. Public protection is our mandate, so we would also be wanting to ensure that. That would be part of the rule making process, and certainly, OKR would put forward a rule that did not provide for someone who had adequate OPR would not forward a rule that would allow someone that did not have adequate training and expertise and education to be that collaborating provider.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So how do we say that Or another prescribing provider with adequate training. Surely say that. With adequate training and training education and experience. Equivalent training. Up above, you have the primary care doctors. And so Which can't be an APR. I know. Can you do this for us? Yes. We'll work on language. Can we get that? Can I ask a question? No.

[Jennifer Coleman (Director, Office of Professional Regulation)]: So,

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: as another prescribing provider is approved by the board, is that assumed and approved by the board that they have adequate training? I mean, isn't it? So, we're just like driving at home. Yeah, we want to make sure they got their Yes, go ahead.

[Katie McGinn (Office of Legislative Counsel)]: It's the development, I'm sorry, Martine Larocque Ginny Deputy Secretary of Statement of Records. It's the development of this guidepost approach. It's the making sure it's in statute and approved by the board in the rule. And I think we should work on the right language. I just want to be sensitive to the fact that probably there are some differences in training between psych APRNs and psychiatrists. So, equivalent is maybe not the right word, but extensive adequate. We'll work

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: with everybody on the language. Can we do that? Can we get that and work with Katie on that? Yes. And everybody else and his sister will have the And

[Jennifer Coleman (Director, Office of Professional Regulation)]: Senator Gulick, Thank you, Madam Chair. Also looks like adding this language is going

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: to change the effective date '29. Yes, ma'am. Okay. So that we

[Jennifer Coleman (Director, Office of Professional Regulation)]: can do bullying. Okay. Before we in order

[Sen. John Morley III (Member)]: to implement that. Okay.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So, thank you very much. Is that located with all parties concerned? Yeah. Okay. You have so you have section three. You have some changes.

[Jennifer Coleman (Director, Office of Professional Regulation)]: Yes, in section three, section 3,019, with the clinical rotations, we have worked with BPA and have agreed on five practice settings. We think that that would be adequate. There are some practice settings in here that really wouldn't pertain to who psychologists would be prescribing to, so the five practice settings and removal of some of those specific practice settings. Pediatrics,

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: obstetrics and gynecology, surgery, and while elective, it looks like it's what we So we wouldn't be seeing a psychologist prescribing to a child? Correct. Remind me.

[Sen. John Morley III (Member)]: Okay.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Okay. And then I was explaining my incentive. Okay, so can we agree to put the changes in section three? Can you do that? And then can we agree that we're going to have OPR recommend some language on the section one collaborating practitioner? Do that? So we get some equivalent knowledge base.

[Katie McGinn (Office of Legislative Counsel)]: Can I ask you a question? There are also effective dates in this proposal that are different from what we just looked at, that the remaining sections take effect 01/01/1929 instead of Right, we Yeah, we do. We're good with it. Got it.

[Sen. Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Thank you. Senator Gulick, state. Thank you. Any other questions? No, this is good. Hear testimony, we get the gist of what's going on, and then when we do markup, we have to go back and look carefully at what's in the bill, and that's what we're doing right now. This is helpful. Thank you. Okay. So, what is the timeline on getting some language for us to look at? Fifteen or twenty minutes. So in fifteen or twenty minutes, we're going to be in Room 10. So she can get that to us when we come back at 10:45. We are hearing testimony, but we'll try to sort out what that language is and and then we'll put the bill into our hopper for final consideration. Okay. Alright. Terrific. Thank you. Thank you all. This has been difficult, but good. I think we're in a good place right now. Alright. So we are gonna go off