Comments Document

Chairperson Orrock, Vice-Chair Head, and honorable members of the House Health, Welfare and Institutions Committee: On behalf of the American Counseling Association (ACA), I am writing to express our strong support for the Counseling Compact. Founded in 1952, ACA is the world's largest association exclusively representing 60,000 professional counselors in all fifty states including the Commonwealth of Virginia, the home of our national office. The American Counseling Association is built on enduring values and a mission that promotes human dignity, diversity, respect, and the attainment of quality of life for all. Removing barriers to access critical life-saving services in a time of urgent need could not be more important to this mission. COVID-19 has exposed unacceptable health care disparities throughout our country, highlighting the critical need for services. The question we now face is how to promote accessibility of mental health services safely across the country. The Counseling Compact is the most viable way of achieving this goal. Much like the existing licensure compacts for nurses, physical therapists, physicians, psychologists and EMS personnel, the Counseling Compact will increase licensure portability for practitioners while allowing member state regulatory boards to better protect consumers through enhanced sharing of licensure information. Existing interstate occupational licensure compacts have been successful in reducing barriers for practitioners who wish to provide services in other states. The Counseling Compact will benefit clients and the counseling profession by: • Enhancing mobility for counselors who meet uniform licensure requirements. • Increasing access to care for clients. • Ensuring continuity of care when clients or counselors relocate or travel to other states. • Allowing military personnel and spouses to maintain their certifications when relocating with greater ease. • Preserving and strengthening the current system of state licensure. While providing these benefits to our members and the counseling community, the Counseling Compact also preserves the authority of each state to protect public health and safety through existing state regulatory structure. The Compact does not determine scope of practice or alter the state practice act in any way. Unlike national licensure initiatives that supersede state regulatory authority, an interstate compact allows a member state to continue to determine the requirements for licensure in that state as well as maintain the state’s unique scope of practice for all professional counselors practicing in that state, whether it be through a state-issued license or through a privilege to practice. Additionally, by ensuring the sharing of investigative and disciplinary information among member states, the Counseling Compact will allow member state regulatory boards to better protect the public. With these benefits in mind, the American Counseling Association is excited to endorse the Counseling Compact and urges your support in the passage of this critical legislation. Sincerely, Shawn Boynes CEO

Chairperson Orrock, Subcommittee-Chair Edmunds, and honorable members of the Health, Welfare and Institutions Subcommittee: On behalf of the American Counseling Association (ACA), I am writing to express our strong support for the Counseling Compact. Founded in 1952, ACA is the world's largest association exclusively representing over 55,000 professional counselors in all fifty states including the Commonwealth of Virginia. The ACA is built on enduring values and a mission that promotes human dignity, diversity, respect, and the attainment of quality of life for all. Removing barriers to access critical life-saving services in a time of urgent need could not be more important to this mission. COVID-19 has exposed unacceptable health care disparities throughout our country, highlighting the critical need for services. The question we now face is how to promote accessibility of mental health services safely across the country. The Counseling Compact is the most viable way of achieving this goal. Much like the existing licensure compacts for nurses, physical therapists, physicians, psychologists and EMS personnel, the Counseling Compact will increase licensure portability for practitioners while allowing member state regulatory boards to better protect consumers through enhanced sharing of licensure information. The Counseling Compact will benefit clients and the counseling profession by: • Enhancing mobility for counselors who meet licensure requirements. • Increasing access to care for clients. • Ensuring continuity of care when clients or counselors relocate or travel to other states. • Allowing military personnel and spouses to maintain their certifications when relocating with greater ease. • Preserving and strengthening the current system of state licensure. While providing these benefits to our members and the counseling community, the Counseling Compact also preserves the authority of each state to protect public health and safety through existing state regulatory structure. The Compact does not determine scope of practice or alter the state practice act in any way. Unlike national licensure initiatives that supersede state regulatory authority, an interstate compact allows a member state to continue to determine the requirements for licensure in that state as well as maintain the state’s unique scope of practice for all professional counselors practicing in that state, whether it be through a state-issued license or through a privilege to practice. Additionally, by ensuring the sharing of investigative and disciplinary information among member states, the Counseling Compact will allow member state regulatory boards to better protect the public. With these benefits in mind, the American Counseling Association is excited to endorse the Counseling Compact and urges your support in the passage of this critical legislation. Sincerely, Shawn Boynes, CEO American Counseling Association (ACA)

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

Comments Document

Providing testimony in support of HB 1511 on behalf of the PUSH Coalition of more than 40 advocacy and health care organizations across the Commonwealth, working to provide solutions in Virginia to the escalating U.S. maternal health crisis. HB 1511 is critical to address the leading causes of preventable pregnancy-related deaths. Nearly 90% are due to hemorrhaging and preeclampsia, both of which can be mitigated with medications that fall under the scope of practice of licensed midwives, yet those working in freestanding birthing centers are not permitted to carry and administer these life-saving medications. There are also medications under their scope of practice that provide local anesthesia during episiotomy surgical cuts or suturing tears during delivery. Without access to these medications, this outdated limitation on their practice forces licensed midwives to deliver babies without the full capacity to ease the pain of their maternity patients. It is inhumane. I urge you to authorize licensed midwives to carry and administer medications essential to provide safe and compassionate birth settings, by voting yes on HB 1511.

I write in support of this legislation. Certified Professional Midwives are valued colleagues who should be able to practice to the full extent of their education and standards of care. Thank you.

Comments Document

I am asking the committee to support HB 1511, which would allow Licensed Midwives to carry and administer certain medications to pregnant and intrapartum women and newborns. Licensed Midwives are trained to use a short list of medications that are standard of care and necessary to ensure the safety of birthing families. Using these medications is part of our training, and our credential, per the North American Registry of Midwives Job Analysis. These medications are used to prevent and treat postpartum hemorrhage, and newborn vitamin k deficiency bleeding. Please see the attached one pager for further information. Thank you.

I am a Certified Nurse Midwife who has worked in Hospital and Birth Center practices to support families through pregnancy, birth and postpartum. In many of my practices, we were the touch point for transfer from Community Birth venues with Certified Practicing Midwives were needed, and we welcomed them to our hospital for that advanced care. However, there were times when the CPM attending those families could have been providing lifesaving medications while arrange transfer, or even avoiding transfer all together, directly making a positive impact on the health and safety of our community while decreasing healthcare costs. I am in full support of CPMs being able to practice to the full scope of their education and standard of care within their communities including access to medications relevant to their practice.

My name is Emily Moore, and I am the Policy Analyst at Voices for Virginia's Children. We thank Delegate Dawn Adams for introducing this bill, and we are writing to voice our support for HB 1511 and encourage all members of the committee to vote yes in support of HB 1511 on Tuesday during the Health, Welfare and Institutions subcommittee meeting. Licensed midwives must have authorization to give their patients life-saving medications during labor and delivery. Ensuring safe practices in birth settings is one step towards addressing preventable pregnancy-related deaths in Virginia that contribute to the alarming disparities in Virginia's maternal mortality rates, where Black women are dying three to four times more than other women, a rate higher than the national average.

I am writing as a doctor of physical therapy with certification as a seating and mobility specialist, which is the highest certification for wheelchair prescription. I have been practicing for nearly 20 years in a variety of settings, including skilled nursing facilities. This bill is crucial to the quality of life and overall health of those with permanent physical disabilities. Just as each person is unique, each person's need for an appropriate wheelchair is unique to their body and disability types. It is not reasonable for a skilled nursing facility to be able to provide the appropriate type of wheelchair for each person to achieve their highest level of independence. Most facilities have a limited supply of basic style wheelchairs that are not appropriate for people with neurologic disabilities (i.e., stroke, spinal cord injury, brain injury, etc.). It is difficult for people to make functional gains (i.e., dressing, grooming, transfers between bed and wheelchair) without the appropriate wheelchair to properly support them. It would be like expecting a runner to reduce race time while wearing shoes that are too large and pants that are too small. Similarly, the appropriate fit of a wheelchair is crucial to the physical functioning of the person using it. Use of an improper wheelchair can lead to strain injuries, skin breakdown, and pain, all of which drive up medical costs and decrease outcomes. With an appropriate wheelchair, the ability to learn successful skills to be more independent in repositioning, self-care, and overall mobility drastically improves. With the support of this bill, people with devastating injuries/illnesses will have much greater potential to return to community than those who are not providing a wheelchair specific to their needs. The cost of the correct wheelchair will be more than offset by the potential reduced stay in the SNF, significantly reduced risk of skin breakdown ("bed sores"), and other co-morbidities related to the decrease in mobility. Without an appropriate and comfortable wheelchair, the alternative is to stay in bed which greatly diminishes all body system and significantly increases the potential for additional medical issues. Therefore, the implementation of this bill will have significant beneficial fiscal impact to the Commonwealth and significant increase in positive outcomes for those with devastating illness/injuries that require skilled nursing facility placement.

We support bill H.B. 1512!!!

I am in support of HB1512! It is critical for people with disabilities to have access to their medically necessary customized wheelchair systems. This equipment has been appropriately and purposefully prescribed by their medical team. Currently Virginian's who live in nursing facilities are denied access to their necessary equipment which results in pressure injuries, decreased independence with functional mobility, inability to perform necessary self-care task, and poor quality of life. I am an Occupational Therapists and an Assistive Technology Specialists and have been serving individuals with a variety of disabilities (e.g., spinal cord injury, traumatic brain injury, CVA) for 20 years. I understand how critical it is for someone who has a mobility impairment to have a customized wheelchair to meet their functional needs. Functional mobility is a human right, and this right should not be denied just because of where you live. When an individual does not have this equipment it not only is detrimental to their health, independence, and well-being, but it is also a HUGE cost to taxpayers. Pressure injuries are a common medical issue for people with mobility impairments but can be prevented with the proper wheelchair and seating system. On average, a single pressure injury cost over $80,000, but the average custom wheelchair costs $5,500. Not having the proper wheelchair and seating system can also lead to falls, especially in the elderly population. Please pass this legislation so Virginian's who live in a nursing facility can have access to their right to have safe and independent mobility, function, and a better quality of life. Thank you for the opportunity for me to have a voice and for your time.

The National Multiple Sclerosis Society supports HB 1512, to provide durable medical equipment for people living with MS on Medicaid in skilled nursing facilities. We thank Delegate Adams for bringing this important legislation forward. Multiple sclerosis (MS) is a chronic, unpredictable disease of the central nervous system for which there is no cure. Symptoms vary and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. While MS presents differently in each person, many people with MS utilize mobility devices to help manage fatigue, weakness, and balance problems and maintain independence. Durable medical equipment, including power and manual wheelchairs, empower those affected by MS to live their best lives by encouraging independence and freedom. However, for patients in skilled nursing facilities, this equipment is often financially out of reach. The National MS Society strongly supports HB 1512 and urges a favorable report. Thank you for your consideration.

The National Multiple Sclerosis Society supports HB 1512, to provide durable medical equipment for people living with MS on Medicaid in skilled nursing facilities. We thank Delegate Adams for bringing this important legislation forward. Multiple sclerosis (MS) is a chronic, unpredictable disease of the central nervous system for which there is no cure. Symptoms vary and may include disabling fatigue, mobility challenges, cognitive changes, and vision issues. While MS presents differently in each person, many people with MS utilize mobility devices to help manage fatigue, weakness, and balance problems and maintain independence. Durable medical equipment, including power and manual wheelchairs, empower those affected by MS to live their best lives by encouraging independence and freedom. However, for patients in skilled nursing facilities, this equipment is often financially out of reach. The National MS Society strongly supports HB 1512 and urges a favorable report. Thank you for your consideration.

These individuals are in dire need of appropriate, medically necessary equipment to prevent further progression of disease and to improve independence with daily tasks. Please support this bill.

As a person with a disability I am fortunate to benefit from the medicaid waiver which pays for my home health care and medically necessary equipment. I have benefited by the provision of complex rehab technology to meet my unique needs. Without custom equipment I would be even more dependent on my spouse and caregivers throughout the day. Gratefully, this durable medical equipment enables me to safely move around in my environment without compromising my health and improves my health altogether. When I learned Virginians on Medicaid released into Skilled Nursing Facilities with complex needs like my own are prohibited from the same opportunity I knew I needed to voice my support for the effort to fund complex rehab technology for these folks. I know people discharged to nursing homes who wait for overwhelmed staff to take care of things they could do with the equipment. I know people left sitting in their room or communal space who could get around independently and participate in their community, travel to meals, therapy and activities, and tend to their own positioning and personal care. A power wheelchair suitably equipped for an individual with mobility impairments like my own makes a tremendous difference in that person's health. Today's power wheelchairs often have features like power tilt and leg elevation which empower someone to lean backward to sit more comfortably and relieve pressure and strain throughout the body, elevate the legs to improve circulation and stretch, and rest comfortably. Even the basic feature of motorized wheels and a joystick greatly improve a person's ability to move independently i n the facility to take advantage of all the resources at hand. When you pass legislation to purchase and maintain this equipment you will immediately improve the daily life of a number of Virginians living in nursing facilities in the commonwealth. They will be more self-reliant, self-sufficient, and empowered to live more independently. This is not just a line item entitlement in the budget, but a truly life-changing resource only the commonwealth legislature can deliver to your constituents. Thank you.

Individuals that need this equipment currently lack full access to this medically necessary equipment. In 2022 HB241 was turned in a directive for the Department of Medical Assistance Services to complete a study to study to determine the cost of this initiative. The study determined the estimated cost to provide this medically necessary equipment is $2.6 million dollars, which is significantly lower than initial estimates and an amount that would help many of our fellow Virginian’s finally get the equipment they need.

Please support HB1512. Access to appropriately fitted customized wheelchairs is critical for individuals with medical necessity. Studies overwhelmingly agree that equipment such as custom wheelchairs prescribed by physicians improves the physical health, mental health, and overall independence of people living with disabilities. Every Virginian prescribed medically necessary equipment should have equal access to the technologies available to meet their health and safety needs regardless of their living arrangement. This specialized equipment: • Reduces costs to the healthcare system for preventable medical issues, • Improves independence and quality of life for people with disabilities, and • Will decrease burden of care for staff in nursing facilities. Please support HB1512 and accompanying budget amendment.

Please support HB1512. Access to appropriately fitted customized wheelchairs is critical for individuals with medical necessity. Studies overwhelmingly agree that equipment such as custom wheelchairs prescribed by physicians improves the physical health, mental health, and overall independence of people living with disabilities. Every Virginian prescribed medically necessary equipment should have equal access to the technologies available to meet their health and safety needs regardless of their living arrangement. This specialized equipment: • Reduces costs to the healthcare system for preventable medical issues, • Improves independence and quality of life for people with disabilities, and • Will decrease burden of care for staff in nursing facilities. Please support HB1512 and accompanying budget amendment.

H. B. 1512 rights an egregious wrong, to deny a person a medically prescribed wheelchair is akin to signing a death warrant for them. No matter how you measure the costs, whether in degrees of human misery or economic terms, this bill will more than pay for itself time and again. The study the legislature directed clearly demonstrates this. Please allow people receiving Medicaid benefits to recover their health as well as maximize the health benefits of being out of bed and functioning as much as they can in a medically prescribed, individually customized wheelchair during their stay in a Commonwealth’s nursing home. Thank you.

This bill is extremely important in maximizing function in those people that are required to transition to a skilled nursing facility. Currently, patients become independent with complex rehabilitation equipment while with me in an inpatient rehab setting, but then due to lack of family support/poor social support/etc., patients often have to transition to a long term care facility. Because of the current law, patients are unable to receive their customized equipment that makes them independent. This is a huge failure to these patients. Without this equipment, they often become dependent for all mobility and tasks which puts them at further risk for medical decline (pressure sores, respiratory compromise, contractures). This bill is very very important to pass for the safety, health, independence, and quality of life for patients transitioning to long term care.

supporting this bill would allow Virginians with disabilities living in nursing facilities access to custom wheelchair options which would significantly increase their quality of life. On behalf of the Virginians with disabilities I'm asking for your support.

these patients/clients need all the help they can get to keep their lifes fullfilled and they sometimes need help in order to do this and this should not be an issue wether they live in their own home, family member, housing, group homes, skilled nursing facilities bec no matter where it still helps they with their daily ADL's to keep them modificated and wanting to keep moving and living forward

Please consider supporting this bill which would allow Virginians with disabilities living in nursing facilities access to custom wheelchair options which would significantly increase their quality of life.

Hello, I have a loved one with a disability and I believe that everyone should have access to the mobility aids they need even if they are on Medicaid. Please continue to support this bill. Thank you for your time!

This is a critical issue and I am in support of this bill.

Everyone should have access to the proper medical equipment in order to live their life as independently and safely as possible. This often requires custom made wheelchairs and equipment. With this equipment, we can save millions of dollars in hospitalizations and illness. Please allow those in nursing facilities to gain access to this right!

Please support this bill as durable medical equipment is vital to quality of life for so many in the state of Virginia.

HB1512 is important for quality of life for those in long term care settings who could gain freedom and independence if provided access to the necessary equipment. These residents are often young adults , not elderly, but lack the socioeconomic resources to be cared for by family. In this era of espousing values of equity and inclusion , it is an essential imperative that all Virginians have accessibility to the same level of care and resources. Please pass this legislation to allow those with disabilities to have access to power and manual wheelchairs . Thank you.

I would say that allowing complex rehab providers to bill for proper equipment needs of residents in skilled nursing facilities is of utmost importance for the health and well-being of our aging population. Without this many of our seniors spend the rest of their days either in pain sitting in ill fitting wheelchairs, confined to their rooms or even beds. Take care of those who cannot take care of themselves.

I work in an inpatient rehab facility and see on a daily basis how custom wheelchairs give someone the ability to get out of bed, independently do pressure reliefs, and participate in activities of daily living. Passing H.B.1512 will allow this equipment to be provided to everyone who would benefit from it, regardless of where they live. Receiving a custom wheelchair should not be determined by a person’s ability to discharge home after spending time in acute care or a rehab facility. Everyone deserves access to this important equipment!

Yes please pass this, it will change a lot of patients quality of life!

It’s very important for residents of nursing homes to have access to the wheelchairs they need so they can have independence and autonomy!

Comments Document

Please support proposition HB1512- Currently there are roughly 20 states in the US that allow Medicaid billing for complex rehab technology (custom manual and power chairs) in skilled nursing facilities; including Texas and Mississippi. These states already see the cost benefits of wound and fall prevention that custom wheelchairs support in addition to the reduced burden on facility staff. When a manual wheelchair that is non custom is provided, the chair is not configured optimally for independent and safe propulsion leaving the wheelchair user to require staff to move them throughout the facility, pressure manage them to avoid wounds, and contribute to falls in the facility. The average cost to treat a pressure wound is $70,000 and these occur in nursing facilities at a rate of 24% (National Pressure Ulcer Advisory Panel). Proposition 1512 supports value based care through preventative measures to reduce preventable comorbidities while enhancing quality of life for residents of nursing facilities.

This bill is imperative in providing individuals in skilled nursing facilities the opportunity to live in dignity and access their environments in the most autonomous way possible. This DME is not just technology- it is a physical extension of an individual with functional mobility impairments. Everyone deserves the opportunity to experience their world in the most independent way possible. Please support this bill to allow for those in our community to mobilize and participate in society at a level most of us take for granted. Keeping this medically necessary equipment from those with mobility impairments is not only cruel- it’s demoralizing. Let us be the catalyst for change and not the passenger of the status quo. Thank you for your consideration.

I am writing in support of H.B.1512 to help provide fellow Virginians with the medically necessary equipment they need. As a physical therapist, I often treat patients with complex physical disabilities, and having the appropriate medical equipment is essential to help them achieve their functional goals. Additionally, having the appropriate medical equipment can reduce the risk of secondary injuries like skin breakdown, wounds, and contractures - all of which are costly healthcare expenses. Please vote in favor of H.B.1512.

I want to emphasize the importance of this bill being passed. Patients who going to long term nursing care are more likely to have skin breakdown and significant decrease in functional activity, which will both increase costs to our healthcare system. Please pass this bill!

I am in support of H.B. 1512. Everyone should be able to receive medical equipment made to their needs whether it is needed in home or a facility. Virginia Medicaid recipients who live in nursing facilities are denied wheelchairs solely because they live in nursing facilities. Lack of access to this equipment not only takes their only source of independence and ability to perform necessary daily tasks but also can lead to bed sores from lack of mobility. If they had the ability to return home after an injury, Medicaid would pay for their wheelchair. If this legislation passes, it would cost Virginians about $2.6million…but would save the taxpayers many more millions while also giving people the chance to get out of bed, out of the nursing facility, and back to their homes/work life.

I support this bill

HB 1512 is a necessary bill that has a tremendous impact on an individual’s life. For the first month after my spinal chord injury I laid in an ICU bed unable to feel, move, eat, talk, or breathe on my own. My only source of movement was when a nurse came in every 2 hours to turn me to my other side. When I went to inpatient rehab, receiving a power chair had the biggest impact on my well-being. It was more important to me than talking, breathing without a tube, and eating… and I love to eat. I even had the beginning of a pressure wound when i arrived at rehab- and I came from intensive 24 hr care at the best medical facility in our commonwealth. If I didn’t have a power chair I would not have left my bed or my room. I may have had to transfer back to the ICU and spent a month healing a pressure wound. I would not be as healthy and happy as I am today, and that is something every individual deserves regardless of their ability level or living arrangement.

Please vote to support this important bill to provide access to provide mobility and quality of life to those with health conditions limiting their ability to move or get out of bed without necessary durable medical equipment.

Thank you for the opportunity to provide comment on HB1512. We appreciate the hard work of the individuals at DMAS who completed the study as required by HB241 in 2022 to determine the cost of this important initiative to close this gap in care for Virginian's who are living with disabilities in our communities nursing facilities. My name is Dr. Megan Murphey, and I am the Assistive Technology Specialist at a large free standing inpatient rehabilitation hospital. I spend my days helping people recover from devastating injuries such as traumatic brain injury and spinal cord injury, as well as medical issues like stroke and Multiple Sclerosis. I also help prescribe custom wheelchairs for individuals with disabilities. When someone is admitted to our facility, they work hard to regain their independence and return to their home, families, work, and community. Unfortunately, not every patient has the support system or resources to return to their home when they discharge and are forced to transition into skilled nursing or long-term care facilities. Because of the current statute they are now also unable to have access to the prescribed wheelchair. This wheelchair is vital to their ability to get out of bed, to look out the window, to go the bathroom to use the toilet or to brush their teeth at the sink. Lack of access to this equipment not only takes their only source of independence and ability to perform necessary daily tasks but also can lead to bed sores from lack of mobility. Bed sores cause pain and suffering and can lead to infection and death. On average, a bed sore costs $86,500 to treat and a custom wheelchair costs on average $5,500. Not only will this legislation improve the quality of life for Virginians with disabilities living in nursing facilities but will provide a way to prevent costly medical issues and save the health care system money. Please pass this legislation and associated budget amendments so I never have to tell another patient they cannot have the wheelchair we worked so hard together to perfect. It should not matter where one lives that determines their access to medically necessary customized wheelchairs but their medical needs.

Comments Document

12VAC30-50-165 precludes MCAID recipients who reside in nursing facilities from being able to obtain necessary wheelchairs prescribed by their doctors. H.B.1512 needs to be passed to fix this for the following reasons: 1. Physical Health: Studies overwhelmingly agree that properly fitted seating and positioning systems decrease the prevalence of secondary medical complications (i.e., pressure ulcers/bed sores). 2. Psychological Health: Imagine having recently experienced a traumatic injury which left you with significant functional loss. It happens every day to Virginians, many of whom cannot absorb the cost associated with such an injury or illness nor have the support systems which would allow them to remain within their community and have access to necessary mobility equipment. Alternatively, they are forced into nursing facility placement. H.B. 1512 would give these people a chance at returning to the community and livelihood just by giving them mobility by way of a suitable wheelchair which their counterparts living in the community have. 3. Costs Savings: As mentioned prior, without suitable wheelchairs and cushions, many MCAID recipients living in nursing facilities are highly susceptible to secondary medical complications such as bed sores. Bed sores, or pressure wounds, currently cost the Virginia taxpayer an exorbitant amount of money due to the cost of hospitalization, surgery, etc. of wound care. A case in point is that of United Spinal member, Christopher Turpin. Chris suffered a spinal cord injury which resulted in complete quadriplegia. Chris was due to return home following inpatient rehabilitation, so he was fitted for a power wheelchair to suit his needs. Unfortunately, Chris was unable to return to his home due to lack of his family’s ability to care for him. Consequently, Chris was placed in a nursing facility, where he was unable to get the wheelchair that was ordered for him because the current law does not allow MCAID to reimburse for durable medical equipment for Virginians living in nursing facilities. Thus, Chris was forced to use a generic wheelchair which was donated to him. Due to this inappropriate wheelchair, Chris developed 4 pressure wounds which required surgery, 2 of which resulted in requiring bilateral amputation of his legs, in addition to a suffering a stroke, all of which treatment were paid for with MCAID dollars. This pain, suffering, and waste of taxpayer dollars could’ve been avoided if Chris received the wheelchair which was ordered for him, but instead that chair remains collecting dust in a warehouse. H.B. 1512 would have resolved all of these issues for Chris, for many others like him, and saved Virginia taxpayers hundreds of thousands of dollars for each case. 4. Staffing Shortages: Its well known that nursing facilities have historically been understaffed. Further, the current health crisis has done nothing but exacerbated the problem. This issue disproportionately effects the population at hand due to the necessity to change their positioning in bed every 2 hours or the number of staff required to get them out of bed and move them about the facility to therapy, meals etc. since they cannot move about unless their chair is setup for them. H.B.1512 would alleviate he strain which nursing facilities have endured historically and are enduring in this tumultuous time. H.B.1512 would uncinch these burdens a great deal. Thank you for your consideration of voting in favor of H.B.1512.

Sam, I am a counselor who has been doing substance abuse counseling as a Licensed Professional Counselor over 40 years. I have a private practice and have not used any drugs during this time. However, I was convicted of the distribution of 2 tablets of PCP and did 22 months in Federal prison in the 70's. I am still subject to the Barrier Crimes laws. If one begins to see drug use as a psycho-social problem and not a crime, it seems a major focus of the Barrier Crimes Law is misdirected and does not recognize the thousands of people who are in recovery and living law-abiding lives. BTY, I live at the World Community in Bedford. Thank you for your support in this effort. Jon Winder

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

Families struggle to 1) find a provider for their loved one who is homebound and 2) find a provider that takes Medicaid. This bill helps to answer both situations. It gives families more options for medical care through telehealth and accessing specialists or experts in their health condition that have expertise but may not have a physical presence in Virginia. COVID taught us the value of being able to access medical care via telehealth options and I hope we incorporate the lessons learned by supporting this bill: give families options and be flexible in accommodating special needs.

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

I am a pediatric physical therapist in Virginia and support HB1809 to expand Newborn Screening. Newborn Screening looks for serious developmental, genetic, and metabolic disorders that would not otherwise be detected in time for life-altering treatment. For these disorders, early detection and treatment is essential to preventing irreversible mental or physical disabilities, even death. For diseases like Krabbe and ALD, early detection through newborn screening is crucial for affected children to receive potentially lifesaving treatment, which is only effective if administered before a child is symptomatic. Krabbe Disease is a severe and fatal disease that occurs in 1 in 100,000 births. Babies with Infantile Krabbe disease can be identified through newborn screening assess that utilize a combination of GALC enzyme level and the biomarker psychosine. Treatment of babies with infantile Krabbe Disease has the best outcomes if delivered in the first month of life. Help ensure that the children in our state are screened at birth for Krabbe and similar diseases by passing HB1809. Thank you!

HB1963 - thank you for looking out on the behalf of disabled persons and helping them to function and be self sufficient. Please report this bill.

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

Support as not all disabilities uses a dog, some can use a wheelchair.

We will speak to what the HVIP does in broad terms and its importance in reducing crimes and retaliation/ hospital reentry in the community. This bill would help to keep HVIPs sustainable in the Commonwealth, instead of relying on state grants.

5 years of practice at Vermont state after finishing the DPH post doctoral program can give equal or more clinical experience than DDS/DMD freshly graduate from school. if other state can give dental license to Dentist with DPH after 5 years, It can help to reduce the health care worker shortage in that state.

Definitely supported

Allow dentist who has licence in another state for 5 yrs to get licensed in VA

Reciprocity is key and is important for dentists who have worked in another state for at least 5 years. Please pass this bill

Thank you for presenting this bill. I am writing these comments in support of bill HB2251 I am a dentist working for Texas Health and human services as the dental director in one of their State supported living centers for people with intellectual and physical disabilities. I have been practicing in the State of Texas in public health clinical settings since 2016, and I hold a dental license in Vermont. In my current capacity treating high-risk patients for the past five years, and throughout my diverse dental career and public health training, I have witnessed the healthcare crisis firsthand; in particular, the oral healthcare inequality that manifests in the form of lack of access to care as a direct result of a severe shortage of dental providers. Recently the COVID-19 Pandemic has tested our healthcare system and exposed how fragile it really is; not only that, but it also accelerated the exit of many baby boomers who represent a large portion of the providers. As a result, the number of new dental graduates will not be enough to meet the growing dental care demands of virtually all states, and the Commonwealth of Virginia is no exception. Yes, I do support this bill because it allows me to come back home and serve the people of Virginia. However, it is way bigger than any personal gain; I support this bill because it can help provide the people of Virginia with much-needed access to quality oral healthcare. A dentist who has practiced in another US state or territory in good standing for a minimum of five years is less likely to endanger public safety and most certainly can help bridge the gap if given the opportunity.

This will be helpful to improve access to dental care, in case dentists from other states reciprocate and work in virginia.

We need l licensed dental surgeons to work in most for the under privileged community and international trained dentist who worked for 5 years in different states should allow to get State license to work as a general dentist.

To improve access to care in. State of Virginia, this bill is a real step forward.

I am a dentist working at a FQHC in Ohio, and before that, completed a hospital-based residency in Ohio as well. I have witnessed the healthcare crisis firsthand; primarily the severe shortage of dental providers. No amount of graduates from US or Canadian dental schools will be enough to meet the dental care demands of virtually all states, and the Commonwealth of Virginia is no exception. I support any bill that can provide the people of Virginia, or any territory or state in the union with good quality healthcare provided by any good dentist with training from a CODA-accredited dental school or residency program, who has also practiced in, or is at least eligable to practice dentistry in another state or territory other than Virginia, regardless of the location of the dental school the dentist graduated from. The Commonwealth of Virginia would benefit immensely from universal license recognition such as that implemented by other states, such as Arizona, Colorado, and Missouri. The benefits extend beyond providing the good people of Virginia with much-needed dental care, to also bring other benefits to the Commonwealth and its economy.

I voting in support of dental reciprocity liscence in the state of Virginia.

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.

RE: HB 2274 (2023) Dear Mr. Chair and Committee members: I am opposed to HB 2274 I have been teaching outpatient lab medicine to medical students, nurse practitioner students, nurse practitioners, physicians in training since 1995. 1. Pharmacists are less trained in this area of medicine. They do not have the time to fill medication, refill medication plus provides vaccinations is well documented by many news articles and personal observations. 2. Diagnosing a strept throat requires a good history and physical exam plus testing if indicated based on evidence-based medicine criteria. If a patient has a sore throat, there are many causes besides strept such as infectious mononucleosis (enlarged spleen in a student athlete can be disastrous) or peritonsillar abscess (which can be life threating if not diagnosed and treated with antibiotics and surgery). Pharmacists do not have adequate training in this area. 3. Pharmacists do not have access to patient’s recent lab tests regarding their kidney function. Many medications require this information before prescribing the correct dose and dosing. 4. It would make more sense, if the burden of dispensing medication in a physicians’ office, was markedly reduced Regarding pharmacists testing urines for bladder infections (UTI) and kidney infections, I have many concerns. 1. Are they going to collect a fresh clean catch specimen on site or are patients going to bring in an old specimen? The older the specimen and not refrigerated the more likely the specimen will be false positive. 2. If it is male patient are the pharmacists going to do the necessary prostate exam? 3. If a patient has a bad reaction to their treatment, can they access the pharmacist after hours? 4. If the urine specimen is dilated since a patient is drinking lots of fluids can result in a false negative test? 5. Urethritis has similar symptoms as a bladder infection. Many of these patients have sexually transmitted diseases such as chlamydia which does not respond to most typical antibiotics for UTI. 6. I frequently see patients who are dehydrated with urinary burning and bladder spasms/frequency who are not infected but treated for UTIs at urgent care sites. 7. In this state we have a major problem with increasing antibiotic resistance. I worry antibiotics will be overprescribed. Are pharmacists aware of the latest antibiogram for their area. Bactrim does not work well for many common E. coli infections in our area. Cipro has lost its usefulness now. 8. Are pharmacists going to recognize any other abnormalities on a urine dipstick? Will they miss bladder cancers, kidney cancer or glomerulonephritis? 9. If there is blood on the dipstick, are they going to spin down the urine and look at it under the microscope to confirm it is blood, hemolysis, or myoglobin? Thank you for your support in opposing this bill. Sincerely yours, Roger A. Hofford, M.D. FAAFP, CPE Roanoke, VA Past President, Virginia Academy of Family Physicians Associate Professor, Family Medicine, Virginia Tech Carilion School of Medicine Clinical Professor, Family Medicine, Virginia College of Osteopathic Medicine Clinical Professor, Family Medicine and Population Health, Virginia Commonwealth University

I am a Certified Peer Support Specialist. I have a barrier crime for a charge I committed in 2014 was charged in 2016. I got clean 12/30/2015. I have completely changed my life and am not the person I was. I worked for NRVCS in Radford Va. I was a CPRS with a Qualified Mental Health Para professional. I worked primarily as a case manager. I trained some case managers that have college degrees, I applied for a position as a Peer Support Specialist Supervisor. The other agency really wanted to hire me and they did only to reject their offer due to my barrier crime. The then called me back 2 weeks later still wanting to hire me. They contacted NRVCS to find out how they hired me, hoping to find a loop hole. They could not. I now work for a non profit that the barrier crime is not a barrier at and I am grateful. My job at NRVCS was then in jeopardy due to being hired illegally. When trying to go through the process with DBHDS I was told by my supervisor at NRVCS that they did not want to rock the boat. I had already started the process however I had no back up to complete the process. This crime has held me back on many different career moves. If you have read this I appreciate you. Thank you! WE need some changes in this bill. I understand there should be some recommendations however it should not be this hard and stressful. Most addicts are going to have drug charges. Thats a given. That does not make me a bad person however my experience, strength, and hope have helped more people than most that do not. If you would like to talk with me my phone number is 5402504804.