Good morning, Thank you all for taking time to review and consider Delegate Tata’s bill to address care for and recognition of human trafficking victims. I am a survivor of domestic trafficking and have seen many varieties of trafficking during my time working in night clubs in Washington D.C. many years ago. Trafficked persons are invisible to most people, and yet they are around us every day. Every trafficked person has been cut off from neighbors, friends and family. It is a rare opportunity to be seen so intentionally as one may be when seeking medical care. It is a rare opportunity for a trafficked person to be recognized and offered help. I understand the additional burden that requiring this kind of training can put on medical staff, but I also believe that most of them would consider it worth the life and dignity of our fellow human beings who are overlooked and severely abused, with no one coming to save them. To stay silent is to participate in the violence and atrocities of human trafficking. To refuse to look deeper at their circumstances and the red flags is to turn our heads away and allow it to continue. I left my abuser/trafficker after a 12 hour ordeal during which I was held hostage in my basement apartment while being beaten and choked, with intermissions of witnessing destruction of my property etc.. I was finally able to escape and call the police, but I ran from the magistrate’s office when it was time to give my testimony. I didn’t want my trafficker to go back to jail. I ran away, like I was the criminal, and called him from a pay phone, desperately pleading for forgiveness. Law enforcement are trained but often ill equipped to help trafficked persons escape because of this Stockholm mindset. Caretakers however, like medical professionals, have a unique ability to calm traumatized persons and provide important information that could save a trafficked person’s life. During my years of torment, I had been to multiple medical facilities and received care for injuries, but no one ever asked me if I needed help or provided resources. It was the owner at a nightclub where I was employed who pulled me into his office the day after the event I described. He looked over the bruises around my neck, shook his head and said “You’ll go back. They always do.” I credit him with helping save my life. He was the only person who had the knowledge of what to look for and the boldness to say it out loud, even if it wasn’t perfect. I made up my mind not to be a statistic and plot my course to freedom. Shortly after, I met my now husband who also saw the warning signs and provided protection as I distanced myself from my trafficker. We have been married 13 years and have a blended family with seven wonderful children, two of whom are now young soldiers in the Army and USMC. My story is rare. But it doesn’t have to be. Please vote yes to HB 1426, or refine further if you must, so that we can shine a light of hope into the lives of those who have seen too much evil. Please help rescue people like me. We are worth it. Respectfully, Monica Gary

Mr. Chair and members of the subcommittee, As a member of the Virginia Coalition Against Human Trafficking and President of Freedom 4/24, an anti trafficking organization in Virginia that specifically focuses on implementing prevention education, I am asking for your support of HB 1426. Between roughly 70% and 90% of trafficking victims who receive medical care while being trafficked are not identified as such and are essentially sent right back into those exploitative situations without support/resources/options. Mandating continuing education hours on this topic ensures continuity of information and increases better outcomes for victims. A key part of this bill is the mandatory component. We want to ensure that medical providers are properly equipped to identify and support trafficking survivors. When training is voluntary instead of mandatory, the health care providers who most need it, often don't get that training. The medical community is one of the few that may have the opportunity to directly interact with and have access to trafficking victims in a way that allows them to understand the deeper issue…if they have been trained to recognize those signs and red flags. Dr. Kanani Titchen, a board certified physician in both pediatrics and adolescent medicine, said in her TEDx Talk titled “How to Spot Human Trafficking: “The eye doesn’t see what the mind doesn’t know.” We want to ensure that the knowledge is provided, that human trafficking education will be implemented to our medical community so they have the “eye” to recognize the signs of someone who has been impacted this atrocity and can respond appropriately. Thank you for taking the time to read this. Joy Cover President of Freedom 4/24 Member and Board Treasurer of VCAHT

In the United States, human trafficking largely impacts young women, girls, and boys who are exploited for the sex industry. In 2018, the National Human Trafficking Hotline identified 23,078 HT victims in the US. Over 15,000 of these victims were females, 16,137 were trafficked for sex, and approximately 5,000 were minors. Trafficked individuals receive health care services, but health care providers often miss opportunities to identify them. The most common providers seen were emergency and urgent care providers, primary care providers, and obstetrician-gynecologists. There are barriers to victim identification. Individuals who are trafficked often struggle to identify themselves based on distrust, fear, or shame. Psychological barriers, trafficker involvement, lack of awareness among healthcare workers, and lack of screening creates a high proportion of missed opportunities to identify and serve trafficking survivors effectively. Research indicates that healthcare workers feel ill-equipped to spot trafficking. One study found 4.8% of clinicians reported feeling confident in their ability to identify a victim of trafficking. A 2014 study found that 90% of trafficking victims received medical care during their trafficking experience, though victim identification rates indicate these victims are unlikely to be identified despite receiving care. Trafficking survivors have often experienced extensive poly-victimization, multiple agency involvement, complex trauma, multiple Adverse Childhood Experiences (ACEs), and have a high likelihood of re-exploitation without specialized, culturally appropriate services. Therefore, it is critical that healthcare providers know how to identify, report, and resource trafficking survivors because without their intervention victims will continue cycle through the hospital system. One study shows that individuals who do not receive services will cost tax payers $5.3M over their lifetime, with many of those dollars being incurred by healthcare networks who administer frequent care to the same individuals without compensation. Effectively identifying and referring trafficking survivors to support services will not only help break cycles of victimization for survivors, but also decrease the cost to the healthcare network. We ask that you vote in support of HB1426 to not only empower our healthcare professionals to feel more equipped to identify and support trafficking survivors, but also provide one of the most marginalized populations within our communities the opportunity to receive the necessary services to avoid re-exploitation.

Human trafficking is a serious problem in the United States and abroad. Its effects implicate law enforcement and human rights issues. Additionally, as research shows, human trafficking is also a health issue. Victims of human trafficking have serious physical and mental health problems, including acute and chronic illnesses, injuries, and impairments such as substance use disorders. A landmark study in 2014 found that 87.8% of survivors indicated that they had sought health care while they were trapped in the trafficking situation. Health care providers are often the first point of contact for victims of human trafficking. As first responders they must be able to identify the signs and indicators of human trafficking and respond effectively. New research shows that relevance is critical to the success of any training. Healthcare providers need specialized training that covers the core competencies of human trafficking, and in addition, specialized information on health and human trafficking including the following: · Research findings on the health issues of human trafficking survivors. · The signs and indicators of human trafficking, tailored to the different roles within the healthcare provider setting. For example, the signs the receptionist sees, the signs while taking the chief complaint, the signs during medical history and the signs during medical exam may all be different.. · Survivor stories and case studies of survivors in health care settings · Barriers to healthcare for victims, both internal barriers specific to victims and external barriers commonly found in healthcare provider settings. · Implicit bias having to do with human trafficking in healthcare settings that can hinder a healthcare provider’s effective assistance of human trafficking victims. · Patient centered, victim-centered and trauma-informed care. · How to create community connections to meet the multi-disciplinary needs of survivors through a strong system of referrals and “warm-hand-offs” · Medical documentation practices, such as ICD-10 codes on human trafficking and how to use them. · Mandatory reporting, addressing the unique needs of immigrant victims and survivors, and using electronic medical records in trafficking cases. · Active participation and practical application of material through role-playing hypothetical scenarios, ensuring competent understanding of training concepts. One best practice in healthcare training is to ensure a process whereby NGOs and other entities can produce trainings that are certified, through some agency in the Governor's office, such as DCJS. Any NGO which produces an accurate, up-to-date training that covers the core compentaencies, as deicded by DCJS, should be able to be listed Laura Lederer, Subject Matter Expert for the US Department of Health and Human Services SOAR Training on Health and Human Trafficking Phone: 703-919-6828 llederer@globalcenturion.org

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.

Del. Tata's bill is needed to protect and help trafficked people. The average age is 12 years old, we need to make sure that these folks get looked out for.

Comments Document

Please see comments attached in support of HB 1426.

Comments Document

Please see comments in the PDF attached.

Our organization strongly supports this bill. We work with hundreds of individuals who have lived experience who should be allowed to support others going through similar situations. For far too long, people with substance use history and/or in recovery have been barred from receiving certification. They are often times allowed to fulfill unpaid roles but often times, cannot work in the field because of the outdated laws around barrier crimes. Those closest to the problem are closest to the solution. As a Peer Recovery Specialist and Harm Reduction organization, we believe that no one can assess and fix the problem like a person who has overcome the problem themselves. The peer recovery support training is provided inside of Department of Corrections in the cognitive community and many of our staff and volunteers have had the honor of working alongside the individuals needing support. Virginia, like many other states, are dealing with an unprecedented number of overdoses and deaths. It is time to employ non-traditional means of addressing the crisis we are currently in. I believe in my fellow peer recovery specialists, especially those who have past convictions and/or past substance use history. Having guardrails in place is fine, but to not allow a person who has lived experience to serve others in these roles is a disservice to our neighbors who struggle with substance use.

As a Certified Peer Recovery Specialist (CPRS) and Registered Peer Recovery Specialist (RPRS) for the last three years and now a regional coordinator for peer support services, I see the positive impact that peer support has as another support tool for people who are in recovery from substance use and mental health. Those who have experiences being incarcerated or going through the justice-system are some of the biggest living examples that recovery is possible. With over 130 specified barrier crimes existing for those with a criminal record trying to get into the peer support field and only a little over 20 even being screenable, the state is contradicting its stance on rehabilitation and recovery and robbing those who are currently struggling of the chance to work with someone who has walked in their shoes. Peer recovery specialists are more than just people with lived experience - we are professionals, with our own code of ethics, certification process, and scope of work. We are so much more than our diagnosis and the rock bottoms we have hit and we have so much to share so that others don't have to experience what we have. I think about my own experiences with substance use and mental health challenges - I was in and out of recovery from the age of 16, heavily abusing substances, hospitalized multiple times, and even dropped out of school all before I was 21 years old. I was in multiple mental health and detox programs, but still my substance use and mental health worsened. But not a day went by where I didn't want more for myself, where I knew the way I was living would eventually kill me; but I didn't know how. Now, six years later, I have not only earned my bachelor's degree, but also my master's degree, coming up on 6 years of recovery from substances and mental health challenges, and am working for my local community services board. But this would have never happened for me if I was being written off in those dark years when I was at my lowest. The substantial number of barrier crimes that exist within the state of Virginia must be reduced significantly in order to more closely align with rehabilitation/recovery, promote employment and continued recovery for those who have histories of incarceration, and improve overall behavioral health outcomes for those with mental health and substance use disorders. The attachment I included is my latest headshot taken last fall - I'm very proud of the girl in that picture and how far she has come. The least that can be done is expand the number of opportunities for others to get that same shot at recovery and happiness.

I'm writing in support of HR1525. I'm a Peer Recovery Specialist with no barrier crimes. However, I know from experience that those who can best help people with substance abuse issues have substance abuse background themselves, and this often includes barrier crimes. I believe that is both unnecessary and immoral to prevent recovered people from helping others due to the very experience that makes them effective at helping. Put another way, when we say that a Peer can't have a criminal background, we're saying we don't care to help those who might have committed similar crimes. It's yet one more way we perpetuate the addiction-incarceration cycle.

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.

Good morning. My name is Elijah Lee, and I am a 15 year old community activist. I have had the esteem honor of being a part of the drafting process for this legislation, as it is more important than ever. This legislation is necessary as we continue to combat the horrid affects of the opioid epidemic, while ensuring, that all Virginians have an opportunity to live long, healthy, and successful lives. Too many times, we are seeing Peer Recovery Support Specialists, individuals that know best how to support those currently experiencing Substance Abuse Disorder be turned away from jobs where they would use their lived-experience to help others. Right now, our communities are suffering. Every county in Virginia has citizens that are experiencing the pain associated with addiction, and right now, by lifting a specific set of barrier crimes, we have the opportunity to help alleviate some of that pain. We know this legislation would help thousands if Virginians, not only making sure that those that have already risen above Substance Use Disorder have a good standing job, but also making sure that those who need our support the most are receiving it, so they have the ability to get back to the things and people they love. While supporting those in need, this bill would also increase employment, offering experience based jobs to those that have been disenfranchised due to their previous addiction. It is pivotal to understand that this bill would expand PRS services, which is an evidence based SUD treatment approach. I hope that it is in the favor of this committee to pass the bill. Thank you.

We support providing reasonable exceptions to the barrier crime statutes for Peer Recovery Specialists when the employer wants to hire them. Passage could help address at least a small part of Virginia's severe behavioral health workforce shortage, while providing a peer specialist the ability to help someone going through some of the same lived experience they went through. Peer work has demonstrated good outcomes and we need them working when the employer wants them on board.

Please vote YES. A person that has paid their debt for their crimes, recovered from past traumas, and rise above symptoms of poor mental health and/or substance use (and then become Peer Support professionals) must be allowed to be employed and use these lived experiences to assist the many citizens of the Commonwealth who are in crisis. Barring people who are in a unique position to do the most good makes no sense and would only contribute to the mental health provider crisis in Virginia. Please Vote Yes and be part of the solution.

Dear sir, and or madame, My name is Almetta Cruff i have been associated with many Peer support Recovery persons in my past they even helped me. while i coped with my father passing away from late Staged Leukemia in 2003. Without many of them, I do not know if any of my friends would be here today. That is all i can think of right now. thank u and please vote YES . thank you , Almetta M. Cruff

Please expand the scope of "Peer Recovery Specialist" to additionally include "any individual who meets the definition of RPRS-"Applicant" as defined in 18 VAC 115-70-10 et seq.

My name is Martin Mash and I am the Network Program Director for Vocal Virginia, the only mental health state-wide education and advocacy nonprofit in the Commonwealth. I would like to speak in support of this important legislation that will help address two concerns facing the mental health community. First, this legislation will help Community Services Boards and other providers across the state address a worsening workforce crisis. Second, this bill gives individuals an opportunity to use their lived experience to improve the life of another person through a recovery-oriented system of care that focuses on the person and their recovery on a peer level, which has been shown to be an effective method for helping those who have struggled with mental health concerns maintain their recovery. For these reasons and others, we ask that you join our 2,000 member network in supporting this legislation. Thank you for your time.

Please expand the scope of "Peer Recovery Specialist" to additionally include "any individual who meets the definition of RPRS-"Applicant" as defined in 18 VAC 115-70-10 et seq.

Well wishes Honorable GA Staff and Delegates, Please vote YES HB1525 and advance this life and health sustaining legislation which is certain to strengthen the mental health and addiction recovery of people, while alleviating some of the behavioral healthcare workforce shortages. YES on HB1525 will make it possible for more Virginians to live healthy lives given skilled Peer and Family Support and Recovery and Wellness Coaching. Many thanks for your service of Virginians! Healthy 2023, Heather Peck Executive Director Laurie Mitchell Empowerment and Career Center

Please vote YES on HB1525. This bill will help many people get the support they need from a person with lived experience giving them hope for change. Who better than someone that has lived and succeeded in changing their own life to give others the chance for change. Peer to Peer relationships are extremely unique in that they have experiences to share in details with a peer. As a Family Support Partner FSP I use our families horrific experience to help guide others and to give hope to a better way of living for those seeking better outcomes. Many other PRS's have barrier crimes that prevent them from employment, based on their past. Giving them the opportunity to be employed and to use this experience that cannot be taught or learned. One must suffer the experience and decide to change. Having that person that has walked in your shoes and is now helping you find your way is remarkable to witness. Many PRS's have been incarcerated. They have chosen to change their life and now want to give back to the community. What a example of redemption and hope such a person brings back into the community. Building stronger people benefits the community. Makes our communities safer for everyone. PRS's go through professional training and have a difficult exam to pass prior to becoming Certified Peer Recovery Specialists. They bring the link needed to the table between Clinical staff and the client being served. We network regularly, we continue to train, we find solutions to our peers worst problems by walking with them as they change giving them the tools and hope needed. As a PRS we dig deep into our own past and experiences to help others. This is self love with awareness and accountability. Please vote yes on HB1525.

Please expand the scope of "Peer Recovery Specialist" to additionally include "any individual who meets the definition of RPRS-"Applicant" as defined in 18 VAC 115-70-10 et seq.

Please expand the scope of "Peer Recovery Specialist" to additionally include "any individual who meets the definition of RPRS-"Applicant" as defined in 18 VAC 115-70-10 et seq.

Please support this bill. It is very essential in mental health reform. This is essential for the rehabilitation of mental health consumers in society as it is very vital in mental health recovery . To be able to be gainfully employed while in recovery. HB1525. And also enable the peer to assist their peers in recovery.

Although the change process is slow, the intent of this legislation to provide a direct pathway for "Peer Recovery Specialists" to participate in a fair screening process re: previous Barrier Crime convictions has TWO SIGNIFICANT OVERSIGHTS in language. In addition to completing all jailtime, probation, and financial restitution + 5 years post-conviction, which is realistically 5.5 -7 years post-offense date, Peer Recovery Specialists must complete 500 hours of supervised experiential training under weekly supervision of a DBHDS Certified Peer Recovery Specialist Supervisor (RPRS, CSAC, or LMHP), before they are allowed to sit for the VA State Exam. The target population of potential Peer Recovery Specialist employment candidates that this legislation intends to impact through increasing screening eligibility, will NOT be able to complete their required 500hrs. (3-4 month) experiential training in these positions, because the language refers only to fully Credentialed and Registered Peer Recovery Specialists defined in §54.1-3500. RECOMMENDED REVISION: Please expand the scope of "Peer Recovery Specialist" to additionally include "any individual who meets the definition of RPRS-"Applicant" as defined in 18 VAC 115-70-10 et seq. in addition to RPRS as defined in §54.1-3500. An "Applicant" has completed the DBHDS Didactic Peer Education Training Course and uploaded completion certificate to DHP Online Registration application / paid application fee - (VALID FOR 1 YEAR). This will allow substance abuse providers to employ these individuals while providing direct oversight / supervision and improved professional development, which should improve outcomes related to intent of this legislation. Please consider reducing the 5-year post conviction requirement to 3-years with evidence of successful treatment as RPRS wages are still in the $17-22/hr. payscale. Strong employment candidates have generally already progressed past entry level wages 5-years post-conviction.

Please vote yes on HB 1525. Peer Recovery Specialists are an important part of the recovery process for so many Virginians and barrier crimes are preventing so many good peers from working in the field and helping others like them.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

After 7 am meeting, then this one. HB 1689 - Please move to report. No one should die without benefit of spiritual help. *HB 1864 - No person should be required to input into their bodies something they don't want there, just to keep their job. We're not North Korea. *HB 1889 - Data shows that they are not at great risk of disease. HB 2057 - Why should people who have worked and paid thousands of dollars for decades, by denied Social Security because those who violated the law came here? Why shouldn't we put infrastructure and improve schools for African American communities FIRST BEFORE any others? Why do they deserve any thing before our veterans? Please PBI this bill. HB 2160 - In honor of those who lost family/friends & weren't allowed to see them at the end, please move to report. HB 2276 - The data is clear: children are not at risk of death from COVID. HB 2293 - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/comparingdifferentinternationalmeasuresofexcessmortality/2022-12-20 Sweden and Norway were essentially tied for the lowest “[p]roportional all-cause excess-mortality scores” (which “measure[] the percentage change in the number of deaths compared to the expected number of deaths (based on the five-year average [from 2015 to 2019])” among the listed European countries, looking at data from Jan. 2020 to June 2022: Their excess mortality was up 2.7%, compared to, say, 5.2% for Denmark, 7.1% for Finland, and 11.8% for the Netherlands. They had the lowest all causes death rate since COVID arrived and didn't do these long, lengthy lockdowns. Sweden had lower rate avg. excess death percentages: https://reason.com/wp-content/uploads/2023/01/ERGExcessMortality.xlsx https://www.baconsrebellion.com/wp/covid-19-update-still-lots-of-idle-hospital-capacity/ noted on 4/25/2000 Roanoke Valley had 80 cases, 6 hospitalizations and 0 deaths compared to Arlington with 764 cases, 137 hospitalizations, 29 deaths. Elective surgery was banned in both, although the whole of Roanoke Valley had 0 deaths. HB2489 - Please move to report so that men can be given the support to become strong fathers.

HB 1689 - Please move to report. No one should die without benefit of spiritual help. *HB 1864 - No person should be required to input into their bodies something they don't want there, just to keep their job. We're not North Korea. *HB 1889 - Data shows that they are not at great risk of disease. HB 2057 - Why should people who have worked and paid thousands of dollars for decades, by denied Social Security because those who violated the law came here? Why shouldn't we put infrastructure and improve schools for African American communities FIRST BEFORE any others? Why do they deserve any thing before our veterans? Please PBI this bill. HB 2160 - In honor of those who lost family/friends & weren't allowed to see them at the end, please move to report. HB 2276 - The data is clear: children are not at risk of death from COVID. HB 2293 - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/comparingdifferentinternationalmeasuresofexcessmortality/2022-12-20 Sweden and Norway were essentially tied for the lowest “[p]roportional all-cause excess-mortality scores” (which “measure[] the percentage change in the number of deaths compared to the expected number of deaths (based on the five-year average [from 2015 to 2019])” among the listed European countries, looking at data from Jan. 2020 to June 2022: Their excess mortality was up 2.7%, compared to, say, 5.2% for Denmark, 7.1% for Finland, and 11.8% for the Netherlands. They had the lowest all causes death rate since COVID arrived and didn't do these long, lengthy lockdowns. Sweden had lower rate avg. excess death percentages: https://reason.com/wp-content/uploads/2023/01/ERGExcessMortality.xlsx https://www.baconsrebellion.com/wp/covid-19-update-still-lots-of-idle-hospital-capacity/ noted on 4/25/2000 Roanoke Valley had 80 cases, 6 hospitalizations and 0 deaths compared to Arlington with 764 cases, 137 hospitalizations, 29 deaths. Elective surgery was banned in both, although the whole of Roanoke Valley had 0 deaths. HB2489 - Please move to report so that men can be given the support to become strong fathers.

In May 2020, I was admitted to the ER for kidney stones. Due to the pandemic, my husband was not allowed to be with me. During the ER stay, I was given an overdose of Fentanyl and was revived with NARCAN. The following day, I was transferred to a hospital for surgery to remove the stones as they were blocking my kidney and another was lodged in my urethra. I am a Roman Catholic. I was slated to undergo surgery with full anesthesia to remove the stones. As such, I am entitled under Canon Law to receive the Anointing of the Sick. The Anointing of the Sick is not intended solely for those "at the brink" of death or with "one foot in the grave," but is instead a Healing Sacrament, intended to not just prepare the Faithful for death but to petition God for Healing if that is His Will. I asked the hospital to contact a local priest to attend to my spiritual needs. The "chaplain" (a woman named Deb) informed me that "no priest will come for you." She stated that since I was not actively dying as a priest would not come due to COVID-19. I asked if this was hospital policy. She said yes and that even if it wasn't, "no priest will come for you." (not true). I argued with her for nearly an hour, in severe pain (taking morphine), and finally, she agreed that if I could find a priest they would allow me to go to the lobby. I did have a priest. He did come. He had to wait in the lobby while I was disconnected from machines, wrapped in blankets, and wheeled into the lobby, still in severe pain. He performed the Anointing and the Sacrament was completed. It was a risk to wheel me into a lobby instead of allowing Father to come to me. It was later discovered that I had the beginning of sepsis and was, in fact, in mortal danger. Had the "chaplain" had her way, I could have died having been denied my final Sacrament. In attempting to contact a Priest, my husband had received feedback from one Pastor that "the hospital would not let them in." It was only a Priest that I had a years-long working relationship with that was willing to take the risk of the hospital denying him entry. I am available for further elaboration and comment if desired.

To deny people access to their faith leaders during the last moments of their life is cruel and inhumane treatment. Faith leaders are perfectly capable of taking the same precautions as the medical staff caring for the patient and medical facilities and the state health department should not be allowed to interfere in the free exercise of religion. For people of faith having their rabbi, shamen, priest, or pastor be able to visit them is as important, if not more so, than the care they are receiving from medical staff. The moment a doctor or nurse is allowed in the room with the patient then there is no justification for interfering in the religious practices of the sick and dying by banning faith leaders from the room and the code of law in VA should make this clear so that there is no question on this should another health pandemic or other health emergency come to VA. Please bring this bill to a vote in committee and then to the full House of Delegates so that it can become law and make it clear how in thesensituations, the rights of the people in VA will be protected and respected.

This bill needs to be brought up for a vote before both the House and the Senate. It was absolutely outrageous how people's most basic religious rights were completely destroyed during the Covid madness imposed upon Virginia. This can NEVER happen again. And legislators need to go on the record regarding this issue--which means a roll-call vote. Make it happen.

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.

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

HB 1764 I am opposed to HB 1764 as original submitted for the following reasons: 1. Proposed Section E requests practice agreements be eliminated. I disagree. A practice agreement is a job description between a physician assistant and the supervising physicians. I do not know many employed people do not have a job description. It is good that these agreements be reviewed and updated every two years to be sure everyone is on the same page regarding responsibilities. 2. Paragraph 54.1-2952 regarding proposed physician entering a patient care team is voluntary is fantasy unless “no compete and nondisclosure clauses” are removed from physician contracts removed. Hospitals will have major leverage over the physician otherwise. 3. Keep the ratio of physician supervision at no more than six physician assistant and nurse practitioners for all hospital physicians. In graduate medical education the Accreditation Council of Graduate Medical Education does not allow a faculty member to supervise more than 4 residents/fellows at a time to ensure patient safety. In the hospital setting many of the supervising physicians (hospitalists) are recent resident graduates who are uncomfortable supervising more than four individuals at a time. Supervising six is stretching their comfort level regarding patient safety. Supervising more than six individuals is stressful and creates moral distress since patient safety is at risk,

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

VALA opposes HB1906 expanding the AG program in its present form and funding levels to include another setting. Virginia's Auxiliary Grant (AG) program is not adequately funded or supported for the current eligible settings of assisted living facilities and supportive housing. The AG program needs to be fixed for the current settings before expanding it. Also, independent community living settings are not regulated, and there is confusion on which settings this would specifically pertain to. As per the 2018 report to the VA General Assembly on the Regulation of Independent Living Communities, "within the senior housing market, there is ambiguity surrounding the term 'independent living.' Consultants found the term used inconsistently to define everything from age 55 and-older senior apartments to assisted living facilities. This can lead to confusion among consumers looking for a community to meet their individual requirements." The fiscal impact on the bill may not provide a specific impact number on VDSS, but it would be substantial. VDSS has had difficulties in meeting inspection deadlines and timeframes for assisted living facilities leaving some ALFs operating past their license expirations waiting on inspections. Adding another setting for them to regulate as would be required by HB1906 per the language in 51.5-160.1 would further delay the crucial inspections process and could jeopardize health, safety, and continued operations. ALFs operating past their licensure date waiting on inspectors could be detrimental to their continued operations due to funding, insurance, and managerial oversight requirements. VDSS is already short staffed, and HB 1906 would further impact the availability of staff for licensure operations. Thank you for considering these concerns. Again, VALA opposes HB1906 expanding the AG program in its present form and funding levels to include another setting.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

The City of Portsmouth supports this bill. It would provide consistent regulations across the Commonwealth. However, it our understanding that the Health Department already inspects the pools for compliance.

Working in the pool industry in both retail and distribution, also having used public pools, I feel HB1917 should be a definite yes.

As a long time industry professional I am writing in support of this bill. My company, AAA Pool Services, manages and operates almost 50 seasonal pools across all localities in the Tidewater area. We have to deal with multiple sets of codes and standards, and then pools in Suffolk have no codes or standards other than VHD code, which does not apply to these pools. I encourage a YES vote on HB1917 to begin to standardize public pool requirements for both ease of business and swimmer safety. James Durkee Vice President AAA Pool Services

I live in Alexandria and am concerned about the health and safety of our public swimming pools. I've heard that showering before entering a pool means germs are less likely to be in the water. My friends and family don't want to get sick when we're at the pool! And keeping the pool environment and equipment up to date is important. An inspection of a facility would make sure we're safe from harm due to lack of maintenance, or issues with handrails, electrical elements, fencing, diving boards or signs, for example. Please help us enjoy our pools.

Comments Document

Attached is a letter of support for the HB1917 Bill. As a pool builder, service provider and retail company in VA for 45 years we feel it is important for all commercial properties to meet minimum requirements for water quality and proper pool operation.

As a citizen of Virginia in excess of nearly 20 years, husband, a father of 4, grandfather of 11, thus far, and a swimming pool professional for these past 50 years I wish to express my full support of VA HB 1917. My aquatics career began in neighboring Maryland, at my local community pool. There I learned how to swim from certified Water Safety Instructors, was provided supervision during the summer months, after passing the pool test, by the licensed guard staff. It was my haven, my safe place to go. I later learned how regulated it was by the Health Department. In 73, I became a part of that staff and by the end of the summer was a lifeguard myself. Over the next four years I became a Water Safety Instructor, Swim Coach, Licensed Pool Operator, SCUBA Diver and eventually received 2 degrees in Recreation. My career spans Public Pool Management, Service, Renovation, Construction and now Design. At one point I held a management position for the largest Commercial Pool Builder in the mid-Atlantic, traveling 6 states and D.C.. It was there that I discovered the great disparity in state and local regulations on Swimming Pool, Spa, Waterpark and Splashground health and safety. Part of my job description was to determine what regulations and codes were in place that we needed to conform to in providing for our clients. Sadly to say, VA had and still does have the least health and safety regulations within this region and perhaps the country. What the Health Department does have, with reference to current regulations, is extremely outdated, circa 1962 and has very poor enforcement. Fortunately, the VA Building Dept, since 2014, now uses the ICC code, which replaced a mostly non existent design and construction code for swimming pools. This likely as part of the result of deaths and near drownings from poor design, construction, renovation and service practices that led to Federal Standards such as the VGB ACT of 2008. While working or vacationing in Virginia back then, I would be appalled at the unhealthy and unsafe conditions I would find at commercial aquatic venues in those jurisdictions without Health Department oversight. Certainly, a RED FLAG, was raised whenever my children wanted to swim in a manmade vessel. Today, I assist Design Professionals, with the mechanical, Building and Health Code compliance and amenity needs of existing and new aquatic facilities, in VA. Frequently, I am asked about conformance to Health Department regulations and find Developers, General Contractors, Designers and Consultants all shocked and in disbelief that most of VA does not have Health Department regulations like other states and jurisdictions. What regulations the Health Department does have are restricted to "Tourist Establishments". Unfortunately, for VA citizens including my grandchildren, VA has until this opportunity, found it more important to protect "tourists" than the citizens of the Commonwealth. Like vehicle safety, aquatic safety must be regulated for the good of the public. Profits would otherwise circumvent the need for seat belts and air bags, or proper filtration and sanitation. Can you imagine what might be served and what cleanliness conditions might be present, if restaurants were not regulated and inspected regularly by a qualified Health Department with adequate regulations. Public health and safety would be compromised. So is currently true in most of Virginia with their swimming pools.

Re: Consideration of House Bill 1917 – Public Pools; Board of Health to Adopt Regulations. We are writing to let you know that we, as the Central Virginia of PHTA, support the bill directing the Virginia Department of Health to promulgate regulations governing swimming pools and spas for public use. Our chapter covers most of the state of Virginia, from Virginia Beach to Jonesville, in the west, and north to Charlottesville. Our members have spent years upholding the standards on safety, operations, and maintenance of pools and spas. We believe strongly that HB 1917 will considerably increase the safety and welfare of public pools in Virginia and protect Virginia residents who use them. The Virginia Department of Health currently only has authority to enforce regulations for pools and spas at campgrounds, summer camps, and hotels. Additionally, only 20 local jurisdictions in Virginia have a code that regulates the operations, maintenance, and safety of public pools. Our members have an incredible relationship with the Virginia Department of Health, working with them on regulating the pools and spas they can enforce. As a chapter, we stand behind PHTA National Offices, in providing recommendations related to regulations to be adopted. We want to ensure that the residents of Virginia have safe public pools and spas to enjoy. On behalf of our many members, we respectfully request that you consider moving this important legislation out of your committee. Sincerely, Vicki Hudson Chapter President Centralva.apsp@gmail.com

Comments Document

Dear Chairman Walker: This bill, directing the Virginia Department of Health to promulgate regulations governing swimming pools and spas for public use is supported by the Pool & Hot Tub Alliance (PHTA). PHTA’s headquarters are established in Virginia and many of its employees are Virginians. Currently, the Virginia Department of Health only has authority to govern and promulgate regulations for pools and spas at campgrounds, summer camps, and hotels. Additionally, only 20 local jurisdictions in Virginia have a code that regulates the operations, maintenance, and safety of public pools. HB 1917 will begin the process to drastically increase the safety and welfare of public pools in Virginia and further protect Virginia residents. PHTA, its Virginia members, and other industry stakeholders have a tremendous relationship with the Virginia Department of Health and provide recommendations related to regulations required to be adopted. Additionally, this relationship has created an environment for industry leaders and the Virginia Department of Health to discuss current and best practices and opportunity for future collaboration. On behalf of the many Virginia pool and spa professionals represented by PHTA, as well as those in neighboring states that do business in Virginia, we respectfully request that you consider moving this important legislation out of your committee. Sincerely, Jason Davidson PHTA, Director of Government Relations jdavidson@phta.org About Us The Pool & Hot Tub Alliance was formed in 2019, combining the Association of Pool & Spa Professionals (APSP) and the National Swimming Pool Foundation (NSPF). With the mission to “Celebrate the Water,” PHTA facilitates the expansion of swimming, water safety and related research and outreach activities aimed at introducing more people to swimming, making swimming environments safer and keeping pools open to serve communities. APSP, now the PHTA, is the world’s oldest and largest association representing swimming pool, hot tub, and spa manufacturers, distributors, manufacturers’ agents, designers, builders, installers, suppliers, retailers, and service professionals. Dedicated to the growth and development of its members’ businesses and to promoting the enjoyment and safety of pools and spas, PHTA offers a range of services, from professional development to advancing key legislation and regulation at the federal and local levels, to consumer outreach and public safety. PHTA is the only industry organization recognized by the American National Standards Institute to develop and promote national standards for pools, hot tubs, and spas. For more information, visit PHTA.org.

Good morning Chair and Members of the Committee. My name is Sequoi Phipps-Hawkins and I am the Director of Communications and Marketing for Birth in Color RVA. I am also a Virginia State Certified Community Based Doula. As a doula, I have seen firsthand the immense need for adequate support during pregnancy and birth that our communities have. Our organization, and our Director Kenda Sutton-EL specifically, have met and interacted with people during the postpartum period and beyond who have previously been incarcerated during pregnancy. They have shared their stories with us and the burden they unknowingly took upon themselves by taking medical furlough in order to birth their babies – because they were not made aware of their right to access emergency Medicaid coverage during medical furlough. This oversight leaves new mothers and parents with medical bills that they are faced with immediately when they are no longer incarcerated. This means that a parent who is reentering the community may simultaneously be finding a job, acclimating to the parenthood of a newborn, and figuring out how to pay the medical bills they did not know they acquired. On behalf of the nearly 100 birth workers who make up the Birth in Color Doula Collective and our organization as a whole, we ask that you would support HB 1919 Pregnant Incarcerated Persons On Medical Furlough Preventing Gaps Medicaid Coverage so that it is required and ensured that pregnant persons on medical furlough are informed of their right to Medicaid Coverage.

This is a comment on HB1946. My name is Einar Ingvarsson and I work as Director of Training and Research at the Virginia Institute of Autism (VIA). We employ around 40 licensed behavior analysts, and typically hire new ones at least quarterly. We provide services throughout the commonwealth, including Charlottesville, Roanoke, Lexington, Lynchburg, and surrounding areas. As things stand now, we would not consider hiring licensed behavior analysts unless they also have a certification from the BACB. The BACB is currently the only certifying agency for behavior analysts that meets the quality criteria that we are looking for, such as the amount and quality of supervised experience, being incorporated as a non-profit, having course sequences verified by an independent agency (Association for Behavior Analysis International), and including competencies on behavior in general (i.e., not specific to a particular diagnostic category). Therefore, VIA strongly supports HB1946, as it would ensure that those that obtain licensure as behavior analysts have been certified by an agency that meets these and other minimum requirements.

Virginia families have benefited greatly from the Autism Insurance legislation we carefully crafted over the past 15 years in Virginia. Quality of care and quality of the services are critical for our loved ones with Autism. This bill to fix the loophole between the statue and regulation is critical to insure we provide services from professionals that meet our Virginia standards. I ask for your assistance in passing this bill as written, Its good for Virginia and it is good for our families who have loved ones with an Autism diagnosis. Thank you, Mark Llobell Virginia Autism Foundation Founder

The Virginia Autism Project and the Virginia Autism Advocacy Alliance support HB1946 which will provide the necessary guides for the profession. Please Vote YES on HB1946.

Support HB 1952. There are multiple delays as noted below why patients have difficulty receiving their medication. I would suggest a Joint Commission on Health Care study after the session to address and suggest legislation going forward. 1. Physicians are noting repeat requests for same refills for the same patient throughout the day, tying up our staff. 2. One physician received refill requests for a medication that has not been prescribed in the previous five years and the patient has not been seen in five years. 3. Patients receive monthly phone call informing them their prescription is ready after the medication has been discontinued months earlier. This confuses the patient and increases the risk of overmedication/drug interaction. 4. Offices are receiving repeated requests to refill a medication after the pharmacy has been notified that the patient and/or physician are not at that office. 5. Pharmacies are requesting a new medication 90-day refill at patient request when the patient did not make the request. 6. Pharmacies are requesting a medication refill for a patient that has left the practice or is now at another practice. The pharmacy has been notified multiple times but continues to send refill requests to the previous practice, and the pharmacy continues to fail to update their database. 7. Pharmacies send refill requests to our practices for a physician who has never worked in our practice. 8. The failure of chain pharmacies to make changes to their electronic databases after issues are brought up repeatedly at the corporate level. 9. I have heard of several physicians who have turned off their fax machines because they were inundated by medication refill requests, forcing the pharmacy to call their office. 10. Pharmacies are not keeping their formulary databases current that causes a physician or staff member to spend valuable time requesting a prior authorization which is then discovered to be unnecessary. This delays patients from getting their medication(s) in a timely fashion.

Comments Document

Honorable Delegates of the Health Welfare and Institutions Committee, Greetings to you and attached please find continued, detailed AAC support memo for HB1969, which will restore unrestricted access to original birth certificates for all Virginia adult adopted persons. We are very happy to be working alongside our partner advocates at the Capitol Coalition for Adoptee Rights (CCAR) to advance this vital human and civil rights imperative. Hope this helps, with tremendous thanks for all efforts to advance adoptee equality in The Old Dominion State. Regards, Tim. Tim Monti-Wohlpart tmw713@gmail.com 917-403-8105 American Adoption Congress, National Legislative Chair

I support Virginia HB1969 and ask each of you to do the same. Adopted persons in Virginia should not be discriminated against and treated as a separate class of citizen. They deserve the same unrestricted rights to their birth certificate as every other person born in the state of Virginia. As the law currently stands adult adopted persons are the only citizens of the Common Wealth of Virginia who have no legal right to the personal vital statistic record documenting their birth. At this time the release of an original birth record to an adult adopted person requires either a state agency’s decision to release identifying information upon good cause shown; or a court order upon good cause shown. The onus is on the adopted person to prove they deserve access to their own birth certificate. The current law is ridiculously difficult, complicated and can come at great monetary expense to the adopted person. Rather than paying the typical $20 fee, adopted persons must hire lawyers, go to court, etc., without knowing if the time and expense they have spent will successfully allow them to obtain their own birth certificate. Please do not continue to allow adopted people born in Virginia to be discriminated against.

CHSVA supports this bill. Adoptees should be afforded the same rights and have access to the same documents as their peers. Currently, these adoptees have to obtain a court order to access their own birth certificate. They should not have to go through the expense and complexities of the judicial system to obtain documentation pertaining to their own identity. We ask that you support this bill.

Comments Document

Honorable Delegates of the Health Welfare and Institutions Subcommittee, Greetings to you and attached please find a new, further detailed AAC support memo for HB1969, which will restore unrestricted access to original birth certificates for all Virginia adult adopted persons. We are very happy to be working alongside our partner advocates at the Capitol Coalition for Adoptee Rights (CCAR) to advance this vital human and civil rights imperative. Hope this helps, with tremendous thanks for all efforts to advance adoptee equality in The Old Dominion State. Regards, Tim. Tim Monti-Wohlpart tmw713@gmail.com 917-403-8105 American Adoption Congress, National Legislative Chair

I am 100% behind this clean bill allowing adoptees be allowed to their OBC. These antiquated laws need to be enhanced to meet todays needs of ALL citizens including adoptees. DNA now leads the way and biological parents can easily be found. Technology has advanced and what a great way for Virginia to advance too When a state values all its citizens with equal opportunity vs oppression the masses will be happier and thrive. Good luck Virginia adoptees from a fellow adoptee in Oregon. With much support and in favor of this Bill 1969. Ann E Weaver-Melendy

Dear Honorable Delegates, I fully support Virginia HB1969 and advocate for unrestricted access to original birth certificates to all Virginia born adoptees. Adult adoptees deserve the same rights to their birth records as any other person born in our commonwealth. Unlike other Virginians, adoptees cannot research medical history and familial disease patterns. Please abolish paternalistic, antiquated policies that prevent an adoptee from knowing essential facts about their own identity. Make the Commonwealth of Virginia more transparent and equitable by supporting adoptees’ access to birth records.

I was born and adopted in northern Virginia in 1961. I am writing in favor of Virginia HB1969. I am in Reunion with my elderly birth mother and have established family ties with my paternal side too. This bill would help put the Baby Scoop era of adoption in the past and create a brighter future for many adult adoptees who are needlessly kept in the dark about basic facts about our own life beginnings. What is more basic or fundamental than knowing the identity of your biological parents? They were never promised anonymity anyway. The search process can be more direct without involving cousins who are DNA matches, the typical sleuthing process that adult adoptees now go through, without OBC access.

Dear Honorable Delegates, I fully support Virginia HB1969 and implore each of you to do the same. As the law currently stands adult adopted persons are the only citizens of the State of Virginia who have no legal right to the personal vital statistic record documenting their birth. At this time the release of an original birth record to an adult adopted person requires either a state agency’s decision to release identifying information upon good cause shown; or a court order upon good cause shown. The onus is on the adopted person to prove they deserve access to their own birth certificate. Please restore unrestricted access to original birth certificates to all Virginia born adoptees. They deserve the same rights to their birth certificates as every other person born in the state of Virginia. Adopted persons should not be discrimated against and treated as a separate class of citizens.

My name Tonya Moore who found out I was adopted at the age of 31 years old. That was devastating for me. So when I went to obtain my birth records to only find out that was not possible was even worst for me. I could only get my non identifying information. I started grieving over records that I couldn't obtained. I believe everyone should access to their birth records. Access will help.put pieces together especially when it comes to medical issues. I am now 51 years old and have no idea about my family medical history. In speaking with doctors to onlly say " I am adopted " It's hard feeling different from others and fighting for your identity every day.

My name is Jamie Weiss, however that has not always been who I am. In February of 1979, I was born. Where, to whom, and when?? Well, that’s a great question that I could not answer for 30 years. After being adopted at 6 months old, my original birth certificate, that recorded the facts of my birth was taken from me and replaced with a falsified birth certificate - listing a different name, a different mother, a different father, a different city of birth, and even a completely different state! As an adult, I thought that I would be allowed to obtain my birth records. Sadly I learned that I could not, due to the law requiring that my own birth certificate be sealed away and kept from me. This was done solely due to the fact that I was adopted. It was not done at the request of myself or my birth mother. Neither of us would have chosen for my birth certificate to be sealed. In fact, it was my birth mother who was able to provide me with the information about myself that I did not know, once I was able to connect with her. So at 30 years old, I learned that Jamie from Georgia is actually Hope from Virginia. If a birth certificate is such a “vital” record, then why am I denied access to mine? I am not a child. I am not dangerous. I am not a criminal. I am a wife, a mother, a caregiver, a neighbor, an entrepreneur, a daughter, a sister. No one is harmed by me knowing the truth about ME! Non-adopted persons can obtain their birth certificate by going online or in person, completing a request form, and paying the $12 fee. It is that simple. In contrast, adopted persons who wish to obtain theirs are forced into an arduous and arbitrary process to petition the court and spend thousands of dollars to gamble for a chance at being granted access by a judge. Solely due to the fact that they were adopted and no other reason. Virginia HB1969 will give adult adopted persons the unrestricted right to obtain their own original birth certificate and it is essential to ensuring dignity and equality for all. This is a basic right that all other groups of people have except adopted persons. It is time for that to change. I am asking that all members of the subcommittee will support HB1969 and provide a favorable report.

Comments Document

Dear members of the Subcommittee, Attached is my letter of support for a favorable report for HB1969. Thank you for your consideration . Respectfully, Susie Stricker Maryland Adoptee Rights, Director Capitol Coalition for Adoptee Rights

Comments Document

Virginia Delegate Wendell S. Walker Chair of the Health, Welfare and Institutions Sub-Committee Pocahontas Building, Room E304 900 East Main Street Richmond, VA 23219 January 18, 2023 Dear Chairman Walker and Members of the Subcommittee: I write on behalf of the New York Adoptee Rights Coalition (NYARC) regarding Virginia’s HB1969. New York State recently enacted bipartisan legislation that secured—like HB1969 would secure—the right of adult adopted people to obtain certified copies of their own original birth certificates (OBC). NYARC was instrumental in securing this right. Adult adoptees are the only group of people who are denied access to the state’s original record of their birth. We are denied this document not because we were relinquished or because our parent(s) had their rights terminated for just cause; but because we were adopted. OBCs are only changed and sealed upon adoption. This fact is true regardless of what year we were adopted. This is true in infant, step-parent, intercountry, and foster care adoptions. Had a person not been adopted but, instead, aged out of the foster care system their name and birth certificate would never have been changed. Critical to note is that every child in foster care, like adoptees, was also relinquished or their parent(s) had their rights terminated for just cause. Obtaining one’s OBC is about dignity and equality. It is not about searching for one’s biological family. Adopted adults do not need a record of their births to locate family. They need only spit in a vial or swab their cheek. I, personally, have helped upwards of 200 people locate their biological families using consumer DNA testing and public records. The people I have helped range in age from 21 to 83. In the technological world of social media and consumer DNA testing, I assure you that the idea of anonymity for anyone is impossible. There are approximately six million adopted people in the United States. We are your neighbors, friends, and family members. We represent first responders, teachers, military, union workers, corporate professionals, and even legislators. We represent every religion, political party, sexual orientation and gender. Imagine if Virginia’s current law stated that military personnel/first responders/teachers/LBGTQ/etc., must secure a court order or approval from a state agency in order to access their original birth certificate. Virginians would never stand for such discrimination. We ask that you not stand for it either. It is our hope that Virginia will, like New York, allow ALL adults born in the state to be able to apply for and receive a copy of their original birth certificate without restrictions or court orders. We hope that you will join New York and the 12 other states (Alaska, Alabama, Colorado, Connecticut, Kansas, Maine, Massachusetts, New Hampshire, Louisiana, Oregon, and Rhode Island) who allow for complete adoptee equality. Vermont will soon become the 13th state. You have the potential to get it right and make it equal in Virginia. It is our hope that you make history happen in your great state, just as we did in New York, Make Virginia the 14th state to restore an adopted adult’s right to their own birth record. We ask for a favorable subcommittee report for HB1969. Respectfully, Annette O’Connell Spokesperson - New York Adoptee Rights Coalition 845-821-4303 coalition@nyadopteerights.org

Comments Document

TO: Delegates of the Virginia House Health, Welfare, and Institutions Sub Committee FROM: Marley E Greiner, Executive Chair, Bastard Nation: the Adoptee Rights Organization RE: Please support HB 1969, Adoptee Original Birth Certificates DATE: January 18, 2023 Honorable Delegates of the Health Welfare and Institutions Subcommittee: Attached please find our written comments in support of HB 1969, a bill to restore the right of all Virginia-born adoptees to their original birth certificates without restrictions or conditions. I am happy to discuss any questions or concerns you have about this bill. (614-795-6819 (cell) or 361-452-1391 (unlisted, but better due to spam)

Comments Document

Please consider the attached letter and materials in support of a favorable report on HB1969, a bill whose chief patron is Del. Walker. Gregory Luce Adoptee Rights Law Center

HB1969 Adult Adoptee Access to their own Original Birth Certificate I am Rebecca Ricardo – an adopted person, a birth mother who placed a child for adoption and a Licensed Clinical Social Worker currently serving as the Executive Director for C2Adopt – a Richmond based adoption agency. I support this bill personally and I can speak on behalf of C2Adopt that the agency also supports this bill. A person who was adopted as a minor child should have equal access to the government documentation of their birth as all other adult citizens of the Commonwealth have access to upon the age of majority. We should not have a lessor citizen status in regards to the document as important as the verification of our birth information. This is an equality issue that needs to be updated and changed. Thirteen other states have already taken this action to provide adult adoptees access to this document. Please make Virginia the next state to enact this critical change to our Code of Virginia. Thank you. Rebecca L. Ricardo, LCSW Executive Director – C2Adopt rricardo@c2adopt.org or rebeccaricardo65@gmail.com 804-360-0920 Resident of Virginia residing in Goochland County

Honorable Delegates, I was born in Virginia and adopted as an infant in 1979. As this was in the era of closed adoptions, my original birth certificate (OBC) was sealed. Many people who were not adopted do not realize that people in my situation have no legal right to view their OBC. The most we are allowed is a copy of non-identifying information with all names redacted. It is my position that adult adoptees have a right to know the names of their birth parents. There are many genetic diseases that doctors cannot screen for without knowing a medical history. Adopted people without access to the names of any blood relatives are stuck in a situation where they could be denied essential medical care - this is unnecessary. I have personally met many adoptees in their 80s and 90s whose only hope in life is to meet just one blood relative before they die. Due to the secrecy built into state laws like Virginia's, their search efforts are often unsuccessful. Please support HB1969. Thank you, Joseph Hamelman

Comments Document

Greetings to you and attached please find an AAC support memo for HB1969, which will restore unrestricted access to original birth certificates for all Virginia adult adopted persons. We are very happy to be working alongside our partner advocates at the Capitol Coalition for Adoptee Rights (CCAR) to advance this vital human and civil rights imperative. Hope this helps, with tremendous thanks for all efforts to advance adoptee equality in the Old Dominion State. Regards, Tim. Tim Monti-Wohlpart tmw713@gmail.com 917-403-8105 American Adoption Congress, National Legislative Chair

Comments Document

HB: 2008 I speak as the Legal Counsel to the non-profit National Capital Lyme Disease Association, headquartered in Northern VA. For over 20 years we have advocated for public awareness of tick-borne diseases. This is no longer a Northeast US problem. Tick-borne diseases have spread throughout the U.S., but the mid-Atlantic states, and particularly Virginia have seen the greatest growth in these dreaded diseases. It is imperative that Virginians be educated on how to prevent the spread of these diseases and how to deal with them should they or a family member contract the disease. Similarly, the medical profession has, for the most part, lacked the education and resources to effectively diagnose and treat victims of these diseases. There is a great deal of misinformation in the medical community about them and we need this legislation and the working group it will authorize to help bring a spotlight and resources to the Virginia medical community and the public at large. It is time for a working group. In 2002, our Executive Director was honored to sit on Governor Bob McDonald’s first Lyme disease task force in the Commonwealth to study this problem. Much has happened since that time and it is past time to return to a serious and definitive effort to make a difference in the lives of the residence of Virginia. I will speak to this issue.

Dear Legislators, On behalf of our volunteers and members, the Virginia Black Leadership Organizing Collaborative strongly supports HB 2021 and HB 2025, both introduced by Del. Roem. Our volunteers and members have fought hard for equitable school meal policies for our communities, and more importantly, our children, for years and the passage of these bills will bring us all closer to those goals. We know that access is key to getting families the help they deserve. If a family is in need of help that the school system provides, then the school board should make every effort to get that information to the parents and guardians of school age children. This becomes even more important when we are talking about providing children with quality and nutritional meals during the school days. Many studies have shown that children learn and behave markedly better when they are not hungry during the day. Information should and must be readily available to those who need it most. Thus, we support HB 2021 and HB 2025 because they take further steps to ensure that not only free & reduced meal applications are readily accessible, but HB 2025 also takes the extra step in providing that parents of students in public schools would be fully informed on updated SNAP benefits and eligibility guidelines. Let’s continue building upon the efforts that you all have made in the general assembly with the community in ending childhood hunger. Please, vote ‘YES’ on HB 2021 and HB 2025.Thank you so much for your consideration, hard work, and service to the Commonwealth. Sincerely, VA BLOC

On behalf of the American Speech-Language-Hearing Association, I write to support HB 2033, which adopts the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 223,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Over 4,800 ASHA members reside in Virginia. ASHA members often have difficulty obtaining multiple state licenses to practice due to administrative burdens. These burdens hinder their ability to provide quality services and restrict consumer access in underserved and rural communities. I am pleased to support HB 2033, which will address these issues by: • Increasing access to care for clients, patients, and/or students; and • facilitating continuity of care when clients, patients, and/or students relocate or travel to another state, specifically with members of the military and their spouses. ASHA recognizes there are questions regarding the fiscal note and would assert that this Compact is no different than any other compact that Virginia has joined, including nursing, physical therapy, EMS, psychology and occupational therapy. The Compact Commission will have the ability to levy and collect an annual assessment from each member state to cover the cost of operations. The amount will be formulated by the Commission and will be binding upon all member states. At the present time, the amount, if any, that will be imposed upon each state’s budget is unknown. If Virginia passes this legislation, they will be among the group of delegates that make that determination. Currently, the Nursing Compact and the Psychology Compact are the only compacts that levy an annual assessment. The Nursing Compact assesses $6,000 and the Psychology Compact assesses states on a sliding scale. The ASLP-IC Commission views these numbers as guardrails for what this Commission may implement. Virginia is also a member of a number of national compacts that assess the state an annual fee. The ASLP-IC member states have indicated that they will seek grants from the Health Resources & Services Administration, the Department of Defense, and other relevant funders to help avoid a state assessment. Additionally, the American Speech-Language-Hearing Association, the Academy of Doctors of Audiology, and the American Academy of Audiology have committed to financial support. The Compact also allows states to charge a fee for the privilege to practice and its renewal to offset and any costs. These numbers don’t include the fiscal benefit that can be realized by the Commonwealth for the recruitment and retention of qualified providers. Passage of this bill would allow Virginia to enjoy the same benefits of the 23 other ASLP-IC member states, including the neighboring states of Maryland, West Virginia, Kentucky, Tennessee and North Carolina. The United States Department of Defense State Liaison Office joins ASHA in supporting HB 2033. If you or your staff have any questions, please contact Susan Adams, ASHA’s director of state legislative and regulatory affairs, at sadams@asha.org.

Comments Document

My name is Christopher Arnold. I am the Mid-Atlantic Regional Liaison for the United States Department Defense-State Liaison Office. Joining the 23 states who have enacted the compact before you today over the last 24 months will improve access to care and allow military personnel and spouses to more easily maintain their certifications when relocating. Federal law requires the military departments to produce annual strategic basing scorecards considering factors such as membership in licensing compacts and the quality of healthcare near bases. Future basing decisions made with a consistent framework will ensure optimal conditions for service members and their families. Common misinformation about compacts is that they either lower or raise the standards for the occupation, when in fact, compact states have the option to issue both “compact license” and also a “State-only license”. As 45 states have joined hundreds of DOD's compacts, including five here in the great commonwealth of Virginia, academic research and real world experience have proven reservations initially expressed by some groups, such as lost revenue to the state board or public safety concerns, have not materialized. DoD pivoted in its approach toward licensure after 2017 to consider occupational license compacts our optimal end state. Compacts establish common understanding of competency and its measurement within the occupation, and provide seamless reciprocity for military spouses in an occupation. House bill 2033, the Audiology and Speech Language Pathology Interstate Compact addresses these issues affecting our service members and their families and facilitates interstate practice of audiology and speech language pathology with the goal of improving public access to services, while preserving the regulatory authority of states to protect public health and safety through the current system of state licensure. Portable employment opportunities support military spouse career development. The language of the compact allows an active duty servicemember, or their spouse, to designate a home state where the individual has a current license in good standing. This state then serves as the individual’s home state for as long as the servicemember is on active duty, while adhering to the laws, rules and scope of practice in Virginia. This is particularly important insofar as outside of the interstate compact, there is no state specific law Virginia can pass to help Old Dominion state residents who are stationed in other states and are involuntarily relocated to other states obtain a license. There are no fees to the service member or spouse other than for their home state license, and these are reimbursed by the military services pursuant to federal law. We appreciate the opportunity to support the policies supporting military spouses outlined in the House Bill 2033 and are especially grateful to Delegate Sewell for her leadership and sponsorship in carrying this initiative forward and thankful to the committee for your thoughtful consideration and all your prior support of our service members and their families. As always as liaison to the Mid-Atlantic region, I stand ready to answer whatever questions you may have.

I have been a Virginia licensed speech-language pathologist since 2004 when my husband was stationed in Quantico, Virginia. I have worked in Virginia schools, private practice, and out-patient rehab. When my husband was stationed outside Virginia, I maintained my Virginia license, but could not work out of the state unless I applied and paid for a different state license. In Florida, it took over 6 months for me to obtain a license. In North Carolina, I was only able to find work on a military station because I did not have a license in North Carolina. The time and cost of obtaining and maintaining licenses for every state that we moved was cost prohibitive and a barrier to work. Now that my husband has retired from active duty, we remain in Virginia for our children to graduate high school and attend one of Virginia’s many accredited state colleges. I hope to advocate for speech-language pathology and audiology services for Virginians. The https://aslpcompact.com/compact-map/ includes states that allow for a speech-language pathologist or audiologist to practice without obtaining and maintaining another state license. This is important because we have military spouses in Prince William County. We have a shortage of speech therapy service providers. Virginians with hearing loss need access to quality audiology services. With the interstate compact, expansion of services to residents in rural areas closer to West Virginia and North Carolina and Maryland have access to more service providers and options for telehealth. Audiologists and SLPs are trained to identify, assess, treat, and manage speech, language, feeding/swallowing, cognitive, hearing, and balance disorders. It is critical that the Audiology and Speech-Language Pathology Interstate Compact be successfully operationalized and expanded, that licensure and certification requirements be preserved, and that the ability to practice to the fullest extent of one’s education and training be supported. Please support the Audiology and Speech-Language Pathology Interstate Compact.

Comments Document

On behalf of military families and the Department of Defense, I am writing to provide comment regarding the policy changes proposed in Virginia House Bill 2033, the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC), which addresses licensing issues affecting our service members and their families. I would like to thank you for considering this issue in the 2023 legislative session. My name is Christopher Arnold. I am the Mid-Atlantic Regional Liaison for the United States Department of Defense-State Liaison Office, operating under the direction of Under Secretary of Defense for Personnel and Readiness. Our mission is to be a resource to state policymakers as they work to address quality of life issues of military families. The ASLP-IC enhances opportunities of portable careers for military spouses by providing consistent rules which allow licensed members to work in other states through “privilege to practice policies”, or more easily transfer their license to a new state. Frequent moves and cumbersome licensing and certification requirements limit career options for military spouses. Enacting the ASLP-IC will serve to relieve one of the many stressors of a military move by allowing service members and military spouses to more easily maintain their profession when relocating. We appreciate the opportunity to support the policies outlined in the ASLP-IC introduced this session. Please feel free to contact me with any questions you might have.

Comments Document

On behalf of the American Speech-Language-Hearing Association, I write to support HB 2033, which adopts the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 223,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Over 4,800 ASHA members reside in Virginia. ASHA members often have difficulty obtaining multiple state licenses to practice due to administrative burdens. These burdens hinder their ability to provide quality services and restrict consumer access in underserved and rural communities. I am pleased to support HB 2033, which will address these issues by: • Increasing access to care for clients, patients, and/or students; and • facilitating continuity of care when clients, patients, and/or students relocate or travel to another state, specifically with members of the military and their spouses. Passage of this bill would allow Virginia to enjoy the same benefits of the 23 other ASLP-IC member states, including the neighboring states of Maryland, West Virginia, Kentucky, Tennessee and North Carolina. The United States Department of Defense State Liaison Office joins ASHA in supporting HB 2033. If you or your staff have any questions, please contact Susan Adams, ASHA’s director of state legislative and regulatory affairs, at sadams@asha.org.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

I support this bill.

I strongly support this bill.

I support this bill

I am writing in support of the compact for universal licensure for Audiology and Speech Pathology. As a Speech Pathologist for over 26 years, a military spouse, it has been challenging applying and receiving my license in a timely fashion; thus, impacting work and financial well being. Each state requires different administrative items making it time consuming and an administrative burden. Following Covid, the ability to offer telehealth across state lines for a short period of time due to the governors allowing this reciprocity, allowed patients to be seen more freely. One instance, a military family going back to their family due to spouse being deployed and the child being able to continue to be seen through telehealth and maintaining continuity of care. Imagine this to be an event always available if universal license was approved. I urge this compact to pass and for single license across state lines for speech pathologists and audiologists.

To Whom It May Concern: I am a speech-language pathologist in full support of this bill, as I currently hold both a separate VA license and MD license. I recently moved from VA to MD, and am currently residing in an area where I could easily provide services to patients in need in DC, MD, and VA. I have considered keeping both state licensures due to my location, however the additional cost without a compact licensure option is a greater financial burden on me and my practice. I would greatly benefit from the passing of this bill, and I think it would be a great step towards progress to a more universal compact licensure and regulations state by state. Thank you in advance for your consideration!

I support this bill.

I have been a Virginia licensed speech-language pathologist since 2004 when my husband was stationed in Quantico, Virginia. I have worked in Virginia schools, private practice, and out-patient rehab. When my husband was stationed outside Virginia, I maintained my Virginia license, but could not work out of the state unless I applied and paid for a different state license. In Florida, it took over 6 months for me to obtain a license. In North Carolina, I was only able to find work on a military station because I did not have a license in North Carolina. The time and cost of obtaining and maintaining licenses for every state that we moved was cost prohibitive and a barrier to work. Now that my husband has retired from active duty, we remain in Virginia for our children to graduate high school and attend one of Virginia’s many accredited state colleges. I hope to advocate for speech-language pathology and audiology services for Virginians. The https://aslpcompact.com/compact-map/ includes 15 states that allow for a speech-language pathologist or audiologist to practice without obtaining and maintaining another state license. This is important because we have military spouses in Prince William County. We have a shortage of speech therapy service providers. Virginians with hearing loss need access to quality audiology services. With the interstate compact, expansion of services to residents in rural areas closer to West Virginia and North Carolina and Maryland have access to more service providers and options for telehealth. Audiologists and SLPs are trained to identify, assess, treat, and manage speech, language, feeding/swallowing, cognitive, hearing, and balance disorders. It is critical that the Audiology and Speech-Language Pathology Interstate Compact be successfully operationalized and expanded, that licensure and certification requirements be preserved, and that the ability to practice to the fullest extent of one’s education and training be supported. Please consider supporting the Audiology and Speech-Language Pathology Interstate Compact. Thank you for taking the time to read my comments in support of this bill to support the people I love and the profession I adore. I work with children who do not communicate with verbal language. I work with patients who will need care for their entire lives. My patients deserve access to care throughout their lifetime. This bill would ensure access to more providers and get Virginia on board with the surrounding states.

I support this bill.

I support this bill

As a SLP that is licensed in VA, please consider allowing SLPs that are licensed in other states to be allotted a reciprocal license in our state. I work in the public school in VA and it has been so hard for us to obtain staff due to licensing issues and an overall SLP shortage and it’s taking a toll on all of the current SLPs in the state. Not having to worry about applying for an additional license would soften the burden for many SLPs and open up more potential people to work in our state and help with the shortage. Kids are really in need of our services following the pandemic and this would make it one less thing for SLPs to have to obtain. Thank you for your consideration. Please reach out should you have additional questions or concerns.

I support this bill as an SLP in Manassas City

As a military spouse the interstate compact would change the way I am able to function as a working member of society and how I am able to help provide for my family. I have had to apply for licenses in 4 different states and have been not able to work for several months after each post due to waiting for new licensure. Each time, I am also required to pay a large sum of money for licensure that will likely only be used for a short time. Please consider passing this bill to allow spouses more freedom in the workplace.

Comments Document

Attached please find the opinion of the United States Department of Defense in written testimony supporting the policies reflected in House Bill 2033, the Audiology and Speech Language Pathology Interstate Compact. Congress has required the Department to enter into a cooperative agreement with the Council of State Governments to develop licensing compacts and alleviate the barriers military families face to interstate mobility.

Comments Document

On behalf of the American Speech-Language-Hearing Association, I write to support HB 2033, which adopts the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 223,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Over 4,800 ASHA members reside in Virginia.1 ASHA members often have difficulty obtaining multiple state licenses to practice due to administrative burdens. These burdens hinder their ability to provide quality services and restrict consumer access in underserved and rural communities. I am pleased to support HB 2033, which will address these issues by: • Increasing access to care for clients, patients, and/or students; and • facilitating continuity of care when clients, patients, and/or students relocate or travel to another state, specifically with members of the military and their spouses. Passage of this bill would allow Virginia to enjoy the same benefits of the 23 other ASLP-IC member states, including the neighboring states of Maryland, West Virginia, Kentucky, Tennessee and North Carolina. The United States Department of Defense State Liaison Office joins ASHA in supporting HB 2033.

Comments Document

On behalf of the American Speech-Language-Hearing Association, I write to support HB 2033, which adopts the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 223,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Over 4,800 ASHA members reside in Virginia. ASHA members often have difficulty obtaining multiple state licenses to practice due to administrative burdens. These burdens hinder their ability to provide quality services and restrict consumer access in underserved and rural communities. I am pleased to support HB 2033, which will address these issues by: • Increasing access to care for clients, patients, and/or students; and • facilitating continuity of care when clients, patients, and/or students relocate or travel to another state, specifically with members of the military and their spouses. Passage of this bill would allow Virginia to enjoy the same benefits of the 23 other ASLP-IC member states, including the neighboring states of Maryland, West Virginia, Kentucky, Tennessee and North Carolina. The United States Department of Defense State Liaison Office joins ASHA in supporting HB 2033.

Too expensive and time consuming. Pharmacists are too far and in between and this is just more busywork for them. Not all techs could do this also and they're hard to find also.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

As a resident that lives in close proximity to the Catawba Hospital, I and several other neighbors have concerns. There are currently two ways into Catawba Hospital. One being from Keffer Road, which I consider the back entrance and the main entrance from Catawba Creek Road. We are not opposing the renovations, however we do feel some safety measures need to be added. 1. A fence needs to be placed around the full facility. Since we moved into the area in 2016, there have been 2 escapes. We often do not receive the emergency phone calls in a timely manner (it is several hours later) and they come from an 804 area code, not a 540. I don't answer phone calls out of the area. The residents need to be notified by every means possible, such as text also. 2. Keffer Road is a narrow, curvy residential neighborhood Road that is 25 mph. Most employees, delivery drivers, government employees use Keffer Road to access the hospital. I propose that this entrance to the hospital be closed and all business at the hospital needs to be done through the main entrance on Catawba Creek Road. The hospital staff treat Keffer Road like it's an interstate, exceeding way above the 25 mph limit. At one time many residents have placed signs on their property to remind them to "Drive like your kids live here". The employees are not allowed to smoke on hospital property for their breaks. So they will leave the property for their smoke break. One of the neighbors recently had an employee back into her driveway and sit there for his smoke break. Please review my concerns. Again, I support the need for mental health, but there are some safety protocols that need to be put in place too for the surrounding neighbors. Once the hospital gets renovated and expanded, it means more employees and staff will be using Keffer Road, which means more traffic, if the traffic is not diverted to the main entrance. This is going to be a drastic change to our community and we just want to make sure our voice is heard too and protect the reason why we chose this area to live.

HB 2192- Good Afternoon, My name is Jon Dance and I am a person in recovery. I am writing in support of HB 2192 as a member of the Recovery Communities in Virginia a resident of Montgomery County. The need for more support services such as Cawtaba Hospital is a must in our area for those suffering from Substance Use and/ or Mental Health Disorders. Speaking from experience of the benefits of treatment and receiving the necessary support and resources I am 5 years into my own Recovery and 2.5 years substance free. Because of the support and resources of a treatment facility such as the proposed Catawba Hospital Bill, I was able to return to Virginia Tech to obtain my bachelor's degree in Human Development and graduate in May of 2023 and also dual enrolled in a Masters of Public Health Program graduating May of 2024. My hopes are to continue to provide support and advocate for those still suffering. I have worked with adults and students who are in recovery or curious about recovery as a R-CPRS and being involved with the Virginia Tech Recovery Community, Hokies for SUD Recovery, and also helped with starting the Recovery Organization for Community College Students in Southwest Virginia. Please consider this mine and many others in SWVA's support for this bill.

The Roanoke Regional Chamber strongly supports passage and funding of HB 2192. The renovation of Catawba Hospital as a state of the art substance abuse and mental health treatment facility is sorely needed to address the outcomes of the opioid crisis and the prevalence of mental/behavioral health disorders. Its location in a region where substance abuse and mental health disorders are on the rise makes it an ideal place to treat these conditions. We thank the committee for it’s consideration and ask for support of this vital project.

Comments Document

See attached letter of support from United Way of the National Capital Area.

In her book, Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis, Roanoke writer Beth Macy, cites that “The Centers for Disease Control and Prevention estimates that more than a million Americans have died from drug overdose since 1996, the largest factor by far in decreasing life expectancy for Americans.” Since publication of her groundbreaking book, Dopesick, and during the Covid-19 pandemic, overdose deaths have increased by more than 50%, and noting that “addiction has become the No. 1 destroyer of families in our time, with almost a third of Americans reporting it as a serious cause of family strife, and drug overdoses claiming the lives of more than 100,000 Americans in a year. In the Roanoke Valley and parts of Southwest Virginia, we have seen overdose deaths in the range of four times the number of deaths by gun violence. In 2019, as a response to this growing epidemic, over two hundred community partners joined efforts to create the Roanoke Valley Collective Response and have developed a Blueprint for Action which includes essential grassroots and government led responses toward a comprehensive continuum of care to address addiction and create sustainable recovery models including recovery care, health care and housing. According to a report submitted by the Secretary of Health and Human Services, Data from the State indicates that between 35% and 55% of all patients at the State’s hospitals analyzed in the report prepared for the Commonwealth, suffered both from substance use disorder and a mental health illness. The report further recognized the immediate need for approximately 100-150 acute behavioral health beds, 80-120 residential substance use disorder treatment beds and 16 detox beds in the surrounding Catawba Hospital area. We are grateful to Delegate Sam Rasoul for introducing the re-imagining of the Catawba Campus to address these essential recovery needs in our region and as a model for the State, and to the Governor and General Assembly for championing the connection between substance abuse disorder, mental health support, and increased access to recovery services in a health care setting. These actions are bold and combined with local grassroots efforts in a continuum of care from effective harm reduction, addition and recovery education, recovery housing, and restored health and wholeness, we will see a comprehensive reduction and slowing of this epidemic. I wholeheartedly support this HB2192 and its full funding in the state’s budget. Vice-Mayor Joe Cobb

The report submitted by the Secretary of Health and Human Services to the Senate Finance and Appropriations Committee and the House Appropriations Committee in December and January, vividly demonstrates the need for a transformation of the Catawba Hospital Campus into a best-in-class expanded facility. As noted in the report, more than 100,000 people in the United States died from drug overdoses in 2021, 2,656 of those were Virginians and sadly, the Roanoke region is one of the hardest hit areas of Virginia. Our local coordinated response to the Opioid epidemic, the Roanoke Valley Collective Response recently completed a white paper – “Building on Hope”, analyzing the impact of COVID-19 on the opioid addiction crisis in the Roanoke region. The report notes significant increases in overdoses, instances of depression or anxiety and fatigue experienced by the region’s caregivers. Data from the State indicates that between 35% and 55% of all patients at the State’s hospitals analyzed in the report prepared for the Commonwealth, suffered both from substance use disorder and a mental health illness. The report further recognized the immediate need for approximately 100-150 acute behavioral health beds, 80-120 residential substance use disorder treatment beds and 16 detox beds in the surrounding Catawba Hospital area. A bold and meaningful response to this crisis needed. The Governor and General Assembly have taken the first vital step by commissioning the referenced study and report. Delegate Rasoul has taken the next critical step in requesting funding to fulfill the recommendations of the report. Our region, through its Collective Response has been on the ground providing resources, services and help for those in need. And many of our region’s elected and appointed officials are here today to voice their support for additional actions. HB2192 has the ability to take this bold and meaningful response and turn into actual action – much needed action, and for that reason as Mayor of the City of Roanoke, I am in full support of the Bill and request your support of the same. - Mayor Sherman P. Lea, Sr.

I am writing to express the City of Roanoke’s support of HB2192, with the goal of transforming Catawba Hospital into a state-of-the-art facility addressing the full spectrum of substance use disorder treatment, recovery services, and behavioral health services necessary to meet the growing need in our region. As you are aware, in 2021 through funding support by the City, the Roanoke Valley-Alleghany Regional Commission became the home of a staffed, formalized Roanoke Valley Collective Response, under the leadership of an Advisory Committee representing organizations that had led the Collective since its inception. The City of Roanoke was a supporter of last year’s bill to study the potential expansion of Catawba Hospital to meet both your vision and the critical needs of the region. Just recently, the Roanoke Valley Collective Response completed Building on Hope, a white paper that analyzed the impact of COVID-19 on the opioid addiction crisis in the Roanoke Valley. The report notes an overall increase of 30% in overdose rates nationwide, a 9% increase in adults reporting in adults reporting issues with depression or anxiety in 2021 over 2018 as identified in Carilion Clinic’s Community Health Survey, and a sharp increase in compassion fatigue experienced by the region’s caregivers and public safety staff, just to list a few of the many impacts. Broadly, the City and the Collective Response recognize that every aspect of this crisis, from prevention to treatment to workforce reentry, has become more critical and in need of more and better services to help those in our City and region, struggling with substance use disorder. A reinvigorated and well-resourced Catawba Hospital would be a vital tool in meeting this need. As Mayor of the City of Roanoke, I stand ready to support this effort to further the development of Catawba Hospital. I appreciate your leadership on this effort. Should you need anything further, please do not hesitate to contact me. Bob Cowell City Manager Roanoke Virginia

Thank you members of this committee, for taking the time to hear this bill. My name is Brittany James, and I am a student at Virginia Tech. I am currently the lead organizer of Hokies for SUD recovery at Virginia Tech, and I am asking you to support HB2192. This bill prioritizes the needs of Southwest Virginians. The repurposing of Catawba Hospital into a state-of-the-art SUD recovery facility would bring treatment, resources, and long-term care to a centralized location, and would be easily accessible for many individuals. I have heard many stories from the members of the Virginia Tech Recovery Community, and I want to emphasize this bill's importance to Southwestern Virginia. This bill would greatly benefit a number of constituents, particularly those in recovery from Substance Use Disorder. This bill would also improve the existing mental healthcare systems already in place at Catawba Hospital, giving those in recovery a safe environment as well as potential long-tern care. Once again, I want to speak on behalf of thousands of constituents across Southwestern Virginia who could benefit from HB2192 and ask for your support for HB2192.

On behalf of the Botetourt County Board of Supervisors, I am writing to express support of HB2192. Transforming Catawba Hospital into a state-of-the-art facility addressing the full spectrum of substance abuse disorder treatment, recovery services, and behavioral health services is necessary to meet the growing need in our region. A recent report by the Roanoke Valley Collective Response documented an overall increase of 30% in overdose rates nationwide. The many consequences of substance abuse and the associated costs in lost productivity and economic output, and the social and health-related costs to individuals, families, communities, the Commonwealth, and our nation are devastating in every measure. HB2192 offers a realistic opportunity to begin to mitigate and prevent these losses to our economy and society -- an opportunity that may not be available is less favorable budgetary times. Botetourt County encourages your strong support of HB2192 and stands as a willing partner to help address this critical need across our Commonwealth. Thank you.

Comments Document

REGARDING HB2192 | Rasoul | Catawba Hospital, substance abuse treatment and recovery services January 25, 2023 Delegate Sam Rasoul Virginia House of Delegates, 11th District P.O. Box 13842 Roanoke, Virginia 24037 Dear Delegate Rasoul, On behalf of the Board of Directors of United Way of Roanoke Valley, I am writing to express our support for HB2192, with the goal of transforming Catawba Hospital into a state-of-the-art facility addressing the full spectrum of substance use disorder treatment, recovery services, and behavioral health services necessary to meet the growing need in our region. Just recently, the Roanoke Valley Collective Response completed Building on Hope, a white paper that analyzed the impact of COVID-19 on the opioid addiction crisis in the Roanoke Valley. The report notes an overall increase of 30% in overdose rates nationwide, a 9% increase in adults reporting in adults reporting issues with depression or anxiety in 2021 over 2018 as identified in Carilion Clinic’s Community Health Survey, and a sharp increase in compassion fatigue experienced by the region’s caregivers and public safety staff, just to list a few of the many impacts. Addiction, substance abuse disorders, and mental illness are often among the most significant barriers to housing and employment – which are key to attaining financial stability. A reinvigorated and well-resourced Catawba Hospital would be a vital tool in meeting the growing need for mental health services, and facilitate access to others. Our United Way’s vision to elevate 10,000 families to self-sufficiency seeks to impact residents in the geographic area contiguous to Catawba Hospital, and would undoubtedly be a resource for many that we serve. Our United Way is fully supportive of HB2192. We are happy to participate in the next steps in the process to the extent we are able, and are eager to see the results of this important and timely work. Thank you for your leadership in this area of need. Sincerely, Abby V. Hamilton President and CEO

My name is Martha Hooker, Chairman of the Roanoke County Board of Supervisors. As the representative for the Catawba District I know that our community is very proud of the work the Catawba Hospital provides in this region. With the acreage provided on the Catawba Hospital campus, I believe the additional footprint added for substance abuse disorder and rehab would work well with its current mission. The need for this type of care is great in our area and we desire all our citizens to be able to return to being productive in the community and having healthy family experiences. I believe the addition to the Catawba Hospital will help meet this need. Moreover, the regional support extends to area members of the House as co -patrons of HB 2192. We ask the committee to pass this bill and thank you for the support.

My name is Phil North, Chair of the Roanoke Valley Allegheny Regional Commission and member of the Roanoke County Board of Supervisors. Before the pandemic the rate of overdoses in our area was 21.5 per 100K population. As a result of the pandemic the rates of overdose have increased to 30.7 per 100K or 43%. The need in our area is great for a continuum of care to address substance abuse disorder and Catawba Hospital location will meet this need. Moreover, the regional support extends to area members of the House as co -patrons of HB 2192. We ask the committee to pass this bill and thank you for the support.

I think the plan to convert the Catawba Hospital to an additional tip. Recovery center and maintaining mental health services is an excellent idea. I think Catawba would be well suited to treat people with addiction during the acute phase and will need a well thought out transition plan for those same patients when they move from acute rehabilitation (6-8 weeks) to the sober living and intensive outpatient care when they will need access to transportation and jobs. The remote location of Catawba hospital lo It’s accessibility to jobs and transition to normal environment.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

I am nurse from Iraq and am trying to get certified to practice here and contribute with my skills and experience in the healthcare field but I have not been able to do so. I am looking forward to an opportunity to do so through the HB2211 introduced by Delegate Kathy Tran because I want to help saw lives.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

I am writing as a certified nurse midwife who provides birth services in Richmond outside of the hospital. My clients that choose home birth and birth center birth deserve unfettered access to this vital screening without the high cost of the testing. This is a government required test, and yet the burden of its cost falls squarely on either the patient themselves or on the provider. These costs add up in even the large practice setting of a hospital. The cost to a small scale midwifery business can easily make or break the bottom line. Practices like mine in Richmond are dwindling. It is so hard to keep doors open in these tiny practices with the many costs and barriers to practice that currently exist. Removing this barrier of the cost of newborn screening would have a positive impact on small business growth in Virginia as well as increasing patient access to their desired form of high quality, personalized care.

I would like to offer my support in favor of House Bill 2224 which seeks to remove the fee for newborn metabolic screening. The newborn metabolic screen is required by law and is an important early step in newborn care the helps to identify serious but rare health conditions at birth. The test can be cost prohibitive for families that do not have adequate health coverage or for those who give birth in a birth center or at home and then need to present to a lab facility or hospital to have the test performed. It would be a great step forward in newborn and pediatric care if the newborn screening test was performed at no cost to parents, guardians, hospitals or health care providers.

My name is Nichole Wardlaw and I am a Certified Nurse Midwife speaking in favor of HB 2224 which will remove the cost associated with the metabolic screening test for newborns. As an American Midwifery Certification Board midwife with 17 years of experience and trained at the Medical University of SC I have chosen to work in communities of color where my presence as a black midwife has been more effective. I also chose to leave the hospital system in 2020 to do home or community birth so that parents who have low risk can have a choice in where they would like to give birth. It is in this setting where parents are forced to decide if they can afford to get the metabolic screening done. The cost is $137 and all insurance companies do not cover the cost. This leaves my colleagues and me to either absorb the cost or pass the cost on to the parents. It is unfair to have a state-mandated test that is beneficial in screening for disabilities not be available for every child born here. It is cost prohibitive and every child may not be afforded the test. If we want to reduce disparities, we should offer these types of screening tests for free. In conclusion, I thank you for your time and leave you with this quote “Change will not come if we wait for some other person, or if we wait for some other time. We are the ones we’ve been waiting for. We are the change that we seek.” Barack Obama

Good Morning! I am Leslie Payne, a community-based midwife serving the central region of Virginia. I would very much like you to support HB 2224. As you know, the metabolic screening of newborns in Virginia saves lives and is critically important to the children and families of the Commonwealth. I serve families in 4 different Amish communities. This screening is particularly important in their communities where the gene pool is small and these disorders show up more often than they do in my "English" (as the Amish call the rest of us) families. Over the years I have seen several children who are now living normal lives because their condition was discovered through the Newborn Screening Program and they are being successfully treated from the beginning of life. These families have very little money. In order to make sure their babies are screened, I often need to foot the bill myself (upwards of $150 for the screening card and equipment to perform the screen). Since about 75 percent of my clientele is Amish, this costs a good bit every year. I feel compelled to do this because the screening is so important for these families and the impact of an untreated child is significant, financially, medically, and emotionally. But it is a financial burden for me. Thank you for considering this bill which would benefit so many of the families I and other midwives serve. Sincerely, Leslie M. Payne, CPM Lynchburg, VA

Charging for the newborn screening cards that are required by law puts an undue financial burden on providers. Many independent providers are not in network with health insurance, and even when they are, insurance will either not cover the tests, or they reimburse far less than the cost of the test. We lose money on every single one.

Additional costs for state mandated testing of the newborn can be a financial burden to families giving birth out of the hospital or with no insurance coverage. These families may choose not to consent to Newborn Metabolic Screening due to the costs of the testing. If the state of VA is mandated testing, that financial burden should not lay upon the parents. It should be the state’s responsibility to provide for and cover testing costs. I support HB 2224 so that my clients can have accessible and affordable Newborn Metabolic Screening.

Please support state funding of HB 2224! The cost of newborn screening is a legitimate and prudent use of taxpayer funds. Every single newly born VA citizen should have access to this important screening tool regardless of location of birth and ability to pay. Testing for and identifying the disorders and diseases screened for at birth will save the state funds in the long run. Thank you!

*Please support HB 2224 so that newborn screening tests shall be performed at no cost to parents, guardians, hospitals or health care providers. The $138 fee for the state-mandated newborn metabolic screening is an unnecessary barrier to this important screening test for newborns. This is especially a barrier for licensed midwives in Virginia who serve families with Medicaid, as Medicaid only reimburses these providers 75 % of the actual fee. This means that it is actually costing licensed midwives $34.50 each time they provide this important screening test for newborns; and they are not receiving any compensation for the time/skill it takes to provide this critical service. As a Certified Nurse Midwife, I rarely get reimbursed from private insurance companies for this state-mandated service.

I am a CPM community midwife who is licensed in Maryland and Virginia and also practices in West Virginia and Pennsylvania. I have seen firsthand the impact of the fee for screening drive families’ decisionmaking surrounding the fee. The vast majority of my MD, WV and PA clients opt to have the newborn screening done as there is no financial burden on their part; the clients more frequently decline the newborn screening for financial concerns when given the option in Virginia even when risk/benefit and informed choice is given. Families birthing out of hospital are already bearing the greater responsibility of cash-pay or low out of network coverage for their safe out of hospital birth choice. Let them continue to make safe evidence based choices without further financial burden involved.

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.

Dear Committee Members, Many years ago, my husband and I had notarized certificates of religious exemption provided by the HEAV expressing that the administration of immunizing agents conflicts with our children's/our religious tenets and practices. The documents say we "understand, that in the occurrence of an outbreak, potential epidemic or epidemic of a vaccine-preventable disease, the State Health Commissioner may order our children's exclusion from school, for our children's/our own protection until the danger has passed." This law, HB2306, "exempts a person, including a parent or guardian on behalf of a child, who objects to administration of a vaccine on religious grounds from mandatory immunization requirements issued by the Commissioner of Health during an epidemic." Epidemics don't change our religious convictions. We believe that our bodies are the temples of the Holy Spirit based upon the Word of God and therefore, we must choose what goes into them. We believe vaccines should never be forced on anyone because they can and do cause injury and death. We urge you to support HB 2306 for our religious freedom as well as for medical freedom to protect those of us who suffer a greater threat from the injection than from an epidemic. Thank you for your consideration.

I am asking you to support HB 2306. Religious freedom and medical freedom are human rights. We should be allowed to exercise these rights when and if we choose not to take a vaccine. Injections should never be forced on any person. Public health emergencies should not be used as reasons to take away these basic rights. During the COVID situation and continuing even now, people have been denied these basic rights. This bill would protect our freedom to exercise those rights. Please support this bill. Thank you, Susan Franz

Dear Delegate, I am contacting you to request your support for Delegate Freitas' House Bill 2306, which will be considered tomorrow, Tuesday January 24th. This bill ensures that Virginian's religious beliefs are held sacred and will be honored when choosing to reject any vaccination for themselves or their child. Vaccines can and do cause injury and death and should never be forced on anyone. Religious and medical freedom are basic human rights and should never be denied even in the case of an epidemic. Please pass this important bill that provides all Virginians the freedom to make medical decisions based on their religious practices and beliefs. Thank you.

I support this bill. Medical freedom is our fundamental right. Our country is not even recognizable. The government has no right to require any medical procedure against my will!

Comments Document

On behalf of the Virginia members and supporters of Americans United for Separation of Church and State, we oppose HB 2306, which would allow people to take religious exemptions from vaccination requirements during an epidemic, exactly when vaccines are most important to protect public health. The First Amendment to the U.S. Constitution does not require—and in fact prohibits—granting a religious exemption like the one in this bill. I therefore urge you to oppose HB 2306.

I support this bill so physical therapists can better serve their patients' recovery processes.

Comments Document

This bill gives Physical therapists the freedom to treat what we are trained to treat. This eliminates unnecessary follow up trips to MDs (who are already booked out months). Physical therapy is a doctorate level profession. We are trained to treat musculoskeletal issues. This bill will save money and increase efficiency with healthcare.

"To date, only two hospitals in the country received fines for failing to comply with the federal price transparency standards, both of which were in Georgia. Northside Hospital Atlanta was fined $883,180 and Northside Hospital Cherokee was fined $214,320. After being issued fines, both hospitals reformed their price transparency policies and PRA has recognized both as compliant." - 8/18/22 https://www.thecentersquare.com/virginia/hospitals-patient-group-dispute-virginia-price-transparency-compliance/article_2a320b84-1f1f-11ed-8583-df44a918a34b.html

Comments Document

On behalf of Independent Women’s Voice, an organization that fights for women and their loved ones by advocating for policy solutions that enhance freedom, opportunities, and well-being, I urge you to pass HB 2427, the healthcare price transparency legislation.

The Roanoke Regional Chamber is concerned that HB 2427 could drive up healthcare costs due to it providing for a new civil cause of action against hospitals. Legislation that sought to remedy the issue of price transparency already passed the General Assembly in 2022 (in a unanimous vote), with an effective date of July 1, 2023. We believe that the private right of action in HB 2427 will open up hospitals - many still struggling from the pandemic - to the potential for additional financial burden, even as hospitals are already required to provide price transparency under state and federal law. We respectfully ask the committee to oppose the bill.

Patients should be able to get the correct information to make the choice on their health care.

"To date, only two hospitals in the country received fines for failing to comply with the federal price transparency standards, both of which were in Georgia. Northside Hospital Atlanta was fined $883,180 and Northside Hospital Cherokee was fined $214,320. After being issued fines, both hospitals reformed their price transparency policies and PRA has recognized both as compliant." - 8/18/22 https://www.thecentersquare.com/virginia/hospitals-patient-group-dispute-virginia-price-transparency-compliance/article_2a320b84-1f1f-11ed-8583-df44a918a34b.html

Comments Document

The Healthcare Distribution Alliance (HDA) is the national trade association representing healthcare wholesale distributors, the vital link between the nation’s pharmaceutical manufacturers and more than 200,000 customers- pharmacies, hospitals, long-term care facilities, clinics and others nationwide. In Virginia, our members serve over 1,400 such customers. HDA opposes HB 2465. We believe the language would jeopardize the integrity of the drug supply chain and could further exacerbate drug shortages. The language: lacks necessary clarity; does not reflect the systems already in place for drug returns in Virginia and all other states except two which could lead to unfair business practices an d liability concerns; could create drug safety issues; and ultimately could lead to practices that could exacerbate drug shortages for Virginia patients. Therefore we respectfully request that HD 2465 not be advanced. Please see our submitted opposition letter for more information about our concerns.

Comments Document

The Healthcare Distribution Alliance (HDA) is the association representing the nation's wholesale pharmaceutical distributors. Drug supply chain security, integrity, and resiliency is top of mind for our members. On their behalf, HDA is concerned that the amendment proposed by HB 2465 would disrupt the supply chain. It's wording needs further clarity, and as it appears is not compatible with the existing supply chain structure. Additionally, extending the return window of drugs to 6 months after expiration could result in overbuying and stockpiling, ultimately exacerbating drug shortages. Therefore we respectfully request the subcommittee oppose this legislation. Please see our letter for more details. Thank you!

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

After 7 am meeting, then this one. HB 1689 - Please move to report. No one should die without benefit of spiritual help. *HB 1864 - No person should be required to input into their bodies something they don't want there, just to keep their job. We're not North Korea. *HB 1889 - Data shows that they are not at great risk of disease. HB 2057 - Why should people who have worked and paid thousands of dollars for decades, by denied Social Security because those who violated the law came here? Why shouldn't we put infrastructure and improve schools for African American communities FIRST BEFORE any others? Why do they deserve any thing before our veterans? Please PBI this bill. HB 2160 - In honor of those who lost family/friends & weren't allowed to see them at the end, please move to report. HB 2276 - The data is clear: children are not at risk of death from COVID. HB 2293 - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/comparingdifferentinternationalmeasuresofexcessmortality/2022-12-20 Sweden and Norway were essentially tied for the lowest “[p]roportional all-cause excess-mortality scores” (which “measure[] the percentage change in the number of deaths compared to the expected number of deaths (based on the five-year average [from 2015 to 2019])” among the listed European countries, looking at data from Jan. 2020 to June 2022: Their excess mortality was up 2.7%, compared to, say, 5.2% for Denmark, 7.1% for Finland, and 11.8% for the Netherlands. They had the lowest all causes death rate since COVID arrived and didn't do these long, lengthy lockdowns. Sweden had lower rate avg. excess death percentages: https://reason.com/wp-content/uploads/2023/01/ERGExcessMortality.xlsx https://www.baconsrebellion.com/wp/covid-19-update-still-lots-of-idle-hospital-capacity/ noted on 4/25/2000 Roanoke Valley had 80 cases, 6 hospitalizations and 0 deaths compared to Arlington with 764 cases, 137 hospitalizations, 29 deaths. Elective surgery was banned in both, although the whole of Roanoke Valley had 0 deaths. HB2489 - Please move to report so that men can be given the support to become strong fathers.