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.

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 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.

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

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

Eileen Roberts, President of Parents For Life - which serves as a collective voice for parents, educating the public and legislators throughout Virginia and the country for the need of public policy that protects minors and parental rights. It is wrong for parents to be denied access to their children's medical records, as we pay the insurance premiums and when things go wrong, medical malpractice - no procedure is entirely safe - Parents are the ones, parents like yourselves,. who are responsible for the financial costs when things go wrong, no the government. In my case the financial costs amounted to over $27,000, because my rights were denied. PARENTS FOR LIFE OPPOSE HB 2091 parentsforlifeva.org

HB 2091 reduces barriers and supports access to critical mental health care for vulnerable populations. Furthermore, it supports effective engagement in care for improved treatment outcomes.

When HB 2091 comes before you this week, I hope you will consider tabling these legislative changes. While there are many situations in which 14 year olds should not be considered adults, being able to access medical, mental, and sexual health services are situations where we need to trust our kids to reach out for help. The current legislation that allows a minor 14 or over to seek health care and own their medical records is a grace that grants children who are afraid of informing their parents an option to receive necessary care. There are more children growing up with physically and mentally abusive parents than we’d like to believe who will not seek certain health services for fear of their parents finding out. As a parent, I want my child to be healthy, and I would rather they received care without my knowledge than that they allowed their mental and physical health to degrade out of fear or embarrassment. In households with healthy relationships and open communication, this bill isn’t needed because parents are already partners in their children’s health. This bill will target children who don’t have other safe alternatives. Thank you.

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.

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.

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.

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.

"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.

I am a medical student and healthcare policy PhD researcher. I strongly support this bill because it is the most effective way to treat patients- supporting access to healthy diets. Clinical medicine and prescriptions can only do so much if the patient cannot eat well. However, it is often outside of a patients reach due to cost. This provides the clinician a critical tool in helping patients. Last - it is a cost effective solution. A change in diet that reduces the burden of diabetes is much cheaper than caring for a patient experiencing a significant disease burden such as amputations. It is not only the morally right thing to do but it is the financially right thing to do as well.

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!