I support this bill. Teachers need far more protections from what has become a hyper-sexualized punish first, punish last system whereby one is guilty until proven innocent. When I was accused and subsequently found guilty absent "beyond a reasonable doubt" evidentiary standard, all appeals were effectively vacated. Appeal to the useless courts? Nope, courts are required to adhere to the trial court's view unless extraordinary circumstances are met (justice isn't one of them). A review before firing only allows the school to prove you were convicted of a felony, something a precocious 5th grader can do. We need to enact this, and far better safeguards for all those of us whose lives were destroyed on mere accusations and assumptions.

I write in support of House Bill Number 1550 to allow teachers with a founded Child Protective Services Complaint a trial de novo in Circuit Court after state appeals are exhausted. Founded CPS dispositions can occur when teachers defend themselves or defend students in the good faith performance of their teaching duties. Our Virginia Circuit Court due process protections for the wrongly and falsely accused would safeguard teachers' good faith performance of their duties at a time when teachers' safety and the safety of the students are physically threatened. James G. Hunter, III Attorney, Lynchburg

I am an attorney and have represented several individuals who are school personnel accused of abuse. An administrative hearing is very different than a trial. The review by a Circuit Court under the administrative process act is not a meaningful review and is only whether a reasonable fact-finder could have come to the conclusion of the administrative panel. School personnel who have a founded complaint lose their careers. They lose what they have spent years studying for, what they have dedicated their lives towards working for, what they define themselves as. The stakes are much higher for them than the general public. I don't foresee the additional protections of this bill being widely used or being burdensome on DSS or the Courts. While school personnel often have allegations of wrongdoing the majority of these reports are screened out or the initial determination will be unfounded. The small percent that have an initial determination of founded will then go to an informal hearing. These are conducted in a variety of manners around the state. Some allow you to questions witnesses, and present evidence, others do not. Some are conducted not by a neutral party but by the local director who may have been involved in making or approving the initial determination. However the process goes, many of the initial determinations do get reversed prior to going to the state level administrative appeal.

My name is Monica Mroz, and I am an attorney with Strelka Employment Law in Roanoke, Virginia. For the last 15 years, I have represented Virginia teachers in various administrative settings, including defending them against CPS complaints. Though CPS views itself as a non-penal agency, I have seen firsthand the devastating impact that an unwarranted CPS complaint can have on a teacher's livelihood. Complaints can be made anonymously and the threshold for screening in a complaint for investigation is extremely low. It is extraordinarily rare for a complaint to be screened out. Unlike the family setting, where CPS can choose to do a family assessment (a process designed to identify education opportunities and needed services) instead of an investigation, when the target of the complaint is an educator, there is only one track: investigation. Investigations have no end but a "finding." Findings are made by a preponderance of the evidence, only. The impact of a finding (after all appeals have been exhausted) against an educator results in licensure revocation (by operation of statute) and entry into a database for 3 to nearly 20 years, depending on the level of the finding. Presence in the database results in teachers being unable to work, or even volunteer to work, with children for the operative period. Initial findings are made by the investigator with a supervisor's approval. There are two intra-agency appeals--one to the Director of the local agency who is the decisionmaker, and one to a hearing officer. While the teacher can bring witnesses, there is no similar ability to compel witnesses, as one may do in court, and rules of evidence do not apply, which permits a great deal of unreliable evidence into the proceedings. As mandatory reporters, school systems have adopted a very cautious aspect, frequently exercising little critical judgment over whether a complaint actually constitutes abuse or neglect, and report as a matter of course. A teacher does have right to counsel, even in their initial interview with CPS during the investigation, but many school system administrations focus on "getting the process over with" once the report has been made, as during the investigation, the teacher is most often placed on administrative leave. The teacher is often pressured to participate in an interview with CPS, immediately, and frequently on school grounds with their administrator present. I have worked with many different local CPS agencies, and do believe the investigators do their best, but find that many are unprepared or overworked, and perhaps not cognizant of the far reaching effects of their investigations and conclusions. Ensuring a circuit court trial for teachers would provide a much needed extra layer of protection for our educators who devote their careers to caring for and securing our children. I have long thought this process, while no doubt conceived to protect children, has gone too far, and the unintended consequence has been to actually remove good and caring teachers from our schools. Thank you for allowing me to speak--please give our teachers this additional layer of process so that they may protect their livelihoods, and so that further miscarriages of justice may be prevented.

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,

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.

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.

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.

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.