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Final Thoughts heading to Appropriations. HOPEFULLY the various Committee and Subcommittee members have read and followed comments as concerns were registered statewide. Caution has been provided in how the BH System will be affected if moved forward. This would have been extremely important for Legislators patroning bills for SB34 and HB608 to have spoken to constituents expressing concern, their CSB who could have provided ACCURATE and INSIGHTFUL information that would have aided in understanding concern and the right thing. Contact your STAKEHOLDERS WHO WILL BE impacted by proposed bills and despite instead providing or supporting messages as if it is a relief for their benefit. They certainly know the landscape and who works for their interest. They would have appreciated being contacted about their TRUE pressure points with plenty of opportunity to do so. True partners work toward mutual interests and our community – not one system’s. Those not willing to have conversations or demonstrate transparency burden our law enforcement, emergency departments and citizens every day. Yet – messages are that it is for their benefit. Without the willingness to meet with stakeholders – or to demonstrate transparency – will not lead to the change needed. Misleading and inaccurate information to support an initiative – does not move toward meeting public interests. I trust that those governing and supporting our citizens have done their due diligence on the facts, issues and impacts. If so, moving forward with such a bill, a monumental shift in public policy would NOT HAVE weighed public interests --- but rather demonstrate favor = not for those systems, the behavioral health, public policy and not in alignment with other GA interests. Not in consideration of the liberties of your citizens. Moving forward ignores the caution identified in Financial Impact Statements and TDO Evaluator Workgroup report that was legislature directed. All expect burden to the system if such a bill were enacted. Certainly, that could not be ignored. Certainly – if so repercussions to citizens – to community. It would erode trust. The conflict of interest should worry those moving this forward, if the case. It impacts private providers who value transparency and partnerships will be impacted both initially and long term. Immediately it further undermines other hospital systems who are investing in the community. Also, with the budget request Item296#4h – further incentive while controlling a process for one provider. Any decision moving forward ignores important recommendations of JLARC – but remember – liberties are at stake. I’m hoping this is read and no decision to enact would move forward without having done so. Trust your gut. --- how would sacrificing all the principals make since here? It would not.

The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services. I am actively opposed to this as it does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital

This bill would drastically change the current structure of our mental health system and not in a positive way. CSBs work diligently to provide services that advert psychiatric hospitalizations by providing additional services that provide a least restrictive alternative. I believe this change would lead to an increase in unnecessary TDOs which is not in the best interest of the individual, but also puts an unnecessary strain on resources such as law enforcement and state facilities that are already operating at maximum capacity.

This does nothing to speed up the process or get law enforcement “back out on the streets”, but instead, will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital. The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

This bill would require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties. The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

We respectfully request that you do not enact SB34. This bill authorizes a single private behavioral health hospital to evaluate individuals in a behavioral health crisis to determine whether they meet the criteria for a Temporary Detention Order for involuntary psychiatric hospitalization. Community Services Boards are opposed to this bill, as are experts in the field who have studied this issue for decades. See expert letter and from Dr. Richard Bonnie, Dr. Heather Zelle, and Attorney John Oliver on this issue. They also strongly oppose SB34. Doesn’t anyone care that this bill have a conflict of interest? The inpatient provider would also determine where the patients would be hospitalized, which could be their own facility. As per the Code, the evaluator should be independent and have no financial interest. If the evaluator is employed by the hospital, that is a clear conflict of interest and we ask that you to not support this, or at least obtain a legal opinion before changing the code of Virginia for a single provider, even as a pilot! Allowing the provider to absorb the financial impact of this bill in order to move it forward seems like another conflict of interest. Allowing the provider to use their financial resources to pay for the cost of implementing the bill seems to be yet another conflict! Another fiscal impact noted in the proposed bill, is that this change to the code will increase the state hospital census. It has been suggested that in order to prevent this, the bill could be amended to require the CSB to complete a second prescreening evaluation whenever the Psych ED determines that someone needs to be hospitalized. This modification would require fragile individuals who are experiencing a mental health crisis to undergo TWO evaluations, thereby increasing the time spent in the ED. This also places an additional burden on your CSB to carry out all of the required duties of the bed search and placement if the individual is indeed in need of hospitalization, while relieving the Psych ED of that responsibility. This does not help the patient nor the system. Ask yourself why this is necessary. Whom does it serve? It serves the private behavior health provider, not your public CSB and above all not the individual patient lingering in the ED. PLEASE DO NOT SUPPORT THIS BILL. PLEASE SEND IT TO THE BEHAVIORAL HEALTH COMMISSION WHERE IT CAN BE FURTHER STUDIED.

Greetings members of the Health and Human Services Committee, Please oppose this bill as it does not address psychiatric bed availability or streamline care for those in need of acute behavioral health treatment. What has been working to streamline care and treatment is the CSB system operating as an objective party with extensive knowledge of community resources and specializing in strategies to link individuals in crisis to the least-restrictive alternatives. Thus avoiding hospitalization whenever possible. This also serves to maximize linkage to the General Assembly funded STEP-VA mandates and Crisis Now community-based services. Please see attached and thanks for your consideration.

As a certified prescreener I oppose SB34. Our issues with placement have nothing to do with the evaluation response times. It has everything to do with psychiatric hospital acceptance who ultimately are the ones who determine if they accept or do not accept our individual’s. We complete multiple bed searches per shift. Individuals who do not fit the “perfect” psychiatric criteria (meaning they are acute, have ID issues, or any physical limitations) may sit in the ED for days until state hospitals have an available bed. Again, this has nothing to do with assessment response times. Our agency responds within an average of minutes after an evaluation is requested. This bill will UNDERMINE everything that we have done to reduce TDO’s as we have so many less restrictive options that hospitals are unaware of. Our last resort is always a TDO. Private hospitals do not have the options that we have to ensure the best and least restrictive options. This bill Would be a monumental shift in public policy enacted decades ago to ensure that the least restrictive alternative is always considered and avoiding inappropriate TDOs; Ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup which just presented their findings on December 29, 2021; Directly contradicts efforts and General Assembly’s investments in STEP-VA; and counters recommendations in the JLARC Study issued in Dec. 2023 and is inconsistent with goals of moving Virginia toward a Crisis Now System; Ignores caution identified in the Financial Impact Statements for both SB34 and HB608 which anticipates enactment would increase the number to TDO admissions to the state hospital. Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. Hospitals maintain control whether they will admit or not admit; Does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital; Would require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties; Provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed; The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

The amount of opposition is a testament to the inappropriateness of measures proposed to be taken. First, it appears to disregard research designed to promote best practices regarding this area of concern. Second, it appears to be in direct opposition to the goals set forth by the Commonwealth to ensure concerns are addressed in a comprehensive manner. Third, it seems to provide a limited view of challenges it is designed to address. Thus, the bill does not accurately or adequately address its intended purpose, and does not need to be supported.

I strongly oppose SB 34 for the following reasons: This would be a monumental shift in public policy enacted decades ago to ensure that the least restrictive alternative is always considered and avoiding inappropriate TDOs. It ignores and circumvents the concerns and recommendations of the legislature directed TDO Evaluator Workgroup which just presented their findings on December 29, 2021. Passing of SB 34 directly contradicts efforts and General Assembly’s investments in STEP-VA, counters recommendations in the JLARC Study issued in Dec. 2023, and is inconsistent with goals of moving Virginia toward a Crisis Now System. It would also cause delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. Hospitals maintain control whether they will admit or not admit. Unfortunately, this will do nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital. Passing SB 34 would also require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties. This would also provide private hospitals, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed. As you are aware, CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

I am responding to voice strong opposition to SB34. Enabling this legislation to move forward would be a monumental shift in public policy enacted decades ago to ensure that the least restrictive alternative is always considered and avoiding inappropriate TDOs. This also provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed. It has been suggested that the magistrate is the one that determines whether or not a TDO is recommended and choice of placement; however, it is the CSBs responsibility as an unbiased party, to assess, make the recommendation, and determine placement location. SB34 ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup which just presented their findings on December 29, 2021. It also directly contradicts efforts and General Assembly’s investments in STEP-VA; and counters recommendations in the JLARC Study issued in Dec. 2023 and is inconsistent with goals of moving Virginia toward a Crisis Now System. It ignores caution identified in the Financial Impact Statements for both SB34 and HB608 which anticipates enactment would increase the number to TDO admissions to the state hospital. It is important to note that delays in the system are due to individuals being unable to access an accepting bed, not difficulties obtaining an evaluation or waiting extensive times for those evals. Hospitals maintain control whether they will admit or not admit and an individual to be placed on a waiting list. This does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital. This also would require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ rights. In conclusion, the CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services. Part of the success of these programs that have been stood up to assist in decreasing hospitalization rates by DBHDS is that there are staff working in the CSB who are knowledgeable of the resources and who are committed to referring to those programs to avoid hospitalization.

***Please disregard the previously submitted version of this letter (dated 2/20/24) which was inadvertently sent on UVA letterhead. The signatories are submitting this letter in their personal capacities. It does not reflect the positions or policies of the University. The prior submission on UVA letterhead on February 20, 2024 was unintended. *

I am the Divisional Director of our CSB's Crisis Services. I STRONGLY OPPOSE this legislation (SB34). It is misguided in its efforts that it will reduce the wait time for evaluations and obtaining a hospital bed and will somehow quickly return officers back to their intended duties of law enforcement. Delays in the system are due almost exclusively to individuals being unable to access an accepting bed, not for an evaluation. Hospitals have the ultimate authority and maintain control whether they will admit or not admit the individual. This Bill will not change that process. The proposed legislation does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospitals. There should only be one access point to the state hospital system. This would override that process. This Bill will provide a private hospital, with financial interest in the outcome, authority to determine choice of facility for the TDO, whether to their own - or by having direct access to State Hospital Bed. This flies in the face of the General Assembly’s investments in STEP-VA; and counters recommendations in the JLARC Study issued in Dec. 2023.

The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services. This Bill, if approved, would undermine the intent of "objective 3rd party" weighing in on need for compulsory inpatient psychiatric treatment and provide a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed. Furthermore, does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital. Bad bill anyway you look at it.

•OPPOSE : Would be a monumental shift in public policy enacted decades ago to ensure that the least restrictive alternative is always considered and avoiding inappropriate TDOs; • Ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup which just presented their findings on December 29, 2021; • Directly contradicts efforts and General Assembly’s investments in STEP-VA; and counters recommendations in the JLARC Study issued in Dec. 2023 and is inconsistent with goals of moving Virginia toward a Crisis Now System; • Ignores caution identified in the Financial Impact Statements for both SB34 and HB608 which anticipates enactment would increase the number to TDO admissions to the state hospital. • Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. Hospitals maintain control whether they will admit or not admit; • Does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital; • Would require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties; • Provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed; • The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

I strongly oppose SB34. I have outlined my opposition below. • Would be a monumental shift in public policy enacted decades ago to ensure that the least restrictive alternative is always considered and avoiding inappropriate TDOs; • Ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup which just presented their findings on December 29, 2021; • Directly contradicts efforts and General Assembly’s investments in STEP-VA; and counters recommendations in the JLARC Study issued in Dec. 2023 and is inconsistent with goals of moving Virginia toward a Crisis Now System; • Ignores caution identified in the Financial Impact Statements for both SB34 and HB608 which anticipates enactment would increase the number to TDO admissions to the state hospital. • Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. Hospitals maintain control whether they will admit or not admit; • Does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital; • Would require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties; • Provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed; • The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

As you have seen in public comment for SB34 and previously HB608 - great concern is seen around the commonwealth. Please note the following. • Would be a monumental shift in public policy enacted decades ago to ensure that the least restrictive alternative is always considered and avoiding inappropriate TDOs; • Ignores and circumvents the concerns and recommendations of the legislature directed TDO Evaluator Workgroup which just presented their findings on December 29, 2021; • Directly contradicts efforts and General Assembly’s investments in STEP-VA; and counters recommendations in the JLARC Study issued in Dec. 2023 and is inconsistent with goals of moving Virginia toward a Crisis Now System; • Ignores caution identified in the Financial Impact Statements for both SB34 and HB608 which anticipates enactment would increase the number to TDO admissions to the state hospital. • Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. Hospitals maintain control whether they will admit or not admit; • Does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital; • Would require significant adjustments or exceptions for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties; • Provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether to their own facility or direct access to State Hospital Bed; A budget amendment is being introduced to provide private hospitals incentive to take more TDOs. To share the burden of state hospitals - not circumstances such as this. to • The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services.

This bill does nothing to speed up the process or get law enforcement “back out on the streets” but instead will enable the provider to assert additional control over the local publicly funded resources, including law enforcement and the state hospital.

I voice my strong opposition to Senate Bill 34. The issue of Behavioral Health is not a partisan issue. However, this bill would prove to be a monumental shift in public policy with significant immediate and future implications. The General Assembly enacted the current legislation decades, A recent workgroup (December 2021) evaluating such matter, comment on the preadmission evaluation, also noted that: “It is a pivotal point within the larger civil commitment process because if involuntary treatment is recommended and a TDO is issued, the individual in crisis is deprived of his or her liberty” and did not recommend such exception

We strongly oppose SB34! As the Executive Director of the Hampton-Newport News CSB, which is the CSB that represents this district, we are strongly opposed to this bill. In addition to what has already been written repeatedly from CSBs across the Commonwealth, there has been some misunderstanding or misrepresentation as to why this change is needed. It has been stated that due to the backlog at our CSB the ECOs are running out. That is untrue and easily verifiable. It was also stated that CSBs conduct prescreening evaluations on computer screens. Well, that is called telemedicine and is an approved clinical practice. If telemedicine is a concern, we can address that. It was also stated during testimony that there are duplicate assessments. While an individual may undergo multiple assessments, there is only one prescreening assessment and that is completed by the CSB. It was also stated that having a private entity conduct the prescreening assessment will get law enforcement back on the street faster. This is also untrue, law enforcement's obligation is under the TDO, regardless of who completes the prescreening assessment. Please question the information that is presented, and review the law and roles involved in the TDO process under the code of Virginia. It would be great to have the office of the Attorney General weigh in on the conflict of interest or legality of a process that allows for a provider who has a financial interest, conduct prescreening evaluations and bed searches. Thank you for your consideration.

Strongly oppose.

I am strongly opposed to SB34 due to conflation of interest between public and private entities. Please consider that referring clients to your own practice/hospital system is both a legal and ethical dilemma. Ability to detain their own clients to their own hospital system is a conflict of interest. This also allows ability to not detain 'problem' clients and risks the objectivity inherent in maintaining prescreeners as part of a public entity (e.g. CSB) with oversight of DBHDS.

My name is Dean Barker and I have been a Preadmission Screener in Virginia for 32 continuous years now. In that time I have seen a number of legislative changes made. The value of a historical perspective is that changes are always made in reaction to circumstances or specific situations that may or may not be indicative of systemic changes. Often times, it's difficult to properly gauge what changes are necessary versus reactionary. I specifically recall a time in the early 1990s when entities other than the CSBs could request TDOs from magistrates. In those times, I recall multiple events of private hospitals asking for and being given TDOs on persons in their facilities when they were unable to verify insurance benefits. This specific circumstance occurred enough that it was the basis of the inclusion of language stating no person can request a TDO who has a financial interest in the case. I believe, the General Assembly at that time in its wisdom added that language to guard that the least restrictive alternative be utilized while diminishing the possibility of decisions being made out of convenience. I also recall, during this time Veterans at the VA Hospital being TDO'd by psychiatric residents when they were unsure of VA procedures to enroll someone in outpatient services. These cases were never handled this way out of malicious intent however, an involuntary detention for several days, a deprivation of liberty, a potential unwarranted restriction of gun rights are things to be taken into account with someone's choice and the assessment of their ability to make informed decisions. This bill opens the door for private entities to restrict rights with minimal oversight beforehand. The Magistrate's Office issues the TDOs and in testimony given the subcommittee, this was offered as a check-balance of the system. Part of the legislative changes of 2015 changed the Magistrate's portion from "MAY ISSUE" to "SHALL ISSUE". While this change addressed some of the issues from the Deed's tragedy it in the context of this bill opens the door to dangerous control being transferred from the State to Private individuals in direct and immediate response to a deprivation of liberty. Ideas are consistent, not convenient. I am strongly opposed to this bill.

Good morning. I am writing in opposition to SB 34 (Locke) which proposes to open TDO assessments to practitioners employed by Riverside Health System in Newport News and Hampton, Va. I am the retired Executive Director of the HNNCSB where my career began in 1979 and ended with my retirement in 2016. The conflict of interest by having a private practitioner, despite the role of a Magistrate, deciding on the competence of and possible commitment to their own facility is not acceptable. Please see my recent letter to Senator Deeds (attached) which identifies my other concerns about this bill.

I, as many others with whom I work in mental health STRONGLY OPPOSE this bill. It will not do the things it purports to do. Further, It directly contradicts efforts and General Assembly’s investments in STEP-VA It counters recommendations included in the last 2 JLARC studies It is inconsistent with the goals of moving Virginia toward a Crisis Now System & Gov. Youngkin’s Right Help Right Now legislation, the Prompt Placement Task Force & other investments in crisis services; Significant adjustments or exceptions would be required for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties. It ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup just providing findings on December 29, 2021. It ignores caution included in Financial Impact Statement of both SB34 and HB608 It provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether their facility or direct access to State Hospital Beds And enables a private hospital to direct and further tax local publicly funded resources Again, strongly opposed to this Bill. Gregory G Braund, LCSW

• I voice my strong opposition to Senate Bill 34. The issue of Behavioral Health is not a partisan issue. However, this bill would prove to be a monumental shift in public policy with significant immediate and future implications. The General Assembly enacted the current legislation decades, A recent workgroup (December 2021) evaluating such matter, comment on the preadmission evaluation, also noted that: “It is a pivotal point within the larger civil commitment process because if involuntary treatment is recommended and a TDO is issued, the individual in crisis is deprived of his or her liberty” and did not recommend such exception • SB34, submitted at the request of a private hospital ignores and circumvents the concerns and recommendations that a legislature-directed Workgroup studying this very matter had just issued their findings, Dec. 29, 2021. The Workgroup studying, “Who Should Conduct TDO Evaluations in Virginia”, consisting of “representatives from Virginia’s community services boards (CSB), community hospitals, law enforcement, mental health advocates, and other stakeholders”[3], like those previous workgroups evaluating this matter, did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. Instead, the Workgroup identified a number of the concerns, as previous studies had, including how such allowances would not account for complexities of the system and may unwind decades old legislation, which has been referred to as the “bedrock of the public behavioral health system”, including areas needing consideration when evaluating any code changes which would expand who could conduct preadmission evaluations to include: Conflict of interest – including “any potential for real or perceived bias” Connection to community resources, noting “the critical role of the CSB connecting individuals to alternatives to inpatient hospitalization”. “Potential increase in TDO admissions. Evaluators who work in private hospital settings may not be fully aware of all the community alternatives to the state psychiatric hospitals, and the workgroup expressed that this could inadvertently lead to an increase in TDO disposition. This would put additional strain on the state mental health hospital system, which is already suffering significant census pressures and staffing shortages” • The Report, like SB34 and HB608 Financial Impact Statements,, anticipates that enactment of either Bill would increase the number to TDO admissions to the state hospital. Despite CSBs playing such a critical role at all aspects of the Behavioral Health system, at no time were we consulted on the needs, of any concerns nor was the potential impact on stakeholders considered.

I am greatly concerned that SB34 and HB608 Financial Impact Statements anticipates that enactment of either Bill would increase the number to TDO admissions to the state hospital. In my Region, forensic evaluations take up most of my state hospital admissions, causing individuals to be further displaced from their homes. Isn't the goal of hospitalization to return individuals to the community in the most person centered way where they can connect with local services to reduce the need for restrictive services? It also seems that there has not been much consideration for another major player in the current TDO process, the CSBs. Despite CSBs playing such a critical role at all aspects of the Behavioral Health system, to my understanding they have had limited consultation on any of their concerns nor the potential impact on stakeholders considered. I strong opposition to Senate Bill 34.

On behalf of Portsmouth Behavioral Healthcare Services, we strongly oppose SB34.

I strongly opposed SB34. John Konkel, LPC Emergency Services Coordinator CIT Coordinator Marcus Alert Coordinator Eastern Shore CSB Cell: 757-693-3653 Office: 757-442-3636 ext 330

Strongly oppose on behalf of Harrisonburg-Rockingham Community Services Emergency Services Department

Good morning, I have worked in Emergency Services for over 30 years and have seen many changes in code relating to the Emergency Custody and Temporary Detention processes. I am also aware that the mental health "system" has current challenges, none of which will be resolved by this bill. This bill, if passed, would change decades-worth of improvements to the "system". Allowing a private facility to detain to their own facility is a blatant conflict, does not adhere to current code, and will not resolve any of the challenges that currently exist. I want to add that I work with many wonderful staff at Riverside Mental Health and Recovery Center and some I consider friends. My position is not against them in any way, but against this bill, that will not help the challenged mental health system in ANY way, and only hinder it.

I voice my strong opposition to Senate Bill 34. The issue of Behavioral Health is not a partisan issue. However, this bill would prove to be a monumental shift in public policy with significant immediate and future implications. The General Assembly enacted the current legislation decades, A recent workgroup (December 2021) evaluating such matter, comment on the preadmission evaluation, also noted that: “It is a pivotal point within the larger civil commitment process because if involuntary treatment is recommended and a TDO is issued, the individual in crisis is deprived of his or her liberty” and did not recommend such exception

I voice my strong opposition to Senate Bill 34. The General Assembly enacted the current legislation decades ago to protect individuals and their liberties. SB34, submitted at the request of a private hospital ignores and circumvents the concerns and recommendations that a legislature-directed Workgroup studying this very matter had just issued their findings, Dec. 29, 2021. The Workgroup studying, “Who Should Conduct TDO Evaluations in Virginia”, consisting of “representatives from Virginia’s community services boards (CSB), community hospitals, law enforcement, mental health advocates, and other stakeholders”, like those previous workgroups evaluating this matter, did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. Instead, the Workgroup identified a number of the concerns, as previous studies had, including how such allowances would not account for complexities of the system and may unwind decades old legislation, which has been referred to as the “bedrock of the public behavioral health system”, including areas needing consideration when evaluating any code changes which would expand who could conduct preadmission evaluations to include: Conflict of interest – including “any potential for real or perceived bias” Connection to community resources, noting “the critical role of the CSB connecting individuals to alternatives to inpatient hospitalization”. In addition to changes in the codes and other regulatory, local, state, and regional protocols this action directly contradicts Other Critical Investments in VA's Behavioral Health System: Directly contradicts efforts and General Assembly’s investments in STEP-VA; Counters recommendations included in the last 2 JLARC studies; Inconsistent with the goals of moving Virginia toward a Crisis Now System & Gov. Youngkin’s Right Help Right Now legislation, the Prompt Placement Task Force & other investments in crisis services; Significant adjustments or exceptions required for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties; Ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup just providing findings on December 29, 2021; Provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO; Enables a private hospital to direct and further tax local publicly funded resources. Do not allow the role of the preadmission evaluation to be minimized, devalued or to be regarded as “duplicative”. It is not a duplicative assessment, but rather a determination if an individual may lose their liberties, and as the legislation enacted must ensure that least restrictive alternatives must always be considered for the Commonwealth's most vulnerable citizens. Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. CSBs responsiveness is not an issue and we strictly adhere to performance contract standards.

I voice my strong opposition to Senate Bill 34.  This bill would prove to be a monumental shift in public policy with significant immediate and future implications. SB34, submitted at the request of a private hospital, ignores and circumvents the concerns and recommendations that a legislature-directed Workgroup issued in their findings, Dec. 29, 2021.    The Workgroup studying, “Who Should Conduct TDO Evaluations in Virginia”, consisting of “representatives from Virginia’s community services boards (CSB), community hospitals, law enforcement, mental health advocates, and other stakeholders”[3],  did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. Instead, the Workgroup identified a number of the concerns, as previous studies had, including how such allowances would not account for complexities of the system and may unwind decades old legislation. Evaluators who work in private hospital settings may not be fully aware of all the community alternatives to the state psychiatric hospitals, and the workgroup expressed that this could inadvertently lead to an increase in TDO disposition.  This would put additional strain on the state mental health hospital system, which is already suffering significant census pressures and staffing shortages. Despite CSBs playing such a critical role at all aspects of the Behavioral Health system, at no time were we consulted on the needs or any concerns, nor was the potential impact on stakeholders considered. SB34, like HB608, would authorize newly designated “certified evaluators”, employed by a private facility, to recommend issuance to the magistrate for a TDO.  It enables the private hospital to identify the TDO facility, whether their own facility or now with direct access to state hospital beds.  Fundamentally, this poses the position of a private entity’s financial interests being a consideration, real or perceived, in the outcome of this determination, while simultaneously dismissing the importance of an individual’s civil liberties.  The Financial Impact Statements for both Bills and the Dec. 2021 TDO Evaluator Workgroup Study (pg. 16), all anticipate that if enacted, would increase the number of individuals evaluated and TDO’d. Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation.  The provider and VHHA’s testimony were misleading and did not demonstrate an appreciation for civil liberties being discussed.  Testimony indicating that such an allowance would lead to more timely access to an evaluation is inaccurate and characterized patients as waiting for CSB to evaluate, delaying care, which is also inaccurate.  Current waits are  related to securing an accepting bed, which this bill does nothing to address.  CSBs strictly adhere to performance contract standards with regard to evaluation times. This allowance does nothing to speed up the process or get law enforcement “back out on the streets”.  Instead, it will enable the provider  to assert additional control over the local publicly funded resources and the state hospital. The Code is also very clear on matters related to financial consideration, noting in §37.2-817.01, regards to the evaluator,  - (g) have no financial interest in the admission, treatment, or denial of admission of the person being evaluated; (h) have no investment interest in the facility detaining or admitting the person under this article;[9].

I voice my strong opposition to Senate Bill 34. This bill would prove to be a monumental shift in public policy with significant immediate and future implications. SB34, submitted at the request of a private hospital, ignores and circumvents the concerns and recommendations that a legislature-directed Workgroup issued in their findings, Dec. 29, 2021. The Workgroup studying, “Who Should Conduct TDO Evaluations in Virginia”, consisting of “representatives from Virginia’s community services boards (CSB), community hospitals, law enforcement, mental health advocates, and other stakeholders”[3], did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. Instead, the Workgroup identified a number of the concerns, as previous studies had, including how such allowances would not account for complexities of the system and may unwind decades old legislation. Evaluators who work in private hospital settings may not be fully aware of all the community alternatives to the state psychiatric hospitals, and the workgroup expressed that this could inadvertently lead to an increase in TDO disposition. This would put additional strain on the state mental health hospital system, which is already suffering significant census pressures and staffing shortages. Despite CSBs playing such a critical role at all aspects of the Behavioral Health system, at no time were we consulted on the needs or any concerns, nor was the potential impact on stakeholders considered. SB34, like HB608, would authorize newly designated “certified evaluators”, employed by a private facility, to recommend issuance to the magistrate for a TDO. It enables the private hospital to identify the TDO facility, whether their own facility or now with direct access to state hospital beds. Fundamentally, this poses the position of a private entity’s financial interests being a consideration, real or perceived, in the outcome of this determination, while simultaneously dismissing the importance of an individual’s civil liberties. The Financial Impact Statements for both Bills and the Dec. 2021 TDO Evaluator Workgroup Study (pg. 16), all anticipate that if enacted, would increase the number of individuals evaluated and TDO’d. Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. The provider and VHHA’s testimony were misleading and did not demonstrate an appreciation for civil liberties being discussed. Testimony indicating that such an allowance would lead to more timely access to an evaluation is inaccurate and characterized patients as waiting for CSB to evaluate, delaying care, which is also inaccurate. Current waits are related to securing an accepting bed, which this bill does nothing to address. CSBs strictly adhere to performance contract standards with regard to evaluation times. This allowance does nothing to speed up the process or get law enforcement “back out on the streets”. Instead, it will enable the provider to assert additional control over the local publicly funded resources and the state hospital. The Code is also very clear on matters related to financial consideration, noting in §37.2-817.01, regards to the evaluator, - (g) have no financial interest in the admission, treatment, or denial of admission of the person being evaluated; (h) have no investment interest in the facility detaining or admitting the person under this article;[9].

I wanted to voice my strong opposition to SB 34. I am the emergency services director for one Virginia's 40 CSBs. While I understand this bill is intended to be very limited in scope, I wanted to give an example of just how many citizen's rights are likely to be infringed upon by this bill. In FY 2023, my team released 176 people that we were asked to evaluate by local psychiatrists in hospitals. These are 176 people that would, under SB 34, be placed into involuntary hospitalization unnecessarily, and this total represents just 1 of the 40 CSBs in the state. More alarmingly, our team found 75 people actually were voluntary for treatment after having the involuntary hospitalization system explained and hearing our recommendation. This is another 75 people who would have unnecessarily been TDO'd and had their rights removed, due largely to a lack of understanding of process, under SB 34. Again, this is 1 of 40 CSBs in the state, and this is just in the last fiscal year. The unnecessary infringement of rights this bill would cause for people seeking mental health help in the Commonwealth is an ethical nightmare. The hospital bed space situation in the state is already disastrous, consider what that would look like when you add these 251 people x40 CSBs across the state to the pool each year. The Right Help Right Now model that the commonwealth is pursuing is meant to increase community based services and lessen the need for emergency and psychiatric hospital treatment, it'sunclear to me why we are perusing a bill that is the antithesis of this goal.

I voice my strong opposition to Senate Bill 34. In addition to code changes and other regulatory, local, state, and regional protocols, this action directly contradicts Other Critical Investments in Virginia’s Behavioral Health System as outlined below: o Directly contradicts efforts and General Assembly’s investments in STEP-VA o Counters recommendations included in the last 2 JLARC studies o Inconsistent with the goals of moving Virginia toward a Crisis Now System & Gov. Youngkin’s Right Help Right Now legislation, the Prompt Placement Task Force & other investments in crisis services; o Significant adjustments or exceptions would be required for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties. o Ignores and circumvents the concerns and recommendations of the legislature-directed TDO Evaluator Workgroup just providing findings on December 29, 2021. o Ignores caution included in Financial Impact Statement of both SB34 and HB608 o Provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether their facility or direct access to State Hospital Beds o The Code is also very clear on matters related to financial consideration, noting in §37.2-817.01, regards to the evaluator, - (g) have no financial interest in the admission, treatment, or denial of admission of the person being evaluated; (h) have no investment interest in the facility detaining or admitting the person under this article;[9]. Similar concerns were addressed in the TDO Workgroup’s Report issued on Dec. 29, 2021. The fact is, Magistrates must have reliable, unbiased recommendation that evaluates least restrictive alternative.

I am strongly opposed to Senate Bill 34. This bill would prove to be a monumental shift in public policy with significant immediate and future implications. It would reverse strides made in the past by removing the previous protections enacted by the General Assembly and actually counters recommendations included in the last 2 JLARC studies. It would also circumvent the concerns and recommendations outlined in the findings of a legislature-directed Workgroup that studied these matters and subsequently did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. There are extremely clear conflict of interest concerns which should not be dismissed when making decisions regarding a process that impacts the civil liberties of individuals in crisis. As history has demonstrated and recent reports have indicated, enactment of this Bill would open the door to increasing TDO admissions to an already overburdened state hospital system. Delays in the system are due to individuals being unable to access an accepting hospital bed, not due to the timeliness of an evaluation. In fact, this legislation would most certainly make the situation worse by increasing bed utilization and thereby the number of available beds. The CSBs are an objective party with extensive knowledge of community resources and specialize in strategies to link individuals in crisis to the least-restrictive alternatives; thereby maximizing linkage to the General Assembly funded STEP-VA and Crisis Now community-based services. Any deviation from this centralized and specialized role will create system vulnerabilities and set a precedent for private access to precious public resources that will worsen citizen access to beds, not help it. In addition, the Code is very clear on matters related to financial consideration, noting in §37.2-817.01, in regards to the evaluator: (g) have no financial interest in the admission, treatment, or denial of admission of the person being evaluated; (h) have no investment interest in the facility detaining or admitting the person under this article;[9]. Similar concerns were addressed in the TDO Workgroup’s Report issued on Dec. 29, 2021. It is my sincere hope that you will take note of the lessons history has taught us, the undeniable conflict of interest issues, the advisory groups who advise against this change, and vote against this bill to avoid damaging repercussions with a long-lasting impact. Thank you for your service and commitment to the safety and liberties of Virginia citizens.

Senate Bill 34 allows a pathway for private hospitals to utilize the pre-screening process to select which people to accept and which ones will ultimately, most likely, end up in State hospitals. Although the private provider requesting this permission reduces this dialogue to "which organization is completing the pre-screening," the greater concern is the fact that the pre-screener also searches for the hospital bed for those who need one; having that pre-screener employed by the hospital who can decide whether or not to admit an individual is in fact a conflict of interest for multiple reasons. This is not just a concern about one specific provider, but rather about the system of protection that has existed for 30 years to ensure that when someone is at possibly the lowest point in their life, they receive equal access to the care and resources that they need, by having trained CSB pre-screeners to complete the pre-screening and conduct the bed search. Previous legislation was put in place to provide this protection. Of the flaws in our system, the pre-screening process is not one of them. This bill does not help CSB workforce or get law enforcement personnel back on the streets more quickly. These are buzz words and phrases that are not based on facts or studies. The term "pilot" is used to soften what is actually an "experiment" as this is not based on any facts that indicate a need to change how pre-screening is already occurring. Two years to pilot this might not seem like a long time to some, but it is too long to experiment with people's access to care. Had there been an interest in having a pre-screener onsite in the hospital, this could have been approached by having a conversation with the CSBs about how we could work together to accomplish this. This requires conversation, not legislation. A review of facts and studies will show that private hospitals have other ways to support the system; giving them access to the public system is not one of them. This is, in fact, at odds with all of the other positive things that are being done to support the behavioral healthcare system. We ask that you not take this step back when so much has been done to move us forward. Thank you.

Do not allow the role of the preadmission evaluation to be minimized, devalued or to be regarded as “duplicative”. That will not serve the individuals, families and public and private providers well in our collective efforts addressing the needs of some of Commonwealth’s most vulnerable citizens. It is not a duplicative assessment, but rather a determination if an individual may lose their liberties, and as the legislation enacted must ensure that least restrictive alternatives must always be considered. SB34, like HB608, would authorize newly designated “certified evaluators”, employed by a private facility to recommend issuance to the magistrate for a TDO. It enables the private hospital to identify the TDO facility, whether their own facility or now with direct access to state hospital beds. The Financial Impact Statements for both Bills (page #s) and the Dec. 2021 TDO Evaluator Workgroup Study (pg. 16), all anticipate that if enacted, would increase the number of individuals evaluated and TDO’d including the impact to the already overburdened state hospital system. Financial Impact Statements - Please note the concerns, cost, and anticipated fall-out identified in both the SB34 Financial Impact Statement and the HB608 Financial Impact Statement, which included some of those identified by the TDOO Workgroup Study in just Dec. 2021. This pilot is not only at a cost to the Commonwealth for this one provider’s benefit, a benefit clearly contrary to the text of CODE. It is notable that the HB608 provided more information about financial impact that SB34, however, clear that the substance of both bills has the same devastating effects and costs, those immediately estimated, but also others that will be costly for the Commonwealth which are indeterminate, but also recognize that increased state hospital admissions and pressure throughout the behavioral health system is anticipated. No doubt costly due to policy shift, a stark contrast to other current DBHDS and General Assembly directed efforts. Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. The provider and VHHA’s testimony were misleading and did not demonstrate an appreciation for civil liberties being discussed. Testimony indicating that such an allowance would lead to more timely access to evaluation inaccurate, characterized patients as waiting for CSB to evaluate delaying care is inaccurate and misleading. CSBs responsiveness is not an issue, and we strictly adhere to performance contract standards.

I voice my strong opposition to Senate Bill 34 which would be a monumental shift in public policy with significant immediate and future implications. The GA enacted the current legislation decades ago for reason. SB34, submitted at the request of a private hospital ignores and circumvents the concerns and recommendations that a legislature-directed Workgroup studying this very matter had just issued their findings, Dec. 29, 2021. The Workgroup studying, “Who Should Conduct TDO Evaluations in Virginia”, consisting of “representatives from Virginia’s CSBs community hospitals, law enforcement, mental health advocates, and other stakeholders, like those previous workgroups evaluating this matter, did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. Instead, the Workgroup identified a number of the concerns, as previous studies had, including how such allowances would not account for complexities of the system and may unwind decades old legislation, including areas needing consideration: Conflict of interest; CSB's critical role of the CSB connecting individuals to alternatives to inpatient hospitalization and the “Potential increase in TDO admissions which would put additional strain on the state mental health hospital system. The Report, like SB34 and HB608 Financial Impact Statements, anticipates that enactment of either Bill would increase the number to TDO admissions to the state hospital. Despite CSBs playing such a critical role at all aspects of the Behavioral Health system, at no time were we consulted on the needs, of any concerns nor was the potential impact on stakeholders considered. Financial Considerations - The Code is also very clear on matters related to financial consideration, noting in §37.2-817.01, regards to the evaluator, - (g) have no financial interest in the admission, treatment, or denial of admission of the person being evaluated; (h) have no investment interest in the facility detaining or admitting the person under this article;[9]. Similar concerns were addressed in the TDO Workgroup’s Report issued on Dec. 29, 2021.The fact is, Magistrates must have reliable, unbiased recommendation that evaluates least restrictive alternative. I ask you to consider that members of the General Assembly will likely have a future budget request before you which will provide additional financial incentives to private hospitals accepting more TDOs to relieve burdens of state hospitals, operating in crisis years following the well-intended “bed of last resort legislation”. In addition to changes in the codes and other regulatory, local, state, and regional protocols this action directly contradicts Other Critical Investments in Virginia’s Behavioral Health System: including efforts and GA investments in STEP-VA; Counters recommendations included in the recent 2 JLARC study; is Inconsistent with the goals of moving Virginia toward a Crisis Now System & Right Help Right. It requires significant adjustments or exceptions would be required for the orientation, training, oversight, & supervision of Certified Pre-screeners, initiated by the Deeds Commission in 2016, intended to safeguard an individuals’ liberties. It also provides a private hospital, with financial interest in the outcome, authority to determine facility of TDO, whether their facility or direct access to State Hospital Beds and enables a private hospital to direct and further tax local publicly funded resources.

I voice my strong opposition to Senate Bill 34. The issue of Behavioral Health is not a partisan issue. However, this bill would prove to be a monumental shift in public policy with significant immediate and future implications. The General Assembly enacted the current legislation decades, A recent workgroup (December 2021) evaluating such matter, comment on the preadmission evaluation, also noted that: “It is a pivotal point within the larger civil commitment process because if involuntary treatment is recommended and a TDO is issued, the individual in crisis is deprived of his or her liberty” and did not recommend such exception SB34, submitted at the request of a private hospital ignores and circumvents the concerns and recommendations that a legislature-directed Workgroup studying this very matter had just issued their findings, Dec. 29, 2021. The Workgroup studying, “Who Should Conduct TDO Evaluations in Virginia”, consisting of “representatives from Virginia’s community services boards (CSB), community hospitals, law enforcement, mental health advocates, and other stakeholders”[3], like those previous workgroups evaluating this matter, did not make recommendations to allow a non-CSB clinician to conduct a preadmission evaluation. Instead, the Workgroup identified a number of the concerns, as previous studies had, including how such allowances would not account for complexities of the system and may unwind decades old legislation, which has been referred to as the “bedrock of the public behavioral health system”, including areas needing consideration when evaluating any code changes which would expand who could conduct preadmission evaluations to include: Conflict of interest – including “any potential for real or perceived bias” Connection to community resources, noting “the critical role of the CSB connecting individuals to alternatives to inpatient hospitalization”. “Potential increase in TDO admissions. Evaluators who work in private hospital settings may not be fully aware of all the community alternatives to the state psychiatric hospitals, and the workgroup expressed that this could inadvertently lead to an increase in TDO disposition. This would put additional strain on the state mental health hospital system, which is already suffering significant census pressures and staffing shortages” Delays in the system are due to individuals being unable to access an accepting bed, not for an evaluation. Current waits are related to securing an ACCEPTING BED, which this bill does nothing to address. CSBs responsiveness is not an issue and we strictly adhere to performance contract standards. This in no way assists Law Enforcement in “getting back on the street” as suggested by provider in previous subcommittees. The allowance for a private hospital to conduct a preadmission evaluation has no relevance of waits. Will they admit, which this provider currently maintains control of whether they will admit or not admit, their timeframe to review, and regards to their efforts or lack of to provide the CSB clinical or medical documentation that would enable a search for an alternative bed. This allowance does nothing to speed up the process or get law enforcement “back out on the streets”. Instead, it will enable the provider to assert additional control over the local publicly funded resources and the state hospital.

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Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.

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Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.

I am writing to urge you to support Senate Bill 119, which aims to protect the pharma-funded drug discount program from the harmful restrictions imposed by the pharmaceutical industry. This program provides much-needed relief to individuals who cannot afford their medications, but the pharmaceutical industry has been placing harmful restrictions on it, limiting its effectiveness. Passing Senate Bill 119 will ensure that the pharma-funded drug discount program remains accessible to those in need. This will help to address the growing issue of rising healthcare costs and will ensure that people can continue to receive the medications they need to maintain their health and well-being. Here at New Horizons Healthcare, we are already seeing the effects of the current limitations placed by the drug manufacturers. Some patients are unable to get their provider-prescribed medications and have to either wait, try to find another suitable medication, or not have their prescriptions filled at all. This situation can and most likely will result in more adverse effects, especially for those who already have chronic conditions. I urge you to consider the positive impact that Senate Bill 119 will have on the lives of many individuals. By supporting this bill, you will be taking a step towards ensuring that everyone has access to affordable medications. Thank you for your time and consideration.

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In its present form, SB231 is not appropriate…and should be defeated. Virginia citizens and taxpayers cannot …and should not pay for illegal immigrants who have entered our country and state in violation of our law. This is an undue burden on much needed state-wide resources ; and on a grander scale…creates another incentive for non-citizens to come to our state. I highly recommend you remove any language ….providing for coverage of those here in Virginia in violation of our immigration law.

Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.

The Lung Association believes that every child in Virginia should have access to affordable and comprehensive health coverage. Senate Bill 231 would get us closer to that reality by creating a health coverage program available to all children in Virginia, regardless of immigration status. The Lung Association strongly supports this bill as a way of increasing access to healthcare for all Virginians. If you have any questions or need additional information, please feel free to reach out to me.

The Lung Association believes that every child in Virginia should have access to affordable and comprehensive health coverage. Senate Bill 231 would get us closer to that reality by creating a health coverage program available to all children in Virginia, regardless of immigration status. The Lung Association strongly supports this bill as a way of increasing access to healthcare for all Virginians. If you have any questions or need additional information, please feel free to reach out to me.

I hope this bill does not support illegals when there are Virginia citizens who are suffering right now. Shame on Democrats and Republicans who do not take care of their own America citizens first.

I will keep my comment short and simply say that as the parent of child with severe special needs and medical needs life is already a constant struggle. He is 14 unable to speak, unable to regulate his own emotions, has seizures, suffers from such severe behaviors that he literally gives himself rhabdomylosis from kicking his legs so hard. The last things parents need is the ever changing hoops that are constantly being put up on them. I am fortunate in that I do not even act as the Paid caregiver for my child. So these changes as of now do not impact me. My father is healthy enough to be his attendant and care for my hard to handle son but many people do not have that as an option. I would ask that you as lawmakers simply put yourselves in our shoes for one week, heck for one day, and think what our lives are like and how these changes impact us and our children.

Please consider approving HB 909 and not SB 488. Delaying the decision to approve LRIs as attendants by having DMAS review SB 488 will prevent many LRI attendants from being paid after 3/1/24. My husband/LRI has taken care of our 3 children as a stay at home father for over a decade. My younger two children are Autistic and due to the guardrails put forth by DMAS, my husband is the only one to take care of our younger Autistic sons. I am the only one working at a gross pay of $63K/year as a School Nurse, so my husband will be home to receive and take care of my younger ASD sons when they come home from school. With the amount of pay it takes to provide for our ASD sons, and our oldest daughter, who is going to go to college this coming year, we would need that extra pay to make ends meet (help pay for food/tuition for my daughter next year). The extra pay that we received from my husband working as an attendant since 10/14/23, has helped us with unexpected medical bills, food, and rent. Please consider extending the deadline for LRI justification or eliminating the guardrails that prevent both my husband and I from being paid to take care of our sons.

Thank you for your support of HB909 that closely aligns with SB488 to be considered today. I am writing to ask that you continue to support both bills and work with the Senate on a compromise that will keep this very important legislation moving forward. Unfortunately, the Senate version does not allow for an immediate impact and kicks the can down to road so to speak as SB488 calls for DMAS to make a report later this year instead of calling on DMAS to seek approval from CMS immediately. Special needs children who are receiving Medicaid waiver services have already proven that the care of these individuals is in fact extraordinary. According to DMAS, approximately 1700 of the 40,000 waiver recipients are currently utilizing the ability to have a Legally Responsible Individual (LRI) provide much needed daily supports. Families like my own have struggled for years to find qualified providers outside our families to effectively care for our children. Sadly, in just a few days on March 1 this ability is removed from us unless we meet subjective requirements of DMAS reviewers. I say subjective as families like mine have submitted our proper advertisements proving our attempts to hire, written justification as to why we are the providers of both last resort and best providers, and our service facilitator has submitted the documents to DMAS not once or twice but three separate times and are continuously told the documents are missing. There is a clear flaw in the system, and time is running out. While SB488 includes respite services, HB909 did not include respite. LRIs cannot and have not been able to bill for respite services and therefore respite could easily be removed due to the potential fiscal impact. Instead, it would make more sense to pass the legislation NOW to eliminate the burdensome guardrails DMAS has placed on families without respite included. Perhaps respite could be reported on at a later time instead of grouping all of this together. In closing, I would ask for you to continue to push for supporting the original wording in HB909 by incorporating SB488 into the house bill and eliminating the need for a report later this year. I suspect DMAS can provide a lot of data now on the usage of LRIs currently. Thank you for your consideration in moving forward with legislation to support the disabled community and ensure our children can thrive and grow in their own communities.

Please protect waiver children by allowing parents to be paid caregivers! SB 488 IS NOT worded strongly enough and should be replaced with HB 909. DMAS needs to be forced to address the LRI issue and seek CMS approval, not just "review" it. Please help us continue caring for Virginia's most vulnerable children in their homes with their loving and competent families where they belong! The 3/1 implementation of onorus and abusive "guardrails" need to be addressed NOW. Thank you!

Please protect our special needs kids! I have been unable to find a qualified dependable attendant.

So not only can we not hire people, it’s going to take an arm and a leg to get approved to continue to be the paid attendant. Which means disabled families will lose grocery money, etc. We will risk losing our waivers. Don’t our children suffer enough being disabled. Isn’t our lives already HARD enough? Do you want constituents on welfare so you can continue to call us burdens on the state? What more do you want from us? I mean really?

Please pass this bill. Our disabled children deserve to be cared for by their family members. We should not be forced to seek a stranger as a EOR to over see our personal information and HIPPA information. Where is the responsibility when that person steals our identity, abuse, damages our home etc? Will DMAS take responsibility for that? NO! Most agencies are making parents pay a $200 non refundable fee for training to “maybe be hired as a parent caregiver”. Why are only parents being forced to pay that to be a caregiver but an outside family member of the agency does not? We are being taken advantage of by everyone in this stressful time. There are only 1,700 families being affected by this. Why are we treating disabled families with such disgust. DMAS is worried about fraud. Where is our concern for abuse, identity theft, HIPPA volition?? There are to many people in the cookie jar. We need to change this program like California’s and make it simple. One state department, one agency for all. One payment to a family caregiver. Simple! Our children do not have a voice. Please hear ours and do what’s right.

This bill is so important to our family. We tried for years to hire outside help for my son who has a rare genetic condition. We tried multiple agencies and even tried to hire help directly through the consumer directed model. We haven’t been able to find anyone who is willing to take on this job. The only person who was interested and able to pass the background checks was so scared of my son that she quit after only 4 shifts and never even touched my child. We want to know that my son is receiving the best care possible. At this point in his life that care is coming from me. Allowing me to serve as his paid caregiver has also allowed our family to reduce our dependence on public assistance. We want to always do what is best for my son so that he can grow and thrive in his community. We happen to be one of the families who have an easy time finding someone to take on the role of the employer of record (EOR) but not all families are as fortunate. We ask you to please roll back the new restrictions on who can function in this role and allow families to find the best possible candidate (even the other parent) to take on this unpaid role that has access to so much sensitive personal information including private health information. Please support individuals within the waiver program. The system is desperately trying to keep up with demand but the need is far too great.

I am writing in hopes that the Senate will support legislation allowing parents to continue to serve as paid caregivers. My daughter Maria is two years old and has Lissencephaly, an extremely rare genetic disorder. Maria has daily seizures, is immobile and non verbal. She requires constant care. The care she requires is quite nuanced and very much above the pay grade Virginia has set for attendants. I could not and would not leave her in the care of someone making $17/hr, as we live in Alexandria Va. I could only leave her in the care of a registered nurse. Leaving her with an attendant with extremely basic medical knowledge would be negligent. I will, for the remainder of her short life, serve as her caregiver. I hope you respect the value of my daughter’s wellbeing and the invaluable role I play for her by continuing to allow parents to serve as paid caregivers. I invite anyone who chooses to not support this effort to come to my home and meet my child.

As an LRI for 2 children on the waiver, I am urging you to back this legislation. There are parents and children for whom these changes are so deeply impactful that we have become paralyzed in regards to advocating for ourselves/our children . In 2017 I was given custody of a child who was born to an incarcerated individual suffering from drug addiction. He was born with multiple birth defects. Shortly after taking custody of him— as his organs were shutting down and an emergency order was necessary to protect him from his parents— my own child who is 5 months older began showing signs of special needs. In less than a year I went from 1 medically fragile, high needs child to 2 complex children. In the 4 years that followed, my marriage broke down under the strain and my husband left, unwilling/unable to cope with the constant appointments, care, and protection from illnesses these children required and our inability to secure appropriate care in the form of an attendant to help relieve the burden he was being asked to share. The child I have custody of is related to him, yet no one in his family has been willing to share this responsibility or help in any way. The Appendix K flexibility has literally saved my children and I from homelessness by allowing me to work for one of the children, however, this came after years of trying to hire an attendant unsuccessfully. I have had some people apply, but once the wait for background checks and paperwork surpasses a month or two (or more), they have moved on to other jobs. Some ridicule me for not offering more when they are told about the pay or lack of benefits. In 2021, I was able finally to hire my own adult child for one of the clients, but even they had to leave due to lapses in pay and lack of stability. Hiring is made additionally challenging by regulations governing attendants whereby they are unable to feed my children on a shift, as this task— tube feeding— is not allowed per the attendant and EOR manuals and will not be paid by DMAS. Last year, during a change in fiscal agents due to insurance contracts, I was unpaid for over 3 months, had utilities shut off, had to apply for SNAP & was facing eviction while begging someone to take accountability and fix the “error”. I am now facing the loss of my income if not approved as an LRI, and have been unable to find one caregiver much less the two it will take for me to be able to leave my children and find outside employment. One child missed 40 days of school last year due to illnesses and complications of their conditions— there isn’t a single job I am qualified for that would allow for that sort of absence, nor allow me to return home to administer tube feedings the attendant isn’t allowed to do. The children do not qualify for nursing care otherwise. Compounding this is the numerous medical appointments and therapies each child needs— they are each a full time job in the eyes of the state, as long as a stranger is hired to do the work. Parents/LRIs are the ONE sure thing DMAS can count on to provide safe, reliable care for these children. Some of us are biologically tied to these children, others are guardians who have already relieved another strained system by taking on kinship placements with no assistance. We’re asking for the bare minimum and have already provided the proof that it works and is sustainable. Please support and enact this bill— our lives depend on it.

Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.

Please pass this bill. I have an adult son with lifetime disability and as a pediatric physical therapist I work with disabled children. It is very difficult to get individuals that are not family members to work at the present pay rate. Why are we making it so difficult to allow family members and live ins to provide the needed service as they are unable to work outside the home without having paid personal aids that are reliable.

We already have enough on our plates taking care of disabled children, nobody wants to do this job for coins. Virginia wants to be pro life. Where is the same care and consideration, and fierce support for our disabled children as there are a fetus. Where is this “pro life and pro family”? Stop using our children who already have hard enough lives as political pawns and do the right thing! I’ve already had to leave my career…now you want us to have an even harder time by taking away our caregiver pay and making us humiliate ourselves with these excessive job postings, people laughing at the pay rate, saying our kids are “too much work for too little pay?” What more do you want from us? Help us out. We VOTED for you all. Our lives are already hard!!!!!

SB488 is very important to my family. I have the sweetest 2 year old daughter with disabilities. She cannot walk (or even sit up on her own. She is non-verbal but man does she have a HUGE personality and can communicate to me in her own way. She has many doctors/therapy appointments, at least 2 a week if not more. She just finished a 3 week intensive therapy where she went every day for 3 weeks. I love being involved in her daily care and desperately want to keep it that way. If LRI's (which is me) can only be caregiver of last resort I will have to find another job while someone else takes care of my child. Unfortunately we cannot pay our bills without the Caregivier income. Please support this Bill and allow me to remain my childs paid caregiver of first choice and NOT last resort. I know 100s of families that are begging for this same thing. In emails I have recieved from DMAS, they are making it seem like this transition with their new regulations is making it easy on the parents and at least parents are still getting to remain caregivers to some extent. We only get to remain the caregiver until someone else is found to replace us. Do you know how stressful that is? Constantly posting ads and interviewing when we don't want to find someone else to replace us. Us parents (LRI's) want to be our child's caregiver without posting the ads and being the last resort. If you are going to pay someone to do the job, why not the parent? They say this has to be put into place because of fraud and parents can't "just Bill" for money like we aren't doing anything. Caring for a child with disabilities is not the same as caring for a "typical" child. If they think we aren't properly taking care of our children and just logging hours than can't DMAS come up with something else? Maybe we have a log the tasks we have done while logged in? Maybe our service facilitators have to check in on us more than once a month? There can be other regulations put into place other than having the parent be the Caregiver of last resort. Please consider this Bill. Something needs to happen fast because come March 1st if nothing changes many families and vulnerable children will be affected.a

Our local, state, and federal government needs to fully support families of disabled children. This includes payment for in-home care to legally responsible adults caring for medically fragile children in their home. Parents like myself left full time, great paying jobs, to focus our energy on our special needs children. We know how to best care for them. It is irresponsible to require a parent to bring in an unskilled stranger into our homes to care for our vulnerable children. There are hundreds of reports of outside staff coming in and abusing, neglecting, and stealing from the client. The position is complex and difficult, yet the pay is nominal and there are no added benefits. We need to reward parents and caregivers who are able and willing to drop everything to care for their children. The job is mentally and physically and financially exhausting. But we love our children like no one else can and we want to do the job to its best! Let’s bring our society back to caring for loved ones BY loved ones rather than discarding them off to strangers. We know there must be guardrails to ensure the vulnerable are protected, but do not punish those with good intentions because of the few who abuse the system. Do not make the requirements impossible to achieve. Do not make the rules too complicated to understand. We are doing this for our children! Not for ourselves! Let us help them succeed at life in every way possible. The citizens you serve need your support.

Part 2 of 2 The current language used by DMAS to determine if an LRI is qualified is unclear, subjective and unnecessary and put constant strain and stress on the affected families, in excess of what they already have. As parents, we are in fact the most qualified individuals to care for medically complex minors. It is in the Childrens’ best interest to have the option for LRI caregivers, with the same rules as non-LRI caregivers. There is an ongoing issue we have experienced with DMAS. Our new EOR, who used to work as our service facilitator and is another parent of a child on a medical waiver. After following all of the DMAS guidelines, submitting all necessary paperwork, and submitting the job ads for non-family caregivers, both of our families were denied as LRIs. DMAS’s explanation of the denial was that we did not provide copies of our ad postings and did not submit our plan of care forms. Both families received the same email, yet we completed and submitted our plans of care at the same time in October and sent our ads as we posted them. We just received their denial determination just last week and the new rules go into effect on March 1 leaving very little time to correct the problem. We are not alone in this as we have read several other LRI’s Facebook posts that are experiencing the same issue. Our service facilitator contacted DMAS, including the DMAS Director directly, to make them aware of our personal situations and they acknowledged that it was likely a glitch. We have yet to receive any updates from DMAS. I hope this further illustrates the detrimental impact that the new rules will have on countless Virginia families. They are all watching these bills closely. LRI denials will leave Virginia families with no paid caregiver for their children and loss of income on short notice. Allowing DMAS to self-police and do their own report is not going to solve any issue and will immediately hurt Virginia families. Furthermore, we are genuinely concerned that if we continue to push DMAS to correct the issue any further, they will respond by decreasing our children’s allotted hours as they done so in the past. Again, I urge you to support SB488 as originally written. The new rules set by DMAS eliminates respite services for paid LRIs (LRIs cannot charge respite hours themselves, only non-LRI caregivers are allowed to charge respite). Respite hours provide relief for parents without the worry of leaving their medical complex child with an unqualified, and often underage, babysitter. As a compromise, I will gladly support placing hour limitations per pay-period charged as respite to limit the possibility of fraud which was the original intention of eliminating respite for paid LRI caregivers. I would also support the elimination respite in favor of supporting the elimination of the other unnecessary guardrails on parents as LRIs. I hope for a positive outcome that both respects and supports the Virginia families of medically complex minors, all of which you represent. Respectfully, Richard Plebuch

Part 1 of 2 My name is Richard Plebuch and I am writing to urge you to vote yes on to the original version of Virginia SB488. This bill directly affects my family with 2 medically complex girls, 5 and 8. Both of our children have Medicaid waivers due to their extensive list of medical and behavioral conditions. For the last 8 years we have constantly struggled to find and keep qualified caregivers that are willing to accept the responsibilities at the set pay rate, which we cannot legally subsidize.. We have placed multiple ads to hire caregivers since October 2023, to abide by the new LRI guidelines, and have had no applicants, only comments stating that we should be ashamed of ourselves by offering such a low wage for the required requirements of the position. The caregivers that we have are only sporadically available to work a few respite hours a month, as they have other jobs and cannot afford to accept the caregiver position full time. Among their numerous other medical conditions, both of our daughters have an extremely rare neuromuscular gene mutation which causes numerous issues like falling, periodic paralysis, limited mobility, eating, drinking, vision, respiratory, and most notably choking (laryngospasm) at any time as if they are being strangled from within. The first time I had to perform CPR on her was on the side of I-95 when she was only 7 weeks old. I have personally administered CPR on both of our children countless times. Our children require close supervision due to the high probability of choking and they are not accepted into daycare programs for this reason. We have had only 1 full-time longtime caregiver, but she has since become a full time nurse. The countless other full time caregivers we’ve had only lasted for short periods of time before leaving. We’ve had one caregiver that we had to press charges for grand larceny of, including but not limited to: cash, schedule 1 prescription drugs, and my wedding ring. In addition, she also used illegal drugs, conducted drug deals over the phone, and negligence/child endangerment by leaving our then 9 month old on the edge of our kitchen counter and walked away, all of which were captured by a single camera on the same day. She was only with us for a month before this incident occurred.

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Community Health Workers (CHWs) create a huge and great impact on the health and well-being of Medicaid beneficiaries and communities, For this and more the state Medicaid programs should pay for the broad kind of services that CHWs are experts in providing to the community.1 Many studies provide significant evidence that CHWs are effective in these roles, particularly when serving underserved communities, medically, socially, and with many health barriers. More than half of the 50 states planned to expand their state’s CHW workforce. With all the positive health outcomes, well-designed CHW programs have been demonstrated to save as much as $2.47 in Medicaid spending for every dollar spent.16. All of this is because CHWs promote early detection and help with the management of chronic conditions, they have a well of resources to connect individuals into social services that address a range of social determinants of health improving care coordination, and helping prevent illness or hospitalizations. Providing Medicaid financing the CHWs can control costs while improving care coordination, culturally responsive care, and other outcomes to promote health equity. Let me list some of the good outcomes the individuals and the community can receive by providing coverage to pay for CHW: Cultural Mediation Among Individuals, Communities, and Health and Social Service Systems, Providing Culturally Appropriate Health Education and Information, Care Coordination, Case Management, System Navigation, Providing Coaching and Social Support, Advocating for individual communities, Building Individual Community Capacity, Providing Direct Service, Implementing Individual, and Community Assessments Conducting Outreach Participating in Evaluation and Research “By covering the CHW services, state Medicaid programs can more effectively address social determinants of health and health inequities, positioning CHWs to ensure treatment of the whole person and advance community-level health, rather than limiting them to condition-specific activities for individual patients. CHWs can help increase savings while improving care coordination, culturally responsive care, connections to services, and other outcomes to promote health equity.” Partners in Health United States PIH.org/united-states

Why and how should CHW services be covered by Medicaid programs? Several studies have found that interventions using CHWs help to improve health outcomes among racial and ethnic minorities. Therefore, addressing the social determinants of health and health inequities should be done more effectively. CHWs can help improve disease control and reduce mental health symptoms such as depression and substance use disorder. Many state Medicaid programs use CHWs as part of their strategy to address the needs or manage the care of specific populations. States can provide Medicaid payment for CHW services through the state plan or Section 1115 demonstration authority. Section 1115 allows the Secretary of the U.S. Department of Health and Human Services (HHS) to waive almost any Medicaid state plan requirement under §1902 of the Act. The Secretary can also permit federal financial participation for costs not otherwise matchable, allowing states to cover services and populations not included in the Medicaid state plan. There are no federal Medicaid requirements for training and certification for CHWs. States that provide CHW services under the state plan are most likely to define certification and training requirements as a condition for receiving Medicaid payment. There is no reason for not implementing this Bill. Some states require Managed Care Organizations (MCOs) to provide certain CHW services, while others allow but do not require MCOs to provide such services. Medicaid payment for CHW services can be authorized under multiple state plan benefits, such as coverage under the preventive services benefit. States may also cover CHW services under other benefits, such as the outpatient hospital services benefit (42 CFR 440.20). For this benefit, states are not required to identify CHW services in the state plan. A standardized community health worker intervention aimed at addressing unmet social needs estimated a return on investment of $2.47 for every dollar invested to an average Medicaid payer (Kangovi et al. 2020). Considering the overall benefit this will bring to the community, several studies have found a 23.8 percent average reduction in annual Medicaid spending per participant during three years. This resulted in $2.6 million in net savings for the Arkansas Medicaid program (Felix et al. 2011). The special community relationships that CHWs develop can facilitate connections and build an important level of trust between the community and health care systems. CHWs may be members of communities that are typically underrepresented in healthcare settings or may be specifically qualified to provide culturally competent care (CDC n.d., Lloyd et al. 2020). Source: https://www.macpac.gov/wp-content/uploads/2022/04/Medicaid-coverage-of-community-health-worker-services-1.pdf

The National Association of Community Health Workers (NACHW) is pleased to support SB 615. Please see attached PDF for our full testimony.

Necesitamos este bill para mejorar la calidad de vida de las personas de bajos recursos

Los Promotores de Salud (CHWs) son trabajadores publicos en las comunidades quienes trabajan con miembros de las comunidades los cuales experimentan inquidades en salud. Hoy, el subcomite de Servicios Sociales en el comite de Health and Human Services tendran un voto legislativo que impactara la creación de un equipo de trabajo para estudiar los beneficios de Medicaid. Esto hace que hoy sea un dia muy especial para discutir el role e impacto de los Promotores de Salud (CHWs). Como lo dijo la Dr. Leana Wen, Comisionado de Baltimore City, "la salud publica es una herramienta podeora que balancea los niveles en general, al aleja los valores de los miedos de desconfianza y inequalities y los une a los valores de equidad y justicia"

I need you support

Please support LRIs as paid attendants and support the system that surrounds it. The service facilitators that enable consumer directed services are underfunded which leaves us unable to access the services that our children are promised. I wish I could convey how frustrating it is to navigate a broken system to get simple services for our disabled children. Our lives are difficult, but one of the most frustrating parts about it is trying to navigate the red tape for "supports" that are promised to us only to find out that they are actually inaccessible due to lack of funding and support. I'm asking you to support LRIs as paid attendants. We simply ask to be paid for the same work that anyone else would be paid to do. We have more experience, training, and motivation to do the job well, but DMAS wants us to be the "last resort." They would rather I hire anyone else. This makes no sense, especially when I have had to quit my job to care for my child. Even if I were able to find an attendant, I would not be able to go back to work because attendants have a track history of negligence, if they show up at all. Again, this seems built into the system as they are paid very little for the job being done, and often go months without pay for paperwork errors. Our children are in crisis and need your help.

Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.

I am writing on behalf of Virginia Association Of Community Health Workers, thank you for continuing to champion Medicaid reimbursement for Community Health Workers (CHWs). We are so grateful for your support. We respectfully ask that you continue to support this important cause. Community Health Workers improve health while reducing costs. Every dollar invested in a Community Health Worker intervention returns $2.67 dollars to an average Medicaid payer within one fiscal year. Please support: SB615 Thank you again for supporting Community Health Workers.

En nombre de la organizacion de Virginia Community Health Workers], gracias por continuar defendiendo el reembolso de Medicaid para los trabajadores comunitarios de salud (CHW). Estamos muy agradecidos por su apoyo. Le pedimos respetuosamente que continúe apoyando esta importante causa. Los trabajadores de salud comunitarios mejoran la salud y reducen los costos. Cada dólar invertido en una intervención de un trabajador de salud comunitario devuelve $2,67 dólares a un pagador promedio de Medicaid dentro de un año fiscal. Por favor apoya: SB615 Budget Amendment 292 #7s Budget Amendment 288 #68h Gracias nuevamente por apoyar a los trabajadores comunitarios de salud. No dude en ponerse en contacto conmigo en [INFORMACIÓN DE CONTACTO] si puedo ser útil. Atentamente Ysabel Lovo

Me dirijo a ustedes como ciudadano de este estado expresar mi preocupacion Por saber que SB615. Sea aprobada , necesitamos mejorar el acceso a la atención medica y reconocer el papel fundamental que Desempeñan los trabajdores de la salud y comunitarias. En la prestación de servicios de salud a las comunidades

On behalf of [ORGANIZATION], thank you for continuing to champion Medicaid reimbursement for Community Health Workers (CHWs). We are so grateful for your support. We respectfully ask that you continue to support this important cause. Community Health Workers improve health while reducing costs. Every dollar invested in a Community Health Worker intervention returns $2.67 dollars to an average Medicaid payer within one fiscal year. Thank you again for supporting Community Health Workers. Please do not hesitate to contact me at [CONTACT INFORMATION] if I can be helpful. Sincerely,

On behalf of the Virginia community, thank you for continuing to champion Medicaid reimbursement for Community Health Workers (CHWs). We are so grateful for your support. We respectfully ask that you continue to support this important cause. Community Health Workers improve health while reducing costs. Every dollar invested in a Community Health Worker intervention returns $2.67 dollars to an average Medicaid payer within one fiscal year. Thank you again for supporting Community Health Workers. Please do not hesitate to contact me at (571)237-4558] if I can be helpful. Sincerely, Veronica R. Stokes

Necesitamos este bill para tener mejores oportunidades para la comunidad de bajos recursos

I, Christopher Rashad Green, thank you for continuing to champion Medicaid reimbursement for Community Health Workers (CHWs). We are so grateful for your support. We respectfully ask that you continue to support this important cause. Community Health Workers improve health while reducing costs. Every dollar invested in a Community Health Worker intervention returns $2.67 dollars to an average Medicaid payer within one fiscal year. Please support: SB615 Budget Amendment 292 #7s Budget Amendment 288 #68h

I am writing on behalf of the Virginia Association of Community Health Workers (VACHWA) to express our gratitude for your attention to the important issue of Medicaid reimbursement for Community Health Workers (CHWs). Your consideration of this matter is greatly appreciated. We respectfully ask for your continued support in advocating for this cause. Community Health Workers play a significant role in improving health outcomes and reducing costs. It has been observed that every dollar invested in a Community Health Worker intervention yields a return of $2.67 to an average Medicaid payer within one fiscal year. Thank you for your attention to the valuable work of Community Health Workers. Should you require any assistance or further information, please do not hesitate to contact me at (703) 438-1481. Best regards,

On behalf of my self , thank you for continuing to champion Medicaid reimbursement for Community Health Workers (CHWs). We are so grateful for your support. We respectfully ask that you continue to support this important cause. Community Health Workers improve health while reducing costs. Every dollar invested in a Community Health Worker intervention returns $2.67 dollars to an average Medicaid payer within one fiscal year. Thank you again for supporting Community Health Workers. Please do not hesitate to contact me at thaynes5007@email.vccs.edu if I can be helpful. Sincerely, Thomas Cory Haynes

"It is crucial to ensure that legislators and committee members understand the importance and impact this legislation has on the care provided by Community Health Workers (CHWs) to Medicaid members and many vulnerable communities across the Commonwealth of Virginia. The workgroup's creation is a necessary step toward designing an infrastructure that ensures equitable access to health information and resources for the most vulnerable individuals. As you may know, many CHW positions are funded through grants, including federal grants that are about to expire. Sustainable financing through Medicaid will help maintain and expand the CHW workforce and directly address premature leading causes of death." I am a student in this program and I am ready to work for the many underserved cititzens in my community. WE NEED YOUR HELP NOW!

Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.

Please protect disable children in Va. We need to take care of them. As parents, We can’t find attendant care, well trained. The regulation changes affect families, adds confusion. Consumed directed services are necessary to proceed our kids.