YES, We support this bill. I am the founder and Lead Policy Advisor of MRCI, a survivor led organization to advanced legislation towards the prioritization of safety and the well-being of all children., especially those of marginalized and vulnerable populations . I am also a foster child who was in the system, in and out as long as I can remember until I age out at age 18. There are no words to describe the trauma of being passed from home to home and discarded, having no feeling of belonging or true love of and care from a family, as their own flesh and blood. My brother and I were finally taken from our biological mother and court ordered into the foster care system due to poverty, the lack of childcare, and assistance for my brother for his violent temperament and uncontrollable rages. My mother also received minimal assistance to recover from her domestic violence injuries from being battered by her ex ex-husband, the same father who was sexually assaulted me until I was age 8. Please vote yes for this very simple gesture that will help children feel more in control and empowered , and some tiny level of safety and security,,due to circumstances that are not their fault., and help them heal.

As a domestic violence survivor who fled to protect her children and has fallen through every crack in the system, I have see the failures of the current model of state funded locally administered DSS. 99% of reports made on behalf of my children by professionals have been thrown out before intake due to bias (I was emotional when I fled to protect my children and therefore must have been the problem according to them). By requiring all reports be entered into the system, patterns can be tracked. By having the state determine validity of reports, local bias can be reduced. This would help protect more children. I urge you to please support this bill and help other families not suffer like mine has. Thank you

Please accept the attached written comments on behalf of the R Street Institute in support of HB 283.

LeadingAge Virginia, representing not-for-profit aging services providers, including assisted living communities, supports HB 297. Our members are committed to ensuring the highest quality of care and services for older Virginians, and we view this legislation as an important consumer protection measure that brings transparency, accountability, and clear standards to resident referral agencies operating in the assisted living space. By establishing consistent requirements, HB 297 helps protect residents and families, promotes ethical practices in referrals, and strengthens trust in the assisted living system across the Commonwealth.

As a clinical professional with over 20 years of experience in rehabilitation, I want to highlight the essential role of clinically informed referral resources in the senior living placement industry. Senior living transitions—especially during medical crises—require more than a directory of facilities. They demand clinical insight and local expertise. Online referral platforms often lack the ability to accurately assess a community’s capacity to manage specific acuity levels and focus on contracted locations only. Current “lead ownership” practices frequently lock families into working with an online source. Families should be able to choose their preferred referral partner and have limits placed on how long a referral can be “owned.” Recently, a family using an online service spent days touring communities that ultimately declined admission due to clinical needs. After a brief connection with the family by a rehab case manager, I was able to identify appropriate local matches that accepted the patient within 24 hours. Families deserve the freedom to work with the advocate who best meets their needs—not the one tied to their initial web search. I think that referral entities should disclose how they are compensated while remaining no cost to the client. By prioritizing clinical expertise and protecting a family’s right to choose their advocate, we can help seniors receive the right level of care the first time—reducing stress, preventing unnecessary delays, and allowing families to focus on their loved one rather than navigating a complex system alone. For many families, this support is invaluable.

I am writing to support the spirit behind HB297. As an occupational therapist serving seniors in Virginia for over 24 years, it is important to have safeguards to help protect one of the most vulnerable segments of the population. HB297 is an important step toward protecting older adults’ autonomy and ensuring ethical, person-centered guidance at a time when decisions carry significant financial, health, and emotional consequences. This bill clearly affirms a client’s right to freely choose their senior advisor—and to change advisors at any time without penalty—puts the older adult at the center of the process. This safeguard helps prevent coercive practices, conflicts of interest, and undue influence, while reinforcing informed consent and transparency. Seniors and their families deserve confidence that recommendations are based on their needs and values, not on locked-in contracts or referral arrangements that limit options. I disagree with the provision in lines 48-55, however, because it creates a financial incentive for community-based staff to influence or discourage residents from using referral agencies. Allowing residents to opt out at any time without a referral fee—particularly after substantial coordination, counseling, and placement work has already occurred—may unintentionally encourage staff or affiliated parties to steer residents away from referral services for financial or competitive reasons. This undermines ethical decision-making, compromises resident autonomy, and devalues the legitimate role referral agencies play in supporting informed, resident-centered placement decisions.

Dear Members of the House, As a healthcare provider with more than 20 years of experience, I am writing to express my overall support for HB 297, while also offering several areas for clarification and improvement. As a Senior Living Consultant and Physical Therapy Assistant, I have worked across multiple settings including home health, skilled nursing, inpatient, outpatient, and most recently assisted living as a program manager. This experience has allowed me to observe the continuum of care firsthand—both its strengths and its challenges. I have consistently seen that residents and families who are educated, guided, and supported through informed decision-making tend to fare significantly better than those forced into rapid decisions without adequate support. As a senior living consultant, my role is to assist families during times of stress and uncertainty, providing transparency that is often missing when families attempt to navigate assisted living options on their own. Without guidance, families frequently experience confusion, wasted time and resources, and unnecessary emotional strain. HB 297 provides meaningful transparency for families by clearly outlining how “no cost” referral services are funded and ensuring families maintain choice throughout the process. This is particularly important for families who begin their search online, only to discover later that local referral options may not be accessible due to large chain companies who do not provide the same services as small, local companies. The bill’s provisions allowing residents and families to opt out at any time, along with clearer disclosure of how referrals work, are a significant benefit and align with resident-centered care. Additionally, the bill’s current opt-out provision—which allows families to disengage from referral services as late as the day before move-in while still proceeding with placement—does not fully reflect the scope of work referral agencies perform. This work often includes comprehensive assessments, coordination with multiple providers, facilitation of tours, family education, crisis support, and ongoing guidance throughout the decision-making process. I respectfully recommend that the bill be amended to allow referral agencies to receive compensation if a resident moves into a community that was recommended and toured through the agency within a specified time period, even if the family later opts out of services. Referral agencies that prioritize integrity, transparency, and resident-centered guidance will benefit from the clarity and consistency this bill provides. However, those same agencies should also be protected and fairly compensated for the expertise, time, and guidance provided at no cost to families—particularly when their recommendations are ultimately followed. Without this protection, there is a risk that assisted living facilities may attempt to avoid referral fees despite benefiting from the work performed. Thank you for your consideration and for your continued efforts to support transparency, choice, and quality care for Virginia’s seniors and their families. Sincerely, Angelina M Fortin, MS Ed, LPTA, ATC Senior Living Consultant

I am writing to respectfully share my professional perspective regarding the proposed legislation addressing transparency in senior placement services, particularly those involving compensation from assisted living communities. I have spent many years working in clinical and advisory roles, first as a licensed physical therapist and now as a senior living advisor. Prior to becoming an advisor, I worked extensively in home health, where I frequently encountered seniors who were at significant risk due to the absence of professional guidance when selecting appropriate living arrangements. Too often, families were left to navigate complex decisions alone, resulting in moves that did not adequately support safety, health, or quality of life. As senior advisors, we work collaboratively with case managers, social workers, families, and caregivers to ensure seniors are moving where they can safely thrive. Our services include in-person and virtual consultations, guided tours, transparent pricing discussions, and ongoing support through the move-in process. From the onset, we clearly disclose that our services are provided at no direct cost, and that compensation is paid by the assisted living community. In my professional experience, this transparency has consistently been met with appreciation and trust by families. We are often contacted by families who initially selected an assisted living facility based on online searches or informal recommendations, only to discover later that the placement was not appropriate. In many of these cases, seniors are forced to relocate again—an emotionally and physically taxing process that could have been avoided with proper professional guidance from the beginning. Many families are unaware that local, personalized advisory services exist to walk alongside them throughout this journey. Failing to connect seniors with qualified advisors whose sole purpose is to advocate for their well-being does a disservice to this vulnerable population. Local advisory services provide a level of personal engagement, accountability, and community knowledge that cannot be replicated by large, nationwide referral platforms. For these reasons, I support reasonable oversight measures aimed at ensuring transparency and accountability, particularly among large national companies that do not offer the individualized, hands-on support that local advisors provide. Such oversight will help protect seniors and families while preserving the essential, high-touch services that truly serve their best interests. I do have concerns regarding the opt-out language in lines 48–55. It unintentionally creates a financial incentive for community staff to encourage residents to discontinue using referral professionals after substantial work has already occurred. A simple clarification that the referral fee remains owed if the resident moves into a recommended community after services were provided would protect resident autonomy, ethical consultants, and the intent of the legislation. Thank you for your time, consideration, and commitment to the well-being of our senior population. Respectfully, Heather Doré, DPT, CDP Senior Living Consultant

Please support this important piece of legislation, HB297. Far too often, seniors or their loved ones perform internet searches when initiating their journey to find an assisted living community. In doing so, they search the internet and click what they think is a link to a community they are interested in. However, large referral companies use this as click bait, and it isn't the communities' link, but rather the referral agencies. They are then contacted by that company and unwittingly sign an agreement with that agency. Regardless of if the senior or loved one uses that agency; the agency has their name in their system. We have seen these agencies then try to enforce a "proprietary" claim on that resident and demand payment from the assisted living where the senior moves into. This bill will offer protections from these types of agencies and tactics.

I support House Bill 297. As a former caregiver and a current senior citizen, I think it is important for referral agencies to openly and honestly disclose how they are paid for providing referral services. They say it is free, but I have now learned that it is not free, since they are paid by the assisted living communities. Everyone knows that costs get passed down to the end user, which would be the resident and their family members that pay their bills. I also do not think the referral agencies should have the right to use my name to make money indefinitely.

Navigating senior living options can be overwhelming—I know this both personally and professionally. As a granddaughter, my family was forced to make a difficult decision for my grandmother during a moment of panic and uncertainty. She needed more care than we were able to provide at home, and a decision had to be made quickly. At the time, we didn’t know that quality referral services existed—services that could truly guide us, educate us, and present viable options tailored to her needs. Instead, we chose a community based primarily on location and immediate availability—factors that, in hindsight, should have been among the least important considerations. We didn’t know what questions to ask. We didn’t understand levels of care, the importance of aging in place, or that services such as hospice, home health, or therapy could be brought in. We didn’t know to ask about staffing models, programming, dining, or long-term care planning. Most importantly, we didn’t know how to be better advocates for our loved one. That question still lingers with my family today: Did we choose the right place? Could we have made a better decision? Professionally, I have spent nearly 15 years as a practicing physical therapist. I’ve sat in countless care plan meetings where families are told their loved one is no longer safe to return home alone. In many of these situations, families are handed a single sheet of paper with a generic list of local senior living communities. While well-intentioned, these lists are often outdated, vague, and not personalized to the patient’s clinical, emotional, or social needs. This is where a trusted, local healthcare focused group comes in- Benchmark Senior Solutions. As trusted consultants, we step in to bridge the gap for families during one of the most vulnerable moments of their lives. Our work is not about handing over a list—it’s about truly knowing our clients and their loved ones. We take the time to listen, to understand medical needs, personal preferences, family dynamics, and long-term goals. With our clinical background and deep knowledge of senior living communities, we provide families with meaningful guidance. We educate them on levels of care, advocate on their behalf, schedule and attend tours, assist with the many details of the move-in process, and follow up after placement to ensure each client is set up for success. Our services require time, empathy, and clinical expertise—and that is exactly what we offer. We are deeply committed to the families we serve, and we also value the relationships we build with the communities we partner with. Our goal is always the same: to ensure our clients are well cared for, supported, and positioned to thrive in the right environment.

My name is Whitney Crawley, and I am the owner of Benchmark Senior Solutions, a senior living consulting group serving families throughout Richmond, Charlottesville, and Hampton Roads, Virginia. I want to express my overall support for the intent of House Bill 297. With thoughtful revisions, this legislation has the potential to significantly strengthen trust in senior advising services while protecting Virginia families and improving transparency across the aging services system. This bill is timely, necessary, and an important step toward distinguishing true resident-centered referral professionals from large, volume-driven lead-selling organizations whose business model is based on CRM data and referral quantity rather than individualized guidance. Benchmark Senior Solutions is a member of the National Placement and Referral Alliance (NPRA), and we strictly follow the NPRA Code of Ethics. I have worked in the senior care industry for over 20 years, and each member of the Benchmark team is a licensed healthcare professional with long-standing experience serving older adults. We have all personally worked within CCRC’s, independent living, assisted living, memory care, and skilled rehabilitation settings throughout the regions we serve. That experience allows us to provide families with informed, ethical, hands-on guidance to ensure residents transition into the most appropriate setting for their needs. We build meaningful, lasting relationships with the families we serve, which is reflected in our public reviews and community reputation. Please read our public reviews at : https://g.page/r/CbDdGhpFzBhlEAE/review to better understand how beneficial a local senior living consulting group can be in the communities we serve. *Please see attachment for full summary

Please pass the bill HB297. As a senior citizen, I have the right to own my own name and to know if a company is making money off of my name! It is morally wrong for a referral company to make money off of my name after only giving me referrals that pay them a fee. I don't know how to use the internet to view any terms that they say are in place. They don't pay me to use my name. So please pass the bill HB297. Thank you.

This bill improves transparency and helps protect seniors and families during an already stressful decision-making process. Families deserve to know whether financial relationships may influence referrals, so they can make fully informed choices based on a resident’s needs. HB297 promotes trust, accountability, and person-centered care while preserving consumer choice. I urge support for this important legislation.

It has been my pleasure and privilege to have been working in the senior living industry for the past 25 years. I have been approached by many referral agencies over the years and know that they are not all created equal and not all are in the referral business because they want to serve the senior population as they deserve to be served. Thank you, legislators for giving HB297 the time and attention that it needs to stop some referral companies from trying to collect fees for simply passing names and contacts along when they have never met with the family or potential resident, nor take the time to make a visit with them to a prospective community. Thank you for reminding assisted living communities that they do not have to work with any agency or company that does not have the same level of experience, professionalism, ethics, transparency or compassion as we do.

I support HB297. I have worked in and around senior healthcare services for almost 20 years. Many of these years have been spent as a Sales Director within an Assisted Living Community. I am in favor of HB297 because it provides regulation and standards to an industry that has very little of either. An industry that at its best can help guide seniors and their families through very trying periods, but at its worse can be predatory towards the general public and Assisted Living Communities it claims to be helping. More transparency and oversight are needed.

Comments Document

Requesting the opportunity to speak on behalf of referral services agencies and families. Re: House Bill 297 Summary below... Good morning, Chair and members of the committee, thank you for the opportunity to speak today. My name is Mikelle Rappaport, and I am the owner of a senior care consultant agency who serves the Hampton Roads area of Virginia and specializes in senior living placements, care coordination, and health care advocacy. I am also a member of NPRA and have made a commitment to operate our agency using best practices and under a defined code of ethics. I have also served professionally in the senior care industry for over 25 years. Today, I am here in strong support of House Bill 297. (remaining support of my position is attached and welcome the opportunity to speak today)

HB297 Referral companies like Owl be there, Families Ties, Care Patrol, Oasis Senior are all missed leading clients. They don’t disclose to their clients that they are being paid by the communities one month ( 10k-15k) or one month rent . It’s also on their agreement that we as the providers CANNOT disclose to our clients that we pay them a month rent . As a company, we charge our clients large amount of entrance fee to recuperate from those big expenses that goes to Referral companies. Also, these referral companies would not refer people to other facilities if they don’t have a contract with them. These referral companies does not even visit or assess the community for their services. They just give out the information to their clients. But, they advertise their services as free referral, but in reality.. they are NOT. It’s not fair for clients not to know this arrangement. They all get mad after they found out that we paid the company $12,000 . We need transparency! Grace Kimball Executive Director Vienna Manor

Comments Document

VALA supports HB297. We received support for this bill from numerous assisted living providers and resident family members as well as a placement & referral alliance. Why this bill is needed:  Informed consent should be the standard when seniors are making life-changing housing decisions. Many families do not realize referral agencies are paid by the ALF. Families will finally understand who is being paid and for what reasons. The referral industry has grown rapidly with little oversight. Families often make placement decisions under crisis conditions. Without standards, bad actors can operate unchecked resulting in negative experiences and higher costs. Virginia already regulates assisted living facilities, and this bill closes the regulatory gap affecting the same residents.  This bill establishes basic consumer protections and transparency requirements for resident referral agencies that assist seniors and adults with disabilities as well as their families in finding assisted living facilities in Virginia. It ensures individuals clearly understand financial relationships and referral fees, creates transparency in requiring referral agencies to provide meaningful services before being paid, limits duplicate referral fees per resident, and protects residents’ personal information through a defined look-back period. Overall, the bill creates basic, common-sense consumer protections for Virginia’s seniors and their families, and promotes informed choice, fairness, and accountability during a critical and often stressful housing decision for seniors and their families. Clarification of this bill:  Aligns Virginia with other states that already regulate referral agencies (e.g. WA, OR, AZ, OK, NV)  Does NOT ban referral agencies.  Does NOT cap referral fee amounts.  Does NOT restrict families from using multiple referral resources.  Uses civil penalties only for noncompliance – not criminal sanctions.

SUPPORT. Dear Del. Hayes, Chairwoman Tran, and members of the committee, my name is Dr. Elizabeth Kielb. I’m the Director of Maternal and Infant Health at March of Dimes for Virginia and across the DMV region. I’m here today in support of House Bill 652, in collaboration with Virginia Interfaith Institute for Public Policy and other stakeholders. In my work, I have seen what happens when a parent consents to a urine screening expecting care and instead is met with fear. When clinical staff are not trained in treating parents with substance use disorder, or even those already receiving treatment such as MOUD or MAT, which are the gold standard of care, they are falsely characterized as “drug abusers.” That mischaracterization can trigger unnecessary child separation, criminal involvement, and in some cases, avoidable deaths. More importantly, it fractures trust between patients and providers. When stigma replaces medical best practice, families disengage, care is delayed, and harm increases rather than decreases. In fact, the Center for Disease Controls reports that overdose is one of the leading causes of maternal deaths, particularly in the first year after delivery- year after year. The evidence is not neutral. Punitive or CPS-first approaches to prenatal substance exposure consistently produce worse outcomes, while non-punitive, health-centered approaches produce better ones. When substance exposure alone triggers child welfare involvement, pregnant patients delay prenatal care, are less likely to disclose substance use, and are less likely to engage in evidence-based treatment, like MOUD or MAT, the two I mentioned before. Further, punitive approaches are associated with increased NICU utilization and foster care entry without improving infant safety or health outcomes. HB 652 does not remove child protection; rather makes child protection more effective by aligning statutory reporting requirements with evidence-based care. This bill removes automatic CPS suspicion based solely on substance exposure, requires documented evidence of harm or substantial risk, encourages honest disclosure and treatment engagement, reinforces Plans of Safe Care and discharge planning, and preserves CPS involvement when safety concerns are present. This is exactly how non-punitive systems achieve better outcomes: by keeping the door to care open while maintaining safety oversight.

Position: Support Dear Del. Hayes, Chairwoman Tran, and Members of the Committee, March of Dimes has been working with Virginia Interfaith Center for Public Policy and other stakeholders on this important bill. We offer the following comments in support of HB 652. *Support for HB 652 – Evidence-Based Outcomes* Perinatal Substance Use Disorder: Substance use disorder during pregnancy is a complex medical condition that intersects with maternal mental health, access to care, and social determinants of health. Virginia data and national evidence demonstrate that early prenatal care, honest disclosure, and engagement in evidence-based treatment are critical to preventing adverse maternal and infant outcomes. Policies that deter care or discourage disclosure undermine these protective factors and increase the risk of preventable adverse outcomes. Evidence on Punitive vs. Non-Punitive Approaches: The extant evidence is not neutral. A growing body of peer-reviewed research demonstrates that punitive or CPS-first approaches to prenatal substance exposure do not improve infant safety or health outcomes, but rather are associated with predictable harms, including delayed initiation of prenatal care, reduced engagement in substance use disorder treatment, and under-disclosure of substance use, which can compromise clinical care. In contrast, non-punitive, health-centered approaches, including health-led Plans of Safe Care that reserve CPS involvement for situations involving documented safety concerns, are associated with earlier initiation of prenatal care, higher treatment engagement and adherence, improved maternal–infant bonding, reduced NICU utilization and length of hospital stay, and higher rates of infants being safely discharged to parents when no safety concern exists. Child Protections and Outcomes: HB 652 does not remove child protection; rather makes child protection more effective by aligning statutory reporting requirements with evidence-based care. Specifically, HB 652: -Clarifies that prenatal substance exposure alone does not constitute a “reason to suspect” abuse or neglect. -Requires documentation of evidence of harm or substantial risk when a report is made, improving the focus and effectiveness of CPS involvement. -Encourages honest disclosure and engagement in evidence-based treatment by reducing fear-driven avoidance of care. -Reinforces Plans of Safe Care and discharge planning for substance-exposed infants. -Preserves mandatory reporting and CPS involvement when independent safety concerns are present. This approach reflects federal intent under CAPTA and aligns Virginia law with best practices that protect infants by keeping families engaged in care while maintaining appropriate safety oversight. Conclusion: HB 652 represents a practical, evidence-aligned step forward for Virginia. By removing barriers to early prenatal care and treatment engagement, while preserving child protection when safety concerns exist, this legislation supports safer outcomes for infants, stronger families, and more effective use of child welfare resources.

This bill is necessary due to how often DSS workers say one thing and then another enters the record. We need more accountability in the agency tasked to protect children. Too often I have seen it fail due to false statements by workers, despite evidence being presented that it is false. Anything that brings more scrutiny and accountability is a win for children. Please vote yes on moving this forward. Thank you

Food is Medicine is a proven, cost-effective solution that: (1) Saves money: Preventing costly hospitalizations and emergency visits (2) Improves health: Demonstrated reductions in A1c, blood pressure, and food insecurity and (3) Strengthens communities: Supporting local food systems and Virginia's agricultural economy and (4) Has bipartisan support: Successfully implemented in red and blue states nationwide. Food is Medicine interventions include Medically tailored meals, Medically tailored groceries, and Produce prescriptions. These interventions are supported by evidence showing improvements in A1c, BMI, and blood pressure, increased produce intake, reduced depression, and decreased hospitalizations/ER utilization. HB1434 will grant Virginia Medicaid managed care organizations authority to offer Food is Medicine interventions as In Lieu of Services (ILOS) for eligible populations, starting with high‑priority groups identified by DMAS. In Roanoke City, and now throughout the region, our Food is Medicine Produce Prescription program has improved diabetes control (HBA1c reduction of 0.39), improved food security (45% of participants), and improved nutrition (71% increased fruit and 63% increased vegetable intake). In words of one of our Produce Rx participants: "I stopped taking my blood pressure medicine, because I was eating more fruits and vegetables and that I could afford to eat now." Produce Rx programs can improve health by tackling the root causes of illness. By helping people obtain fresh fruits and vegetables and learn about nutrition as part of their medical care, these programs support better health and quality of life. They also strengthen local food systems by supporting farmers, local businesses, and economies.

Support Food is Medicine: A Cost-Effective Solution for Virginia As a constituent from Fairfax County (5904 Mount Eagle Drive, 22303), I urge you to support Food is Medicine HB 1434 (Delegate Cole) that will improve health outcomes and reduce healthcare costs across Virginia. Food & Friends home delivers almost 300,000 medically tailored meals (MTMs) to 779 Virginians facing serious illnesses and chronic conditions. We see firsthand how food insecurity fuels Virginia’s chronic disease crisis. In fact, 67% of Food & Friends' clients have an income of less than $1,800/month. We believe in the power of compassion and the importance of neighbors helping neighbors, so we create opportunities for impactful and fulfilling volunteer service that helps our sick neighbors and builds a healthier community for all. MTMs have been associated with reduced depressive symptoms and fewer dilemmas between paying for either food, healthcare or prescriptions. Our client survey shows that 73% of our clients report improved mental health, 83% report improved quality of life, 81% report they are better able to follow doctors’ orders and over 93% of our clients reported that they learned to eat better for their health condition after talking with our dietitians. Our services matter. This year, more of our clients reported that Food & Friends is their only source of food. When we provide medically tailored meals to folks experiencing food insecurity, we alleviate strain on the overall food system. We’re also part of a larger healthy eating movement. With SNAP Ed eliminated, there is a gap in nutrition education. When our clients receive these MTMs, their kids see healthy food choices being modeled. One client recently shared that she appreciates the fresh fruits and vegetables we send with her meals. She said her grandson, who lives with her, likes to share the apples and oranges with his friends in the neighborhood. Proper food and nutrition helps increase absorption of medication, reduces side effects, and helps patients maintain a healthy body weight. As a member of the national Food is Medicine Coalition (FIMC), we adhere to rigorous nationwide nutrition and quality standards and uniquely employ Medical Nutrition Therapy through our Registered Dietitians, personalizing each client’s nutrition needs and encouraging lifelong improved nutrition. According to the Virginia Department of Health and the American Diabetes Association, serious illnesses such as diabetes cost an estimated $8.4 billion dollars in Virginia each year for the approximately 733,300 adults with diabetes or prediabetes. Research shows that people living with complex health conditions and enrolled in medically tailored meal programs experience 50% fewer inpatient admissions and 70% fewer emergency department visits than similar patients not enrolled in a MTM program. Recently published national research shows that if all US eligible patients received access to MTMs with nutrition standards such as ours, in just the first year of service 1,594,000 hospitalizations could be avoided for a net cost savings of $13.6 billion. Will you support these priorities? Thank you for considering this important investment in Virginia’s health and fiscal future. Sincerely, Raisa Wells Food & Friends rwells@foodandfriends.org

Hello. My name is Mary A. McFarland. I am asking for your support for Delegate Bonita Anthony House Bill 1452My sweet daughter Amy was in the hospital ICU for 29 days prior to her death. Home care attendants save the state a significant amount of money each year vs. institutions and nursing homes. Also, most people prefer to stay in their homes and communities, which is a much less restrictive environment. They are able to be with friends and family and participate in life and not just observe it from a nursing home or institution window. Therefore, I am respectfully requesting that you will please support Delegate Anthony and vote to pass HB 1452 . This will no longer help my beloved daughter, Amy McFarland, but I am hopeful that by advocating in her memory and sharing her story that it will help others with disabilities who cannot advocate for themselves. I would like to share with you a little of my daughter’s story, and the red tape that we had to go through to try and get my precious Amy a generator. My daughter had serious breathing issues and was on oxygen, medication, and was on a noninvasive ventilator. We live in a very rural area and are prone to power outages. Amy’s pulmonologist had written her a prescription for a generator to operate her medical equipment in the event of a power outage. Her case manager submitted everything that was requested by DMAS and DBHDS. We did everything that they wanted including having me sign a document stating that I would pay any amount over the $5000 waiver limit. It’s ridiculous the stipulations they have including it can only be big enough to run Amy’s concentrator, oxygen, and any meds needing refrigeration. What about heat in the winter! What about air conditioning in the summer! What about food that needs refrigeration! Needless to say, due to all of the red tape, Amy died waiting on a generator. This is so wrong, and I pray that no other vulnerable person ever has go through this. Critical lifesaving Home Mods/ Durable Medical Equipment need to be addressed in a much more timely and urgent manner. My precious daughter died while she was on approval for a generator because of all the red tape involved in getting it. Also, I would like to add that the $5000 allocation for Home Mods/Durable Medical Equipment has been the same since 1994. 32 years later it is still the same, and very much outdated as costs have increased significantly since 1994. In time, I feel that we can work to improve all these conditions. However, as I mentioned earlier, I am asking you to please support and vote in favor of Delegate Anthony’s bill . Prior to my daughter’s serious breathing issues, and despite her disability of being blind and having ataxic cerebral palsy and unable to walk, with her waiver and her attendants, Amy was advocated many years at the General Assembly In fact, because of her advocacy and mine, we were invited to the White House in 2010 by then President Barack Obama. In 2012, because of her numerous accomplishments and community involvement, Amy also competed in local, state, and national pageants and won numerous titles and awards. After my precious Amy passed, Amy’s Memorial Resolution, ((House Resolution No.90) was read on the House Floor. This truly touched my heart and was an affirmation of her contributions and a life well lived. Thank You Delegate Anthony for presenting this bill Respectfully, In Honor of Amy McFarland

As a radiological Technologist, I do not believe it is in the best interests of the public to have a person or persons take an xray of a patient outside the range of a hospital setting, IF they are not licensed. Radiology is more than just hitting a button! It is anatomy, physics and so much more. I am a licensed Rad Tech and work in an urgent care setting. As a patient, I would not feel comfortable having someone take my xray if they are unlicensed.

Passing this bill would be detrimental to the patients safety. We are trained and skilled to have knowledge about radiation safety. Without those skills, patient safety is compromised thus allowing just anyone to dose patients without the proper radiation safety, knowledge, and skill that is used to obtain a diagnostic image. Allowing individuals without this training to perform imaging puts patients at risk by increasing the chance of improper radiation exposure

As a Registered Radiologic Technologist who recently graduated, it is very disheartening to hear this is trying to pass. In no way is anyone without a degree, no matter what department or profession, in good standing to take jobs from those with a degree. It is negligent and unsafe to allow these employees to operate xray tubes, the length of some of their programs are the length of my radiation safety course, therefore resulting in a significant depletion of knowledge to safely expose patients for diagnostic imaging quality. Not only is it unsafe for the patients but for the employee themselves. I strongly urge you to reconsider this bill in consideration for patients all over to receive the care they deserve. I also urge you to try and compare this to someone with the degree you have trying to do your job as good as you know how to without even half the education you have. Thank you for your time.

As a student getting ready to graduate a radiology program to become a X Ray tech in virginia, I am very saddened to hear this is even a bill trying to be passed. In no shape or form can/should any nurse have the capability of being able to assist a physician or radiologist or PA in taking x ray’s whether that is in the operating room, fluoroscopy, or diagnostic imaging. We spend 18 months straight learning the ends and outs of patient and workers protection when it comes to radiation that no nurse could be taught in a couple of trainings. No patient will be safe if this bill passes.

As a domestic violence survivor who fled to protect her children and has fallen through every crack in the system, I have seen the failures of the current model of state funded locally administered DSS. 99% of reports made on behalf of my children by professionals have been thrown out before intake due to bias (I was emotional when I fled to protect my children and therefore must have been the problem according to them). This is the norm when it comes to protective parents who are domestic violence survivors. By requiring all reports be entered into the system, patterns can be tracked. By having the state determine validity of reports, local bias can be reduced. This would help protect more children. I urge you to please support this bill and help other families not suffer like mine have. Thank you

This bill is dangerous for children and protective parents. It harms abuse and domestic violence survivors by limiting their rights and options even more than the current system does. It sounds great on the surface but this same type of bill has had negative consequences in other states and caused more harm. It leads to dangerous fathers to not being scrutinized while protective mothers who have fled to protect their children lose custody. Currently, if a woman reports abuse of her children, she has a 90% chance of losing custody to the abuser despite concrete evidence. I beg you to reject this bill so that more children don't suffer like mine have. Thank you

I strongly urge a no vote on HB1511. The allocation of fatherhood initiative funds and grants within Health and Human Services has created serious conflicts with child abuse intake and investigation processes. Evidence indicates that federal fatherhood initiative funding has interfered with fair and impartial handling of child abuse reports, placing children at increased risk of harm. Financial incentives tied specifically to fatherhood initiatives are influencing decisions in ways that prioritize funding goals over child safety. There are documented cases in which fathers with criminal records and substantiated abuse histories have been granted full custody, while mothers are separated from their children without just cause. In these situations, child abuse reports appear to be minimized, overlooked, or inadequately investigated. In effect, money is speaking louder than the evidence of abuse. The same agency should not be responsible both for receiving gender-specific grant funding and for accepting and investigating child abuse allegations. This creates an inherent conflict of interest. Fathers do not require financial incentives to be fathers; the ability and responsibility to parent should not be determined by grant funding. While fatherless households are a real concern, these grants are now producing unintended consequences—children growing up without their mothers, even when those mothers are fit and protective parents. Caseworkers have increasingly treated abuse allegations against fathers as though they did not occur, failing to conduct thorough investigations. Notably, when the federal fatherhood initiatives were first introduced, official transcripts from those discussions raised concerns about potential interference with child abuse cases. Those concerns are now materializing. I am requesting the opportunity to testify and present evidence demonstrating how children’s safety has been compromised due to these financial incentives. Without an equivalent investment in motherhood or gender-neutral parenting supports, abuse allegations involving fathers are not being taken seriously, and mothers are losing custody without due process or just cause. These funding motivations are also influencing court proceedings and custody outcomes, even when abuse allegations are central to the case. When large sums of money are directed into a system favoring one gender, the result is unjust and potentially dishonest outcomes. Before continuing or expanding this funding, the state must first conduct a thorough investigation into how these initiatives are impacting children and families. A comprehensive program evaluation is necessary—one that examines not only positive outcomes, but also the most severe and harmful consequences, which are occurring far too frequently. Children’s safety must come before funding priorities. Respectfully, Erica M. Allen Winslow MD, MPH Founder & Executive Director Center for the Rights & Protection of Children, Inc. https://crpcwatch.org/