Mr. Chairman and Members of the Committee., I oppose “civil immunity for health care professionals serving as members of or consultants to entities that function primarily to review, evaluate, or make recommendations related to health care services to include health care professionals serving as members of or consultants to entities that function primarily to address issues related to career fatigue and wellness in health care professionals licensed, registered, or certified by the Boards of Medicine, Nursing, or Pharmacy, or in students enrolled in a school of medicine, osteopathic medicine, nursing, or pharmacy located in the Commonwealth. “ Aren’t these the same people that own the facilities?

I am for nurse practitioner to be able to practice without a doctor being there

Black women babies are 9x more likely to die during the during pregnancy and first 12 months of birth. No one knows why or has implemented systems to research. This is a very important bill. No reason black women are dealing with issues of maternal mortality and infant mortality rates that are extremely higher than other races.

The day I had been waiting so patiently for will never come. I can’t stop thinking had I requested more work or ultrasounds to be done, my baby girl would still be here. I beat myself daily and don’t know if this pain and void will ever leave. It was a Saturday, I noticed my baby not moving as much, I contacted my doula, she instructed it’s better to be safe than sorry, so I went to the ER. Initially they had trouble finding a heartbeat but they did and my baby’s heart was doing fine. They kept me on the monitor for about 30 minutes and said everything is fine and I’m free to go. I contacted my doula to express that movement still wasn’t like normal and is there anything else they normally do. She said you can ask if they will do an ultrasound to ensure everything fine or if they have another test that can provide more clarity for my nerves. Dr. Instructed I’m just overthinking and baby has a strong heartbeat so it’s no need. I said okay I have a doctors appointment on Monday anyway I can have them check. Fast forward Monday is hear and I’m at my OB for a checkup she goes to find a heartbeat and just like that it’s never comes. I’m terrified crying yelling and loss for words when I’m told there is no heartbeat and we need to run tests to see if there is anything at all. Nope nothing can be done. I’m 36 weeks and my baby girl is no longer hear. For weeks I’m reviewing everything over again and I’m looking at the autopsy report no reason is given. No one knows what happened. I go through phases of blaming myself to blaming my husband. I’m healthy, wealthy, college educated, and I made all of my prenatal appointments but my baby is still not hear. I can’t even be happy for my friends who are expecting because my baby is no longer here without an explanation I will never see her wiggle her toes and even gaze into her eyes. 26, African American, and afraid to get pregnant again. Please support this bill. Chelsea Stewart Richmond, Virginia

Establish a review team to study and improve outcomes for fetal and infant mortality (currently exists, but needs dedicated funds and structures to operate effectively) Virginia Needs to Review and Study Fetal and Infant Mortality The U.S. has one of the best healthcare systems in the world—and yet our fetal and infant mortality rate is unacceptably high. Within the U.S., Virginia ranks 21st, which demonstrates the need to study and improve in this area in the Commonwealth. Black women are 9 times more likely to lose a pregnancy than white women. It is imperative that this division along racial lines also be addressed. In order to do that, we must understand the factors that put women of color at substantially greater risk of losing a pregnancy. A Fetal and Infant Mortality Review (“FIMR”) Team would use an integrated, multidisciplinary, community-based approach to study all of the elements and circumstances that contribute to fetal and infant mortality. FIMR includes action-oriented processes to improve services, systems, and resources for women, infants, and families. These improvements are crucial if we are to address these problems. For all of the above reasons, I strongly support HB 1950.

My name is Rebecca Gotwalt and my [Senator/Delegate] is Chap Petersen/Karrie Delaney. Currently the Commonwealth is undeserved in many areas of reproductive healthcare. When I was young I was shamed and threatened by a Giles County Health employee for requesting a check up and birth control. After that failure, I fell pregnant and had to come up with what seemed an impossible amount of money and travel more than 120 miles round trip to obtain my abortion. If something as simple as birth control and abortion are so difficult to obtain, what chance do Virginians have who want to complete a healthy pregnancy? Maternal, fetal and infant mortality must be addressed – with an emphasis on the health of Black and brown families that have death rates up to nine times that of their white counterparts. Please support HB 1950 and move Virginia forward in our quest to provide quality reproductive healthcare for all.

I am for nurse practitioner to be able to practice without a doctor being there

In favor of programs to better facilitate the development and progress of my community.

I am for nurse practitioner to be able to practice without a doctor being there

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I urge you to vote yes on HB 1976. The ability to attract and retain a quality workforce to provide behavioral health services in Virginia is among the most significant challenges our members face. Last June, our association launched OneVACBP, an initiative focused on fighting racism and promoting diversity, equity and inclusion. We applaud Del. Willett for introducing this bill to ensure the Authority is engaged in developing strategies to increase diversity in our healthcare workforce and to examine demographic data on race and ethnicity in training programs and licensure to support this goal. I'd also like to take this opportunity to remind the members that it is critical that workforce needs in the behavioral health industry be recognized and included in the focus of the Virginia Health Workforce Development Authority. Thanks to Del. Willett for introducing this legislation. The VACBP also supports HB 2070. While private-sector behavioral health agencies provide 80% of the Medicaid behavioral health services in Virginia, private providers play virtually no role in STEP-VA. As the CSBs continue their work to achieve the STEP-VA milestones, we encourage consideration of how private-sector providers in Virginia can support their efforts. The VACBP strongly supports any action this body may take to encourage partnership between the CSBs and private providers and for this reason, we ask that you vote yes on HB 2070.

I am for nurse practitioner to be able to practice without a doctor being there

Rare disease patients in Virginia face unique challenges every day, from obtaining an accurate diagnosis and accessing medical specialists with knowledge of their condition, to battling for fair insurance coverage of their treatment and care. As the mother of two children with a rare disease, I can certainly relate to some of these unique challenges. My son Stephen was born with a rare metabolic disorder called isovaleric acidemia detectable with newborn screening. Due to lack of expanded newborn screening, his disorder was not diagnosed until he was 3 ½ years old resulting in a traumatic brain injury and multiple complex medical issues. Thanks to knowledge gained from Stephen, my daughter was diagnosed with the same disorder before birth. Her early diagnosis enabled her to receive immediate treatment for her high school this year and go on to college. Since their diagnosis, we have faced various challenges over the years. Finding a pharmacy to fill their prescriptions for the medications to treat their disorder has been difficult. There have been hurdles in obtaining their medical formula and receiving insurance coverage for it. The current pandemic poises new problems. They are definitely in the high-risk category keeping them primarily at home and no access to the vaccine in our county. I am the primary caregiver for Stephen, but do not fall into a prioritized category for the vaccine. These are just a few examples of struggles we and others in the rare disease community across the Commonwealth face on a daily basis and are left to find solutions on our own. The Virginia Rare Disease Advisory Council would help address the challenges faced by rare disease patients, their families and their caregivers by providing a forum for stakeholders across the state to analyze the needs of the rare disease community and make recommendations on how to improve public policy. To date, sixteen states (Alabama, Connecticut, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, New Hampshire, New York, Nevada, North Carolina, Ohio, Pennsylvania, Tennessee, Utah, and West Virginia) have created a Rare Disease Advisory Council and proven that it is an effective way to ensure better government engagement and action on issues of importance to the rare disease community. I urge you to vote in support of HB 1995 and help Virginia become the 17th state to enact an RDAC. Thank you.

On behalf of the 1-in-10 individuals in Virginia with one of the approximately 7,000 known rare diseases, the National Organization for Rare Disorders (NORD) thanks you for putting House Bill 1995(HB1995) on the Appropriations - Health and Human Resources Subcommittee’s agenda. HB1995 establishes a Rare Disease Advisory Council (RDAC), which if passed, would help to give a voice to the rare disease community within Virginia’s state government. NORD urges you to vote in support of HB1995 and swiftly move it out of your committee. NORD is a unique federation of voluntary health organizations dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. We are committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and patient services. Rare diseases are present across a broad spectrum of medical conditions. For example, there are more than 500 types of rare cancers and all forms of pediatric cancer are rare. For patients suffering from these and numerous other rare conditions, it can take several years to receive an accurate diagnosis and effective treatment. Further, only a handful of rare diseases are well-understood, with most not receiving sufficient attention or funding for research. Creating an RDAC in Virginia will give rare disease patients a unified voice in Virginia ’s state government, helping to provide educational awareness and make recommendations to elected officials and other state leaders on how rare diseases are handled and treated in the state. From providing information on the diagnostic journey, to making recommendations on state programs such as newborn screening, the council will serve as a tremendous opportunity for important decision-makers in Virginia to better understand and meet the needs of their constituents. Since this council would include broad participation from the different health care sectors present in Virginia, it will also serve as an educational resource to all stakeholders about the ways rare disease patients interact with our health care system. In creating this council, Virginia will be joining sixteen other states (Alabama, Connecticut, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, New Hampshire, New York, Nevada, North Carolina, Ohio, Pennsylvania, Tennessee, Utah, and West Virginia) who have already enacted similar legislation in support of their rare disease community. Once again, on behalf of the Virginia rare disease community, we thank you for putting HB1995 on the Appropriations - Health and Human Resources Subcommittee’s agenda and urge its swift passage. For any questions, please feel free to contact Annissa Reed via email at areed@rarediseases.org. Thank you for your consideration.

Dear Chairman Sickles and Members of the House Health, Welfare, and Institutions Committee: On behalf of the 1-in-10 individuals in Virginia with one of the approximately 7,000 known rare diseases, the National Organization for Rare Disorders (NORD) thanks you for putting House Bill 1995(HB1995) on the Health, Welfare, and Institutions Committee’s agenda. HB1995 establishes a Rare Disease Advisory Council (RDAC), which if passed, would help to give a voice to the rare disease community within Virginia’s state government. NORD urges you to vote in support of HB1995 and swiftly move it out of your committee. NORD is a unique federation of voluntary health organizations dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. We are committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and patient services. Rare diseases are present across a broad spectrum of medical conditions. For example, there are more than 500 types of rare cancers and all forms of pediatric cancer are rare. For patients suffering from these and numerous other rare conditions, it can take several years to receive an accurate diagnosis and effective treatment. Further, only a handful of rare diseases are well-understood, with most not receiving sufficient attention or funding for research. Creating an RDAC in Virginia will give rare disease patients a unified voice in Virginia ’s state government, helping to provide educational awareness and make recommendations to elected officials and other state leaders on how rare diseases are handled and treated in the state. From providing information on the diagnostic journey, to making recommendations on state programs such as newborn screening, the council will serve as a tremendous opportunity for important decision-makers in Virginia to better understand and meet the needs of their constituents. Since this council would include broad participation from the different health care sectors present in Virginia, it will also serve as an educational resource to all stakeholders about the ways rare disease patients interact with our health care system. In creating this council, Virginia will be joining sixteen other states (Alabama, Connecticut, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, New Hampshire, New York, Nevada, North Carolina, Ohio, Pennsylvania, Tennessee, Utah, and West Virginia) who have already enacted similar legislation in support of their rare disease community. Once again, on behalf of the Virginia rare disease community, we thank you for putting HB1995 on the Health, Welfare, and Institutions Committee’s agenda and urge its swift passage. For any questions, please feel free to contact Annissa Reed via email at areed@rarediseases.org. Thank you for your consideration. Sincerely, Heidi Ross Annissa Reed Director of Policy State Policy Manager, Eastern Region National Organization for Rare Disorders National Organization for Rare Disorders

I am for nurse practitioner to be able to practice without a doctor being there

Spoken

McShin supports this bill.

We strongly support HB 2070 that gives Community Services Boards' the ability to increase the availability and quality of services through public/private partnerships to all Virginians with behavioral health challenges and substance use disorders.

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I urge you to vote yes on HB 1976. The ability to attract and retain a quality workforce to provide behavioral health services in Virginia is among the most significant challenges our members face. Last June, our association launched OneVACBP, an initiative focused on fighting racism and promoting diversity, equity and inclusion. We applaud Del. Willett for introducing this bill to ensure the Authority is engaged in developing strategies to increase diversity in our healthcare workforce and to examine demographic data on race and ethnicity in training programs and licensure to support this goal. I'd also like to take this opportunity to remind the members that it is critical that workforce needs in the behavioral health industry be recognized and included in the focus of the Virginia Health Workforce Development Authority. Thanks to Del. Willett for introducing this legislation. The VACBP also supports HB 2070. While private-sector behavioral health agencies provide 80% of the Medicaid behavioral health services in Virginia, private providers play virtually no role in STEP-VA. As the CSBs continue their work to achieve the STEP-VA milestones, we encourage consideration of how private-sector providers in Virginia can support their efforts. The VACBP strongly supports any action this body may take to encourage partnership between the CSBs and private providers and for this reason, we ask that you vote yes on HB 2070.

In favor of programs to better facilitate the development and progress of my community.

Good morning. I am George Barry Hamann, a funeral director here in Delegate Mugler’s district in Poquoson, Virginia and I am in full support of this bill. In March, because most of the PPE supplies were diverted to hospitals and recognized first responders, funeral homes were unable to receive the equally necessary PPE’s to support our service to our communities. It took literally months to receive even one box of gloves and even now we are just receiving some of the back ordered supplies that we attempted to purchase in March and April. I ask that you support this bill to ensure that funeral homes can receive the PPEs during a pandemic to fulfill our essential role of caring for those who were lost during this difficult time. Funeral homes and their staff are uniquely and unquestionably an essential part of any loss that our communities face. Thank you Delegate Mugler for introducing this bill on our behalf. Thank you all for your time and consideration. 

I am providing vehement objection to any and all funding of House Bill 2117 for the Children's Services Act (CSA). I have four and a half years of personal experience including dispute with this law involving my 17 year old child, who has Autism. This law puts funding, decisions, and authority in the hands of the Community Policy Management Teams, the Family Assessment Planning Teams, and the City Councils and County Boards of Supervisors. This is a clear and flagrant misrepresentation of Special Education, as the educators do not administer the law. The only Special Education Law in the United States recognized by the Supreme Court of the United States is the Individuals With Disabilities Education Act (IDEA). All legal record for the child is contained by IDEA. All Due Process hearings are contained within IDEA. By creating the CSA, Virginia has artificially defined a group of IDEA children, and has discriminated against them by informing parents that somehow this different and unequal law is official and necessary. Nothing could be farther from the truth. IDEA serves the most severely disabled children in Virginia, the least severely disabled, and an infinite range in between. The CSA, including HB 2117 is being misrepresented to parents because it is only beneficial to the schools and corporations in the Private Special Education industry and not ultimately to the child. This results in extraordinary burden of cost on taxpayers, as there is the unnecessary CSA administration. In Norfolk, the contracted CSA private schools are more than $50,000 per year, while there are other private special education schools in the state and region which have much lower tuition. But the highest tyranny is not the cost. The worst of it is that the highest executive authority for the IDEA in the commonwealth of Virginia for Special Education, VDOE Assistant Superintendent Dr. Samantha Hollins, is being subverted by the Virginia House, Senate, Governor, Attorney General, and Taxpayers, because the entire State Government believes other agencies should have her funds and authority through the CSA. As I stated I have been in a dispute with the CSA, and this is because my child was contracted and placed by a CSA committee to a private special education school licensed by the VDOE. This school utilizes restraint and seclusion, has a seclusion room, no outdoor playground, and is designated as being able to take sex offenders, severe maladaptive behavior children, psychotic children, juvenile offenders and many other scary designations. Would you want that to happen to your children??? Financially, it is extraordinarily easy for Virginia to fix this problem. Step one is shut down the CSA, step two is put the education funding into the State Education Agency (SEA) and Local Education Agency (LEA) under the IDEA. Then, my local School board, Special Education department and IEP team would have the money and the authority to fund private or public school for special education with the IEP team. HB2117 denies Equal access to IDEA, partially defunds all IDEA agencies by competing for scarce state funds and provides the FAPT, which is not admissible in IDEA due process decisions. There is no legal reason for the CSA to exist, so you shouldn't fund it. It hurts children by segregating them out of district, where the typical peers and opportunities are no longer available. You simply don't need two laws to serve one child.

On behalf of The Arc of Virginia, disAbility Law Center, NAMI Virginia and CA Human Services: Summary Statement: We must oppose both HB 2117 & SB 1313 in their current form, and have proposed a viable amendment to patrons to address the strong concerns over continued inequity. Virginia already demonstrates it’s belief that CSA State funds should pay for additional services needed for students with more complex needs. Unfortunately, the bills as written continue to reinforce the inequitable requirement that in order for a student with complex needs to have their additional services funded, they must be willing to be segregated. Facts Regarding OPPOSITION We are not proposing the implementation of JLARC Recommendation #4, this session. We strongly believe, as written, HB 2117 & SB 1313 may result in an unsuccessful implementation of JLARC Recommendation #3. We are not proposing anything that cuts off funding to private day schools. We no longer oppose the 12-month cap for a transition period, a time in which funding in both public and private day schools may be necessary, we understand the need for that cap. We are opposed only based on the lack of CSA funding for ongoing post-transition services necessary for a student’s success in the public school system. Facts Regarding Post Transition Services Proposal As proposed, ongoing POST Transition Services would be limited ONLY to that Student AND ONLY for those services identified during the Transition Period as necessary for that child’s success in public school ---- eliminating any concerns about CSA funds going into the general budget of any public school division. Ongoing services after transition do NOT add to Virginia’s costs over what would have been spent had the child not transitioned out of private day school back to their public school. If a student’s needs could be met by the existing funding in public schools, that student would/should not have been placed in a private day school in the first place -- therefore demonstrating the need for ongoing funding for services after transition. Why this position on the legislation is necessary: It is collectively our strong opinion that, without ensuring ongoing availability of funding for this specific student population after transition, Virginia is putting students, families, and our local school divisions at a disadvantage -- and very likely setting them up for failure. Additionally, the unsuccessful implementation of JLARC Recommendation #3 puts at risk any future implementation of other recommendations -- and implementing those additional recommendations should be something towards which all stakeholders are actively working. Thank you, with permission of those organizations listed, Tonya Milling Executive Director of The Arc of Virginia

I support HB 2117 which supports collaboration, partnerships, protections for ALL children, and transitions. This bill supports the JLARC recommendations and this is a great step forward. I am curious if it actually affects any of the legislators deciding this personally like it does my family? Or my friends’ families? Do you have to decide to put every ounce of self-respect you have as a human being in the pit of your gut to beg, literally beg the public school system to help your child communicate? Y’all can get tied up in schematics of who has what in whose bill. Why this one?! It actually benefits the students not the public school, CSA, not the ARC. Which bill actually has parent support? Genuine parent support? This one! We already have a stacked dispute resolution system that the school districts have a 97% win ratio. It is, almost, what is the point to even ask y’all to do anything anymore if you don’t listen to the people you are supposed to represent? Y’all are more worried about keeping your funders happy than the people that voted to put you in the office you have. Anyone with a bad comment about this bill isn’t a parent. They are with the schools, or special interest groups to get the money. That is telling, isn't it!? Remember your decision today actually impacts real families especially mine. I urge you, also, to vote for Senator Mason’s Children Services Act, S.B. 1313, and keep funding at the state level for private day schools that serve the special needs community. Virginia’s most vulnerable children and families must be protected. questions: emhopi@msn.com

Thank you Madam Chair and Members of the Committee, I am the Policy and Legislative Chair of the Virginia Council of Administrators of Special Education (VCASE). Our more than 400 members work directly with local CSA offices in addressing special education placements in private school settings as well as serving our 164,000 students with disabilities in our public schools through participation in IEP meetings. We appreciate Del. VanValkenburg's addressing JLARC recommendations included in HB2117. VCASE has long advocated the flexibility of CSA funds that could be used not only to assist students in transitioning back to public from private placements but also and more critically needed to intervene with CSA-funded services BEFORE consideration of private placement. We believe that elements in Sen. Sutterlein's bill including our recommendation for enhanced services to provide students services to keep them in the least restrictive environment of the public schools PRIOR to expensive private school placements. We do not require a year of study by a work group to replicate CSA funding flexibility that was permissible and effective back in 2010. We appreciate the work Del. VanValkenburg and Sen. Mason have done in response to our suggestions. Thank you! Mike Asip

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My son Kingsley needs BRAAC because he can not do virtual learning with his disability and attention span. He can not be in public school as well. He can only be helped one on one with his serves BRAAC is highly trained to give him.

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My son twin boys needs BRAAC because they are stage 3 autistic. The public schools could not help them. Since being at BRAAC my boys can get the therapies they need. Since being at this school I have seen drastic improvements. This school has been a life saver for my boys.

My son Ethan is not a neurotypical child. He has a severe form of autism. He is 11 years old. He cannot speak, and while very intelligent, he has trouble interacting in the world in the way a “typical” child is able. He doesn’t live in a world that makes sense to him in the same way it does to you or I. His world, while it may be the same that you and I share, is quite different. Entropy and chaos replace for him that which control and order reside in ours. Alienation and loneliness stalk him, even in a room of those who love him, since he cannot express his thoughts or feelings to them, not they to him, in any effectual way. Respite is found in behaviors that other children label as “odd” or “weird”. Flapping of his hands, or bouncing on a yoga ball with more dexterity than most gymnasts, replace “normal” childhood activities like playing video games with friends or having a sleepover. My son in the care of the wonderful professionals at Plan Bee Academy and has made more progress than we thought he could. His use of a device to communicate has improved greatly, his behaviors have decreased, his aptitude more fully realized. Its not been without hard work on his part, but with far greater volumes of effort from the staff. They teach the hardest of our little ones. Those that others have long since abandoned and given up on as “not worth it”, or “incapable”. Each tiny progress is another of Ethan’s victory songs, lifted up by the voices of those who have struggled alongside of him every step of the way. His mother and I sat in tiny chairs, in a crowded auditorium last winter, and watched him ring a tiny little jingle bell, on a very chaotic, gorgeously full stage of his classmates, just staring out into the audience with this brilliant luminescence of joy beaming from him. Most parents would have been laughing at the discombobulation of the kids, or winced at the cacophony of a dozen little angelic voices with no semblance of harmony, but not us. We cried. Not pretty little tears, or delicately hidden sniffled weepings. No, full on crying, lost in the warmth of his smile, and the totally off-rhythm shaking of a bell to music we couldn’t even hear. Because for one instant, he wasn’t an autistic kid, he was just a kid. And while he may still never have a sleepover or a best friend to share his secrets with, in that moment he was with his classmates, the closest thing he has ever had to friends, on that stage. A kid, who for the first time in his life got to be in a Christmas “play”. That moment, for him, and for us, represents so plainly what places like Plan Bee are all about. They aren’t about helping “Autistic” kids, or making “Special Needs” childrens’ futures brighter. They aren’t, because they don’t see them that way. Places like that, and people like them work every day to make our childrens’ lives better and futures brighter because………..they are KIDS, and they deserve the chance for a better life, no matter its degree.

"I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My son needs BRAAC because he was removed from by the public school system due to behaviors and they couldn’t educate him. Since attending BRAAC, my son has been able to learn at a his own pace and not get overwhelmed in large classroom. He has trained staff to help him navigate obstacles and teach him in his own unique learning style. He has made great strides both academically and behaviorally. During the summer, he was able to return to school because BRAAC knew the challenges these children face with routine changes. It negatively affects every aspect of his life not having a structured daily routine. Public schools still aren’t able to offer 5 days a week locally. Without this private day school, I am certain that my son would be in a residential facility. BRAAC provides so much more than an education. Public schools aren’t capable of providing my son his unique educational and social needs. Grateful for private day schools, Amanda Beheler

My name is Uchenna Elechi, I am a Physical Therapist and the mother of a 20 year old man on the Autism Spectrum. We live in Roanoke County. I am writing to SUPPORT HB2117 which supports collaboration, partnerships, and protections for all Children and transitions.. This bill supports the JLARC recommendations and this is therefore a great step forward. In 2003 at the age of 3 my son Chukie was diagnosed with Autism. We got the diagnosis and quickly realized that there was no help, no plan and no quick fix for what ails our son. We were advised to get him into the Roanoke county preschool which we did. To their credit, his first classroom teacher and Aide loved him , but didn’t know how to help him; more so with 11 other kids in the classroom. And so our son spent much of his school day restrained in a “ high chair”. After many agonizing months of searching for help for our son who at this age was completely non verbal, did not make eye contact, appeared to be unaware of self, lacked the ability to interact with us or his peers, and was prone to fits of outbursts and tantrums we heard about BRAAC! AND WHAT A LIFE SAVER THAT HAS BEEN. In the 16 years since then, Chukie has benefited tremendously from the intense one on one ABA therapies he has received and continues to receive. He has been taught things as simple as making a thumbs up 👍🏾 sign , to writing his name, appropriate social behaviors ,interactions with others and self regulation albeit with prompts as needed; He continues to work on communication with the help of a speech augmentation device, as well as on building skills that hopefully will help him to transition out of school soon, allow him secure supported employment and exist as a productive member of his community. I therefore implore you to please support this HOUSE BILL 2117 . Thank you for taking the time to read this, Uchenna Elechi.

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My son/daughter needs BRAAC because in 2010, my family was in crisis. At the time, our three-year old with autism (and a severe intellectual ability), Kaedan, was in a public school preschool program. His behaviors grew worse and out of control. Kaedan urinated and defecated on our floors. He stripped both at home and in public (Yes, he has been naked in Kroger). He screamed so loud we wore ear plugs. He woke at night, jumped on the floors loudly, and kicked holes in the walls. He bit family members frequently. Frankly, my wife and I were tired, frustrated, isolated, desperate, and losing it mentally. The public school had no answers. Our saving grace was BRAAC. They trained us in applied behavior analysis. They worked with our son intensely. They committed to programming a public school simply can never match (and I say that as a public school secondary teacher). He quickly became potty-trained. He learned language to express his needs. His behaviors improved. I urge you to vote for Senator Mason’s Children Services Act, S.B. 1313, and keep funding at the state level for private day schools that serve the special needs community. Virginia’s most vulnerable children and families must be protected. If you have any questions, I'd be happy to speak with you (540-915-0604). Sincerely, Mark L. Ingerson 4609 Great Glen Drive Salem, Va 24153

I support HB2117 which supports collaboration, partnerships. Protection for ALL children and transitions. My son needs BRAAC because he is on the autism spectrum and requires 1:1 throughout his day. He has behaviors daily that BRAAC staff know how to handle and keep him safe. He is in a safe nurturing environment with well trained and qualified staff who know how to met his individual needs and provide family support as well. Thank you The Crush Family

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My brother NEEDS BRAAC and I know all families feel this way about their special education day schools. At BRAAC they understand my brothers needs. They understand his communication device and how to show him how to use it to reduce his frustrations. BRAAC understand when a 12 year old is still working on toilet training. BRAAC understands how to reduce self injurious behavior. BRAAC understands how important the team approach is to my brothers success with his activities of daily living. Please vote for this bill so my brother can remain in an educational environment that meets his unique, individualized, educational and behavioral needs. In order for him to be successful he needs to continue to participate in an intensive autism program with highly trained staff and receive 1:1 intensive ABA in a year round school... as do all of the children that are thriving in this type of school. Please support HB2117

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! If you do not have a child with the needs of an intensive educational program like the BRAAC offers, then I would ask you to take my word for it and support this bill. This is a REAL NEED in our community! My son is nonverbal and uses a communication device to speak. His ability to communicate needs to be strengthened in order for him to have meaningful dialog with his peers and adults in school, at home and in the community. My son also has self injurious behaviors that need intervention and also he needs help working on his activities of daily living. The BRAAC offers him the services he needs so he can continue to receive the intensive behavior plan simultaneously, in order to meet his needs and work towards accomplishing these goals. My sons school is filled with children just like him that need the support of BRAAC and these kids and our families need YOUR support of passing this bill.

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My daughter needs BRAAC because not only does she love Braac Roanoke and the technicians she is with. She has made progress that many doctors believed was not possible. She has really opened up and is starting to speak because of her technicians at school take the time to really get to know her and understand her. Without a school like Braac I fear she will be back in public school where she set for an entire school year not making progress where they did not have high hopes or expectations for her. So she was essentially taught that she could escape school because they never had her comply with instructions. Because this behavior was reinforced in public school...it continued into the hope. It became dangerous to take my daughter anywhere and she could not interact with her baby brother because she would not comply with instructions. Now that she is at Braac she is flourishing...she is able to be in public. Her behavior is more compliant. She is learning to play with others. Her future looks brighter with Braac in our forefront. PLEASE help us to make sure her future is still bright.

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! Our daughter needs BRAAC because it is the only option that provides a FAPE given her unique needs. Our daughter failed to make meaningful progress, and in fact REGRESSED, in the public school setting in both academic and life skills over a three year period. Although our daughter could read and speak, she lacked the ability to use her language skills functionally, and to demonstrate understanding of appropriate behaviors. The public school discontinued autism consultation and therapies even as her abilities declined. Upon the recommendation of multiple developmental specialists, we explored more intensive educational settings. BRAAC was able to meet our daughter's unique needs and to increase her functional communication skills greatly, despite the sudden onset of intractable epilepsy just prior to enrollment. BRAAC met our daughter where she was and developed a truly INDIVIDUALIZED educational plan for her, instead of trying to make her fit into a one size fits all program that did not provide the one on one instruction that she required. While we believe that the public school is making progress to meet the needs of more students than in decades past, it is not capable of meeting the highly specialized needs of some students with autism, and some other educational needs. BRAAC provides one on one instruction with highly trained staff that develop and implement a program for our daughter, tracks her progress, and regularly modifies and fine tunes the program based on progress and interpretation of data. Furthermore, parents are provided with multiple avenues to be involved in a meaningful manner, which will provide the greatest chance of transfer of learned skills and behaviors. For our daughter, it included gathering relevant medical updates during frequent meetings, and tracking behavior, skill progress, and medical events when medications were changed. This was especially helpful when seizures climbed to over 100 per day at one point. Safety measures were put in place and we were able to have clear data when medications had an adverse or positive effect on learning. Finally, BRAAC provided in-home and in-community training for our daughter with us to address real life challenges. In the community, I was frequently unable to take our daughter into many settings with a reasonable degree of safety. She would scream, scratch, hit, and throw herself down, sometimes near sharp shelves or when crossing parking lots. I struggled with her unbuckling and moving around in the car to hit younger siblings. There were multiple occasions where I had to pull off the side of a busy highway to get her under control. BRAAC developed plans with us for situations like those, and also routines for home such as a morning routine that would help address her inappropriate behaviors that were causing her to be late for school. BRAAC sent staff to observe the mornings at home, developed and implemented a plan. Then staff trained and observed us implementing the plan, and made adjustments until we had a successfully working plan that greatly decreased the frequency and duration of problem behaviors, and insured that Caroline got to school on time. In conclusion, schools like BRAAC provide a critical service to meet the needs of certain students.

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions.  This bill supports the JLARC recommendations and this is a great step forward! My son needs Blue Ridge Autism and Achievement Center (BRAAC) in Roanoke. Matthew attended public schools for four academic years, from age 3 to age 7. He was diagnosed as being on the Autism Spectrum at age 6. He was identified as being “twice exceptional” during testing but his education suffered because of the public school’s inability to provide the supports he needed.  During his time in public school he was repeatedly physically restrained, put in a “calm room”, (closet with mats on the wall and floor), removed from general education classes and left to watch YouTube videos by himself, excluded from class events, false ABA practices were used by Instructional Aides with no training which escalated behaviors and caused mental anguish. Despite numerous IEP meetings, hiring an Educational Advocate, providing proof the data was incorrect and his IEP was not being followed nothing was done. He showed PTSD symptoms related to school. By the end of 2018-19 school year no place would accept him for summer childcare and I had to take FMLA unpaid leave. His escalations had us fearing inpatient treatment might be the only option. Out of desperation we withdrew him from public school and enrolled him privately at BRAAC in the fall of 2019. Within only a few months the aggression drastically reduced, he wanted to attend school, and was excelling academically. BRAAC provides parent classes where we learned what ABA should look like and how it works when used by trained certified staff.  Now in our second year at BRAAC he is testing at least one grade level above his grade in all subjects, is learning to advocate for himself and how to use coping strategies. Our play therapist and child psychologist have praised BRAAC’s ability to combine ABA with a trauma informed approach due to his childhood trauma prior to our adoption of him. We have been able to reduce the amount of medications being taken and Matthew is now, at just shy of age 9, receiving an education that meets his needs, has a community of friends and supports, and we are confident in his successful transition, when the time is right in the future, to a school system to earn his diploma.  Our school and other special education day schools are needed to educate these students with unique educational and behavioral needs. Please feel free to contact me with questions at 540-529-5246.

I support HB 2117, which supports collaboration, partnerships, and protections for ALL children and transitions. This bill supports the JLARC recommendations, and this is a great step forward! My son attends the Blue Ridge Autism and Achievement Center (BRAAC) in Roanoke County. He has multiple diagnoses and special education needs, and the public school district, through the IEP process, has determined they cannot provide him with the services he needs, and thus supports his placement at BRAAC (since the 2017-18 academic year and every year since). The highly trained educators at BRAAC have helped him advance his academic skills, but they are able to do so at HIS level and adjust as he masters skills, rather than at grade level. They are also helping him develop his social and vocational skills. He has overcome an inability to sleep because he loves to go to school now instead of dreading it like he did when he attended public school. At BRAAC, he is included in all activities, rather than excluded due to behaviors that teachers can't manage in crowded classrooms, as happened daily in the public schools. He is learning to manage his behaviors as well as his relationships with peers and adults. I could go on and on. Really, I can't overstate it. My son's attendance at BRAAC has been life-changing in so many positive ways that will impact what he can achieve--and there are similar stories from other parents, some of whom may get a chance to speak with you today. Please support HB 2117. My son needs BRAAC because, by the public school district's own determination, the public schools cannot provide what he needs. BRAAC can and does! In fact, the highly trained staff at BRAAC are providing my son with intensive, evidenced-based instruction and services that are making a tremendous impact on his abilities, knowledge and skills, and in turn, they have boosted his overall well being, both now and into his future.

Mu husband and I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and is a great step forward! My son needs the Blue Ridge Autism and Achievement Center (BRAAC) because he is considered to be on the profound end of the autism spectrum. He is 15 years old and is not able to speak any words. He communicates solely though sign language, gestures, and his communication device. He requires intensive 1 on 1 assistance and teaching due to his high level needs and behavioral issues. BRAAC has been a lifesaver for our son and for our family!

I support HB 2117 which supports collaboration, partnerships, protections for ALL children and transitions. This bill supports the JLARC recommendations and this is a great step forward! My son, Noah, attends BRAAC and has had academic and social success all because of the BRAAC staff giving him the guidance he needed. Noah was refusing to even get out of the car when he was attending public school. On the days he did attend school he was either being suspended or spending time in a padded room because staff did not know what to do with him. It was pure torture and heartbreak UNTIL he was able to attend BRAAC. He needs private day and he deserves to be able to access the kind of education he NEEDS. I hate to even think of where he would be and where our family would be had he not been able to attend BRAAC. They do GREAT things and they deserve every penny they can get and support from everyone in the education field.

My son was diagnosed with autism just prior to his 3rd birthday. He was completely non-verbal. We had to strongly advocate for placement in a specialized school, and it was the most appropriate decision we could make for him. Specialized placement provided a learning environment that encouraged intensive skill acquisition. Every child has unique learning challenges that can not always be met in a student's home district. If we had not advocated for this, we would have lost a precious window of opportunity for skill acquisition in his early intervention. Special needs students, particularly students with autism, need that intensive intervention. By doing this early and intensive intervention, as well as specialized learning environment, he excelled in expressive language, social skills, as well as job readiness and other academic areas. Today, he is 29 years old, and lives in a regular apartment in downtown Roanoke. He has been on his own for 6 years. Blue Ridge Autism and Achievement Center and other specialized day schools provide unique environments for learning, and have programs and staff not typically available in a public schools. It is important for this bill to be considered for the future of special needs students. Thank you!

I am writing on behalf of House Bill 2117. I am not the parent or caretaker of a child/ adult with disabilities or Autism but I am involved in the daily operation of a private school serving this population. I can tell you without hesitation that our school like many private schools take that responsibility very seriously. The students who attend BRAAC are the priority period. This includes the facility designed to meet their needs, qualified staff who receive continuous training, parent training on -going, equipment updates, supplies for educational and academics needs, care and maintenance of our facility community awareness and more. The Administration of our organization develops fund raisers continuously in order to support the school, the students and scholarships for our program. The personal attention we give to the students and their families is often key to our success and doing that to the degree we do is difficult for public systems with tight budgets and large enrollments. Our private setting which is entirely set up for the students we serve gives the students individual attention , protection and trained therapists from the time they arrive until the time they leave each day. We also provide therapists who go to their homes to assist the student and their family which is also key. This is what we do and because this is our only mission as a Private School, we are able to put all our efforts and energies into each individual challenge, each individual student on a daily basis. Funding Private Schools such as BRAAC not only meets the needs of the population we serve but it supports the community and the public schools in our community and surrounding counties. We have proven to be a good neighbor. Please listen to the parents of children who feel they have been lost in the public system. Please know we serve a very special purpose in our community and yes those funds are very much needed to continue what has been proven to be a successful Private School. Thank you for your consideration of House Bill 2117. With Respect, Lucy Henderson do

Hello, Please Pass and support Delegate VanValkenburg's House Bill 2117! This bill enables private schools such as BRAAC to receive the funding they need to provide individual instruction to their students. My family is forever changed because of the support and kindness they have showed my family. Students who receive BRAAC’s services need a safe place to learn and be themselves. My son’s life will be forever changed because of the individualized education BRAAC has given him. Nicholas was diagnosed with Autism at age two and was unable to speak or communicate his needs. He often became frustrated and would hurt himself and potentially others if his behavior got out of control. Because of the individualized instruction that BRAAC provides, Nicholas is now able to communicate and be a valued member of his community. I want other families to experience this remarkable experience by allowing their children the opportunity to receive BRAAC support. Please support Bill 2117 so that BRAAC can continue to help children in our community. Best Regards, Brittany Schrepf

While the Virginia Association of School Superintendents supports parts of this bill, we feel that it should include prevention services as well as transition services. We also feel that rthe tranostion services should last longer than 12 months. Thank you, Dr. Tom Smith VASS

Before working at BRAAC I worked as a Registered Behavior Technician for a local ABA therapy company. We provided in home and clinic therapy. My clients who had autism and intellectual disabilities all went to public school and we’re not receiving the care they needed. I had a client who was non verbal and we were tracking 9 different problem behaviors within 15 minutes, including intense self injurious behaviors. She was 10 years old and put in a 5th grade special needs classroom, she was also integrated with the regular class and asked to read books and do multiplication. She was also bullied by the other students who would throw food and milk on her. Public schools are not fit to handle children like this. BRAAC focuses on stopping those problem behaviors as well as educating students using ABA methods. I had to go through intense training before starting my job at BRAAC, I am so thankful that I can use those skills I was taught to help the kids at BRAAC. It’s so amazing being there seeing these children’s lives changed for the better and I truly wish all schools would operate like BRAAC because so many lives would be changed. Cutting funding for BRAAC would devastate families and children.

Please support HB 2117, which works towards partnerships and collaboration with educators for high needs children, including public schools and the hard working non-profit special education day schools, who give their all to help the most vulnerable. Although we appreciate the desire to save the state money, we parents of children with severe disabilities understand that the highly specialized educational interventions during their school years IS the answer to saving the state money. The costs of specialized care for ADULTS are astronomical when their aging parents can no longer care for them! This bill DOES encompass the JLARC recommendations for the CSA study. I am the founder of Blue Ridge Autism and Achievement Centers, and the mother of a special needs son, for which this school was built. This is a quote from one of the families we serve: "In 2010, my family was in crisis. At the time, our three-year old with autism (and a severe intellectual ability), Kaedan, was in a public school preschool program. His behaviors grew worse and out of control. Kaedan urinated and defecated on our floors. He stripped both at home and in public (Yes, he has been naked in Kroger). He screamed so loud we wore ear plugs. He woke at night, jumped on the floors loudly, and kicked holes in the walls. He bit family members frequently. Frankly, my wife and I were tired, frustrated, isolated, desperate, and losing it mentally. The public school had no answers. Our saving grace was BRAAC." Hundreds of similar stories can be repeated. The cost of special education day schools ARE expensive because our staff is charged with eliminating the behaviors Kaeden exhibited, then teaching them to shower independently, toilet themselves, read, write, tell time, manage money, prepare food, communicate their wants and needs, wash their clothes....the list goes on and on. Then we teach them a specific skill so that one day they can be employed. And after that we teach them to load/unload a dishwasher, cook easy meals, manipulate water so they do not get scalded when showering, make purchases at the grocery store, not walk out in the street in front of cars, how to safely take medication....again, the list goes on. I guess the gist of what I am saying is that we teach EVERYTHING! And the state will not save money in the long run! My son will live in his community thanks to schools like BRAAC. BRAAC has 65 children on our waitlist. Public schools will not be able to do what we do. Will public school employees stand beside a shower while they teach, step-by step, every day, a seventeen year old boy how to wash his body? Or will they continue to scoop up clothing soiled with feces, balled up and thrown in a plastic Food Lion bag to be sent home for the parent to take care of and not clean the soiled legs of the student then complain about how bad he "stinks"? (true story). Will they continue to call our children "ankle-biters," with whom they are thankful to get rid of? God Bless the ARC, but they do NOT represent the children with the most severe needs, such as the ones our schools take care of, and the examples I just gave. We have a long way to go to work TOGETHER for the needs of very special children who require the highest level of training for many years to become like my son, for whom the school was started: He is now employed by Mission Barbecue and working towards living semi-independently in his own place. He has community! Support HB 2117!

I am the Policy and Legislative Chair of the Virginia Council of Administrators of Special Education (VCASE). Our more than 400 members work directly with local CSA offices in addressing special education placements in private school settings as well as serving our students in our public schools through participation in IEP meetings. VCASE generally supports the efforts that have come before the General Assembly to provide flexibility with the use of CSA funds to support public services for students who may otherwise need private school placements. We appreciate Del. Van Valkenburg addressing JLARC recommendations included in HB2117. I do have some suggestions that I have already provided to Del. Van Valkenburg and Sen. Mason (SB1313) with additional info below: 1. HB2117 addresses only the intervening (transition) services AFTER a private placement. We also support CSA funding and services that intervene in public school settings BEFORE private school placement to avert a costly private school placement. This bill should be merged with other bills before the GA that advocate for preventative public services IN ADDITION TO intervening services to support transition from private back to public schools. 2. I suggest changing the term "transition" and "transitional" to "intervening" or some other nomenclature. Transition services are a discrete set of regulated IEP processes and services to assist students with postsecondary planning. This would avoid any confusion by practitioners. 3. I agree that a one year term of CSA funded intervening services is appropriate, but that an IEP team could continue those services even without CSA funding. This part of the bill should focus on the funding stream, not appear to require specific IEP driven services. 4. I suggest a less prescriptive set of services in the bill. The IEP team (in most cases involving public and private school participants) determines the intensive services a student may need. Any list could be seen as prescriptive. 5. I suggest the last sentence (lines 53-55) would more appropriately read: "In addition, pool funds may be utilized for local agencies to contract with a private school education program provider in the public school." Current wording that asserts that the "best transition" includes contracting with private providers is overly prescriptive and may not be accurate in all circumstances. 6. Regarding lines 16 and 17, the JLARC recommended that the Commonwealth "prohibit the use of state funds for any private day school tuition payments to schools that are not licensed by the Virginia Department of Education (VDOE) .." The language in lines 16 and 17 should be explicit with this prohibition. 6. There is a fiscal impact in establishing a Work Group addressing the several JLARC recommendations. I would be glad to discuss any questions you may have. I can be reached at 757-927-0588. Dr. Mike Asip

Why are we paying for illegal people here when we need to take care of African American, Hispanic and Asian Americans concerns FIRST? Some of our own need food.

As a lead Community organizer for the latinx population in Richmond Va I have seen that many people did not go to the hospital with COVID-19 or with symptoms of the pandemic because just thinking about the bills that these people could face, they put their lives in danger and that of others, it is not fair that because they do not have legal status they cannot access to a health care. I ask please consider this bill, there are thousands of people who would benefit

As a family physician in Richmond, VA, I am acutely aware of devastating and disruptive consequences of COVID-19 on our communities. Access to testing, treatment, and vaccination, is essential to get us functional as soon as possible. With an illness that has disproportionately affected our Black and Brown community members, we must level the access to care and provide free testing, treament, and vaccination, regardless of insurance or immigration status. This is the only way that we, together, can move forward. Thank you.

The Jewish Community Relations Council of Greater Washington (JCRC) submits this testimony in support of HB 2124, because the public health crisis we are facing is a clear emergency, and ensuring widespread testing for, treatment of, and vaccination against COVID-19 is a necessity for individuals and the community at large. Access to COVID-19 related treatment and services will improve individual health outcomes, as well as curb the spread of this virus throughout the Commonwealth and beyond. Enabling all individuals to get treatment – both preventative and therapeutic – ultimately will reduce the burdens on our medical facilities and on society. JCRC is honored to present this testimony on behalf of over 100 local synagogues, schools and institutions, including a network of agencies that provide excellent cost-effective social services to the community at-large on a non-sectarian basis. We are guided by Jewish law, history and tradition, which insists that we assist in the caretaking of all immigrants.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

My name is Stephen Grammer, from Roanoke. I encourage you to pass HB1987 and HB2124. HB1987 would allow people who without transportation easier access to being able to communicate with their primary doctors. This also would be cost-effective, due to the fact that people will not have to get ambulances going to hospitals over non-emergency situations. HB2124 would allow people with disabilities to get treatment for COVID. We are on a very low-budget, and can not afford to pay out of pocket for treatment. Again, I encourage you to support HB2124 and HB1987. Thank you for your time and consideration.

Hello Mr. Chair and members of the committee. I am Zowee Aquino, Community Health Manager at NAKASEC VA. During the special session, the General Assembly made a monumental fix that gave legal permanent residents greater access to Medicaid in Virginia. I worked with Asian American youth and impacted families to support this effort, and was so glad to be part of this legislative victory. In this session, as COVID-19 continues to decimate working class communities, we have another opportunity to support access to health care for immigrants in HB 2124. I speak with undocumented, uninsured Asian American residents of Virginia about accessing healthcare and there is considerable confusion. They think COVID-19 vaccination is only for citizens, and won’t sign up for the vaccine. In some cases, they don’t even get tested - they instead stay at home, isolate, and deal with it themselves - because they think it is their only option. This is one of their stories: My name is Mi-Kyung, I live in Burke, and I am an undocumented person. I have rheumatoid arthritis and my husband has been laid off due to COVID-19. We’ve been surviving off of our two college aged children’s part-time jobs. Because we cannot afford to go to the hospital if I get COVID-19, I fear even going to the grocery store. I have heard of many people like me, who immigrated to the U.S. only to go bankrupt due to hospital bills through no fault of their own. These stories feel even closer to me now with the COVID-19 pandemic and make me fear for my safety. I hope this bill, HB 2124, passes for low income, undocumented people so that I can feel some security for doing necessary things, like going grocery shopping or picking up my medication, right now. People like Mi-Kyung are why we need HB 2124. Passage of HB 2124 could make it very clear that anyone in Virginia can receive COVID-19 testing, treatment, and vaccination without concern over affordability or fear for everyday tasks - so that everyone can help protect their communities and themselves. Without access to treatment for all Virginians, we cannot effectively stop or slow the spread. Thank you Mr. Chairman and members of the committee.

I am Zowee Aquino, Community Health Manager at NAKASEC VA. I work with undocumented, uninsured Asian American residents of Virginia about accessing healthcare and there is considerable confusion around COVID-19 treatment and services: They think COVID-19 vaccination is only for citizens, and won't sign up for the vaccine. Sometimes, they don’t get tested - they instead stay at home, isolate, and deal with it themselves. This is one of their stories: "My name is Mi-Kyung, I live in Burke, and I am an undocumented person. I have rheumatoid arthritis and my husband has been laid off due to COVID-19. We’ve been surviving off of our two college aged children’s part-time jobs. Because we cannot afford to go to the hospital if I get COVID-19, I fear even going to the grocery store. I have heard of many people like me, who immigrated to the U.S. only to go bankrupt due to hospital bills through no fault of their own. These stories feel even closer to me now with the COVID-19 pandemic and make me fear for my safety. I hope this bill, HB 2124, passes for low income, undocumented people so that I can feel some security for doing necessary things, like going grocery shopping or picking up my medication, right now." People like Mi-Kyung are why we need HB 2124. Passage of HB 2124 could make it very clear that anyone in Virginia can receive COVID-19 testing, treatment, and vaccination without concern over affordability or fear for everyday tasks - so that everyone can help protect their communities and themselves. Without access to treatment for all Virginians, we cannot effectively stop or slow the spread.

VIRGINIA POVERTY LAW CENTER SUPPORT HB 2124 & BUDGET AMENDMENT 313 #4H Cover COVID-19 Services as “Emergency Only” Medicaid Services Medicaid is required by federal law to provide “Emergency Only” services to any immigrant who (1) resides in the state and (2) is financially eligible for Medicaid, but does not meet the specific requirements for non-citizens. [For example most LPRs with a Green Card must be in the U.S. for 5 years before qualifying for full Medicaid.] Medicaid’s Emergency-Only services are now available for urgent health needs generally provided by hospital emergency departments (e.g. accidents, heart attacks, labor/delivery). As allowed by federal law, HB 2124 appropriately broadens such services to COVID-19 testing, treatment and vaccines. • The disparate impact of the COVID-19 pandemic on black, brown and immigrant communities is well established. If low-income individuals in those communities are not encouraged to get tested, treated and vaccinated (through free, and broadly available services), ALL OF US suffer because of community spread. The Medicaid Emergency Only mechanism is in place to ensure access to this essential care for needy Virginians. • At least 12 states have administratively declared this policy for their Medicaid programs. Those states are able to ensure and market free services and timely treatment to all low-income individuals, regardless of immigration status. • This bill is desperately needed NOW! Virginia must reach out to encourage all low income immigrants to come forward to get COVID-19 testing, treatment and vaccines. This helps all Virginians by reducing the spread of the virus, long-term health issues and death. This is truly a matter of life or death – not just for immigrants, but for all of us. For More Information Contact: Jill Hanken, Health Attorney, jill@vplc.org. (804) 351-5258

Thank you for the opportunity to provide comments on HB 2124 by Delegate Lopez. The American Lung Association in Virginia strongly supports this proposed legislation and asks members of the committee to vote yes. The American Lung Association is the oldest voluntary public health association in the United States, representing the millions of Americans living with lung diseases, including chronic obstructive pulmonary disease (COPD), lung cancer, asthma, cystic fibrosis and pulmonary fibrosis. The Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through research, education and advocacy. We are especially concerned with COVID-19 as it is a respiratory disease. The COVID-19 pandemic has continued to highlight long-standing inequities in health care coverage and access in Virginia and across the country, which has contributed to the higher incidence of the virus in Black, Latinx, and immigrant communities. Unfortunately, some low-income Virginians who are excluded from most Medicaid coverage due to their immigration status fear that seeking treatment for COVID could result in unaffordable medical bills. As more therapies are approved that can reduce the likelihood that COVID will progress to more serious stages access to these treatments and care is even more critical. Virginia can support wider access to COVID-19 testing, treatment and vaccination by clarifying that emergency Medicaid specifically covers COVID-19 testing, treatment, and vaccination. The emergency Medicaid program is offered to people that would qualify for regular Medicaid but are ineligible due to immigration status. Services are traditionally limited to medical treatment required after the sudden onset of a medical emergency that places the individual’s health and bodily function in severe jeopardy. The Lung Association believes all individuals should receive vaccination at the appropriate phase of the framework regardless of immigration status. Undocumented workers are disproportionally employed in many essential industries where they have a higher risk of exposure to COVID-19, such as agriculture and home health.1 Migrant workers also have high rates of lung diseases, such as asthma, and other health conditions that may put them at greater risk for severe illness from COVID-19. If large proportions of certain communities do not receive vaccinations, the risk of COVID-19 outbreaks increases for everyone. 2 Twelve states are already offering COVID-19 services through this program and doing so may encourage all individuals regardless of status to seek the services they need without fear of how they will pay for it. Providing COVID-19 care to individuals with low-incomes will help reduce the spread of the virus. The Lung Association urges the Committee to support HB 2124 and include COVID-19 testing, treatment and vaccination for all Virginians regardless of immigration status. 1Tracy Jan, “Undocumented workers among those hit first – and worst – by the coronavirus shutdown. The Washington Post. April 4, 2020. Available at: https://www.washingtonpost.com/business/2020/04/05/undocumented-immigrants-coronavirus/ 2 Holguin, Fernando et al. “Respiratory Health in Migrant Populations: A Crisis Overlooked.” Annals of the American Thoracic Society vol. 14,2 (2017): 153-159. doi:10.1513/AnnalsATS.201608-592PS

My name is Austin Chavez. I am with NAKASEC Virginia. I live in Springfield, Virginia. I support HB 2124 because I think it will help uplift all different types of families during this unprecedented pandemic. Many families are already burdened with rising unemployment and decreased wages. To offset COVID testing and treatment costs from families will be a huge benefit for the community at large. It will empower folks to get tested and seek treatment, and create a unified culture in stopping the pandemic.

Voices for Virginia’s Children is a member of the Healthcare for All Virginians coalition and supportive of this bill. As of January 17th, VDH reported 19,982 Hospitalizations. While the Black community accounts for about 27 percent of that group, they represent just 20 percent of the commonwealth’s population. Likewise, the Latinx population makes up roughly 20 percent of Virginia’s COVID-19 hospitalizations, but only 10 percent of the population. Meanwhile, the white community accounts for 42 percent of the commonwealth’s coronavirus hospitalizations, but nearly 61 percent of the population. Communities of color are experiencing much higher hospitalization rates. Black communities have almost a 7% hospitalization rate compared to the 4% average. In order to increase equitable access to healthcare, especially during this time, Virginia should follow the patterns of 12 other states that have elected to cover COVID-19 screening, testing, and all related treatment for any immigrant who meets the financial requirements for Medicaid. This clarification would allow a singular statewide message to be shared widely. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community. Thank you, Delegate Lopez, for championing this bill.

VIRGINIA POVERTY LAW CENTER SUPPORT HB 2124 & BUDGET AMENDMENT 313 #4H Cover COVID-19 Services as “Emergency Only” Medicaid Services Medicaid is required by federal law to provide “Emergency Only” services to any immigrant who (1) resides in the state and (2) is financially eligible for Medicaid, but does not meet the specific requirements for non-citizens. [For example most LPRs with a Green Card must be in the U.S. for 5 years before qualifying for full Medicaid.] Medicaid’s Emergency-Only services are now available for urgent health needs generally provided by hospital emergency departments (e.g. accidents, heart attacks, labor/delivery). As allowed by federal law, HB 2124 appropriately broadens such services to COVID-19 testing, treatment and vaccines. • The disparate impact of the COVID-19 pandemic on black, brown and immigrant communities is well established. If low-income individuals in those communities are not encouraged to get tested, treated and vaccinated (through free, and broadly available services), ALL OF US suffer because of community spread. The Medicaid Emergency Only mechanism is in place to ensure access to this essential care for needy Virginians. • At least 12 states have administratively declared this policy for their Medicaid programs. Those states are able to ensure and market free services and timely treatment to all low-income individuals, regardless of immigration status. • This bill is desperately needed NOW! Virginia must reach out to encourage all low income immigrants to come forward to get COVID-19 testing, treatment and vaccines. This helps all Virginians by reducing the spread of the virus, long-term health issues and death. This is truly a matter of life or death – not just for immigrants, but for all of us. For More Information Contact: Jill Hanken, Health Attorney, jill@vplc.org. (804) 351-5258

I am writing in support of HB2124 on behalf of The Commonwealth Institute and the Healthcare for All Virginians Coalition. The COVID-19 pandemic has put into sharp focus long-standing inequities in health care coverage and access and working conditions in Virginia and across the country, which has contributed to the higher incidence of the virus in Black, Latinx, and immigrant communities. And, unfortunately, some low-income Virginians who are excluded from most Medicaid coverage due to their immigration status fear that seeking treatment for COVID could result in unaffordable medical bills. This is particularly tragic as more therapies are approved that can reduce the likelihood that COVID will progress to more serious stages. Virginia can support wider access to COVID-19 testing and treatment by clarifying that emergency Medicaid specifically covers COVID-19 testing, treatment, and vaccination. The emergency Medicaid program is offered to people that would qualify for regular Medicaid but are ineligible due to immigration status. Services are traditionally limited to medical treatment required after the sudden onset of a medical emergency that places the individual’s health and bodily function in severe jeopardy, such as a heart attack or a broken bone. Twelve states are already offering COVID-19 services through this program and doing so may encourage all individuals regardless of status to seek the services they need without fear of how they will pay for it. Legislation (HB2124, Del. Lopez) to make this change has been introduced during Virginia’s 2021 legislative session. This clarification would allow a singular statewide message to be shared widely and leave no doubt as to health care costs related to COVID-19 for all families with low incomes. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community.

LeadingAge Virginia supports House Bill 2154 with the amended language provided by the Virginia Health Care Association.

Support with Amendments

VPLC supports implementing these minimum standards for nursing home staffing. This bill would set in place these standards and allow adequate staffing to be defined. Virginia ranks 38th in states overall in care hours. Due to Covid-19, the issues in nursing homes have been highlighted and the needs for change is great. Sufficient staff needs to be defined and be enforced to protect vulnerable adults. Although there is a cost, the impact on people's lives has shown to be great and we urge Virginia to move forward with protections for vulnerable individuals.

Mr. Chairman and Members of the Committee, I strongly believe nursing home and long term care facilities should provide excellent care for the elderly and disabled and should have few complaints in regard to lack of care and abuse. They should be vetted, trained in regard to infection control and dosing of medications to these patients, and provided sufficient ppe. It concerns me, however, that “Medical facilities inspectors of the Department of Health are exempt from reporting suspected abuse immediately while conducting federal inspection surveys in accordance with § 1864 of Title XVIII and Title XIX of the Social Security Act, as amended, of certified nursing facilities as defined in § 32.1-123.” Suspected abuse should be reported by them.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

SUPPORT FOR HB 2156 Every day Virginia nursing home residents experience needless injury, decline and poor care because there are simply not enough nursing staff to provide for basic needs. COVID-19 has exposed the devastating effects of longstanding and persistent understaffing. We need a clear,enforceable standard to ensure sufficient staff to meet resident basic daily needs. HB 2156 takes a realistic, practicable approach toward achieving the 4.1 staffing standard that extensive research has shown to be effective. The Northern Virginia Aging Network (NVAN) urges your support for HB 2156.

AARP Virginia supports HB2156.

AARP Virginia supports HB2156.

In concert with the federal and state mandates of the Long-Term Care Ombudsman Program to bring the concerns of our nursing home residents to our leaders, we urge our legislators to enact urgently needed, enforceable standards for the minimum levels of staff nursing homes must ensure in order to meet the basic care needs of residents. Delegate Watts’s House Bill 2156 proposes a clear and practicable plan to move Virginia gradually toward an evidence-based standard that would ensure nursing homes provide enough staff to meet residents’ basic care needs. We have attached to this email a brief summary of why this legislation is critically needed. On a daily basis, ombudsmen around the state hear of tragic outcomes, unnecessary suffering, avoidable injuries, and serious and life-threatening health complications resulting from inadequate staff in many of our nursing homes. The pandemic has exposed in new and alarming ways the tragic effects of longstanding, persistent patterns of low staffing in our nursing homes. While we can never undo the devastating impacts of COVID-19 on our most vulnerable citizens – those in our nursing homes – we must take steps now to ensure a tragedy of this magnitude does not happen again. We urge that you enact legislation to create a standard that is critically needed to protect our parents, grandparents, teachers, retired military heroes, public servants, and neighbors from the undue suffering and decline and the loss of human dignity that result from the lack of adequate staff in nursing homes to meet their most basic needs. Thank you for your consideration of these urgently needed protections for those who so often cannot speak for themselves. Sincerely, Joani Latimer State Long-Term Care Ombudsman