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

HB1915- Children are the future. Teachers care for our future and should be paid in a way that reflects the sentiment that we care for the future of our country. HB1987- This should be allowed for mental health especially. Many mental health in-person appointments are missed because someone’s mental illness keeps them from leaving the house or the person doesn’t have childcare at the time where they need to make the appointment. Telehealth will help with accessibility.

The Virginia Poverty Law Center strongly supports HB 1987 which extends and clarifies Medicaid telehealth services and remote monitoring of many health conditions. During this horrible COVID-19 pandemic, Virginia (and the U.S.) has gained new appreciation for the value of tele-medicine. Both providers and patients have benefited from easier access to medical care and improved monitoring of chronic conditions. The Medicaid program has fully participated in authorizing more telehealth during the pandemic. HB 1987 builds upon this experience and maintains valuable telehealth services to Medicaid enrollees. I have two concerns about the FIS for HB 1987. The estimated costs to DMAS appear inflated because (1) the FIS seems to count all telehealth services as ADDITIONAL services, rather than replacements for appointments and services that would normally occur; and (2) the FIS doesn't consider any cost benefits or reduced hospital/ED services which are very likely to result from better access and monitoring through telehealth. Thank you for supporting HB 1987. Jill Hanken, VPLC Health Attorney

We support this bill. Extending the use of telhealth in Virginia will benefit those with chronic conditions that live in our underserved communities. It can also reduce hospitalizations and other health care costs by helping to control conditions such as diabetes, high blood pressure, etc.

Chairman Sickles, members of the Subcommittee, good morning. I am Dr Karen Rheuban, Director of the UVA Center for Telehealth and board chair of the Virginia Telehealth Network. Thank for the opportunity to speak to HB1987, which directs the Department of Medical Assistance Services to cover remote patient monitoring services for priority, high risk, high cost patients and conditions. Remote patient monitoring programs improve patient outcomes, and lower the cost of care. I would respectfully like to address the fiscal impact statement prepared by the Department of Planning and Budget. UVA began our remote monitoring program in 2014. Based on our prior data, and the first 6 months of FY 21, we anticipate monitoring approximately 6200 high risk patients this year. For those monitored patients with the conditions identified in this bill, we project a reduction of 25,034 hospital bed days. These reductions result from hospital admissions and readmissions avoided and shortened length of stay. With an average total cost per bed day of $2015 for low case mix index patients, we conservatively project cost savings across all payers of $50,443,510 in FY21. In addition, our data demonstrated a reduction in emergency department visits for our monitored patients by 14%. One additional note for consideration as it relates to the costs of remote patient monitoring: many patients only require 30 days of monitoring, others only 3 months, rather than as projected, all patients for a full year. Medicare has covered remote patient monitoring for a broad range of conditions since 2018. We urge the committee to consider this additional information, particularly regarding cost savings to the Medicaid program, when considering the true fiscal impact of HB1987. Thank you.

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.

January 20, 2021 Chair Mark Sickles Health Welfare and Institutions Committee Virginia General Assembly 1000 Bank St Richmond, VA 23219 RE: HB 1987--Physical Office Location Amendment to Conduct Telehealth Chair Sickles and Member of the Committee, On behalf of Hims & Hers, a direct-to-consumer digital health company, we urge you to preserve access to healthcare treatment for thousands of Virginians by removing language recently added to HB 1987 that would require a physical office or relationship with a practice” in order to conduct telehealth in the Commonwealth. This onerous and unnecessary language will have a chilling effect on direct-to-consumer health platforms like Hims that are providing care to thousands of Virginia residents during a global pandemic but do not have a physical location. Especially during the COVID-19 pandemic, it is critical that we encourage, not curtail telehealth usage, and reduce nonessential, face-to-face encounters between patients and healthcare workers while maintaining the highest quality of care. At Hims & Hers, we connect patients to licensed healthcare providers for medical consultations and treatment across all 50 states. Our platform is powered by virtual care, without an in-person visit, which is a care delivery model that has been embraced by state legislatures, hospitals, healthcare providers and patients across the country. Since our launch in 2017, we’ve powered more than two million digital healthcare visits across a variety of conditions, ranging from sexual health to psychiatric health. In response to the pandemic, Hims & Hers has incorporated access to additional telemedicine offerings, including primary care services, mental health support groups, and access to at-home COVID-19 testing kits. We believe providers should always be held to the highest standard of care regardless of the mode of delivery, and that is why providers on our platform are licensed, highly-credentialed, and held to evidence-based clinical standards. Our executive team and board of directors are composed of some of the most experienced minds in healthcare, like Dr. Toby Cosgrove, former CEO and current Executive Advisor of the renowned Cleveland Clinic, and Dr. Patrick Carroll, our Chief Medical Officer (CMO), the former CMO of Walgreens. We recognize that telehealth is not an appropriate mode of care delivery for all conditions, and that is why we rely on licensed providers to make those determinations and refer patients to the appropriate healthcare systems and platforms. However, the current proposed physical location requirement in HB 1987 would effectively ban Hims and other direct-to-consumer digital health platforms from providing care in the Commonwealth. This is especially troubling for those in underserved areas, where telehealth is a lifeline for receiving quality care. We hope that you will remove this language from the bill, and ensure that quality care is preserved for thousands of Virginia residents. Sincerely, April Mims VP of Public Policy Hims & Hers, Inc cc: Vice Chair Rasoul, Committee Members, and Clerk Rushawna Senior

To the Members of the Committee: On behalf of the Virginia Community Healthcare Association and the 155 community health center sites across the Commonwealth that serve over 355,000 Virginians in medically underserved communities, we ask for support for House Bill 1987. Remote Monitoring Services would be invaluable in monitoring the health conditions of some patients, particularly those recently released from a hospital setting. In North Carolina, a pilot program conduced several years ago in a community health center led to significantly reduced A1C numbers in diabetic patients. For cardiac patients, one can cerrtainly see the benefit of having remote monitoring at home after having stents, or having a heart attack. On the last paragraph on audio only services – this has been an important part of delivery of services in medically underserved areas that have limited access to internet broadband services. In some parts of the Commonwealth, video is not available due to limited bandwidth. Although not mentioned in the bill, I would ask the committee to remember that when a health provider does provide services by audio only, they bring to bear their full knowledge. Reimbursement for audio only services should be at a full and regular rate, not a discounted rate, as the services of the provider requires their full abilities. Thank you, Rick Shinn - Director of Government Affairs Virginia Community Healthcare Association

VACo supports this legislation in keeping with our long-standing position in favor of the use of telemedicine to provide long-distance clinical care, patient and professional education, and public health, as well as support for flexibility in the delivery of these services.

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 want to express our support for HB1987. The ability to provide and be reimbursed for behavioral health services delivered via telehealth and telephone has been absolutely critical to our members as they have worked to meet the needs of Virginia's most vulnerable residents. We applaud DMAS, DBHDS and DMAS for their quick action to develop the regulatory framework within which services could be provided early in the pandemic and in close coordination with providers. We support efforts to continue to allow use and reimbursement for telehealth and telephonic delivery of services where appropriate throughout the duration of the current public health crisis and beyond it. Thanks to Del. Adams for introducing this bill and for her commitment to identifying how telehealth can continue to be leveraged to increase access to quality healthcare services for all Virginia residents. The VACBP also supports HB2197, which would create a workgroup to evaluate and provide recommendations for the permanent use of virtual supports and assistive technology for the ID/DD population in Virginia. We believe that such an effort that is collaborative and inclusive will yield valuable insight that can guide future policy in this space. Thanks to Del. Runion for introducing this bill.

Teladoc Health would like to register our concerns with amendments to House Bill 1987. Recognized as the world leader in virtual care, Teladoc Health directly delivers millions of medical visits across 175 countries each year through the Teladoc Health Medical Group and enables millions of patient and provider touchpoints for thousands of hospitals, health systems and physician practices globally. Specifically, we strongly oppose the amendment to Section 54.1-3303 B. As written, the bill would require that a Virginia-licensed health care provider practicing using telemedicine and prescribing Schedule II–V controlled substances also have a physical office practice in the Commonwealth or an immediately contiguous jurisdiction. This provision has no clinical basis and is an arbitrary restriction to Virginia-licensed practitioners who treat patients using remote technology. The clinical guidelines for telehealth and telemedicine are anchored in standard of care, and the Commonwealth should maintain such standards and continue to tie state policy to federal restrictions on prescribing controlled substances. A requirement for a physical practice in Virginia or an immediately contiguous jurisdiction is an artifact of “old thinking” and would gut the ability of telehealth to deliver access to affordable quality health care. This bill fails to acknowledge the capacities of technological innovations in medicine. Today there is no other state with such an antiquated requirement in statute or regulation. Federal law (Ryan Haight Online Consumer Protection Act of 2008) already imposes rules around the prescription of controlled substances (Schedules II–V). This is simply bad public policy and ill-advised. Simply stated, the standard of care should dictate whether or not a prior physical examination of the patient is required prior to diagnosis and treatment of the patient, including prescribing Schedule II–V controlled substances. After the establishment of the valid professional relationship and treatment in accordance with the standard of care, geographic restrictions on follow-on care are arbitrary. We are very appreciative of the hard work that has gone into this legislation and respectfully request the sub-committee reject the proposed amendment. Thank you for your consideration. We are happy to answer any questions.

On behalf of the ATA and the 400 organizations we represent, I am writing to express concerns about an amendment made to HB 1987 in §54.1-3303 (B). In its revised form, HB 1987 would create unnecessary and impractical barriers to the establishment of telehealth services across Virginia, limiting practitioners’ ability to prescribe vital medications to their patients throughout the state based on arbitrary geographic restrictions. Currently, the bill would place geographic restrictions that determine the practitioners who can provide prescriptions to their patients, the language reading: “To prescribe a Schedule II through V controlled substance utilizing telemedicine, prescribers must maintain and practice or maintain a relationship with a practitioner at a physical office practice in the Commonwealth or in an immediately contiguous jurisdiction in order to unsure availability for an in-person examination when required by the standard of care.” In mandating the existence of a physical presence for practitioners to prescribe Schedule II through V controlled substances, the language establishes an arbitrary geographical barrier that would limit Virginians’ access to the prescriptions they need to lead healthy lives. When applied to real-world scenarios, the requirement proposed in this amendment is not practical in protecting Virginians’ safety or ensuring their access to accessible and high-quality care. If this bill were passed with the amended language, a Virginia citizen located in Alexandria could legally receive a prescription from a provider in Memphis, Tennessee (as Tennessee shares a border with Virginia), 881 miles away. However, a practitioner in Philadelphia, Pennsylvania, just 146 miles away from that same citizen, could not prescribe this patient’s medication simply because Pennsylvania does not border Virginia. Moreover, this language is not needed because if an in-person examination is needed to meet the standard of care for prescribing, then the practitioner would already be violating the standard by using telehealth technology to do so - regardless of whether they have a physical office or a relationship with a practitioner in Virginia or a “contiguous jurisdiction.” Simply put, there is no overlap between when a practitioner can use telehealth to prescribe medication and when an in-person exam is needed to prescribe, making this proposed amendment unneeded. Finally, the language also is likely in violation of the 10th Amendment. While the 10th Amendment gives broad discretion to states to regulate the health, welfare, and safety of its citizens, it still cannot “arbitrarily” or “capriciously” violate the Commerce Clause when doing so. The requirements imposed by this bill certainly would legally violate the Commerce Clause by limiting an out-of-state practitioners’ ability to practice medicine in Virginia despite the fact that they are licensed to practice there. The ATA applauds other aspects of HB 1987 which guarantee that nothing shall preclude coverage of telehealth services by insurers, including those services which involve remote patient monitoring. However, the ATA strongly objects to the amended language, and we believe that passing House Bill 1987 in its current form would be a step backward for patients and practitioners in the Commonwealth. We urge you and all of your colleagues to strike the amended language in §54.1-3303 (B) before considering the approval of this bill.

It is essential to address the demand for healthcare in a practical way - and these proposals are safe, evidence based, and needed. HB1987: Reimbursement for remote patient monitoring is proven to improve quality of care, lower readmissions, and lower travel and treatment costs. Remote patient monitoring is an essential benefit that allows patients to leave the hospital and get the same quality of care at home. For high risk pregnancies, it can cost as little as $26 a day to provide this service with higher convenience, better care, and keeps a hospital bed open for someone else who might need it more. Compare that to a $5,000 a day stay in the hospital with lower convenience, higher costs, and lower satisfaction. The Governor wisely removed reimbursement barriers to providers to offer this service to those suffering COVID-19 with great results. Virginians deserve access to this benefit and remote patient monitoring needs to be reimbursed immediately. HB1737: Nurse practitioners have safely served their communities with 2 years experience during the pandemic, and states across the country already allow for them to practice with the scope of practice with less restrictions that we have in Virginia. We need frontline healthcare workers practicing to their full capability and this reform achieves that safely. HB1747 / hb1817 : Enabling providers s to practice to their full capability is essential. Nurse practitioners deserve the opportunity be certified and practice according to their skills and education. This common-sense reform helps front line care providers to be more efficient and useful in serving in care deserts. In the same way, we should better leverage physician assistants in the field who could do more but are restricted by regulatory barriers. HB1769: Virginia law, unfortunately, puts walls between patients who are seeking care from licensed providers beyond our state lines. The commonwealth of Virginia does not care if a patient gets in the car and travels to another state to get treatment from an outstanding provider, but if a Virginia gets on the information highway, it can lead to criminal charges who is merely offering care to a Virginian in need of it. When the law was written, a phone was tethered to the kitchen wall. Today, our phones are supercomputers that can provide detailed healthcare information to a doctor in real-time. Our laws are still looking backwards in healthcare - not forward. Patient behavior is seeking better care with more convenience. This bill removes barriers between patients and providers across the country.

Please consider putting these bills into effect.

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

Representing many groups of the EMS community I have heard horror stories from providers who have responded to calls for patients whom the providers have no idea what the problem is. There is a need to know what the problem or illness is prior to arriving or even leaving their headquarters in order to get the PPE on and be ready. We appreciate Del. Aird for submitting this bill in order to assist the EMS providers across the state.

I support the VPLC comment pointing out the removal of any consumer benefits from the current version. While it is important to learn more about the factors behind drug pricing and costs, it is just as critical that all Virginians can see some direct and immediate benefits at the same time.

Support Drug Transparency AND Lower Drug Costs for Consumers AMEND HB 2007 to restore a basic rebate-pass-through for consumers! HB 2007 is a significant FIRST STEP to require more drug pricing transparency from insurance plans, pharmacy benefits managers, and pharmacy manufacturers. However, there is NO FIRST STEP in the bill to protect consumers from exorbitant drug costs, EVEN WHEN INSURERS AND THEIR PHARMACY BENEFITS MANAGERS RECEIVE REBATES AND OTHER PRICE CONCESSIONS FROM MANUFACTURERS. HB 2007 only requires PBMs to give insurance plans an OPTION to pass through rebates. (see, lines 528-530) . The Virginia Poverty Law Center and many disease groups, whose members must have extremely expensive specialty drugs, believe an option isn’t good enough. The original bill REQUIRED a simple rebate pass-through for consumers. The following amendments are needed: Line 491 – delete “Option for rebates” and insert “Rebates” Line 528 - after “B” delete remainder of lines 528-530 and insert “An enrollee's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.” This original language should be restored to give consumer some price relief while the state collects data and learns more about the very complex world of prescription prices and costs. Future reforms should be based on that data. Thank you. Jill Hanken, VPLC Health Attorney

Del. Sickles and Members of the Committee, AARP Virginia remains neutral on HB2007 due to inclusion of language on which we have no applicable policy. However, on the language directly related to price transparency beginning on line 330 of the current draft, we acknowledge a marked improvement on lines 491-492 in the initial price threshold for brand names and biologics being set at $100/year. Thank you for for your work on this issue. Respectfully submitted, Natalie Snider AARP Virginia State Advocacy Director 804-344-3063 nsnider@aarp.org

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

Del. Hope and members of the committee, AARP Virginia thanks Del. Sickles and the co-patrons of HB2007 for their efforts to bring transparency to the prescription drug pricing supply chain. As the bill is currently written, however, there are several sections where AARP has no applicable policy, so we will remain neutral in our position. As Del. Sickles has shared that this bill is a "work in progress", AARP Virginia respectfully recommends that the non-reporting penalty be increased to $15,000 per day and the 3-year reporting threshold be set at 40%. Prescription drug price transparency is an important foundational building block for other reforms, such as affordability boards, bulk purchasing, and other efforts. AARP Virginia is committed to this issue and will continue to work for meaningful reforms. Respectfully submitted, Natalie Snider AARP Virginia State Advocacy Director 804-344-3063 nsnider@aarp.org

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

HB 2035 is an administration bill and has the strong support of the Virginia Department of Social Services. The Full Employment Program provides employer subsidies for hiring and training TANF recipients. There are several areas in the Full Employment Program, which if addressed, will greatly improve it. 1) The current employer stipend is too low and does not attract employers. 2) TANF recipients are reluctant to participate because they lose their TANF benefits. 3) Case managers are reluctant to assign participants to the program because people that do not receive a TANF payment are excluded from the calculation of the state’s work participation rate. In other words, staff do not receive “credit” for these placements. 4) Case managers find it difficult to devote the time necessary to recruit employers. This legislation addresses all of these issues by increasing the employer stipend, allowing the participant to retain TANF benefits, and including funding for two job developer positions. Funding for this bill is included in Governor Northam’s introduced budget. I urge you to support HB 2035 and make the Full Employment Program a more effective tool to obtain employment opportunities for TANF recipients. Mark L. Golden TANF Program Manager Virginia Department of Social Services mark.golden@dss.virginia.gov

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

Thank you to the committee, my name is Shaddai R. from Richmond, Virginia. I am here to encourage you to.. 1. Increase the allocation of tax revenue towards the reinvestment fund from 30% to 70% because anything less than a majority of the revenues is disingenuous to the priorities of the bill. 2. Allocate 50% of all licenses towards Virginia social equity license holders as no other licenses are required to be owned by Virginia residents. 3. Add another tier of license, micro-business licenses, so that smaller applicants can enter with unique integration privileges. 4. Do not add any new crimes nor criminalize another generation of youth because of a fake war on drugs

I am a constituent of the 7th district but I feel it is necessary to work together to protect the younger members of our society and stop the criminalization of the Hispanic and African American communities. Rules must be stated clearly now so we are better prepared to face a future when marijuana is officially legalized in the Commonwealth of Virginia. Please increase the reinvestment from 30% to 70% for new companies and entrepreneurs. Make sure the new market is equitable and accessible to all not just large corporations.

The Virginia Academy of Nutrition and Dietetics and the Virginia Nurses Association strongly supports Delegate McQuinn's efforts around food access and security to improve the health of all Virginians. We hope the General Assembly will support this legislation. COVID-19 has increased Virginia's food insecurity rate from 9.9% to 13.1%. Numerous studies have demonstrated correlation between food insecurity and poor health outcomes, particularly higher levels of chronic disease such as diabetes, hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, arthritis, COPN and CKD. Similar programs in other states have demonstrated efficacy for increasing participants' consumption of fruits and vegetables.

Virginia First Cities' 16 older, core city members are supportive of HB2065 and all investments to ensure our cities and citizens have access to thriving, sustainable food options. Delegate McQuinn's bill will help remove barriers and costs of access to healthy foods so that no one has to experience food insecurity.

On behalf of our 57 free clinic members located throughout the Commonwealth, including 11 clinics are also Medicaid, providers, the Virginia Association of Free and Charitable Clinics supports HB2065. Our clinic members serve over 60,000 vulnerable Virginians each year, many of whom suffer from chronic conditions such as diabetes and heart disease and would benefit from improved access to healthier foods. Our clinics that currently offer food pharmacy programs similar to the Produce Rx Program pilot proposed in HB2065 have experienced positive outcomes from these programs with their patients, including lower blood sugar levels, weight loss, and lower blood pressure readings, and in some cases a decreased level of need for prescription medications to address certain conditions. Based on this positive experience our clinics are having with their food pharmacy efforts, we strongly believe the proposed Produce Rx Program pilot will yield improved health outcomes for the Medicaid patients who participate in it, help to decrease the need for prescription medicines among these same patients, and ultimately reduce the overall cost of their care.

Virginia First Cities' 16 older, core city members are supportive of HB2065 and all investments to ensure our cities and citizen have access to thriving, sustainable food options. Delegate McQuinn's bill will help remove barriers and costs of access to healthy foods so that no one has to experience food insecurity.

Dear Members of the House Appropriations Committee, We are contacting you today in regards to HB2166, Patroned by Delegate Hope. HB2166 amends current processes of involuntary detainment and Mandatory Outpatient Treatment orders. As we voiced during the previous Committee and Subcommittee hearings, VOCAL and our membership of 2,000+ peer/consumers of Virginia's mental health care system, do not support the bill as written. From our perspective, there are two main reasons for our opposition. The first reason relates to HB2166's degradation of personal choice and person-centered care, through the removal of an individual's consent and commitment to the goals within the MOT order. The second reason for our opposition relates to concerns over the preparedness, or lack thereof, of our local communities to support the adherence to MOT orders. Specifically, the inequitable spread of local communities' infrastructure and funding, both of which are critically necessary to support an individual's efforts to comply. We encourage you all to read through the 2019 SAMHSA article "Civil Commitment and the Mental Health Care Continuum" (referenced below) prior to all Committee discussions of HB2166. https://www.samhsa.gov/sites/default/files/civil-commitment-continuum-of-care.pdf Thank you in advance for your time and attention to this important matter.

The Virginia Association of Community Services Board (VACSB) has no position on this bill; however, the VACSB would anticipate putting forth a budget request in the 2022 session of the General Assembly in order to mitigate for the additional requirements beginning on line 290 in the introduced bill which reads "The community services board responsible for monitoring the person's progress and adherence to the comprehensive mandatory outpatient treatment plan shall report monthly, in writing, to the court regarding the person's and the community services board's compliance with the provisions of the comprehensive mandatory outpatient treatment plan described in clause (viii) of subsection G of § 37.2-817. " Most often, the MOT coordinator in a CSB is going to be a Certified Prescreening Clinician which means that individual, in addition to his/her duties as an MOT coordinator, is conducting emergency evaluations for the purposes of determining whether a request for a TDO is appropriate for an individual experience a psychiatric crisis. If that clinician is spending time organizing submitting paperwork for every individual on his or her MOT caseload, he or she will not be available to do prescreening evaluations. This means that another clinician will need to be paid overtime for coverage or perhaps, depending on the MOT caseload, an additional prescreening clinician will need to be hired. At a minimum, staffing patterns will need to be examined and supplemented in order to comply with these requirements. The VACSB plans to collect data regarding the impact of the legislation, should it pass, in order to support the budget request in 2022.

VSC NAACP is in full support of HB 2166

Thank you to the committee, my name is Shaddai R. from Richmond, Virginia. I am here to encourage you to.. 1. Increase the allocation of tax revenue towards the reinvestment fund from 30% to 70% because anything less than a majority of the revenues is disingenuous to the priorities of the bill. 2. Allocate 50% of all licenses towards Virginia social equity license holders as no other licenses are required to be owned by Virginia residents. 3. Add another tier of license, micro-business licenses, so that smaller applicants can enter with unique integration privileges. 4. Do not add any new crimes nor criminalize another generation of youth because of a fake war on drugs

I am a constituent of the 7th district but I feel it is necessary to work together to protect the younger members of our society and stop the criminalization of the Hispanic and African American communities. Rules must be stated clearly now so we are better prepared to face a future when marijuana is officially legalized in the Commonwealth of Virginia. Please increase the reinvestment from 30% to 70% for new companies and entrepreneurs. Make sure the new market is equitable and accessible to all not just large corporations.

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

As a Licensed Clinical Psychologist and independent forensic examiner for the court with many years of experience evaluating individuals with intermittent serious mental illness (Schizophrenia, Bipolar Disorder, and Dual Diagnosis Disorder), it is my recommendation that special justices be granted broad judicial discretion to order an MOT order with or without consent under any proposed revision of 37.2-817 under conditions otherwise proposed in the revised Code. "One size does not fit all". Schizophrenia is a disorder that presents in varying ways, to varying degrees, at different stages of the illness and with widely varying prognoses-- usually determined by how early in the disease process effective antipsychotic medication can be prescribed and "adhered to"(John M. Kane, MD, RAISE Research Program). The same point might be made for most SMIs (Major Depression, Bipolar Disorder, etc. ). Psychosis is also commonly a symptom in its acute manifestation that can present initially in many unrelated medical conditions that need to be competently and expertly assessed with rule out. There are many individuals with a history of recurring SMI and presenting to the special justice on a "green warrant" who, after a reasonable initial period of psychiatric stabilization and expert capacity assessment, could benefit from having the legal option to voluntarily consent to a court ordered MOT with periodic review and/or status hearings through the auspices of the CSBs that have the resources to properly implement such "legal clinics". These orograms can be customized according to the needs and resources of the individual and the community. There is something about "answering to a judge" that makes all involved in the proceeding take the whole process more seriously. Many individuals after years of "non-adherence" to treatment and/or failure to obtain appropriate services in the community might recognize that they require and would benefit from voluntary court supervision (particularly those with Dual Diagnoses). Where homelessness or incarceration may be the likely alternative consequence of their actions and choices, this might seem the "lesser of the available evils". Without appropriate judicial prudence, including a "choice" option for the individual whose civil liberty is vitally affected, however, the present incarnation of 37.2-817 may be at risk long-term of going the way of mandatory minimal criminal sentencing and other ill-conceived laws.

I can only support involuntary treatment orders when individuals meet the criteria for involuntary detainment (TDO/ECO criteria). In the current version of the bill, "1.b." the Pre-Authorization Step-down MOT option allows for individuals to be mandated to intensive, outpatient treatment, for up to 6 months, at a time when they no longer meet those criteria. I strongly feel that mandated treatments for individuals that do not currently meet criteria for emergency detainment is a threat to their civil rights. Furthermore, the success of mandatory outpatient treatments are contingent on the local communities' infrastructure (or lack thereof) of available public services. I fear that, while the Patron of the bill's community (Arlington) likely has the available services in place, there are countless communities, rural and/or lower socioeconomic, that simply do not currently have the needed services in place. The absence of these services, in my opinion, render the work on the MOT process significantly less impactful.

As an independent examiner with over 15 years of experience providing independent TDO evaluations for special justices and the courts, I can tell you that safety-- that of the individual with serious mental illness, of family members. and of the community) always comes first in the preparation, execution, and disposition of these civil judicial hearings and cases. In the past, the large majority of the MOT orders have been for "Direct" MOT orders, not "step-down" MOT orders-- whether by advance order of the court or "de novo" MOT hearings and orders after physician approval for discharge. I am concerned that the present House Bill 2166 in its present form will not allow sufficient time under the current statutorily required 72 hour period limit (exclusive of weekends and holidays) in pre-hearing detention to be sufficient for the type of multidisciplinary capacity assessments and judicial deliberations proposed under 37.2-817 et seq. This bill, as proposed in most instances, as it applies at least to "Direct' MOT orders as an alternative to inpatient hospitalization, would allow at most 72 hours for the physician and independent examiner, and others, to accomplish the following: initial risk and capacity assessments, authorized family contacts, authorized medical records releases, initial treatment team reviews and follow-up pre-discharge MOT step-down treatment planning jointly conducted by the hospital and the CSB, and, where applicable, Psychiatric Advance Directive for legal review. Unless the proponents of this bill advocate committing all TDOs for inpatient psychiatric acute hospitalization initially for stabilization, capacity assessment, and extensive case management review, including MOT pre-discharge planning, I would strongly recommend and advocate for a voluntary option for MOT post-discharge planning for those individuals with SMIs who are "at risk" but who are not an imminent danger to self or others. I would also strongly advocate for extending the statutory pre-hearing TDO initial assessment period from 72 to 96 hours. There are many individuals who have been ECO'd or TDO'd by well-meaning family, clinicians, and law enforcement officers "out of an abundance of caution" who are not dangerous but who act or claim to be in order to obtain services that are not immediately available in the community. Often their families are desperate to obtain services. With In in red an extension of the TDO pre-assessment period from 72 to 96 hours, or longer, many of these individuals could be psychiatrically stabilized and diverted to community care safely with or without an MOT order. See Wanchek and Bonnie (2012 Psychiatric Services) for a research study that provide evidence-based findings supporting the cost-effectiveness of such an approach.

I am a social worker by training and a person in recovery from mental health challenges. I believe in the autonomy and choice of individuals to direct and control their recovery process. I recognize that without the investment from the individual, all behavioral health interventions will be destined to fall short. With that said, I disagree with HB2216's removal of the individuals consent/agreement requirement, within the MOT process. The consent of the individual should not be overruled, except in instances where a magistrate has ruled the individual lacks decisional capability. I also stand in opposition to the bill's significant extension of the time period for the mandated, intensive, outpatient, treatment order. The current lifespan of an MOT order lasts 90 days. HB2216 proposes to double that time period to 180 days. Individuals should be treated in the least restrictive settings--this intention of the recent reinvigoration for promoting the use of Mandatory Outpatient Treatments, is one I support. However, the community services and the individual's social supports MUST be in place in order for an MOT to be successful. I cannot speak for all of Virginia, but I can say that I highly doubt that Petersburg, VA has the current infrastructure of community services needed to support individuals working to adhere to MOT orders. Please listen to me and my fellow consumers on the ground and vote "nay" on HB2216. This is a complicated, technical piece of Virginia's Behavioral Healthcare system and a quick fix will not work.

Thank you to the committee, my name is Shaddai R. from Richmond, Virginia. I am here to encourage you to.. 1. Increase the allocation of tax revenue towards the reinvestment fund from 30% to 70% because anything less than a majority of the revenues is disingenuous to the priorities of the bill. 2. Allocate 50% of all licenses towards Virginia social equity license holders as no other licenses are required to be owned by Virginia residents. 3. Add another tier of license, micro-business licenses, so that smaller applicants can enter with unique integration privileges. 4. Do not add any new crimes nor criminalize another generation of youth because of a fake war on drugs

I am a constituent of the 7th district but I feel it is necessary to work together to protect the younger members of our society and stop the criminalization of the Hispanic and African American communities. Rules must be stated clearly now so we are better prepared to face a future when marijuana is officially legalized in the Commonwealth of Virginia. Please increase the reinvestment from 30% to 70% for new companies and entrepreneurs. Make sure the new market is equitable and accessible to all not just large corporations.

As the Chief Operating Officer of Elk Hill, a non-profit that has provided TDT services since 2012, I would like to share some of our experiences with the MCOs and TDT. The MCO interpretations of DMAS TDT regulations create barriers to service with little clinical rationale. Mental health/behavioral interventions provided by the school are no longer considered previous mental health interventions, even when provided by LCSWs or LPCs. Some MCOs require that a child be at risk of out of home placement to qualify for TDT, even if the other two of three criteria for service have been met. Virginia’s focus on keeping children in their home make this an almost impossible criteria to meet. MCOs deny TDT services, recommending lower level services even when those services are unavailable in the child’s community. TDT was designed as an intervention for the most significant behavioral and mental health impairments yet MCOs are now denying children services because they’ve been in service too long. These are children with chronic mental health conditions which are not cured by TDT or other therapeutic intervention. Their conditions are managed through these services, just as diabetes may be managed through insulin. The idea that a health professional would deny a diabetic insulin because “they’ve been taking it too long” is absurd yet that is exactly what the MCOs are doing for children with severe mental health conditions. TDT is often the service that maintains these children in public schools rather than referring them to private day placements. More than 80% of Elk Hill’s initial service request authorizations (SRAs) are initially pended for more clinical information yet in almost every case, the information requested by reviewers was already included. Our clinicians have been told by MCO medical directors that their reviewers don’t have time to read the entire SRA . Our clinicians must then submit the requested information in writing again and the MCO has another three days to respond. MCO reviewers have recently started “bargaining” with units. We may have requested 140 units over a three- month period and the reviewer will offer 100 units, stating that if we don’t accept the 100 units, the request will be denied altogether and the family will have to go through the appeal process. DMAS oversight of the MCOs thus far has been largely ineffective. Between November 2019 and January 2020, my clinicians submitted 12 complaints regarding the MCOs to the established DMAS complaint e-mail with no response from DMAS, beyond an automatic reply receipt. In October 2020, I contacted DMAS acting behavioral health senior program advisor. She requested more data and more complaint forms. We submitted four of those complaint forms on October 13, 2020. To date, we have had one e-mail from an MCO representative who has since not responded to my clinician. Elk Hill spent over $150,000 in private donor funds in FY2019 to subsidize TDT services in the public schools. Our mission is helping children and we did not abandon those children as many of our for-profit counterparts did when the MCOs made the model economically unsustainable. Although we are a non-profit, we cannot sustain loss indefinitely. The reduction of TDT services is not in keeping with Virginia's earlier commitment to provide community based services to children. Respectfully submitted, Laura Easter, PhD, LPC Chief Operating Officer, Elk Hill

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

Supported Decision Making (SDM) legal agreements should not be limited to ID/DD (Intellectually Disabled/Developmentally Delayed) individuals and their supporters alone. Serious consideration should be given by DBHDS in this bill to legal SDM agreements, negotiated between the Community Service Board (CSB), designated family advocates, and treatment providers, as "designated supporters", and individuals with SMIs (Serious Mental Illnesses, such as Schizophrenia Spectrum, Bipolar Spectrum). This could conceivably be as part of routine outpatient treatment planning and care or as part of the terms of a court-ordered "Mandatory Outpatient Treatment" (MOT) order. Such agreements would typically take the form of Psychiatric Advance Directives (PADs) negotiated by individuals with SMI judged mentally competent, as recommended by a qualified forensic physician or psychiatrist, to have sufficient mental capacity to understand and give informed consent, with support, to a PAD (binding mental health contract with or without Ulysses Clause). See Paul F. Stavis "The Nexum: A Modest Proposal for Self-Guardianship by Contract: A System of Advance Directives and Surrogate Committees-at-Large for the Intermittently Mentally Ill" Journal of Contemporary Health and Law Vol 15-1 for an example. (Proposed to the New York Legislature as a bill in 1999). Such SDM agreements in the form of a freely negotiated PAD could serve as one alternative to full or plenary guardianship orders for persons with SMIs or in transition through "limited guardianship" (in the form of a modified court order under 64.2-2009) in negotiating an SDM PAD agreement with the long-term goal of full restoration of the affected individual's full legal emancipation and civil rights. In a legally contested case, such a court order could be negotiated through legal mediation and entered by the court as a "consent agreement" by the parties.