Medical boards and regulators urge scope‑of‑practice clarifications for H.32 prescription language

Legislators on the House Corrections and Institutions Committee heard detailed technical testimony on draft bill H.32 on April 9, focusing on language that would govern continuation of community medical care and medication‑for‑opioid‑use‑disorder (MOUD) for people entering correctional facilities.

David Herlihy, executive director of the Vermont Board of Medical Practice, told the committee the draft bill's repeated phrase "licensed to prescribe" is incomplete for controlled substances and MOUD. "Saying someone needs to be licensed to do it is not adequate," Herlihy said. He explained prescribers of controlled substances also require DEA registration and that some licensed professions have restricted scopes — for example, podiatrists and dentists may prescribe for conditions within their fields but not treat opioid use disorder broadly.

Why it matters: committee members and regulators said the bill should ensure that only practitioners who are authorized, qualified and acting within their lawful scopes of practice can initiate or continue prescriptions inside correctional facilities, and that continuity of care requires an actual prescription to be issued before medication may be dispensed from a facility's stock.

Key testimony and concerns

- Prescription and DEA requirements: Herlihy said any change that permits discontinuation or initiation of MOUD or other controlled medications must account for DEA registration and professional scope. He suggested language such as "licensed, qualified and authorized to prescribe" to capture DEA and practice‑agreement requirements.

- Definition of "health care practitioner": The draft defined "health care practitioner" broadly as someone "licensed or certified by the Office of Professional Regulation or the Board of Medical Practice to provide professional health care services…" Office of Professional Regulation and Board of Nursing staff warned that language is too broad and could unintentionally permit licensees who are not authorized to perform assessments or prescribe (for example, licensed nursing assistants or LPNs) to be treated as able to perform the statute's clinical tasks.

- Scope‑of‑practice amendment recommended: Sheila Boney, executive director of the Board of Nursing, and Lauren Hibbert, deputy secretary of state for the Office of Professional Regulation, recommended replacing the bill's phrase "to provide professional health care services to an individual during the course of that individual's medical care and treatment" with language that requires practitioners to be "acting within the individual's lawful scope of practice." "If an activity is not within [an LPN's] scope of practice, they're not authorized to perform that activity even if they're instructed to do so," Boney said.

- Continuity of care and verification: Committee staff and regulators reiterated that continuity of medication requires verification of outside prescriptions (pharmacy of record, primary care clinician, or the state prescription monitoring system) and then a new prescription issued by an authorized prescriber to allow the facility to dispense or administer the medication. "There needs to be a prescription," Herlihy said, noting common practice in other care settings is for the receiving facility's authorized prescriber to issue immediate short‑term prescriptions to bridge care while a fuller evaluation occurs.

Office of Professional Regulation input and enforcement context

Deputy Secretary Lauren Hibbert described OPR's framework for licensure and enforcement: multiple practitioner categories (LNA, LPN, RN, APRN, PA, physicians) have distinct scopes and regulatory requirements; OPR receives complaints and enforces standards under unprofessional conduct statutes. Hibbert and OPR staff said modifying the bill to reference scope of practice and lawful authorization would align the statute with existing professional oversight and continuing‑education requirements for opioid prescribing.

Committee next steps

Committee members said they will take the regulators' recommendations under consideration, obtain DOC medical‑provider practice details and follow up with additional testimony. Members asked regulators and DOC for clarifications about how DOC's contracted medical providers verify outside prescriptions, whether DOC reissues prescriptions to release medications from facility stock, and how MOUD prescriptions would be handled under DEA requirements.

Ending: Regulators supported the policy aim of ensuring continuity of care for people entering custody but urged clearer statutory language that limits prescribing and clinical decisions to appropriately licensed, authorized practitioners acting within their professional scope and with any necessary DEA authorizations for controlled substances.