Committee reviews H.32 draft to clarify MOUD care in correctional settings, seeks medical testimony

At its April 1 meeting the House Committee on Corrections & Institutions reviewed a strike‑out draft of H.32 that would revise how correctional facilities screen for substance‑use disorders and continue medication for opioid use disorder (MOUD) when people enter, remain in, or exit custody. Katie, legislative counsel, led the committee through the draft; Tony Follin, Division of Substance Use at the Vermont Department of Health, provided technical comments.

Katie told the committee the draft reorganizes two existing statutory sections so that general medical‑care provisions and specific substance‑use disorder rules are clearer. The draft would replace several inconsistent terms with a single defined term — “healthcare practitioner” — and add a definition of “detainee” to distinguish people awaiting trial from sentenced offenders for certain discharge‑planning rules. Katie said, “The committee decided that any drug that is authorized for MOUD doesn't have to be specifically named” in statute and instead proposed referring generically to drugs approved for MOUD.

Under the draft, correctional facilities would screen incoming inmates for substance use disorder within 24 hours, determine whether an incoming person is currently receiving MOUD, and — pending a clinician’s evaluation — allow continuation of preexisting prescriptions that are verified as valid by a pharmacy, a prescriber, or a prescription monitoring system. The draft removes a previous, narrower list of prescriber types and instead requires the clinician who evaluates continuity to be licensed to prescribe the medication in question; the draft’s definition of healthcare practitioner refers to individuals licensed or certified by the Office of Professional Regulation or the Board of Medical Practice.

The bill would also address reentry: if a prescribed medication is both available at the facility and clinically appropriate at discharge, the department "shall provide" an offender (a sentenced person) with not less than a 28‑day supply of the prescribed medication when feasible, and "may provide" a detainee the same, reflecting differing obligations for sentenced and pretrial populations. Committee members asked whether the phrase "and thereafter" in contractor policies should be read to include reentry planning; legislative counsel said the language can be clarified to make reentry obligations explicit.

Committee members and agency staff debated whether the statute should name contractors directly or state that responsibilities assigned to the department can be carried out by an entity under contract. Katie said the committee had agreed the department must ensure services are provided even when care is delivered through a contractor, and noted the draft already allows department contracts with external medical providers for health and substance use disorder services.

The committee spent substantial time on continuity of care and the logistics of injectable MOUD. Tony Follin summarized the technical issue: “the conversation we had was whether or not the the medication delivery system or the medication itself … are we focused on the delivery system or are we focused on the medicine itself?” He explained that injectable products exist for some MOUD medications and that the choice of delivery can be driven by patient circumstances — including difficulty getting to a pharmacy, risk of diversion, or dental/taste issues — and that some injectable formulations are given weekly to monthly while oral or sublingual alternatives require daily dosing.

Members raised cost and operational concerns: committee members asked whether the department could practically continue all community treatment types inside facilities and whether injectable MOUD would be affordable and available through current contracts. The committee heard that some contract terms already require provision of medication at admission and that a major implementation issue has been ensuring returning people have a usable supply (and a means to fill prescriptions) after release.

The committee requested additional, technical testimony before advancing statutory language. Staff asked the Department of Health to coordinate outreach to the Board of Medical Practice and the Board of Nursing (OPR) to clarify scope, licensing and how out‑of‑state providers or providers at contracted out‑of‑state facilities should be treated under the proposed language. The committee scheduled follow‑up work and asked for DOC legal staff and program staff to join the next session.