Legislative counsel gives checklist as Corrections & Institutions committee reexamines MOUD policy in H.32

The Corrections & Institutions Committee turned to H.32 on Feb. 19, working through a policy checklist from legislative counsel designed to clarify choices the legislature must make about providing medications for opioid use disorder (MOUD) in correctional facilities.

Legislative context and checklist Katie, Legislative Counsel with the Office of Legislative Counsel, told the committee the session would focus on policy choices rather than drafting precise bill text at first. She reviewed separation‑of‑powers principles and said courts allow overlap among branches so long as one branch does not “so completely encroach” on another’s constitutional functions. "What is the problem we're trying to solve?" Katie asked the committee, and she offered a checklist of issues including who should deliver MOUD, when people should be screened, which medications to provide, reentry planning, staff training, data collection and funding.

Parity and current practice Representative Troy (committee sponsor) and other members said parity with community care is a principal concern: the committee wants to ensure incarcerated people receive an equivalent standard of MOUD as community patients. Tony Fallin of the Vermont Department of Health, Division of Substance Use, said the program’s guiding principle has been “no more, no less” than community care: therapy and counseling are available but not mandatory, and nursing and care‑management supports were built into the correctional MOUD program to mirror the hub‑and‑spoke community system. “We make it available but it's never required,” Tony said of counseling tied to MOUD, explaining the policy avoids removing life‑saving medication when someone declines counseling.

What’s already in statute and practice: the committee reviewed existing statutory language that requires continuation of prescribed MOUD when a person enters a facility and allows an inmate who screens positive to elect to begin buprenorphine if medically necessary. Committee members recalled a change last year that clarified release supplies for non‑MOUD medications while noting the committee clearly intended a shorter transitional supply for MOUD so people can get to a hub appointment.

Reentry, data and the 1115 waiver Committee members pressed for better measurement of postrelease continuity of care. Several lawmakers asked state agencies to report aggregated data on whether formerly incarcerated people are filling MOUD prescriptions after release. Tony and other agency speakers said the data exist but are labor‑intensive to assemble; officials said a planned Section 1115 Medicaid waiver and a unique identifier in the MMIS claims system could make such reporting easier in the near term. The committee asked legislative counsel to draft a reporting requirement that could take effect when the 1115 waiver is implemented.

Diversion and operations Members discussed diversion (unauthorized transfer of medication) and operational burdens, including early morning med lines and staffing implications for supervising doses. DOC and contractor staff said diversion is monitored and handled through medical and disciplinary policies; one speaker said statewide diversion incidents are a small share of the doses dispensed but vary by facility, with some facilities showing higher incident rates. Committee members asked DOC and Wellpath (the current contractor named in discussion) to provide existing diversion‑management policies and said statute could formalize reporting or standards if the committee chooses.

Provider responsibility and continuity The checklist asked whether medical decisions should be made by in‑house DOC clinicians, a contracted healthcare provider, or by outside community hubs via memoranda of understanding (MOUs). Committee members and agency witnesses discussed practical limits: facilities are not typically licensed opioid treatment programs (OTPs) and licensing an OTP inside every correctional facility would require significant investment and infrastructure. The bill as drafted requires DOC to execute MOUs with the closest OTPs to ensure continuity of care for methadone patients and to expand access to the full range of MOUD options where feasible.

Next steps and committee direction The committee made no final decision but gave several directions: legislative counsel will draft language reflecting the policy checklist, including (1) a reporting requirement asking the relevant agencies to provide aggregated postrelease MOUD prescription‑filling data (timed to the 1115 waiver implementation), (2) a framework or contractual standards to preserve continuity of MOUD when vendor contracts change, and (3) follow‑up to obtain DOC diversion‑response policy documents for review. Members indicated interest in limiting prescriptive clinical mandates while ensuring minimum standards and transition planning are codified so care does not vary with contractor turnover.

Ending: The committee paused the discussion for lunch and agreed to reconvene with legislative counsel and agency staff to continue drafting H.32 language based on the policy checklist.