Committee examines House Bill 32 on medication for opioid use disorder, asks DOC to refine language

The House Corrections & Institutions committee on Feb. 12 took testimony and asked the Department of Corrections (DOC) to return with specific language changes to House Bill 32, a bill intended to codify continuity of care for people in custody who receive medication for opioid use disorder (MOUD).

Dr. Jamie Zilliger, medical director for Wellpath in the Vermont Department of Corrections, told the committee, “we strongly support the legislative intent of the bill as written,” but warned the bill as drafted could make care less consistent in practice. Zilliger said DOC currently uses memoranda of understanding (MOUs) with some opioid treatment programs for methadone dosing and that logistics — including whether outside providers evaluate patients in person or asynchronously by telehealth — affect how dosing and adjustments are made.

The bill would require an MOU with the opioid treatment program nearest each correctional facility, language that committee members and DOC staff said could create multiple MOUs across the state and raise questions about who is accountable for care inside facilities. “If we were instead relying on services through an MOU, we lose an amount of leverage over those services,” a DOC witness said, noting that DOC’s current contract structure with Wellpath provides a single entity responsible for health care across six facilities.

Why it matters: Committee members emphasized the bill’s twin aims — maintaining quality MOUD access while securing a “seamless transition” to community care at reentry — and flagged trade-offs between codifying specific operational steps and setting high‑level outcomes. Several witnesses warned that prescribing how DOC must perform operational tasks (for example, “shall execute” MOUs or apply for grants) may raise separation‑of‑powers and implementation questions that require legislative counsel and DOC legal review.

Key details and concerns

- Continuity vs. operational control: DOC and Wellpath witnesses said the current single-contractor model yields consistent standards across all six DOC facilities; inserting multiple community providers through required MOUs could make care uneven depending on local providers’ staffing and ability to operate within correctional security constraints.

- Methadone logistics and DEA rules: Testimony cited existing MOUs used to deliver methadone and the DEA’s chain‑of‑custody requirements for methadone storage and dosing. Committee members used methadone as an example of operational complexity when dosing must happen outside facility walls.

- Legal and budget questions: Committee members asked whether the legislature can and should require DOC to enter MOUs or to apply for grants, and whether the bill’s use of “shall” imposes detailed operational mandates on the executive branch. DOC staff asked the committee to specify which services the MOUs would cover and warned that some reporting requirements in the bill (for example, cost‑and‑recidivism analyses) may fall outside DOC’s jurisdiction or require other agencies’ data.

- Reentry and Medicaid: DOC staff said Vermont’s upcoming Medicaid 1115 waiver implementation (targeted Jan. 1, 2026) and changes to Medicaid claims systems — including automatic pause/restart functionality for up to 90 days around incarceration — are relevant to ensuring continuity of care at release.

- Staffing and contract continuity: Committee members repeatedly raised concerns about turnover in the contractor role (Wellpath) and asked whether language should focus on the outcome (high‑quality, continuous care for a period after release) rather than prescribing specific contracting mechanisms. Several members urged DOC to propose contract performance measures that would link pay‑for‑performance to continuity and quality benchmarks.

Committee direction and next steps

Committee members asked DOC to: (1) review the bill line by line with legislative counsel; (2) flag operational, legal and budgetary implications; and (3) propose alternative language or edits that preserve the bill’s intent while addressing the department’s implementation concerns. The committee also scheduled a follow‑up, line‑by‑line review with legislative staff (referred to as “Katie” in testimony).

No formal vote was recorded on Feb. 12. Committee members said they expect additional testimony from opioid treatment hubs, people with lived experience in MOUD programs, and other medical providers before further action.

Ending

Committee members emphasized the bill’s goal of protecting access to MOUD in custody and improving the continuity of care at reentry, but said they needed clearer, legally vetted language to ensure the statute would not create unintended operational or budgetary barriers. DOC agreed to return with recommended edits and legal guidance for the committee to consider.