Committee reviews H.32 to expand medication for opioid use disorder in correctional settings

The House Committee on Corrections and Institutions on Feb. 4 reviewed H.32, a bill that would require the Vermont Department of Corrections (DOC) to enter memoranda of understanding (MOUs) with the opioid treatment program nearest each correctional facility to provide medication for opioid use disorder (MOUD) and to expand reentry planning and reporting related to MOUD.

Legislative counsel Katie McLennan, Office of Legislative Council, told the committee, “This is a bill that's looking at the, administration of medication for opioid use disorder in a correctional setting.” McLennan said the draft directs DOC to execute an MOU with the nearest opioid treatment program (the “hub”) and authorizes—but does not require—MOUs with office-based opioid treatment providers (known as “spokes”).

Why it matters: the draft explicitly tries to create parity between community and correctional MOUD services, broaden the range of medications available, require individualized reentry planning, and add annual reporting and staff training requirements. Those changes could affect DOC operations, vendor contracts and budgets, and community treatment providers.

Key provisions outlined in the draft

- MOUs and provider structure: H.32 would direct DOC to execute MOUs with the hub closest to each correctional facility and may execute MOUs with one or more OBOT (spoke) providers in reasonable proximity. Each MOU "shall require the parties to adhere to the Department of Health's rules around medication for opioid use disorder," McLennan said.

- Expanded medication access: The draft would require MOUs to "expand access to the full range of medications for opioid use disorder at each correctional facility," including opioid antagonists where clinically appropriate, instead of restricting initiation or continuation to specific drugs such as buprenorphine only.

- Initiation, continuation and transfer: If an inmate screens positive for opioid use disorder, the inmate may elect to begin MOUD, and an inmate already receiving MOUD before admission would be authorized to continue that medication "as long as medically necessary as determined by the provider serving the correctional facility in accordance with the MOU." The draft removes statutory limits that previously specified some medication transitions (for example, buprenorphine-to-methadone transfers).

- Discontinuation and documentation: A provider operating under the MOU would determine whether discontinuation is medically necessary and must document the reason in the inmate's medical record and provide the inmate oral and written notice of that decision.

- Reentry planning and bridging supplies: H.32 would require individualized reentry plans for inmates receiving MOUD at release that address housing, employment, behavioral health and other social determinants. Plans must facilitate continuity of care for a minimum of six months postrelease, schedule regional follow-up appointments, provide a discharge summary with referral appointments and resources, and supply at least a seven-day bridge supply of MOUD at release plus a valid prescription to continue medication after the supplied doses are depleted.

- Case management, reporting and training: The bill would require a case manager to monitor treatment adherence and offer long-term recovery supports. It would also add an annual report (due Jan. 15) to the House Corrections and Institutions Committee and the Senate Judiciary Committee on the number of individuals receiving MOUD by medication type, recidivism rates for those receiving MOUD, cost analyses related to recidivism and health expenditures, and six-month postrelease health and social outcomes. DOC staff involved with MOUD administration or support would be required to complete annual training developed with MOU providers.

- In-house hubs and grants: The bill requires DOC to produce a one-time plan to obtain federal certification for opioid treatment programs (OTPs) at correctional facilities and directs DOC to seek federal and state grants to support MOUs, training, technology, and infrastructure needed for care coordination.

Other health-care language and carve-outs

McLennan explained that H.32 also amends the broader section on health care in correctional settings. The draft adds a 24-hour screening requirement for substance use disorder upon admission and retains a physical assessment requirement for inmates admitted for 14 or more consecutive days. The draft carves MOUD rules out of some general health-care provisions so MOUD is governed primarily by the MOUD-specific section rather than duplicative language across sections.

Questions and concerns raised at the hearing

Committee members and DOC representatives pressed for practical detail the bill does not specify in its current draft: who pays for treatment once someone loses insurance on incarceration; how MOUs would interact with existing vendor contracts (including Wellpath); how DOC would verify the validity of out-of-area prescriptions; and the effect on DOC's budget and staffing. Several members flagged testing and testimony needs on scope of provider networks, responsibilities for case managers, and how community-based prescribing would coordinate with facility medical care.

Isaac Danno, policy director for DOC, said the agency is already working on related operational changes and urged a measured timeline: "there's a lot currently at the moment that we're working with DEA and BDHDSU on in terms of modernizing our employee practices," he said, adding that the proposed changes would require detailed technical testimony from DOC and community providers.

Committee decision and next steps

Committee members indicated a majority interest in continuing work on H.32 rather than advancing it immediately. The chair asked staff to schedule testimony from DOC, the Department of Health (the chair suggested contacting Tony Fallon, who oversees MOUD programs in the community), community MOUD providers and the vendor Wellpath. Members discussed treating the bill as a longer-term effort across the biennium that would allow more thorough testimony and technical drafting rather than a rushed two-week push.

What the bill does not yet resolve

The draft leaves several policy choices and implementation details open: whether DOC must contract only with hubs or may rely on spokes in practice; how continuity of care will be funded when inmates lose insurance upon incarceration; the operational interaction between an MOU provider and existing DOC contractors; precise oversight and employer responsibilities for DOC case managers and facility staff; and the timeline and costs for seeking federal OTP certification for correctional facilities.

The committee will schedule testimony and follow-up meetings to hear detailed operational, budget and provider testimony before deciding whether to formally take up the bill for amendment and advancement.