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Vermont DOC, Wellpath outline plan to add ASAM level-3 treatment as Chittenden accountability court winds down
Summary
DOC and Wellpath told the Corrections & Institutions Committee they are building a higher-intensity ASAM level-3 substance use disorder program at two facilities tied to the Chittenden County accountability court pilot, highlighting staffing, space, IT, budget and statutory hurdles to wider rollout.
John Murad, interim commissioner of the Vermont Department of Corrections, and Shamiliger, introduced as the medical director for Wellpath at the Vermont DOC, told the legislaturethat the accountability court pilot in Chittenden County has cleared a large backlog and that DOC is building an additional tier of substance use disorder (SUD) care to be available at Northwest and Chittenden Regional Correctional Facility.
Murad said the court has "been remarkably successful" in Chittenden County and that DOCis responsible for determining post-sentencing treatment needs when individuals enter custody. He told the committee that of roughly 43 individuals whose dockets have been resolved in the special court, 10 were remanded to DOC custody and six were placed on pretrial supervision (one currently active), and that the new ASAM assessments will be part of DOCintake process rather than a court-ordered referral.
"This is really about us developing a new capacity for treatment inside the system that will be applied to anyone," Murad said, adding that the pilot has not yet created a "tremendous burden" on DOC but that the department must plan for additional supervision and bedspace if the model expands.
Shamiliger, the medical director for Wellpath at the Vermont DOC, described the difference between MOUD (medications for opioid use disorderbuprenorphine, methadone, naltrexone) and higher-level SUD treatment under ASAM (American Society of Addiction Medicine) levels. He said DOC has primarily operated at ASAM level 1 (medication plus limited group therapy) and that the pilot is intended to build an ASAM level-3 program, which requires roughly 10to 20 hours of therapeutic contact per week.
"When I'm having that conversation about buprenorphine with somebody, this is the one with lots of data to save your life," Shamiliger said, arguing the enhancement is clinically justified while acknowledging operational limits.
Committee members and staff pressed leaders on operational barriers. Wellpath and DOC said a single recently hired masters-level clinician will perform ASAM assessments at the two pilot sites and begin some treatment delivery, but members flagged limited private clinical space, transportation and head-count constraints inside facilities, and the difficulty of sustaining 10hours per week in a custodial environment.
Technology and continuity of care after release were also prominent concerns. Shamiliger said identified clinical spaces at Chittenden and Northwest are not yet wired for Wellpath WiFi, which limits tablet-based evaluations, and urged follow-up from DOC, BGS and the Agency of Digital Services. He also warned of shrinking community capacity: "Better Life Partners is leaving Vermont," he said, noting that the provider planned to continue current patients through February, which could complicate post-release appointments and medication continuity.
On cost, legislators revisited previously cited contract totals (one member referenced a prior figure of about $39 million) and debated per-person calculations and overhead; Murad said contract and budgetary changes would be addressed in the upcoming DOC budget and that any expansion would require new funding. Committee members also asked about injectables; DOC communications staff said injectables have not been pursued because of cost, though a Medicaid waiver might permit use for some sentenced individuals.
Members noted statutory limitations that affect detainees: one legislator said current law allows MOUD for sentenced people but not detainees, and asked legislative counsel to compare existing statute with proposed bill language on file as "32" (draft references discussed). The chair asked legal counsel and the Department of Health to participate in follow-ups, and requested an update and the February report on converting a work camp into treatment space to inform fiscal and statutory planning.
The committee did not take formal votes. Members requested additional data (sentence lengths for the 10 remanded individuals, the Wellpath contract value and renewal terms, and clearer measures for program evaluation) and signaled intent to have legislative counsel reconcile law and practice before any broader rollout.
