House Health Care Committee reviews H237 to allow specially trained psychologists to prescribe psychotropic drugs, delays straw poll

The House Health Care Committee on April 15 reviewed H237, an act to authorize limited prescribing by specially trained doctoral-level psychologists as a tool to address Vermont’s mental-health provider shortage. The committee heard a section-by-section walkthrough of Senate changes, Office of Professional Regulation (OPR) rationale and competing views from medical stakeholders and patients, and agreed to postpone a straw poll until the next meeting.

The bill would create a prescribing specialty for licensed doctoral psychologists who complete a designated postdoctoral psychopharmacology program, pass a national certifying examination, complete at least 14 months of clinical rotations in specified practice areas and enter a written collaborative agreement with a collaborating practitioner. "To be clear, this bill is not going to solve the problem. It's just one tool in the toolbox to ease the potential harms of provider shortage," a Senate bill reporter told the committee.

Why it matters: supporters say H237 can shorten delays in medication management by allowing the clinician who sees a patient frequently to make timely adjustments; critics say it may not materially improve overall access to care and worry about overprescribing without sufficient safeguards. The Office of Professional Regulation told the committee the Senate amendments remove rotations in pediatrics and obstetrics because the specialty would exclude prescribing to patients under 18, pregnant patients and those over age 80, and add neurology among required rotations to focus the specialty on relevant adult practice.

Key provisions and safeguards - Training and certification: The bill requires a postdoctoral psychopharmacology program (curriculum standards added in the Senate amendment), clinical rotations totaling at least 14 months in five practice areas and a national certifying exam as determined by rule. OPR said programs would be reviewed by the Board of Psychological Examiners. - Collaborative practice: A prescribing psychologist must have a written collaborative agreement filed with the board; the Senate language defines a collaborating practitioner as a physician licensed in psychiatry. OPR said the report requirement will assess whether that requirement creates access barriers. - Scope limits: Prescriptive authority would be limited to DSM-recognized mental-health conditions. The statute would prohibit prescribing for patients younger than 18, older than 80 and pregnant patients; it would not authorize dispensing, administering or injection of controlled substances by psychologists. Schedule II–V controlled substances would have to be identified by brand or generic name in any prescriptive authority listing. - Portability and endorsement: The director of the Board of Psychological Examiners may grant a prescribing specialty without examination for applicants who hold substantially equivalent prescribing authority in another U.S. or Canadian jurisdiction. - Reporting and timeline: The Senate added a reporting requirement directing OPR to report to policy committees by Nov. 15, 2032, on numbers of prescribing psychologists, availability of collaborating practitioners and whether qualifications should change. OPR requested later effective dates (discussed as 2029) to allow coordinated rulemaking with broader mental-health profession reforms.

What witnesses said - Stephanie Winters, deputy director of the Vermont Medical Society and executive director of the Vermont Psychiatric Association, said the societies "do not generally support the bill because we don't believe that it will have impact on access," adding they support added safeguards that require a psychiatrist as the collaborating practitioner. (Stephanie Winters) - Jennifer Coen, director of the Office of Professional Regulation, explained the Senate changes and said the removals of pediatrics and obstetrics were based on the scope limits and that delaying the effective date would allow OPR to align psychologist-prescribing rulemaking with planned mental-health profession reforms. (Jennifer Coen) - A patient who spoke during discussion described frequent specialist visits and argued that allowing a psychologist with prescribing training to coordinate medications could reduce delays: "For me as a patient, that's why this bill I was like, 'Yes, I need this.'" (Resident)

Process and next steps Committee members asked for the senator's written floor report and prior witness testimony to review overnight. Members agreed to take the straw poll on whether to concur with the Senate amendments at the committee's next scheduled meeting; one member said she intended to report the bill out on the floor the following day. No formal committee vote was recorded during the April 15 session.

The committee also clarified administrative points: OPR confirmed collaborative agreements will be developed by the practitioners to meet statutory requirements and that complaint and appeal procedures were omitted from the bill because Title 3 V.S.A. §129 already governs OPR appeals and board procedures.

The committee recessed to await another participant and to continue other business.