Appropriations committee advances wide-ranging health care payment bill with funding for Green Mountain Care Board and AHS implementation

The Senate Appropriations Committee on March 19 voted to move S.146 — a bill to reform health care payment and delivery in the state — to the floor after approving committee amendments that change how some implementation costs are funded.

Senator Lyons, sponsor of the bill's policy provisions, told the committee the measure aims to slow rapidly rising health-care costs by adding transparency, piloting reference-based pricing for hospitals, pursuing global hospital budgets and integrating clinical and claims data to improve care coordination. "The cost of health care is escalating, too rapidly for people to afford," Lyons said, arguing the bill requires upfront investment to stabilize hospitals and access to insurance.

Eugene Kirby of the Office of Legislative Counsel summarized the bill's appropriation provisions for fiscal year 2026. Key items discussed by staff and committee members included:

- $1,525,000 from the general fund to the Agency of Human Services (AHS) in FY26, broken down as $250,000 for grants to hospitals for transformation planning, $100,000 for expenses to develop a statewide health care delivery plan, $1,000,000 for contracts and consultants to support implementation and $175,000 for two limited-service positions.

- $250,000 appropriated from the Health Information Technology (HIT) Fund to AHS for data-integration grants that will support linking clinical and claims data.

- $1,350,000 appropriated to the Green Mountain Care Board (GMCB) for implementation: $850,000 estimated for five new positions and $500,000 for contracts to help implement reference-based pricing and related work. Staff also described a $150,000 HIT Fund appropriation tied to standardizing hospital budget and reporting formats.

During markup, the committee considered and approved an amendment that keeps the $1,350,000 total to the GMCB but shifts the funding source so that 40% is from the general fund and 60% from the GMCB regulatory and administrative fund (the board's bill-back authority to recover costs from regulated entities). Committee counsel said the amendment reflects agreement with the board on a 60/40 industry/state split for those expenses.

Committee members discussed the relationship between the bill's work and a proposed AHEAD federal model to develop global budgets. Lyons and others said the state has a tentative outlook from federal officials and potential federal funding to support parts of the work; staff noted that GMCB had pressed for additional positions to carry out the expanded regulatory and implementation work and had asked the committee for five positions now and an expressed intent for more in subsequent years.

Committee members asked for caution about near-term federal budget uncertainty and the timing of other budget decisions; some members said they would move the vehicle to the floor for debate while reserving judgment on final funding in the annual budget process.

A motion to move S.146 favorably to the floor with the amendment was made in committee; committee members registered their votes and the bill was advanced for floor consideration. The committee also discussed related bills and amendments that may affect regulatory workload.