Conference committee considers re‑adding global hospital budgets, sets fiscal-year timelines

Members of the continuing conference committee reviewed a Senate proposal that would restore global hospital budgets to the health‑care reform bill and clarified target implementation dates for reference‑based pricing and budgets.

The proposal keeps the House draft as the underlying document while adding back Senate language that would: establish reference‑based pricing in hospital fiscal year 2027; require at least one non‑critical access hospital to enter global budgeting by hospital fiscal year 2028; and phase in global hospital budgets for all Vermont hospitals by hospital fiscal year 2030, "to the extent that resources are available," language repeated throughout the Senate text, Jen, legislative counsel with the Office of Legislative Council, told the committee.

Why it matters: reference‑based pricing and global hospital budgets are central payment‑reform tools the bill is using to control health care cost growth. Timing, the responsible agencies, and the resources to implement global budgets will determine whether the state can move from pilots to systemwide budgets without disrupting hospital operations.

The committee discussed who will lead the planning. The Agency of Human Services (AHS) is listed to lead the statewide health care delivery strategic plan, with the Green Mountain Care Board tasked with developing global hospital budgets in its hospital budget review duties. Committee members noted the bill text does not define "global hospital budget" and urged that the Green Mountain Care Board or AHS provide an operational definition as the budgeting work proceeds.

Committee members pressed for clarity on resource needs. The proposed language includes several references that global budgets are subject to available resources and an intent clause that the General Assembly provide sufficient resources in future fiscal years to enable full implementation. One member asked whether the board’s existing hospital budget process amounts to a cap; presenters said there are multiple models (net patient revenue, hospital expenses, total cost of care) and that the board would need to develop operational definitions and methods.

No formal vote was taken during the session. Committee members agreed to continue drafting language and to reach out to the Green Mountain Care Board and other experts for details on definitions and implementation steps.

Ending: Committee staff said they will return with revised language that clarifies definitions, sequencing, and resource implications for any phase‑in of global hospital budgets.