Conference committee reviews S.126 provisions adding Green Mountain Care Board staff and funding, and debates global hospital budgets

At a conference committee meeting reviewing S.126, Jen McCarthy, legislative counsel, said the bill would add new reporting requirements for the Green Mountain Care Board and change language related to the future use of global hospital budgets.

The discussion centered on section 16, which would amend the Green Mountain Care Board’s annual report to require the board to include the status of its efforts on reference‑based pricing. McCarthy said the Senate draft would “end development of global hospital budgets,” while the House draft would go further and “end any considerations regarding the future use of global hospital budgets.”

Committee members also discussed staffing and funding proposed for the Green Mountain Care Board. McCarthy summarized section 17 as creating three new permanent classified positions in fiscal year 2026: a director of reference‑based pricing, a project manager for reference‑based pricing, and an operations, procurement and contractual oversight manager. She said those three positions would be in addition to three positions already in the governor’s recommended budget, for a total of six new positions; senators had previously sought eight positions.

On funding, McCarthy described section 18 as appropriating $2,200,000 from the General Fund to the Agency of Human Services in FY2026, with the largest share — $2,000,000 — directed to feasibility analysis and transformation plan development with hospitals, designated agencies, primary care organizations and other community providers. The bill text discussed by the committee also allocates $100,000 for development of quality and access measures and monitoring strategies and $100,000 to support development of alternative payment models. McCarthy said the bill includes a notwithstanding direction to tap the Health Information Technology (HIT) fund statute, moving $2,000,000 from that fund to the agency for hospital grants to reduce costs and expand access, including telehealth infrastructure.

She provided additional line‑item detail the committee discussed: $1,062,500 to a care award in FY26, of which $512,500 would fund the positions authorized in section 17; $500,000 from the General Fund for contracts, including support for implementing reference‑based pricing; and $50,000 per contract with BPQHC to support quality initiatives. For the $512,500 tied to positions, McCarthy said the bill contemplates a 40/60 funding split: approximately $205,000 (40%) from the General Fund and $307,500 from the Green Mountain Care Board regulatory and administrative fund. The bill would also provide $150,000 in FY26 to the Green Mountain Care Board for standardizing electronic hospital budget data submissions under section 4.

Eli Hallgood, legislative liaison for health care reform and for health information exchange at the Agency of Human Services, raised concerns about the bill’s reporting schedule and urged consolidation of overlapping reporting requirements. Hallgood noted that some sections (he cited sections 10 and 11) require monthly reports on hospital transformation and outcome measures, while other sections require annual updates that may duplicate those monthly items. "The updates that we have in here, the monthly updates, is the equivalent of a one‑pager of what have you done this month, what are you working on next month, where are you," Hallgood said, arguing for predictable, consolidated timing so agencies can both implement work and report on progress.

Committee members and staff discussed effective dates. McCarthy said the bill currently lists an effective date of July 1, 2026, for the Green Mountain Care Board annual report change in section 16, but that sections 17 and 18 (positions and appropriations) should take effect July 1, 2025, because FY2026 begins on that date; the committee agreed to amend the dates when the measure is passed out to the conference committee.

Members also flagged several other implementation and coordination questions to resolve before finalizing conference language: how to integrate the primary care steering committee and other advisory groups so primary care recommendations carry weight; the scope of hospital duties and hospital financial reporting; and how Department of Financial Regulation (DFR) work on insurer sustainability should be scoped. The committee asked the DFR to examine preservation of domestic health insurers and options such as reinsurance; McCarthy said the immediate focus is preserving the sustainability of the state’s domestic insurer.

The committee set a follow‑up meeting for 8:45 a.m. the next day to continue section‑by‑section work and asked AHS to submit recommended consolidations of the bill’s reporting requirements and any proposed language changes for committee review.

The discussion recorded in the transcript did not include any formal motions or recorded roll‑call votes on the bill text; committee members discussed drafting and agreed to amend effective dates and to return with revised language and additional staff work.