Fiscal office and advocates warn S.126 could require millions more to implement; committee urged to seek AHS clarity

Lowell Meinwald, of the Joint Fiscal Office, told the Senate Committee on Health and Welfare that fiscal notes tied to S.126 show differing cost estimates depending on which version of the bill is used and that the Senate health committee’s version originally included appropriations later removed and routed to the budget process.

The fiscal office’s breakdown attributes new staffing and contract needs across the Agency of Human Services and the Green Mountain Care Board. "Their ask was 1,500,000.0 general fund, 250,000 for HIT for a total of about 1,800,000.0," Meinwald said, summarizing AHS figures the office received when the bill was before the Senate committee. Meinwald added that AHS later told JFO the actual need to implement the bill could be higher but that AHS had not supplied revised numbers.

Mike Fisher, healthcare advocate, warned lawmakers of broader fiscal risk. "I feel like I am speeding towards a cliff," Fisher said, arguing the state is facing a near-term financing crisis in hospital and health-care spending. Fisher and other witnesses urged clearer, faster action on pricing and budget tools to avoid insolvency in the system.

Sam Putsch, a health care advocate who has followed hospital budget guidance for years, urged the committee to reconsider some commonly used metrics. "If prices are really high already, then setting a benchmark for a rate of growth on top of that… feels challenging to us," Putsch said, criticizing reliance on net patient revenue as a single performance metric because it blends price and utilization and can obscure whether cost growth is driven by higher prices or greater use of services.

Specific fiscal figures and staffing requests described in committee testimony included: - AHS (as reported to JFO): $250,000 for hospital transformation grants; $100,000 for development of a statewide health-care delivery plan; $1,000,000 for contracts; funding for two limited-service positions (a health-care reform integration manager and an administrative services director). JFO summarized those items as about $1.5 million general fund plus $250,000 to the HIT fund (roughly $1.8 million total), while noting AHS later said their final implementation need would likely be higher but had not yet supplied an updated total. - Green Mountain Care Board: funding for five classified positions (including a director of global budgets, a project manager for global budgets, a director and project manager for reference‑based pricing, and a staff attorney) and contract funds. JFO reported roughly $850,000 for five positions and about $500,000 for contracts; JFO presented a gross figure near $3.3 million with approximately $2.8 million general fund, based on the Senate health committee version that included appropriations.

Committee members and witnesses also discussed how sections of S.126 would interact. Witnesses described sections 2–3 as focused on reference‑based pricing and sections 4–6 on hospital budgeting and potential global budgets. Putsch and others recommended clarifying definitions and sequencing in the bill: get price benchmarks aligned first, then consider a global‑budget pilot. Committee members asked whether the bill’s timeline — a referenced provision that would require the board to implement a global budget for at least one hospital by 2028 — is feasible given current data and funding uncertainties.

Witnesses urged the committee to invite AHS and Green Mountain Care Board staff to testify with updated fiscal estimates and more detailed staffing and contract breakdowns before the committee finalizes positions on S.126. JFO recommended such testimony; several legislators echoed that request.

Although the discussion covered specific appropriation figures, no final committee vote or formal action on S.126 was recorded in the transcript. Committee members framed the exchange as information‑gathering and directed staff to seek clearer numbers and testimony from implementing agencies.

Committee members and advocates also debated policy approaches beyond immediate fiscal numbers: whether hospitals should be asked to invest in community programs (witnesses urged the state fund proven community programs directly rather than rely on hospitals), how to separate price and utilization measures in hospital guidance, and how affordability standards (currently tied to inflation metrics) interact with high existing prices.

Next steps reported on the record included JFO and committee staff following up with AHS for updated implementation costs and inviting AHS and Green Mountain Care Board staff to discuss operational needs and definitions of global budgets in a later hearing.

Ending: The committee paused its session after the exchange for a scheduled break and to arrange additional testimony and updated fiscal notes from implementing agencies. No formal motions or votes on S.126 were taken during the recorded discussion.