Committee orders study of designated agencies, seeks clearer funding and contract process

The appropriations committee heard testimony Thursday on budget language directing a study of the state'designated and specialized service agency system and pressed agency and provider representatives for clearer rules about contracts, funding and how new responsibilities would be added to local providers.

Chair opened the session by pointing to study language placed in the budget (pages 160'61) as a placeholder tied to S194 and related House language. "One of the things that we do during the budget process is to resolve language issues," the chair said, calling the review an opportunity for the committee to clarify expectations between the Agency of Human Services and the DA/SSA network.

Simone Rushmeyer of Vermont Care Partners and other provider representatives described DAs and SSAs as nonprofit entities that deliver a wide range of community'based supports. "Designated and specialized service agencies are written into state statute," a Care Partners speaker said, noting that DAs have defined catchment areas while SSAs offer specialty services. Care partners emphasized that much of the work—roughly two'thirds, they said—occurs in people'homes and communities rather than institutions.

Commissioner Bowen, speaking for the Department of Disabilities and Independent Living, told the panel the administration supports an integrated study that sits under the umbrella of ongoing health care reform. Bowen noted the system'level work underway and urged that any study not be siloed from the statewide strategic plan and the Budget Adjustment Act convenings. "We want to do it in a collaborative, coordinated and integrated way," Bowen said.

The session identified three priorities providers and agencies are already pursuing: immediate operational workgroups on fiscal and liability issues, a deep'dive financial review for agencies at fiscal risk, and development of sustainability plans tied to the BAA. Agency staff said five workgroup sessions have already focused on immediate concerns such as budget calculators and liability.

A recurring point of contention was how and when the state may require designated agencies to take on new or expanded responsibilities. Provider proposals include a specific process (appearing as "item six" in the materials) that would require prior agreement on funding, staffing and operational feasibility before imposing new contractual requirements. Committee members repeatedly pressed both sides for a predictable, transparent process. "What we're looking for is a process that everyone knows about," one agency official said.

Agency and provider witnesses used the rollout of the statewide enhanced mobile crisis response as an example of implementation challenges: the program involved years of planning but, some witnesses said, the go'live felt abrupt and exposed gaps in funding alignment and workforce transition. Speakers noted that some reforms qualify for enhanced federal match, which changed the fiscal calculus in certain cases.

Committee members concluded by asking agency and provider representatives to meet offline, reconcile proposed language (including the study charge and the implementation/process clause) and return with a closely agreed recommendation the committee can adopt in appropriations. The chair said the goal is to produce language both sides can support and to ensure the study informs health care transformation and budget decisions.

The committee did not take a formal vote at the hearing; members set a next procedural step: an off'record negotiation among the parties followed by a report back to the committee for possible inclusion in the appropriations bill.