Committee Summary for House Finance Division III (03/21/2025)

Bill/Time	Type	Title	Sponsor
HB570 00:08:26.680 - 12:05:37 PM	General Working Session	(New Title) repealing the prescription drug affordability board.	Edwards, Jess(R)[B+]2024
HB2 00:32:47.279 - 12:29:58 PM	General Working Session	relative to state fees, funds, revenues, and expenditures.	Weyler, Kenneth(R)[B+]2024

HB570: Unnamed Speaker Information Only00:08:26.680 - 12:05:37 PM; The speaker opened the session by calling it into order at 10:05 AM after a brief recess. They mentioned that the committee members were coming from different meetings and needed time to gather their thoughts. The session was specifically convened to discuss HB 570, which deals with the prescription drug affordability board. It was noted that the bill came from the House with an amendment that included a repeal, thus removing the fiscal note associated with the bill.
HB570: Unnamed Speaker Information Only00:09:12.200 - 12:06:23 PM; The speaker discussed the work being done by the Prescription Drug Affordability Board (PDAB). They highlighted that the PDAB has published four annual reports, the latest one receiving criticism from the American Health Insurance Plan (AHIP) for not being discussed in public. The speaker expressed concern about the lack of value added in the most recent report and mentioned ongoing efforts to articulate a business case for three initiatives the PDAB is considering. They stressed the importance of showing a clear return on investment for the taxpayers, mentioning a potential investment of $550,000 over two years. The speaker supports the House's position to repeal the PDAB due to the lack of a compelling business case at this time.
HB570: Representative Mooney Information Only00:15:45.160 - 12:12:56 PM; Representative Mooney discussed the financial implications of the governor's proposed budget, specifically mentioning page 1054, accounting unit 6273, which would result in a savings of over $500,000 over two years if zeroed out.
HB570: Representative Priest Support00:16:36.800 - 12:13:47 PM; Representative Priest sought clarification on whether the $550,000 estimate was for one or both years and proposed retaining the bill until a better report could be provided, expressing belief in the value of the Prescription Drug Affordability Board based on models in other states.
HB570: Unnamed Speaker Information Only00:17:22.959 - 12:14:33 PM; The speaker agreed to retain the bill until Tuesday, acknowledging ongoing efforts to develop a business case for the PDAB's initiatives. They discussed the importance of focusing the PDAB's mission on following successful strategies from other states rather than trying to innovate, and expressed hope in the potential of the PDAB despite the lack of tangible results after four years.
HB570: Representative Stringham Support00:21:00.120 - 12:18:11 PM; Representative Stringham thanked the speaker for their work on the PDAB and emphasized the importance of the board, noting that prescription drugs make up 30% of Medicaid expenditures. They supported the idea of retaining the bill and working on a tighter mission for the PDAB to achieve near-term returns and potential long-term benefits for New Hampshire residents.
HB570: Unnamed Speaker Information Only00:23:39.919 - 12:20:50 PM; The speaker discussed the specifics of one of the PDAB's proposals, the Array RX card, which was projected to yield a return of $1.1 million over two years but with implementation costs reducing the net benefit. They expressed the need for a higher return on investment, suggesting a 6:1 ratio, and mentioned ongoing work on another initiative that might justify the investment.
HB570: Representative Tki Information Only00:24:50.320 - 12:22:01 PM; Representative Tki expressed concern about the time constraints affecting the decision on the bill, noting the speaker's dual stance of supporting the House's repeal position while also seeing potential for legislative tweaking. They worried about losing four years of work and suggested retaining the bill for further consideration.
HB570: Unnamed Speaker Information Only00:25:57.799 - 12:23:08 PM; The speaker acknowledged the concern about time constraints and the need for legislative tweaking, agreeing to retain the bill until Tuesday for further discussion. They emphasized the importance of justifying future investments and not being swayed by past expenditures (sunk costs).
HB570: Representative Walner Information Only00:29:19.399 - 12:26:30 PM; Representative Walner supported retaining the bill and working on it during the budget process, expressing concern about losing necessary language in House Bill 2 if the PDAB were to continue without the executive director. They noted the need for a decision on funding but acknowledged that the Senate could revisit the decision.
HB570: Unnamed Speaker Information Only00:30:30.320 - 12:27:41 PM; The speaker discussed their dual roles and the need to evaluate the PDAB's potential differently from the governor's budget proposals. They agreed to retain the bill until Tuesday and proceed with budget work, specifically discussing the governor's trailer bill.
HB570: Mr. Ripple Information Only00:31:32.279 - 12:28:43 PM; Mr. Ripple mentioned a document he would distribute to aid in the discussion of the governor's trailer bill, which affects Division 3, and confirmed that the committee would start discussing it from page 48 of the document.
HB2: Unnamed Speaker Information Only00:32:47.279 - 12:29:58 PM; The speaker, likely a committee member, introduced the session's agenda to discuss House Bill 2 section by section, inviting feedback and potential amendments from the committee and audience. They emphasized that the session was in the discussion phase, not for voting.
HB2: Representative Priest Information Only00:34:06.720 - 12:31:17 PM; Representative Priest expressed appreciation for the line-by-line review of HB2 but indicated a need for more time before voting on any changes, suggesting a delay until Monday or Tuesday to consider the implications on the entire operation of HHS.
HB2: Unnamed Speaker Information Only00:34:53.560 - 12:32:04 PM; The speaker reiterated that the session was in the discussion phase and not ready for voting, and moved on to discuss page 48, section 85 of HB2, which deals with the opioid abatement trust fund allocation for shelter programs.
HB2: Representative Tersi Information Only00:36:01.720 - 12:33:12 PM; Representative Tersi sought clarification on whether the $5 million allocated in section 85 of HB2 was in addition to or part of the funding provided in HB1 for year-round emergency shelter services.
HB2: Nathan White, Chief Financial Officer, Department of Health and Human Services Information Only00:37:16.359 - 12:34:27 PM; Nathan White clarified that the $10 million in section 85 of HB2 was pulled from the opioid abatement trust fund to replace general funds in the governor's budget. He confirmed that this was only a portion of the funding for shelters, with an additional $2.5 million prioritized for shelter care.
HB2: K Fox, Director, Division for Behavioral Health Information Only00:38:28.119 - 12:35:39 PM; K Fox provided information on the number of beds contracted by the department (934) and deferred a question about the use of opioid abatement trust fund money to the Attorney General's office, noting a decrease in opioid-related deaths but ongoing concerns.
HB2: Unnamed Speaker Information Only00:39:46.119 - 12:36:57 PM; The speaker discussed the funding details in the governor's budget related to section 85, explaining how the opioid abatement trust fund and general funds were allocated and how they maintained the status quo for shelter funding.
HB2: Representative Daniels Information Only00:40:54.079 - 12:38:05 PM; Representative Daniels asked for clarification on the amount being withdrawn from the opioid abatement fund and the remaining balance, as well as the department's efforts to help shelter residents secure jobs and housing.
HB2: Unnamed Speaker Information Only00:42:37.920 - 12:39:48 PM; The speaker continued the discussion on sections 86 through 887 of HB2, focusing on procedural aspects and the importance of the ability to transfer between personnel lines for operational flexibility.
HB2: Unnamed Speaker Information Only00:43:57.960 - 12:41:08 PM; The speaker discussed section 88 of HB2, which extends the suspension of a requirement from House Bill 191 of 2011, noting the potential significant fiscal impact if not continued.
HB2: Representative Tarki Information Only00:45:01.480 - 12:42:12 PM; Representative Tarki encouraged audience participation, suggesting they raise their hands or stand if they had input on sections being discussed.
HB2: Representative Stringham Information Only00:46:14.839 - 12:43:25 PM; Representative Stringham expressed satisfaction with the current process of reviewing sections and suggested marking sections for potential changes.
HB2: Unnamed Speaker Information Only00:47:22.440 - 12:44:33 PM; The speaker discussed sections 89 and 90 of HB2, which deal with the suspension of graduate medical education payments and catastrophic aid to hospitals, noting that reinstating these would require general funds.
HB2: Representative Tersi Information Only00:48:34.359 - 12:45:45 PM; Representative Tersi asked for clarification on the timeline of the suspensions discussed, particularly those from the 2011 budget.
HB2: Unnamed Speaker Information Only00:49:44.079 - 12:46:55 PM; The speaker discussed section 91 of HB2, which allows the department to accept additional federal revenue for Medicaid to schools without going through the fiscal and GNC process, though it has not been utilized recently.
HB2: Representative Daniels Information Only00:50:35.720 - 12:47:46 PM; Representative Daniels sought clarification on whether the provision in section 91 would bypass the fiscal committee, which was confirmed to be incorrect as it still requires fiscal committee approval.
HB2: Unnamed Speaker Information Only00:52:23.079 - 12:49:34 PM; The speaker discussed the potential for an amendment to section 91 to avoid both the GNC and fiscal committee processes, noting the administrative time savings this would provide.
HB2: Unnamed Speaker Information Only00:54:09.520 - 12:51:20 PM; The speaker discusses the future need for Medicaid to schools program, mentioning that by the end of state fiscal year 26, there will be a change in the federal claiming methodology which could benefit schools financially. They also mention the cash flow benefits at the community level from not needing fiscal approval. There is a concern about parental consent requirements for the Medicaid to schools program, which is clarified as being necessary for any services provided under the program. The speaker suggests an amendment to HB2, proposing that if parental consent requirements are dropped, the state should exit the Medicaid to schools program, similar to the logic applied in the Granite Advantage program.
HB2: Unnamed Speaker Information Only00:56:40.880 - 12:53:51 PM; The speaker continues the discussion on HB2, focusing on Section 91. They mention that the historical language allowed the department to accept and expend additional federal revenue without prior approval of the fiscal committee. There is a suggestion to amend Section 91 by adding the word 'with' to line 33. The speaker also recalls discussions during the pandemic about disruptions in school services and budgetary flexibility for schools, which influenced the language.
HB2: Unnamed Speaker Information Only01:00:04.960 - 12:57:15 PM; The speaker addresses Sections 92 and 93, concerning non-aps and restricted revenue for the Division of Medicaid Services, stating no changes are needed. They then move to Sections 94 and 95, discussing the extension of the WIC Farmers Market nutrition program with an appropriation lapsing date extended to June 30, 2027. The speaker explains the delay in standing up the program due to administrative rule processes and confirms the funds will not appear in the HB1 operating budget but will carry forward for use in the next biennium.
HB2: Unnamed Speaker Information Only01:05:22.640 - 1:02:33 PM; The speaker discusses Section 96, which allows the Department of Health and Human Services to accept gifts up to $1,000, aligned with the Department of Corrections. There is a proposal to increase this amount to $250,000, both for DHHS and the Veterans Home, to enable larger donations. The speaker mentions potential legal considerations and the nature of gifts typically received, which are often non-monetary and aimed at specific 24/7 facilities. They also express hope for advocacy groups to raise funds for departmental needs.
HB2: Unnamed Speaker Information Only01:08:22.359 - 1:05:33 PM; The speaker suggests tweaking the language of the amendment to better reflect the nature of gifts to the department, allowing for earmarking of donations to specific divisions within DHHS. They discuss examples of past gifts, such as shoes, games, and clothing for 24/7 facilities, and express a desire for advocacy groups to raise funds for departmental needs.
HB2: Lara McIntyre, Sheandin Capital Group, representing Granite State Home Health and Hospice Association Oppose01:14:44.960 - 1:11:55 PM; Lara McIntyre speaks on behalf of the Granite State Home Health and Hospice Association, mentioning that one of their members, Laconia Housing, uses the congregate housing line in the budget. She notes that Jonathan Field from Laconia Housing spoke in support of the program at a previous budget hearing and would oppose the suspension of the congregate housing program as proposed in HB2.
HB2: Unnamed Speaker Information Only01:16:00.679 - 1:13:11 PM; The speaker clarifies that the funds for the congregate housing program are not currently budgeted in HB1 but would be found in accounting unit 7872 on page 895 of HB1 if they were to be budgeted, under class 103 with an authorized amount of $750,000 in 2025.
HB2: Unnamed Speaker Information Only01:17:36.239 - 1:14:47 PM; The speaker discussed the zeroed-out budget line items for program services on page 896, specifically lines 102 and 103. They also mentioned the establishment of unclassified positions starting on page 49, line 36, which continues through to page 50, line 10. The language in this section has been modified following consultations with the Department of Administrative Services to clarify the appointing authority for the Commissioner of the Department of Administrative Services.
HB2: Unnamed Speaker Information Only01:19:39.639 - 1:16:50 PM; The speaker recommended the repeal of the mental health medical supervisor position, as outlined in the current statute, because they could not find anyone who could explain its purpose or necessity. This repeal would have no financial impact but would eliminate an unclear statute.
HB2: Unnamed Speaker Information Only01:20:48.400 - 1:17:59 PM; The speaker explained the differences between classified and unclassified positions within state government, noting that unclassified positions have specific salary schedules and limited employee rights compared to classified positions. They also mentioned that unclassified employees typically work beyond the standard 40-hour workweek.
HB2: Unnamed Speaker Information Only01:22:28.000 - 1:19:39 PM; The speaker confirmed the repeal of the Mental Health Medical Supervisor position and discussed allowing Medicaid reimbursement for brand-name drugs in certain circumstances to save money through rebate programs, as reflected on page 50 of the governor's HB2.
HB2: Unnamed Speaker Information Only01:24:34.639 - 1:21:45 PM; The speaker discussed the Chief Medical Officer standing orders related to the generic and brand-name drug sections, confirming satisfaction with the language on page 50 of the governor's HB2.
HB2: Unnamed Speaker Information Only01:25:46.400 - 1:22:57 PM; The speaker outlined the extension of funding for a DD pilot program, preventing funds from lapsing on June 30, 2025, and allowing service support to continue for the seven or eight current beneficiaries until they age out of the system.
HB2: Unnamed Speaker Information Only01:28:09.280 - 1:25:20 PM; The speaker discussed the extension of effective dates for court-appointed counsel, referencing SP 463 passed in the 2024 legislative session. They noted the need for additional attorneys to implement this bill, which was not funded in the previous budget, hence the delay in the effective date.
HB2: Representative Walner Information Only01:30:29.800 - 1:27:40 PM; Representative Walner reminded the division of the previous year's extensive work on the legislation concerning legal representation for children facing institutionalization. They emphasized the importance of further discussion regarding the necessity of additional attorneys and the financial implications of not extending the effective dates.
HB2: Representative Priest Information Only01:32:26.239 - 1:29:37 PM; Representative Priest supported Representative Walner's points and mentioned a previous alternative proposal to phase in the program without needing additional attorneys, which would have no fiscal impact. They questioned the necessity of the extensions and the financial implications of proceeding without them.
HB2: Marie Nunan, DCF Division Director Information Only01:33:41.639 - 1:30:52 PM; Marie Nunan, DCF Division Director, stated that additional staff, including attorneys, would be necessary to implement SP 463 due to increased litigation and workload. She provided cost estimates for the required positions, noting potential delays due to a hiring freeze.
HB2: Unnamed Speaker Information Only01:42:00.560 - 1:39:11 PM; The speaker discussed the proposal to increase Medicaid prescription co-pays to $4, noting that the current co-pays have been $1 or $2 for over a decade. They mentioned that this increase would account for inflation and not apply to exempted populations like children.
HB2: Representative Tersi Oppose01:44:05.080 - 1:41:16 PM; Representative Tersi expressed opposition to the policy of increasing Medicaid prescription co-pays and mentioned requesting an amendment due to concerns about the policy itself and the lack of clarity in the language.
HB2: Unnamed Speaker Information Only01:45:05.719 - 1:42:16 PM; The speaker discussed the filing of Medicaid rate each year for the biennium, noting it as a cost-saving measure in the governor's budget by reducing consulting fees. They confirmed satisfaction with the language and mentioned a half-million-dollar savings.
HB2: Mr. Litman Information Only01:46:04.639 - 1:43:15 PM; Mr. Litman explained the intent to institute premiums for Granite Advantage recipients with household incomes between 100% to 138% of the federal poverty level, subject to a federal waiver. He noted that this would generate savings in state fiscal year 27.
HB2: Representative Tersi Oppose01:47:21.639 - 1:44:32 PM; Representative Tersi opposed the policy of instituting premiums for Granite Advantage recipients due to language problems and a lack of clarity on limits and consequences of non-payment. She requested an amendment to remove this provision.
HB2: Unnamed Speaker Information Only01:51:02.800 - 1:48:13 PM; The speaker discussed instituting premiums on CHIP, clarifying that New Hampshire does not have a separate CHIP program but can claim a higher federal match for certain children. They confirmed satisfaction with the language in the governor's budget.
HB2: Representative Tersi Oppose01:52:08.960 - 1:49:19 PM; Representative Tersi opposed the policy of instituting premiums on CHIP due to conflict with the policy itself and planned to draft an amendment to remove this provision.
HB2: Unknown Speaker Information Only01:53:57.599 - 1:51:08 PM; The speaker highlighted a concern regarding the impact of premium non-payment on community mental health centers and federally qualified health centers. They noted that these centers are required by law and contract to provide care regardless of patients' ability to pay. If patients lose coverage due to non-payment, these centers would still provide care but would receive no reimbursement, leading to uncompensated care. The speaker suggested that additional legislative direction might be needed to address this issue.
HB2: Mr. Litman Information Only01:55:01.040 - 1:52:12 PM; Mr. Litman responded to the concern about non-payment by indicating that the department would work with federal guidelines and examples from other states to handle such situations. He emphasized that care would not be denied to those in need, and the department would have the flexibility to address non-payment issues, although uncompensated care would still be a concern.
HB2: Representative MO Information Only01:55:58.520 - 1:53:09 PM; Representative MO discussed the financial burden on providers due to uncompensated care, emphasizing the need for careful policy-making. They mentioned a previous discussion about using a 'magnifying class' to look at uncompensated care issues, indicating ongoing attention to this problem.
HB2: Mr. Litman Information Only01:57:05.239 - 1:54:16 PM; Mr. Litman assured the committee that he would consult further to address concerns about premium non-payment by the close of business on Tuesday. He was open to suggestions from the department to find workable solutions before presenting them to the committee.
HB2: Mr. Litman Information Only01:58:29.079 - 1:55:40 PM; Mr. Litman explained the expiration of the federal Public Health Emergency waiver on income verification, which would revert Medicaid eligibility determination to pre-pandemic requirements. This change would not affect eligibility but would increase the administrative burden for individuals to verify their income. He confirmed that the proposal in the governor's budget was compliant with regulations.
HB2: Mr. White Information Only02:00:48.320 - 1:57:59 PM; Mr. White discussed the Child Care scholarship program, explaining that the proposal would allow for additional funding if the current budget is insufficient. He mentioned a change request to transfer CCDF and TANIF dollars into the scholarship line due to increased utilization, ensuring funds for the next biennium. The provision would give the fiscal committee and governor's executive council the flexibility to fund the program without a waiting list.
HB2: Unknown Speaker Information Only02:02:47.119 - 1:59:58 PM; The speaker discussed the implementation of RSA 167:18-a, which establishes a county cap at 2%. They clarified discrepancies between the numbers in HB2 and the accounting unit, attributing the difference to a $5 million default credit, which varies annually based on legislative policy. The discussion confirmed the accuracy of the numbers in HB2 when accounting for the credit.
HB2: Representative Stringham Information Only02:03:56.400 - 2:01:07 PM; Representative Stringham asked for clarification on the $5 million credit in the county cap calculation. The response explained how the credit affects the county cap and the general funds, noting that the credit has varied in the past and is currently set at $5 million.
HB2: Unknown Speaker Information Only02:06:08.920 - 2:03:19 PM; The speaker reflected on the fairness of the state's obligations to counties, noting that during the last budget cycle, inflation was managed by keeping county payments flat. The discussion affirmed returning to a 2% increment on the county cap, suggesting that this might not necessarily lead to increased county taxes due to natural growth in the tax base.
HB2: Representative Tersi Information Only02:07:15.639 - 2:04:26 PM; Representative Tersi discussed the potential impact of the county cap increase on county taxes, suggesting that natural growth in the tax base might mitigate any increase. They also mentioned a related bill concerning discrepancies in county payments, which would be discussed separately.
HB2: Unknown Speaker Information Only02:08:34.559 - 2:05:45 PM; The speaker introduced the topic of home dialysis, expressing interest in incentivizing it to save Medicaid money. They proposed a $50,000 savings in the second year of the budget, suggesting that home dialysis could be more cost-effective and better for patient care than clinic-based dialysis.
HB2: Mr. Litman Information Only02:09:50.040 - 2:07:01 PM; Mr. Litman confirmed that Medicaid currently provides home dialysis and was open to optimizing its use where clinically appropriate. He acknowledged the potential for new technologies to increase the number of suitable candidates for home dialysis and accepted the challenge of achieving the proposed $50,000 savings.
HB2: Representative Stringham Information Only02:10:58.800 - 2:08:09 PM; Representative Stringham noted that home and center-based dialysis costs are similar, but Medicaid compensates for travel, which might not be included in the Medicaid budget. They suggested looking at the complete savings holistically, including transportation costs.
HB2: Unknown Speaker Information Only02:12:08.920 - 2:09:19 PM; The speaker mentioned a position in HB2 regarding Medicaid coverage for circumcision, stating that it should only be covered for medical reasons, with a potential savings of $50,000 per year. This would be discussed further on Monday and voted on Tuesday.
HB2: Unknown Speaker Information Only02:13:22.760 - 2:10:33 PM; The speaker concluded the session, mentioning upcoming meetings and the distribution of amendments. They emphasized that the amendments discussed were non-controversial and encouraged the department to review them.
HB2: Unknown Speaker Information Only02:15:01.480 - 2:12:12 PM; The speaker clarified that the amendments distributed were drafts and would be discussed further. They also mentioned the passage of House Bill 73, which was passed unanimously and was intended to be distributed as is, though not yet validated.
HB2: Unknown Speaker Information Only02:17:08.879 - 2:14:19 PM; The speaker introduced House Bill 1195-H, which requires HHS to report on cost avoidance associated with the adult Dental benefit before the next budget. The bill aims to assess the long-term savings from dental care on Medicaid costs.