Committee Summary for Senate Finance (03/18/2025)

Bill/Time	Type	Title	Sponsor
SB249 00:09:27.360 - 12:38:13 PM	Executive Session	relative to the uncompensated care and Medicaid fund.	Birdsell, Regina(R)[C+]2024

SB249: Steve Anen, President of the New Hampshire Hospital Association Information Only00:09:27.360 - 12:38:13 PM; Steve Anen discussed the complexities and implications of the Medicaid Enhancement Tax (MET) and Disproportionate Share Hospital (DSH) payments. He emphasized the importance of maintaining the partnership between hospitals and the state, which has been in place for over a decade. Anen highlighted the financial struggles of hospitals post-pandemic, with nine hospitals losing money in 2023 and a negative statewide operating margin. He proposed a solution that would maintain 91% of MET funds returning to hospitals, with an additional use of enhanced funds to generate $80 million more for the state, despite potential losses for larger hospitals. This proposal aims to protect critical access hospitals and provide more resources for the state, while avoiding further controversy.
SB249: Senator Bson Information Only00:13:03.680 - 12:41:49 PM; Senator Bson asked Steve Anen about the current MET and DSH distribution, specifically questioning the 80/20 split and the impact on critical access hospitals. Anen explained that critical access hospitals would receive similar payments under different scenarios due to federal payment limits, and that the proposed scenario would provide an additional $5 million to these hospitals compared to the previous year.
SB249: Senator Waters Information Only00:15:07.199 - 12:43:53 PM; Senator Waters inquired about remaining issues with the funding formula in SB249. Anen noted that while the amendment moving the percentage back to 91% was a step in the right direction, it would still result in significant losses for some of the largest hospitals. He discussed the potential for a mechanism to address the $60 million in losses, suggesting a study committee could help understand the implications of changing the distribution methodology.
SB249: Mr. Anan Information Only00:18:04.120 - 12:46:50 PM; Mr. Anan discussed the transition of payment methodology for the Medicaid Program, emphasizing the importance of maximizing federal revenue while minimizing harm to hospitals. He highlighted the potential financial impact on hospitals if an agreement isn't reached, which could lead to cutbacks in services and lower Medicaid enhancement tax revenues.
SB249: Senator PE Information Only00:19:45.200 - 12:48:31 PM; Senator PE inquired about the financial implications of setting the bill at 91%. Mr. Anan responded that at this rate, larger hospitals would still face significant losses, around $60 million, which would be reduced to about $46 million with additional dollars. He expressed hope that hospitals could manage these losses but acknowledged the challenges, especially with anticipated reductions in Medicare and Medicaid spending from Washington.
SB249: Jeb Bradley Information Only00:24:36.440 - 12:53:22 PM; Jeb Bradley, representing himself, provided a detailed background on the Medicaid enhancement tax issue. He explained the historical agreement between the state and hospitals, the legal challenges faced due to the tax being ruled unconstitutional twice, and the financial implications for hospitals at different reimbursement rates. He suggested incorporating an amendment into Senate Bill 249 to resolve the issue, enhance revenue, and avoid litigation, stating it would benefit the state by about $80 million.
SB249: Senator Waters Information Only00:34:44.199 - 1:03:30 PM; Senator Waters questioned the trade-off between the 91% and 93% rates and the inclusion of the adder. Jeb Bradley responded that the adder, which is more generous to hospitals, still results in a loss for them but helps avoid litigation and protect state finances. He emphasized the importance of a settlement that maintains the healthcare system's integrity in New Hampshire.
SB249: Senator Rosenell Information Only00:37:32.760 - 1:06:18 PM; Senator Rosenell asked about the timing of the $5.7 million add-on, clarifying that it would apply to fiscal years 2026 and 2027, as specified in Senator Birsel's bill.
SB249: Senator Verel Information Only00:38:57.960 - 1:07:43 PM; Senator Verel discussed a proposed 2-year settlement regarding SB249, emphasizing that it would be fair and would be reviewed again after the period. He confirmed the annual allocation of $5.7 million and suggested a correction in the language of the amendment to reflect fiscal years 26 and 27.
SB249: Senator Pearl Information Only00:39:53.480 - 1:08:39 PM; Senator Pearl inquired about the allocation of the $5.7 million per year, specifically how it would be distributed among hospitals. It was clarified that there would be a formula, and the funds would benefit the entire healthcare system, particularly larger hospitals. The senator also noted that even with the amendment, hospitals would still pay more than they receive back.
SB249: David Charney, Deputy Medicaid Director Information Only00:41:48.720 - 1:10:34 PM; David Charney provided detailed information on how the amendment would increase the percentage of total funds paid to hospitals from 80% to 91% starting in state fiscal year 26. He explained the allocation of directed payments based on Medicaid services utilization, both inpatient and outpatient, and how it differs from dish payments, particularly for border hospitals.
SB249: Senator Waters Information Only00:47:28.200 - 1:16:14 PM; Senator Waters questioned the financial impact of the $5.7 million adder, initially misunderstanding it as producing about $80 million, which was corrected to around $14 to $15 million in directed payment pool. He also discussed potential impacts of Medicaid enrollment changes on hospital payments, distinguishing between dish and directed payment methodologies.
SB249: Senator Information Only00:49:46.520 - 1:18:32 PM; The senator clarified the state's policy on out-of-state Medicare payments, noting that critical access hospitals receive a higher base rate than larger hospital systems, while out-of-state hospitals receive rates equivalent to larger in-state hospital systems.
SB249: Senator Bezel Information Only00:51:09.119 - 1:19:55 PM; Senator Bezel moved to pass the bill, emphasizing the importance of a single negotiator from the state side for negotiations with hospitals. He expressed hope that an agreement could be reached within a week and a half, to be reflected in an amendment before the crossover day on the 27th.
SB249: Senator Information Only00:52:34.000 - 1:21:20 PM; The senator reiterated the plan to vote out the bill at 91%, with a hope for negotiations to lead to an agreement that could be amended on the floor before the crossover day. The focus was on ensuring negotiations progress to benefit critical access hospitals.
SB249: Senator Information Only00:54:04.119 - 1:22:50 PM; The Senator discussed the plan to bring the bill to a special order until the 27th, with the intention of voting on it on the Senate floor on that date. They expressed hope in having the backing to do so and mentioned the need for an agreement with the House. The Senator also indicated that they would need to finalize details of the agreement before proceeding.
SB249: Senator Information Only00:55:22.839 - 1:24:08 PM; The Senator expressed concerns about undermining the governor's negotiations by stating preferences too openly. They hoped that a proposal, which would generate income and support a hospital in Dover, would be seriously considered in the negotiations. They also mentioned their inability to vote for the bill due to potential damage to the healthcare system as previously presented at 91%.
SB249: Senator Information Only00:56:49.280 - 1:25:35 PM; The Senator confirmed that all bills discussed that day, including SB249, would be on the Senate calendar for voting on the 27th. They mentioned a brief recess for a caucus and expressed some uncertainty about the exact handling of the bills on the denim calendar.
SB249: Senator Information Only01:02:54.839 - 1:31:40 PM; The Senator called the committee back into session and allowed Senator Waters to make remarks.
SB249: Senator Waters Support01:02:54.839 - 1:31:40 PM; Senator Waters expressed appreciation for the work done by Senator Burell on the bill and felt that significant progress had been made. They hoped that by the following week, a way forward could be found in line with Senator Burell's proposal.
SB249: Bradley Information Only01:04:01.680 - 1:32:47 PM; Bradley expressed the importance of moving SB249 forward, hoping that an amendment would be negotiated between the hospitals and the governor before it reaches the floor. He emphasized the need to send the bill to the House for their concurrence on the agreement.
SB249: Senator Pearl Information Only01:04:52.599 - 1:33:38 PM; Senator Pearl discussed the ongoing issues with Medicaid and uncompensated care, expressing hope that an agreement would be reached between the hospitals and the governor's office by the next week. He stressed the importance of the hospitals and the medical system in New Hampshire and the need for a solution, warning that without an agreement, the committee would have to make the decisions.
SB249: Senator Waters Information Only01:08:05.240 - 1:36:51 PM; Senator Waters mentioned a conversation with Senator Lang about an amendment to Senate Bill 80, which would include synthetic nicotine under the definition of nicotine for taxation purposes. He plans to introduce this amendment in the House, as it was not introduced during the current session due to timing concerns.
SB249: Senator Lang Information Only01:09:20.600 - 1:38:06 PM; Senator Lang explained that Senate Bill 80 resulted from a bipartisan study committee's unanimous recommendation to consolidate the regulation and enforcement of e-cigarette manufacturers and retailers under the liquor enforcement agency. This move is expected to streamline audits and improve tax collection. He also mentioned that Senator Waters would introduce an amendment in the House to include synthetic nicotine in the bill's scope.
SB249: Senator Lang Information Only01:11:15.000 - 1:40:01 PM; Senator Lang introduced Amendment 1078s to Senate Bill 83, which addresses three main points: defining gross video lottery revenue to exclude free play up to 12.5%, lowering the tax rate to 32% to increase state revenue, and correcting the allocation of funds to the general fund instead of a non-existent group two fund. He explained the expected revenue increase and the projected growth in the number of gaming machines in the state.
SB249: Senator Waters Information Only01:13:58.480 - 1:42:44 PM; Senator Waters questioned the rationale behind lowering the tax rate to 32% for Senate Bill 83, expressing concern about the potential impact on business viability. Senator Lang responded by explaining that a higher tax rate would deter investors, and the lower rate was necessary to encourage investment and job creation in the state.
SB249: Senator Ros Information Only01:16:06.719 - 1:44:52 PM; Senator Ros sought clarification on the difference in operational costs between slot machines and HHR machines, questioning why a small reduction in the tax rate would significantly impact investor decisions. Senator Lang explained the current tax rates and the operational cost savings for operators under the new proposal.
SB249: Senator Information Only01:16:52.880 - 1:45:38 PM; The speaker discussed the financial implications of changing the tax rate on gaming revenue from 35% to 32.5%. They explained that under the current law, operators keep about 65% of the revenue, and with the proposed change, they would keep 67.5%. The goal is to enhance the gaming experience in New Hampshire to attract more out-of-state visitors, thereby boosting tourism. The speaker also mentioned a commitment from operators that at a 35% rate, there wouldn't be enough profit to justify the costs, but at 32.5%, they would participate.
SB249: Senator Information Only01:17:50.719 - 1:46:36 PM; The speaker continued discussing the financial aspects of the bill, focusing on the 'group two' issue. They mentioned considering setting up a fund for group two members' retirement but felt it was too late to implement. They also noted that the governor's bill affects group two but felt it was premature to discuss it further in this session, as the focus should remain on the current bill.
SB249: Senator Information Only01:18:57.800 - 1:47:43 PM; The speaker addressed the motion to pass Amendment 1078 and the subsequent vote on the bill as amended. They confirmed the plan to send the bill to the house and mentioned another amendment, 1060s, proposed by Senator Rosell, which would require the treasurer to report any advances to the Joint Fiscal Committee.
SB249: Senator Information Only01:22:17.120 - 1:51:03 PM; The speaker discussed the implications of Amendment 1060s, which was passed, and the bill as amended. They mentioned the potential financial risk to the state if all projects collapsed and the importance of the treasurer reporting advances. The bill was then moved to consent, and the speaker mentioned a personal anecdote about the housing market to justify their support for the bill.
SB249: Senator Information Only01:49:21.719 - 2:18:07 PM; The speaker called for a recess and mentioned the next bill to be discussed, Senate Bill 87, with an amendment number. They briefly discussed the amendment, which was about not allowing bars in homes, and it was passed. The bill as amended was also passed and moved to consent.
SB249: Senator Information Only01:52:03.079 - 2:20:49 PM; The speaker introduced Senate Bill 97, which would allow schools within a district to share facilities if there is room. The bill was passed and moved to consent without objection.
SB249: Senator Information Only01:52:03.079 - 2:20:49 PM; The senator was finishing speaking about the previous topic at 01:52:03.079.
SB249: Senator Information Only01:53:06.920 - 2:21:52 PM; The senator mentioned that the next bill on the list is SB125, which is to be passed and tabled. They discussed the need to clarify the terminology used for nurse practitioners in the statute, suggesting it might have been changed to 'advanced practice registered nurses'. There was a brief discussion about whether this change would affect the bill, but it was decided to table the bill for further review.
SB249: Senator Bell Information Only01:54:53.079 - 2:23:39 PM; Senator Bell mentioned that SB127 is also to be passed and tabled, related to public guardianship. There was a brief comment about the financial implications, mentioning figures around 5.6 to 7 million dollars, but no further discussion was noted.
SB249: Senator Information Only01:55:43.400 - 2:24:29 PM; The senator moved to pass and table SB131, with no further discussion noted.
SB249: Senator Information Only01:56:45.440 - 2:25:31 PM; The senator discussed SB135, which is also to be passed and tabled. There was a clarification about the bill's application to both state plan and CFI case management services under Medicaid, with a specific mention of the 1915c waiver. The bill was passed without further discussion.
SB249: Senator Information Only02:00:24.560 - 2:29:10 PM; The senator discussed SB153, which is to be passed without amendment. There was a question about a revised fiscal note due to an amendment, but it was clarified that no revised fiscal note was received for this bill. The bill was passed with a mention of potential future review in the House.
SB249: Senator Information Only02:01:13.320 - 2:29:59 PM; The senator clarified that a revised fiscal note was sent out for SB153 regarding position costs, but no appropriation was included in the bill. There was a discussion about the number of positions needed, which would be limited to one under the current bill.
SB249: Senator Information Only02:02:23.800 - 2:31:09 PM; The senator moved to pass SB204 with amendment 1065s, which makes the program optional for municipalities and school districts. The amendment was supported, and the bill as amended was passed.
SB249: Senator Information Only02:04:18.520 - 2:33:04 PM; The senator discussed SB228, which is to be passed. There was a mention of potential issues with utilities regarding accounting, but the bill was passed with the understanding that these issues would be addressed in the House.
SB249: Senator Information Only02:05:04.239 - 2:33:50 PM; The senator moved to pass SB243 without amendment. There were no comments or questions, and the bill was passed.
SB249: Senator Information Only02:06:23.360 - 2:35:09 PM; The senator moved to pass and table SB244. There was a brief discussion about the bill's impact on rural healthcare services, and the bill was passed and tabled.
SB249: Senator Rosenell Vote02:07:15.440 - 2:36:01 PM; Senator Rosenell moved to pass SB249. The motion was seconded and passed with a vote of 7 to 0.
SB249: Senator Vote02:08:05.360 - 2:36:51 PM; A motion to pass and table SB246 was made and seconded. It passed with a vote of 7 to 0. Senator Birdell volunteered to take the bill out.
SB249: Senator Pearl Information Only02:09:27.239 - 2:38:13 PM; Senator Pearl discussed SB255, mentioning ongoing work with Senator Carson on funding through a public-private partnership. The bill was moved to pass and table to allow more time for this work.
SB249: Senator Information Only02:10:40.920 - 2:39:26 PM; Discussion on a bill related to utility property tax, which was moved to pass and table due to its impact on revenues, specifically a decrease of $5.36 million in FY 28 according to the FN report.
SB249: Senator Rosenell Vote02:11:46.079 - 2:40:32 PM; Senator Rosenell moved to pass and table another bill, seconded by Senator Waters. The motion passed.
SB249: Senator Vote02:12:35.280 - 2:41:21 PM; A motion to pass a bill was made and seconded. It passed, and the bill was assigned to be taken out by someone.
SB249: Senator Vote02:13:27.440 - 2:42:13 PM; A motion to pass another bill was made and passed. The bill was assigned to be taken out.
SB249: Senator Information Only02:14:46.320 - 2:43:32 PM; Discussion on Senate Bill 300, which was intended to be a straight pass but required a floor amendment to clean up language and ensure an exemption applied to everyone, including minors as young as 16. The amendment was to be sent by Kate.
SB249: Senator Lang Information Only02:15:17.079 - 2:44:03 PM; Senator Lang clarified that a 16-year-old could be tried as an adult in New Hampshire, depending on the court's ruling, in relation to Senate Bill 300.
SB249: Senator Rosenell Information Only02:16:04.880 - 2:44:50 PM; Senator Rosenell confirmed that the floor amendment for Senate Bill 300 would address the issue of parental consent for representation in section B, lines eight and nine.
SB249: Senator Vote02:16:50.599 - 2:45:36 PM; A motion to pass Senate Bill 300 was made and passed with a vote of 7 to 0. The bill was not put on consent due to the upcoming floor amendment, and Senator Lang was assigned to take it out.

Gray, James(Chairman)(R)[C+]2024	Innis, Daniel(V Chairman)(R)[C+]2024	Carson, Sharon(R)[C]2024
Watters, David(D)[CT]2024	Birdsell, Regina(R)[C+]2024	Lang, Timothy(R)[C+]2024
Rosenwald, Cindy(D)[CT]2024	Pearl, Howard (R)[C+]2024