Session Review: Health and Human Services

Senators continued to overhaul the state’s child welfare system this session. Other aspects of health and human service provision addressed included changes to public benefit programs and licensure requirements and consideration of Medicaid expansion.

Child welfare

Certain state wards who have aged out of the foster care system may continue to receive services until age 21 under a bill passed 44-2.

LB216, introduced by Lincoln Sen. Amanda McGill, allows eligible youth to enter into a voluntary foster care agreement with the state Department of Health and Human Services (DHHS) for extended services, including:
• Medicaid;
• postsecondary education assistance;
• continued foster care maintenance payments;
• placement in a foster home, institution or independent living; and
• continued case management to help access additional supports.

Lawmakers passed a bill seeking changes to oversight of the state’s child welfare system.

LB269, introduced by Lincoln Sen. Kathy Campbell, adds a tribal representative to the Nebraska Children’s Commission, adds the Inspector General for Nebraska Child Welfare as an ex officio member and moves the commission to the Foster Care Review Office.

Among other provisions, the bill also requires DHHS to establish new foster home licensing requirements to expand the use of child-specific, relative and kinship placements and secure evidence of financial stability from entities that subcontract with the department to provide child welfare services.

The bill passed 48-0 and takes effect immediately.

LB530, introduced by Fullerton Sen. Annette Dubas, overhauls Nebraska’s foster care reimbursement rate system. The bill requires DHHS to implement by July 1, 2014, the following reimbursement rates:
• $20 per day for children younger than five;
• $23 per day for ages six to 11; and
• $25 per day for ages 12 to 18.

The bill passed 44-0 and takes effect immediately.

LB265, introduced by Lincoln Sen. Colby Coash, exempts kinship and relative homes from the state’s foster home licensure requirement. In addition, the bill allows DHHS to issue a waiver for any nonsafety licensing standard for a kinship or relative home seeking licensure.

The bill also includes provisions of LB443, originally introduced by Omaha Sen. Tanya Cook, which requires a residential child care agency or placement agency to obtain licensure from DHHS before opening.

LB265 passed on a 48–0 vote and takes effect immediately.

Public benefits

Lawmakers approved a bill this session aimed at creating a comprehensive system for assessing and promoting quality care among the state’s publicly subsidized child care providers.

LB507, introduced by Campbell, adopts the Step Up to Quality Act, which will put in a place a quality rating and improvement system (QRIS) for child care providers. The QRIS will be available to all child care providers and early childhood education programs in the state, but will be required for programs that receive significant public funds.

The bill also includes provisions originally introduced by Lincoln Sen. Danielle Conrad as LB625, which will expand eligibility for the state’s subsidized child care program.

Currently, eligibility is capped at 120 percent of the federal poverty level (FPL). LB507 increases the rate to 125 percent of FPL in FY 2013-14 and 130 percent of FPL in FY2014-15 and thereafter. The bill passed 42-1 and takes effect immediately.

LB368, introduced by Bellevue Sen. Sue Crawford, is intended to provide opportunities for employers and participants in the Aid to Dependent Children (ADC) program, known at the federal level as Temporary Aid to Needy Families (TANF).

The bill creates a wage subsidy pilot program for low-income, TANF recipients using existing “rainy day” TANF funds. Participating employees will receive a prevailing wage for 40 hours per week, not to exceed six months. The subsidies will be 100 percent in the first two months, 75 percent in month three, 50 percent in months four and five and 25 percent in month six.

LB368 passed on a 34-7 vote.

Lawmakers also passed a bill that expands eligibility for education to satisfy work requirements in order to qualify for certain public benefits.

Currently, the Welfare Reform Act allows participants younger than 24 to pursue a high school diploma or General Educational Development Test (GED) and remain in compliance with ADC’s work requirements.

LB240, introduced by Scottsbluff Sen. John Harms, removes the age restriction. The bill was approved on a 41-0 vote.

Debate stalled after lawmakers spent two days discussing a bill that would require Nebraska to opt in to expanded Medicaid coverage available under federal health care reform.

LB577, introduced by Campbell, would require DHHS to add the adult population newly eligible under the federal Patient Protection and Affordable Care Act (ACA) to the state’s Medicaid state plan amendment.

The bill was subjected to a filibuster. After more than 10 hours of debate, senators moved on to another agenda item and LB577 was not rescheduled for debate this session.

Licensure and credentialing

Senators adopted the Nebraska Critical Congenital Heart Disease Screening Act this session.

Under LB225, introduced by Papillion Sen. Jim Smith, all newborns in Nebraska will be required to undergo screening for critical congenital heart disease (CCHD) in accordance with standards adopted by DHHS. The bill also requires DHHS to apply for federal funds for the program. LB225 passed on a 47-0 vote.

LB556, introduced by McGill, requires DHHS to develop rules and regulations for utilizing telehealth services for children’s behavioral health. The bill establishes a pilot program for telehealth behavioral services that will include three clinics, with at least one urban and one rural clinic. Parents of children in pediatric practices within the pilot clinics will be offered routine mental and behavioral health screenings for their child during regular physical exams or at the request of a parent.

Children identified through screening as being at risk may be referred for further evaluation and treatment, and faculty and staff of several programs at the University of Nebraska Medical Center will be available via telehealth to the primary care practice. Senators approved the bill on a 42-0 vote.

Under LB528, sponsored by Omaha Sen. Sara Howard, certain health practitioners who diagnose gonorrhea or Chlamydia in a patient are allowed to prescribe, provide or dispense oral antibiotics within their scope of practice to the patient’s sexual partner or partners without an examination. The bill passed on a 37-9 vote.

Under LB326, also introduced by Howard, a Nebraska-licensed pharmacist can install and operate pharmacies in long-term care facilities. The bill passed on a 46-0 vote.

LB487, introduced by Lexington Sen. John Wightman, amends the Nebraska Health Care Certificate of Need Act that governs the establishment, transfer or increase in the number of rehabilitation beds in the state. The bill clarifies that a hospital may transfer rehabilitation beds between locations owned and operated by the same hospital without a certificate of need. The bill passed on a 40-0 vote.

LB484, introduced by Wilber Sen. Russ Karpisek, allows dental hygienists to treat children in a public health care setting. The treatment is limited to include oral prophylaxis, pulp vitality testing and preventive measures, including the application of fluoride, sealants and other agents that prevent oral disease. The bill also allows a licensed dental hygienist with 3,000 hours of clinical experience to provide such treatments to adults in a health care facility.

LB484 passed on a 45-0 vote.

Other measures

Lawmakers adopted a resolution this session that creates a partnership to examine how best to control costs and improve quality in Nebraska’s health care system.

LR22, introduced by Campbell, designates the Health and Human Services Committee, in cooperation with the Banking, Commerce and Insurance Committee, to bring together policymakers and stakeholders at all levels to work toward the following goals:
• providing a comprehensive review of Nebraska’s health care delivery, cost and coverage demands;
• engaging partners in dialogue, roundtable discussions and public policy discourse;
• developing a framework for health care system transformation to meet public health, workforce, delivery and budgetary responsibilities; and
• developing cooperative strategies and initiatives for the design, implementation and accountability of services to improve care, quality and value while advancing the overall health of Nebraskans.

The Health and Human Services Committee may conduct public hearings and, in conjunction with the Banking, Commerce and Insurance Committee, undertake communication, outreach and educational activities. A joint hearing will be held prior to Nov. 1, to brief the committees on information obtained by the partnership.

The resolution was adopted 41-0.

Lawmakers also approved a bill seeking to clarify authorization of disposition of a military member’s remains.

LB420, introduced by McGill, specifies that the federal DD Form 93 be recognized as the legal instrument authorizing an individual to direct disposition of military remains. If a service member dies during active military service, the bill gives priority to direct disposition to the individual authorized by the decedent in his or her federal form.

The bill passed 43-2 and takes effect immediately.

LB23, introduced by Kearney Sen. Galen Hadley, changes allocation of the state’s ICF/MR Reimbursement Protection Fund.

The bill requires DHHS, beginning July 1, 2014, to use the ICF/MR Reimbursement Protection Fund – including the matching federal participation funds – to enhance rates paid under Medicaid to ICF/MR and for annual contributions to community-based programs for persons with developmental disabilities.

The bill also incorporates LB343, originally introduced by Coash, which replaces the term “mental retardation” in state law with the term “intellectual disability.”

The bill passed 46-0.

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