Session Review: Health and Human Services

Changes to public benefit programs, new licensure requirements, children’s issues and consideration of Medicaid reform topped the list of health and human services concerns tackled by lawmakers this session.

Public benefits

A bill to increase ADC payments passed this year. The bill, originally introduced as LB89 by Lincoln Sen. Kathy Campbell, was passed by the Legislature and subsequently vetoed by Gov. Pete Ricketts. Campbell and the governor reached a compromise after the veto and senators gutted LB607, replacing it with the altered provisions from her bill.

LB607 increases the maximum monthly ADC payment to 55 percent of the standard of need. The bill also creates a higher level of income allowable to renew ADC benefits than the initial eligibility income level.

The bill also contains LB335, originally introduced by Omaha Sen. Heath Mello, which establish a task force to study intergenerational poverty in Nebraska.

The task force includes the chairpersons of the Health and Human Services and Appropriations committees as well as three at-large members appointed by the Executive Board of the Legislative Council.

Nonvoting members will include representatives from the state departments of Labor, Health and Human Services and Education as well as a variety of community stakeholders and policy experts.

LB607 passed 45-0.

The state’s child care subsidy for low-income families was modified this session.

Introduced by Omaha Sen. Tanya Cook, LB81 aligns the subsidy to mirror existing Aid to Dependent Children (ADC) and Temporary Aid to Needy Families programs.

Under the bill, if a family’s income at redetermination of eligibility exceeds 130 percent of the federal poverty level, the family will continue to receive transitional child care assistance for up to 24 consecutive months or until the family income exceeds 185 percent of FPL. The transitional child care assistance will be based on a sliding scale.

The state Department of Health and Human Services (DHHS) is required to report annually to the governor and the Legislature regarding the number of families in all transitional child care assistance programs and the number of families no longer eligible due to failure to meet income guidelines.

Senators voted 47-0 to pass LB81.

Lawmakers also increased the Medicaid personal needs allowance from $50 to $60 with the passage of LB366, introduced by Lincoln Sen. Patty Pansing Brooks. The bill passed on a 37-8 vote.

LB500, sponsored by Omaha Sen. Sara Howard, directs DHHS to submit an application by July 1, 2015, to the federal Centers for Medicare and Medicaid Services (CMS) for a state plan amendment to provide payment for multisystemic therapy for youth who are eligible for both Medicaid and the Children’s Health Insurance Program. The bill passed 40-1.

A bill that would initiate a redesign of the state’s Medicaid program was bracketed during general file debate.

LB472, sponsored by Campbell, would create a 16-member Medicaid Redesign Task Force composed of representatives from the Legislature, DHHS and the state Department of Insurance as well as experts in health care delivery, workforce, insurance, education and advocacy.

The task force would perform a review of the state’s Medicaid program and make recommendations on cost effectiveness and quality improvement, reporting annually to the Legislature and governor.

LB472 also would require DHHS to submit a state plan amendment to CMS to provide coverage to a newly eligible population of adults ages 19 to 65 with incomes below 133 percent of the federal poverty level and individuals whose income makes them ineligible for federal premium assistance subsidies.

Costs would be covered by Medicaid with federal matching dollars starting at 100 percent in 2015, and gradually dropping to 90 percent after 2020. LB472 includes a termination clause if federal matching dollars fall below 90 percent.

The measure was bracketed on a vote of 28-16, ending debate for this session.

A bill that would expand eligibility for the state’s publicly funded family planning services and increase funding for a cancer-screening program failed to advance from general file.

LB77, sponsored by Omaha Sen. Jeremy Nordquist, would require DHHS to submit a state plan amendment to CMS no later than Sept. 1, 2015, to provide medical assistance for family planning services to individuals with family earned income at or below 185 percent of the federal poverty level.

The bill also would appropriate funds to the Every Woman Matters program for services including education, outreach and reimbursement for various cancer screenings.

Senators voted 21-23 on advancement of the bill to select file—four votes short of the number required.

Provisions of LB12, introduced by Omaha Sen. Bob Krist were amended into LB605, a Judiciary Committee bill that passed this session. The provisions require DHHS and the state Department of Correctional Services to ensure that Medicaid coverage is suspended rather than terminated when an individual enters a public institution.

Licensure and credentialing

Lawmakers approved a bill this session intended to address the shortage of primary care providers in rural Nebraska.

LB107, introduced by Bellevue Sen. Sue Crawford, removes the requirement for an integrated practice agreement between a nurse practitioner and a collaborating physician and replaces it with a transition to practice agreement.

The agreement provides that the nurse practitioner and the supervising provider practice collaboratively within the framework of their respective scopes of practice. LB107 passed on a 46-0 vote.

New nursing license applicants will be subject to a criminal background check under a bill passed this year.

LB129, introduced by Omaha Sen. Burke Harr, requires a criminal background check of applicants for an initial license to practice as a registered or licensed practical nurse. The bill passed on a 43-0 vote.

LB287, sponsored by Malcolm Sen. Ken Haar, requires all sign language interpreters to obtain licensure by Jan. 1, 2016, and pay a licensure fee. An individual or entity providing interpreting services without a license after that date will be subject to a civil penalty of up to $500 for each offense.

Among the exceptions to the licensure rules include interpreting services conducted in schools, as part of a religious service or in a health care emergency until a licensed interpreter can be obtained. LB287 also creates a licensure category for video remote interpreting services.

The bill passed 48-0.

LB80, introduced by Grand Island Sen. Mike Gloor, replaces the current permitting process for dentists to administer general anesthesia with separate permits for minimal, moderate and deep sedation. The bill also updates education and training requirements for dentists and correlates incident reporting with the new definitions.

Under the bill, a dentist licensed in Nebraska is allowed to administer inhalation analgesia in the practice of dentistry without a permit. The bill passed 47-0 and takes effect July 1, 2016.

Under LB264, sponsored by Lincoln Sen. Adam Morfeld and passed 48-0, the skills and experience acquired through military service will be recognized for the 34 health professions that the state’s Uniform Credentialing Act oversees, beginning Dec. 15, 2015.

LB452, introduced by Omaha Sen. Robert Hilkemann, amends the Uniform Credentialing Act to require that any credential holder’s advertisement for health care services identify the type of credentials held by the health care provider.

The use of deceptive advertising is prohibited. The bill passed on a vote of 46-0.

Children’s issues

A bill that creates a pilot project to establish family connections for state wards passed this session.

LB243, introduced by Lincoln Sen. Kate Bolz, creates a four-year statewide pilot program to provide family finding services in at least two service areas. DHHS will provide oversight and contract with child placing providers to carry out the program.

The department also is required to establish a data collection system and contract with an academic institution to complete an independent evaluation of the pilot project’s effectiveness.

The bill contains provisions of LB441, also introduced by Bolz. The provisions make several technical changes to the Bridge to Independence program, which was designed to assist youth who are aging out of the state’s foster care system.

The bill passed on a vote of 39-5.

Senators also approved a bill that provides funding guidelines for child care grants.

LB547, introduced by Campbell, amends the Quality Child Care Act relating to federal Child Care and Development Block Grants and sets a funding schedule according to federal reauthorization amounts.

The bill requires DHHS to allocate higher minimum spending percentages to early childhood education programs. Funds will be split between the Early Childhood Education Endowment Cash Fund—commonly known as Sixpence—and incentives and support for programs under the Step Up to Quality Child Care Act.

The bill incorporates LB489, introduced by Cedar Rapids Sen. Kate Sullivan, which expands eligibility for Sixpence grants to early childhood education programs and school districts if the child care provider enrolls in the Step Up to Quality Child Care Act system prior to the grant period.

Programs receiving grants will be required to obtain a rating of step three or higher on the quality scale within three years of the start date of the initial grant program and maintain that rating to continue to receive funding.

The bill passed on a 42-0 vote.

The termination date for a children’s behavioral health screening and referral program was extended this session.

In 2013, the Legislature created the Behavioral Health Screening and Referral Pilot Program at the University of Nebraska Medical Center to develop ways to address unmet children’s behavioral health needs that could be replicated statewide.

LB240, introduced by Lincoln Sen. Matt Hansen, extends the program’s termination date to Sept. 6, 2017. The bill passed 36-9.

Other measures

A bill seeking to improve access to existing services and support for Nebraskans who are aging or disabled—including those suffering from Alzheimer’s and related illnesses—passed this session.

LB320, introduced by Bolz, establishes three demonstration projects for Aging and Disability Resource Centers (ADRC) to evaluate the feasibility of establishing such centers statewide. DHHS is required to award ADRC grants to area agencies on aging to participate in the demonstration project.

The bill also includes provisions of LB405, originally introduced by Hyannis Sen. Al Davis, which require the Aging Nebraskans Task Force to develop a state plan to address the needs of individuals with Alzheimer’s and related disorders.

The bill extends the task force termination date to Jan. 1, 2017, to accommodate work on the state plan. The bill passed 42-3 and takes effect immediately.

Lawmakers passed bills this session designed to encourage careers in the health professions and the state’s child welfare system.

LB196, introduced by Campbell, amends the Rural Health Systems and Professional Incentive Act by creating a resident loan repayment program.

Under the bill, a qualified applicant must be enrolled or accepted in an approved medical specialty residency program in Nebraska and agree to one year of full-time practice in a designated health profession shortage area. The medical resident also is required to accept Medicaid patients in his or her practice.

Additionally, the bill increases the financial assistance limits of two existing programs. Any repayment obligations under the act will be cancelled in the event of a recipient’s total and permanent disability or death. LB196 passed on a 48-0 vote.

LB199, introduced by Howard, authorizes use of federal Title IV-E funds to pay for stipends to social work students who commit to work in the state’s child welfare system.

DHHS will develop an application process and determine stipend amounts for eligible students in collaboration with the governing boards of colleges and universities with social work programs. The bill passed 45-0.

Carbon monoxide detectors are required in certain residences by a bill passed this session.

Introduced by Howard, LB34 requires the installation and maintenance of carbon monoxide detectors in any residence sold, rented or receiving a building permit after Jan. 1, 2017.

Building owners are required to install detectors with alarms on every habitable floor or according to applicable building codes. The bill applies only to single- and multi-family dwellings with a fuel-fired heater, fireplace or attached garage.

Senators passed the bill on a 39-2 vote.

LB146, introduced by Crawford, authorizes crematoriums and funeral establishments to relinquish control of unclaimed remains to veterans’ service organizations to provide burial in a veteran cemetery. The bill passed 44-0.

LB315, sponsored by Howard, establishes new guidelines for Medicaid recovery audits in Nebraska. The bill passed on a 44-0 vote.

Finally, lawmakers approved a resolution recommending that an infectious disease training center be established in Nebraska.

LR41, introduced by Campbell, urges Nebraska’s congressional delegation to support efforts in Congress to establish an infectious disease training center at the University of Nebraska Medical Center (UNMC) in Omaha.

UNMC is home to the Nebraska Biocontainment Patient Care Unit, which treated Ebola patients during the 2014 outbreak of the disease.

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