Health and Human Services

Lawmakers addressed a crisis at the state’s youth rehabilitation and treatment centers, made several changes to licensure requirements for health care professionals and revised laws governing public benefits.

YRTCs

The Legislature passed two bills this session that overhaul programming and management at Nebraska’s YRTCs.

LB1188, introduced by Omaha Sen. Sara Howard, requires the Office of Juvenile Services to create a superintendent of schools position to administer education for YRTCs by Dec. 1, 2020.

The bill also gives the state Department of Health and Human Services authority to direct all daily maintenance, minor repairs and custodial duties and operations of the buildings under the department’s administration where a juvenile resides.

OJS is required to provide evidence-based programs and services in the operation of YRTCs and LB1188 prohibits staff from limiting or prohibiting a juvenile from communicating with relatives as a punishment.

The bill passed 42-4.

LB1140, sponsored by the Health and Human Services Committee, encompasses several YRTC related bills brought by the committee. It requires DHHS to engage in significant planning for the YRTC system, including creation of a long-range operations plan for the YRTCs and emergency plans for each facility.

LB1140 also establishes the YRTCs in state law and outlines a series of requirements, including the provision of:
• health care and medical services;
• a safe and sanitary space for sleeping, hygiene, education, programming, treatment, recreation and visitation for each juvenile;
• appropriate physical separation and segregation of juveniles based on gender;
• training that is specific to the population being served;
• sufficient staffing to comply with state and federal law and protect the safety and security of each juvenile;
• an age-appropriate and developmentally appropriate education program for each juvenile;
• a case management and coordination process, designed to assure appropriate reintegration of the juvenile to his or her family, school and community; and
• research-based or evidence-based programming and treatment services.

The bill, passed 48-0, also prevents DHHS from establishing or moving a YRTC until March 30, 2021.

Licensure and credentialing

LB755, introduced by Sen. Carol Blood of Bellevue, allows barbers to provide services inside a client’s home in certain emergency circumstances. It requires barbers to obtain a permit from the state Board of Barber Examiners.

The bill, approved on a 47-0 vote, also allows nail technicians to offer in-home services and requires DHHS and the Nebraska Department of Veterans Affairs to encourage their service providers and state and local agencies to ask applicants if they or their family members have served in the military.

LB755 also includes provisions of the following bills:
• LB37, introduced by Sen. Robert Hilkemann of Omaha, which amends the Podiatry Practice Act to allow a physician’s assistant to perform services that are delegated by and provided under the supervision of a podiatrist and are within the podiatrist’s scope of practice;
• LB772, introduced by Sen. Matt Williams of Gothenburg, which removes restrictions on physician assistants regarding the details of their collaborative agreement and their ability to work in a hospital and prescribe medication, including allowing a physician assistant to work in collaboration with and be supervised by several specialists who may work at the same practice rather than solely under a single physician;
• LB811, introduced by Sen. John McCollister of Omaha, which amends the Parkinson’s Disease Registry Act and requires that a patient’s date of birth rather than Social Security number be included in a pharmacist’s semi-annual report to DHHS;
• LB825, introduced by Hilkemann, which adds Spinal Muscular Atrophy to the list of 32 required screenings for all infants born in Nebraska; and
• LB834, introduced by La Vista Sen. John Arch, which allows architecture candidates to begin taking their professional licensure exam as they are completing their education and experience requirements, and allows engineers to take one of their two exams prior to completing four years of post-accredited degree experience.

Blair Sen. Ben Hansen’s LB312 authorizes licensed dental hygienists to perform all authorized functions within their scope of practice in a public health setting except periodontal scaling, root planing and administrating anesthesia or nitrous oxide.

The bill, approved 47-0, also allows DHHS to authorize licensed hygienists to prescribe mouth rinses and fluoride products to decrease tooth decay and make minor denture adjustments, upon completion of education and testing.

LB1185, introduced by the committee, amends the Child Care Licensing Act to require that providers not required to be licensed under the act but who seek to be providers under the federal Child Care Subsidy program must submit a request for a national criminal history check for each child care staff member.

The bill, passed 48-0, also requires DHHS to seek federal funding to implement a program to assist residential child care providers and their employees with the cost of fingerprinting and national criminal history record information checks.

A bill that changed state law regulating nail technology and tattoo artists passed Aug. 13 on a vote of 31-10. It was vetoed Aug. 17 by Gov. Pete Ricketts, after the 2020 legislative session had ended.

LB607, introduced by Sen. Mark Kolterman of Seward:
• created a three-day license for a “guest body artist” enabling him or her to work at a licensed tattoo establishment or under a licensed body artist;
• created the position of nail technology apprentice and allowed an apprentice to work under a licensed nail technologist;
• updated the definition of cosmetic tattooing;
• added “natural nail” treatment—work done on a person’s nails without adding to the nail—to the definition of manicuring; and
• allowed the Board of Cosmetology, Electrology, Esthetics, Nail Technology and Body Art to administer licensing exams in multiple languages.

In his veto message, Ricketts said the bill would impose requirements on individuals who perform natural nail manicures and pedicures that “go well beyond basic education and training in safe health and sanitation practices.”

Two licensure bills stalled on general file this session.

LB347, introduced by Sen. Dave Murman of Glenvil, would have exempted reflexologists who limit their services to the application of hand pressure to the hands, feet and outer ears from licensure under the Massage Therapy Practice Act. After three hours of first-round debate, the Legislature moved on to another bill. LB347 was not scheduled for further debate.

LB205, as introduced last session by Kolterman, would have established a registry and a minimum standard of competence for surgical technologists in Nebraska. The bill failed to advance from general file on a 15-12 vote. Twenty-five votes were needed.

Medicaid

LB1052, introduced by Lincoln Sen. Anna Wishart, amends the Medicaid Prescription Drug Act. The bill prohibits DHHS, a managed care organization or a contracted pharmacy benefit manager from denying coverage of antidepressant, antipsychotic or anticonvulsant medication if a patient’s health care provider deems the drug medically necessary and it was prescribed within the immediately preceding 90 days.

The bill, passed 47-0, also changes pharmacy provisions at long-term care facilities, allows a pharmacist, in certain circumstances, to adapt a prescription for a patient at the request of the patient and allows a pharmacist to package medications for a patient that have been dispensed from a different pharmacy.

LB956, introduced by Fremont Sen. Lynne Walz, amends the Medical Assistance Act to require notice of material changes to an agreement between health care providers and a managed care organization. Under the bill, approved 47-0, providers will receive:
• 60-day notice of any material change;
• a description of the change and a proposed effective date;
• contact information for the managed care organization;
• the opportunity to meet with the managed care organization; and
• a copy of the entire agreement after three material changes in 12 months, if requested.

The bill also requires DHHS to notify Medicaid recipients when eligibility is discontinued or modified and clarifies the intent of Medicaid program integrity audits.

A bill that requires DHHS to keep its Medicaid reimbursement rate methodology within its existing rules and regulations process passed this session.

LB1053, introduced by the committee, clarifies that any change to the methodology is considered substantive and requires rule and regulation-making proceedings under the Administrative Procedure Act.

The bill, passed 48-0, also allows Programs of All-Inclusive Care for the Elderly facilities that meet DHHS licensure requirements to operate multiple centers under one license and makes several changes to state law governing receiverships of health care facilities.

Bellevue Sen. Sue Crawford’s LB323 updates eligibility standards for Nebraska’s Medicaid Insurance for Workers with Disabilities program from the federal Balanced Budget Act standards to more recent federal Ticket to Work and Work Incentives Improvement Act standards. The bill passed 46-0.

Other measures

Senators passed a bill this session banning electronic smoking devices inside public buildings in Nebraska. LB840, introduced by Grand Island Sen. Dan Quick, amends the Nebraska Clean Indoor Air Act to prohibit use of electronic nicotine delivery systems as defined in state law.

The bill, passed on a 33-2 vote, exempts licensed electronic smoking device retail outlets from the Nebraska Clean Indoor Air Act as it relates to the use of electronic smoking devices. Such an outlet is defined as one that does not sell alcohol or gasoline, derives no more than 20 percent of its revenue from the sale of food and food ingredients and prohibits individuals younger than 21 from entering the premises. Until Jan. 1, 2022, electronic smoking device retail outlet employees may be under 21. After that date, employees must be 21 or older.

LB1061, introduced by Crawford, extends the state’s alternative response procedures in child welfare cases, defines key terms and establishes the criteria in statute for alternative response cases. Nebraska’s alternative response pilot program has been in place since 2014.

The bill eliminates the pilot program’s sunset date; removes abandonment of a child for six months or more immediately prior to a report from the list of cases excluded from eligibility for alternative response; provides clearer definitions of response pathways for reports of child abuse and neglect; and establishes an advisory group under the Nebraska Children’s Commission to examine use of alternative response.

The bill, passed 46-0, also narrows the types of cases eligible for alternative response.

Omaha Sen. Sara Howard’s LB1124 creates the Nebraska Opioid Recovery Fund as the repository of any money that the state may receive from a federal Department of Justice lawsuit against opioid manufacturers accused of deceptive advertising.

The bill, passed 48-0, also requires DHHS to report annually to the Legislature, governor and attorney general regarding how funds were distributed and the outcomes achieved.

LB1002, sponsored by Brainard Sen. Bruce Bostelman, allows the restocking of prescription drugs by a hospital for an emergency medical service if EMS transports a patient to the hospital and the drugs were used for the patient prior to or during transportation.

The measure also adds community care paramedic and critical care paramedic practices as EMS providers and directs the state Board of Emergency Services to provide education and licensure requirements for the classifications. Under the bill, licensed practical nurses are no longer exempt from Emergency Medical Services Practice Act licensing requirements.

LB1002 also requires DHHS to set standards for juvenile inpatient psychiatric units and psychiatric residential treatment facilities. Staff must be at least 20 years old, or at least two years older than the oldest resident in the facility or unit, have a high school diploma or equivalent and be trained appropriately.

The bill passed on a 47-0 vote.

La Vista Sen. John Arch’s LB1183 creates the Health Information Technology Board, composed of health care professionals and other stakeholders. The 17-member board will establish criteria for data collection and disbursement by the statewide health information exchange. The bill passed 47-0.

Finally, LB518, as originally introduced by Elkhorn Sen. Lou Ann Linehan, would have adopted the Support for Trafficking Survivors Act. Those provisions were removed, leaving provisions of Bellevue Sen. Carol Blood’s LB745, which outline procedures for certification of immigration visas by local law enforcement in Nebraska. The bill, passed on a 47-0 vote, requires Nebraska law enforcement agencies to certify a form within 90 days if requested for two types of immigration visas that are set aside for crime victims.

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