Session Review: Health and Human Services

Oversight and reorganization of the state’s troubled child welfare system topped the list of health and human services issues addressed by lawmakers this session.

Child welfare

A bill intended to provide a strategic plan and legislative oversight for child welfare programs in Nebraska was approved this session.

LB821, sponsored by the Health and Human Service Committee, creates a 22-member Nebraska Children’s Commission tasked with creating a statewide strategic plan to reform child welfare programs and services in the state.

Among other issue areas, the commission will be required to create committees to examine foster care reimbursement rates and – based on provisions originally introduced by Omaha Senator Gwen Howard as LB837 – state policy regarding prescription of psychotropic drugs to state wards. The commission is required to report on the strategic plan to the Legislature and the governor by Dec. 15, 2012.

The bill also creates the Office of Inspector General within the Office of Public Counsel, also known as the Ombudsman’s Office.

The inspector general will be appointed by the public council and approved by the Legislature. The office is authorized to investigate allegations of possible misconduct, death or serious injury in foster homes, private agencies, child care facilities and programs.

The office also will review the role and effectiveness of the state’s youth rehabilitation and treatment centers, analyze data and report to the Legislature and the governor annually.

The bill passed on a 49-0 vote.

LB961, also introduced by the committee, returns child welfare case management to the state Department of Health and Human Services (DHHS) by April 1, 2012, except in the eastern service area, in which the department will be allowed to contract for lead agency case management as a pilot project.

Both the department and the pilot project lead agency are required to reduce caseload size to between 12 and 17 cases per worker by Sept. 1, 2012. If children in a family receive services in the home, all children will be considered one case. If any child is placed out of the home, each child will be considered one case.

The bill passed 48-0.

Lawmakers also passed a bill that seeks to tighten budgeting standards for the state’s child welfare system.

The Legislative Performance Audit Committee introduced LB949, which, among other provisions, requires DHHS’s division of children and family services to include a strategic plan in its budget request to the Legislature for the next two budget cycles. The plan must identify the main purpose of each program in the division, goals for measuring progress and benchmarks and time frames for meeting those goals.

Under the bill, the division is required to provide quarterly updates to the Legislature’s HHS and Appropriations committees beginning in October 2012 on any movement of funds greater than $250,000 into the child welfare subprogram from other budget programs.

LB949 passed on a 48-0 vote.

Under LB820, introduced by the Health and Human Services Committee, DHHS is required to apply for a federal waiver for a foster care demonstration project by Sept. 30, 2013.

The bill also incorporates provisions from two other bills – LB926, introduced by Fullerton Sen., Annette Dubas, which requires DHHS to create a Foster Care Reimbursement Committee to develop a statewide standard rate structure for children in foster care and LB874, introduced by Howard, which requires licensure of all foster parents not related to a child by blood, marriage or adoption.

Finally, the bill will provide a $3.10 rate increase for foster parents starting July 1, 2013. A 25-cent administrative fee authorized in the bill for foster care agencies will be in addition to the foster parent payment increase.

LB820 passed 49-0.

Lawmakers also approved a bill that requires development of a new child welfare data system.
Under LB1160, introduced by the committee, DHHS is required to develop and implement a web-based, statewide automated information system to integrate child welfare data.

The department is required to obtain an evaluation of the state’s child welfare system by a nationally recognized entity and to report to the Legislature regarding the completed evaluation and plans for the new data system by Dec. 1, 2012.

The bill also includes provisions of LB774, originally introduced by Howard, which requires the Health and Human Services Committee to report to the governor, the Legislature and the chief justice on progress made by DHHS toward recommendations contained in the committee’s report on child welfare reform.

Reports will be required for three years, with the first due on Dec. 15, 2012.

The bill passed 45-0.

Nebraska’s current Foster Care Review Board will be made a state agency under a bill approved this session.

LB998, introduced by Omaha Sen. Bob Krist, abolishes the board and establishes a Foster Care Review Office. Terms of the current 11-member board will be terminated.

Under the bill, the newly created office will be a noncode agency within the executive branch. All staff except the executive director will be transferred from the board to the office.

The bill also creates a Foster Care Advisory Committee. No member of the advisory committee may have a financial interest in the foster care system or be employed by DHHS, a county, court, child-caring agency or child-placement agency.

The bill has an operative date of July 1, 2012.

LB998 passed 45-0.

Senators also overrode a gubernatorial line-item veto of a provision in the state claims bill related to child welfare reform.

LB1072, introduced by the Business and Labor Committee as part of the Legislature’s budget package, approves claims exceeding $50,000 authorized by the state claims board.

Senators approved the measure on a 42-4 vote. Gov. Dave Heineman subsequently vetoed a provision approving 50 claims totaling $2.5 million made by subcontractors of Boys and Girls Home – a former lead contract agency with DHHS that since has declared bankruptcy.

Senators voted 31-12 to pass LB1072 notwithstanding the objections of the governor. Thirty votes were needed to do so.

Public benefits

Lawmakers voted to override a gubernatorial veto of a bill that will establish a program to offer prenatal services to low-income women in Nebraska regardless of immigration status.

Under LB599, introduced by Lincoln Sen. Kathy Campbell, DHHS is required to establish a program under the Children’s Health Insurance Program (CHIP) solely for the unborn children of mothers who are ineligible for coverage under Medicaid.

Eligibility for service will be determined using an income budgetary methodology of no greater than 185 percent of the federal poverty guideline.

Senators had passed LB599 on a 31-15 vote and the bill subsequently was vetoed by the governor.
In his veto message, Heineman said he opposed the bill because it would provide prenatal care to illegal immigrants at the expense of Nebraska taxpayers. He said the annual $2.5 million cost to fund the program should be spent on other state priorities.

Campbell offered a motion to override the governor’s veto, saying tax dollars would be expended to care for children born without prenatal care regardless of the bill’s passage, but that LB599 would ensure that future Nebraska citizens would be born healthy and could help prevent costly stays in neonatal intensive care units.

Lawmakers voted 30-16 to override the governor’s veto and enact LB599 into law. Thirty votes are needed to override a veto.

DHHS is required to increase staff at local offices to provide more assistance with the state’s system for accessing public benefit programs – known as ACCESSNebraska – under a bill passed this session.

LB825, introduced by Dubas, requires the department to adequately staff existing local offices and includes guidelines to determine the appropriate number of staff needed to provide in-person assistance to clients at each existing office.

The bill passed 38-4.

LB901, introduced by Omaha Sen. Steve Lathrop and amended into the state’s budget adjustment package, allocates $4 million for services for individuals with developmental disabilities who were on the DHHS waiting list and past their date of need for such services on Nov. 14, 2011.

LB1038, introduced by Omaha Sen. Brenda Council, authorizes the DHHS division of public health to create a lead poisoning education and outreach program that will:
• educate health care providers, child care providers, public school personnel and parents about the risks of lead poisoning in children;
• provide a standard to be used in identifying elevated blood-lead levels; and
• recommend that a child be tested for elevated blood-lead levels if the child resides in a zip code with a high prevalence of children with elevated blood-lead levels or if the child meets one of the criteria in a screening questionnaire developed by DHHS.

The department is required to pay the cost of elevated blood-lead testing only for children who participate in Medicaid.

The bill passed on a 44-0 vote.

Senators also created the Children’s Health and Treatment Act this session.

LB1063, introduced by Omaha Sen. Tanya Cook, requires that the guidelines and criteria used by DHHS to determine medical necessity for Medicaid services be published on the department’s website and on those of managed care contractors and the state Department of Administrative Services.

The bill also requires 60 days’ prior notice to providers of changes to treatment guidelines and quarterly DHHS reports on authorization and denial rates for behavioral health services for children under age 19.

The bill passed on a 44-0 vote.

Lawmakers also passed a bill designed to bolster the fiscal integrity of Nebraska’s Medicaid program.

Introduced in 2011 by the Health and Human Services Committee, LB541 was advanced to final reading last session. Lawmakers returned the bill to select file this session and amended it to require DHHS to report to the Legislature by Dec. 1, 2012 on the status of all contracts authorized by the bill.

LB541 requires DHHS to contract with one or more recovery audit contractors and limits contingent fees to no more than 12.5 percent of amounts recovered. All amounts recovered and savings generated from the contracts will be returned to the state’s Medicaid program.

The bill passed 49-0.

Senators extended the termination date for self-sufficiency activities under the Welfare Reform Act from Sept. 30, 2012 to Dec. 31, 2016.

Under LB842, introduced by Scottsbluff Sen. John Harms, recipients of the state Aid to Dependent Children (ADC) program may count hours spent pursuing an associate degree toward their work activity requirements.

The program will be evaluated prior to the new termination date.

The bill passed on a 45-0 vote.

LB507, also introduced by Harms, allows an applicant who is 21 years old or the head of a household to meet the state’s self-sufficiency requirement by maintaining satisfactory attendance at a secondary school, a general education development (GED) program or equivalent or participating in education directly related to employment for an average of 20 hours per week.

LB507 passed on a 48-0 vote.

Senators also passed a bill this session that outlines the parameters of future medical assistance contracts for delivery of behavioral health services in Nebraska.

LB1158, introduced by Krist, will require an at-risk managed care model for behavioral health managed care contacts entered into by DHHS after July 1, 2012.

The bill includes caps on administrative contract spending, restrictions on contract profits and requires that a minimum of 0.25 percent of contract payment be contingent on performance metrics.

The bill passed 48-0 and takes effect immediately.

Licensure and credentialing

Lawmakers passed a bill that changes Nebraska’s supervision requirement for attaining certification as a marriage and family therapist.

LB1148, introduced by Grand Island Sen. Mike Gloor, amends the definition of a qualified supervisor and changes specifications for the current 3,000 hours of supervised experience.

The bill passed 45-0.

Senators also approved a bill that provides a formal licensure process for genetic counselors.
Under LB831, introduced by Howard, a genetic counselor who has satisfied the training and certification requirements of the American Board of Genetic Counseling may apply for licensure.

The bill prohibits a genetic counselor from being required to counsel or refer a patient with respect to abortion.

LB831 passed on a 46-1 vote.

A bill meant to clarify permitted practices under the Nebraska Nurse Practitioner Act was given final approval this session.

Hoskins Sen. Dave Bloomfield said he introduced LB1083 to clarify for DHHS that they may hire licensed nurses to provide home health care to family members or friends.

The bill passed on a 45-0 vote and takes effect immediately.

LB788, introduced by Campbell, changes current state statute to reflect the standards adopted by the federal government and CMS regarding who may order respiratory therapy services.

Under the bill, the scope of practice in Nebraska is extended to include physicians assistants, nurse practitioners and certified residential nurse anesthetists.

The bill passed on a 49-0 vote.

The process used to propose credentials and changes in scope of practice is expanded under a bill passed by the Legislature.

LB834, introduced by Gloor, makes various changes to the Credentialing Review Program and the operation of the Technical Review Committee.

The bill passed on a 46-0 vote.

County hospitals will have more authority to make large purchases under a bill approved this session.

LB995, introduced by Elk Creek Sen. Lavon Heidemann, allows county hospitals to obtain lines of credit without a public vote.

The bill allows a county hospital to:
• encumber hospital property;
• obtain a line of credit or borrow money;
• make improvements and additions to facilities with county board approval;
• participate in group purchasing organizations for large items; and
• open clinics in communities outside its jurisdiction.

Use of general bonds to fund new projects still will require a public vote.

Senators passed the bill on a 45-0 vote.

Finally, the Health and Human Services Committee considered a bill that would remove the state’s prohibition on a certified nurse midwife attending a home birth.

LB712, sponsored by Malcolm Sen. Ken Haar, would retain the requirement that a certified nurse midwife operate under the supervision of a licensed practitioner, who would have to authorize a home birth.

The bill did not advance from committee.

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