Session Review: Health and Human Services

Child welfare, licensure requirements and a second attempt to expand Medicaid topped the list of health and human services issues considered by lawmakers this session.

Child welfare

Senators updated a program that provides foster care transition services and authorized a pilot program for alternative response in certain Nebraska child welfare cases.

LB853, introduced by Lincoln Sen. Amanda McGill, updates the Young Adult Bridge to Independence Act, which is intended to ease the transition for young people aging out of the foster care system.

The bill makes a number of changes to the program, including requiring the state Department of Health and Human Services (DHHS) to provide information on community resources if a former ward voluntarily terminates a support agreement and to meet with former wards who are determined no longer eligible for the program.

LB853 also requires DHHS, in consultation with the Nebraska Children’s Commission, to develop an alternative response implementation pilot program.

Alternative response does not include an investigation or a formal determination as to whether child abuse or neglect has occurred and the subject of the report is not entered into the child protection central registry.

Implementation will include provision of concrete supports and voluntary services, including mental health and substance abuse services and assistance with child care, food, clothing, housing and transportation.

Continuation of the pilot program beyond 2017 will require legislative approval.

The bill also contains provisions of LB790, originally introduced by Omaha Sen. Sara Howard, which requires the same initial training for all child welfare case managers, whether employed by DHHS or an organization under contract with the department.

DHHS also will collaborate with social work programs at Nebraska public colleges and universities to establish a program to provide stipends for undergraduate and graduate students who are committed to working in the child welfare services field. The stipends will be funded with federal Title IV-E dollars.

LB853 passed on a 42-0 vote.

A pilot project authorized as part of the Legislature’s response to the state’s troubled child welfare reform effort may be extended under a bill passed this session.

Efforts undertaken by the 2012 Legislature to address child welfare reform included returning child welfare case management to DHHS except in the eastern service area, where the department was allowed to contract for lead agency case management as a pilot project.

LB660, introduced by Omaha Sen. Bob Krist, allows DHHS to extend the pilot, which is currently under contract with the Nebraska Families Collaborative (NFC). If the pilot project is extended, the bill also requires an evaluation to determine whether case management should be returned to DHHS and whether private contractors should be used in the case management process.

Evaluation results will be reported to the Legislature, DHHS and NFC by Dec. 31, 2014. The bill passed on a 43-0 vote.

Public benefits

Lawmakers voted to override a gubernatorial veto of a bill that creates a statewide task force on aging and seeks federal grant funds.

LB690, introduced by Lincoln Sen. Kate Bolz, creates the Aging Nebraskans Task Force to facilitate implementation of a statewide strategic plan for addressing the needs of Nebraska’s aging population.

The task force will include stakeholders as well as representatives of the three branches of state government and will report its recommendations to the Legislature by Dec. 15, 2014. The task force will terminate June 30, 2016, unless extended by the Legislature.

The bill also requires DHHS by Sept. 1, 2014, to apply for a federal grant to fund the development of a comprehensive and coordinated system of home and community based long-term care services.

LB690 was approved on a 32-11 vote. Gov. Dave Heineman subsequently vetoed the measure, objecting to the bill’s provision requiring DHHS to apply for federal funding.

Lawmakers voted 30-12 to override the governor’s veto and enact LB690 notwithstanding his objections. Thirty votes are required to override a veto.

A second attempt at Medicaid expansion stalled during general file debate this session.

LB887, sponsored by Lincoln Sen. Kathy Campbell, would have established the Wellness in Nebraska Act. Campbell said the measure would provide health care coverage through a Medicaid expansion demonstration waiver to approximately 54,000 uninsured and underinsured individuals who are newly eligible under the federal Affordable Care Act.

After eight hours of general file debate, Campbell offered a motion to invoke cloture to end debate and force a vote on all pending action on the bill. The motion failed on a vote of 27-21, falling six votes short of the number required.

Senators passed a bill that allows schools to seek reimbursement for a broader array of services delivered to Medicaid-eligible special education students.

LB276, sponsored by Omaha Sen. Jeremy Nordquist, allows school districts to seek reimbursement for audiology services, counseling, psychological and behavioral services, nursing, nutritional services, personal assistance, transportation, social work and vision services.

The bill passed on a 48-0 vote.

LB359, sponsored by Omaha Sen. Tanya Cook, increases the percentage of a household’s gross earned income that must be disregarded when determining continued eligibility for the state’s child care subsidy program. The income disregard is set at 10 percent after 12 continuous months on the program and at each subsequent redetermination of eligibility.

The bill also includes provisions of LB732, originally introduced by Omaha Sen. Rick Kolowski, that removes 529 college savings plans, student scholarships and work-study income from asset limit tests for the state’s child care subsidy program and the Supplemental Nutritional Assistance Program.

The bill passed 44-0.

A bill intended to slow proposed Medicaid changes in Nebraska was approved by the Legislature this session.

LB854, introduced by Krist, prohibits DHHS from releasing a request for proposals relating to procurement of Managed Long-Term Services and Supports prior to Sept. 1, 2015. Senators passed the bill on a 46-0 vote.

Licensure and credentialing

Gov. Heineman vetoed a bill that would have changed practice agreement requirements for nurse practitioners in Nebraska.

LB916, introduced by Bellevue Sen. Sue Crawford, would have removed the requirement for an integrated practice agreement between a nurse practitioner and a collaborating physician and replaced it with a transition to practice agreement.

The new agreement was defined in the bill as a collaborative agreement between a nurse practitioner and a supervising provider, which could be a physician, osteopathic physician or nurse practitioner licensed and practicing in Nebraska. The supervising provider would have been required to be in the same practice specialty, related specialty or field of practice as the nurse practitioner being supervised.

Lawmakers passed the bill on a 43-0 vote April 17, the final day of the 2014 session.

In his veto message, the governor said LB916 would give nurse practitioners too much independence and that recent graduates of nurse practitioner programs would lack the clinical experience necessary to ensure patient safety under the bill’s provisions.

LB526, introduced by Howard, authorizes licensed optometrists to administer a body injection for treatment of anaphylaxis and to prescribe oral steroids, oral antiglaucoma medication and oral immunosuppressive agents.

The bill passed on a 45-0 vote.

LB132, introduced by Nordquist, prohibits indoor tanning facilities in Nebraska from allowing people younger than 16 to use tanning facilities. The prohibition applies to sun lamps, tanning booths and tanning beds.

An exception is provided if a parent or legal guardian signs a statement at the facility before each use indicating an understanding of the warnings provided by the facility and consenting to the minor’s use of tanning equipment.

The bill requires tanning facilities to post a warning sign in a conspicuous location outlining the dangers of overexposure to ultraviolet radiation. An owner or operator of a tanning facility found to be in violation of the bill’s provisions will be subject to a civil penalty of $100. The bill also adds a tanning facility owner to the state Board of Cosmetology.

Senators approved LB132 on a 40-1 vote.

A bill that will bring Nebraska into compliance with federal regulations regarding background checks for certain employees passed this session.

LB728, introduced by Scottsbluff Sen. John Harms, removes a requirement for a finger printing and national criminal history record check of all employees who are employed by contracted providers and work directly with developmental disabilities clients.

The Nebraska State Patrol still will be required to undertake a criminal history record search for each state employee and DHHS will coordinate and pay for background checks for third-party contractor employees through an alternative provider.

LB728 passed 44-0.

Other measures

Lawmakers passed a measure intended to increase access to behavioral health services in Nebraska.

LB901, introduced by McGill, requires the University of Nebraska Medical Center’s Behavioral Health Education Center to fund five one-year doctoral-level internships within 12 months of the bill’s enactment. The number of internships will increase to 10 within 36 months.

Under the bill, interns will be placed in communities where their presence will improve access to behavioral health services for patients residing in rural and underserved areas of Nebraska.

The bill also includes provisions of LB931, originally introduced by Bolz, which requires DHHS to establish a mental health first aid training program.

LB901 passed on a 43-0 vote.

Senators passed a bill that increases the fees that DHHS may charge to issue certified copies or abstracts of marriage and for searches of death certificates.

Under LB994, introduced by the Health and Human Services Committee, the fee to issue a certified copy or abstract of marriage will increase from $11 to $16. The current cap of $2 on the fee for a search of death certificates will increase to $3.

The bill passed on a 46-1 vote.

A partnership established to examine how best to control costs and improve quality in Nebraska’s health care system is continued under a resolution adopted this session.

LR422, introduced by Campbell, builds on a resolution adopted by the Legislature in 2013, which designated the Health and Human Services Committee—in cooperation with the Banking, Commerce and Insurance Committee—to evaluate the state’s health care system.

Under LR422, the committees will bring together policymakers and stakeholders at all levels to work toward providing a comprehensive review of Nebraska’s health care delivery, cost and coverage demands 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.

Funding for activities outlined in the resolution will be provided by existing appropriations from the Nebraska Health Care Cash Fund. The resolution was adopted on a vote of 26-1.

Lawmakers also approved a bill intended to promote transparency in the cost and quality of health care services in Nebraska.

LB76, introduced by Nordquist, establishes a Health Care Data Base Advisory Committee tasked with making a series of recommendations to improve transparency in the state’s health care system.

The department director will report the advisory committee’s recommendations to the governor and the Legislature by Dec. 15, 2014. LB76 passed 43-0.

Introduced by Campbell, LB1076 originally dealt with Medicaid authorization and payments but was amended to contain only provisions of LB1078, a bill introduced by Nordquist related to telehealth services.

The provisions update the definition of telehealth—the electronic exchange of information—for the purpose of monitoring a patient from a remote location and transmitting patient data electronically to a health care practitioner for analysis and storage. The bill also will set the reimbursement rate for a telehealth consultation at least as high as the Medicaid rate for a comparable in-person consultation regardless of the distance between the health care practitioner and the patient.

LB1076 passed on a 48-0 vote.

Finally, senators gave unanimous consent during select file debate to bracket a bill that would have required that all new homes in Nebraska include radon resistant construction.

LB13, introduced by Krist, would have applied to all new residential construction beginning Jan. 1, 2016, and would have clarified that any regulation regarding radon resistant construction adopted by a county, city or village must be at least as stringent as that adopted by DHHS.

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