Session Review: Health and Human Services
Occupational licensure reform and public benefits topped the list of health and human services issues considered by lawmakers this session.
Licensure and credentialing
Senators passed an omnibus bill aimed at reducing excessive regulations.
LB1034, sponsored by Ralston Sen. Merv Riepe, requires the standards of care and protection for school-age child care programs located within an accredited or approved school to meet the same standards as an accredited or approved school under state Department of Education regulations.
The measure contains provisions of eight additional bills:
• LB344, sponsored by Thurston Sen. Joni Albrecht, which changes credentials and regulations for substance abuse centers;
• LB686, sponsored by Bellevue Sen. Carol Blood, which adopts the Psychology Interjurisdictional Compact;
• LB703, sponsored by Seward Sen. Mark Kolterman, which provides an exemption from Nebraska’s unlawful practice of medicine statutes for physicians from another state who accompany an athletic team or organization into the state for an event;
• LB704, sponsored by Kolterman, which reduces the requirement for licensure of physician graduates of foreign medical schools from three to two years;
• LB894, sponsored by Bellevue Sen. Sue Crawford, which adopts the Emergency Medical Services Personnel Licensure Interstate Compact, known as REPLICA;
• LB924, sponsored by Riepe, which changes provisions within the EMS Practice Act, Occupational Therapy Practice Act and Uniform Credentialing Act;
• LB1035, sponsored by Riepe, which makes a technical change to the state’s Stroke System of Care Act; and
• LB1057, sponsored by Heartwell John Kuehn, which changes provisions relating to the prescription drug monitoring program.
The bill passed on a 49-0 vote.
Lawmakers also approved a measure that makes numerous changes to occupational and other licensure requirements in an effort to increase access to health-related professions.
Introduced by Gothenburg Sen. Matt Williams, LB731 allows a pharmacy to provide remote dispensing at a location staffed by a certified pharmacy technician and owned by a supervising pharmacy licensed and located in the state.
A remote pharmacy must be located at least 10 driving miles from the nearest pharmacy and dispensing must occur under remote supervision via a real-time audiovisual communication system by a licensed pharmacist employed by a supervising pharmacy.
LB731 includes provisions of six additional bills:
• LB681, introduced by Blood, which adopts the physical therapy licensure compact;
• LB788, introduced by Riepe, which requires certain providers to enroll in opiate administering and prescribing continuing education;
• LB790, introduced by Crete Sen. Laura Ebke, which provides for licensure of mobile cosmetology, barber and nail technology salons;
• LB794, introduced by Riepe, which removes a current ban on consuming, serving, possessing or distributing alcohol by entities operating under the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Act;
• LB1042, introduced by Omaha Sen. Sara Howard, which addresses nail technology licensure; and
• LB1107, introduced by Elkhorn Sen. Lou Ann Linehan, which reduces licensure hour requirements for barbers, cosmetologists, estheticians and nail technologists.
The bill passed on a 49-0 vote.
A bill intended to enable the practice of equine, dog and cat massage in Nebraska received approval this session.
LB596, sponsored by North Platte Sen. Mike Groene, defines dog, cat and equine massage practice as the application of hands-on massage techniques for the purpose of increasing circulation, relaxing muscle spasms, relieving tension, enhancing muscle tone and increasing range of motion.
An individual who engages solely in dog, cat or equine massage practice is not subject to the Veterinary Medicine and Surgery Practice Act. The bill passed on a vote of 46-0.
LB439, sponsored by Lincoln Sen. Anna Wishart, permits an assisted living facility nurse to provide nursing care to residents on a part-time, intermittent basis. Such care is defined as less than 10 hours each week for each resident, with a predictable end time within a 21-day period.
The bill also requires assisted living facilities to disclose in writing if brief nursing care is available in their facility and updates a variety of definitions.
Any expenses resulting from the bill will be paid from the Nebraska Health Care Cash Fund for fiscal year 2018-19 and FY2019-20.
LB439 passed on a vote of 47-0.
A proposal sponsored by Wishart to prohibit Nebraska tanning facilities from allowing people younger than 18 to use tanning equipment failed to advance from general file.
In 2014, the Legislature outlawed the use of tanning equipment—which includes sun lamps, tanning booths and tanning beds—in indoor tanning facilities by people younger than 16. An exception exists if a parent or legal guardian signs a statement before each use indicating an understanding of the warnings provided by the facility and consenting to the minor’s use of tanning equipment.
LB838 would have raised the age to 18 and removed the exception for parental permission.
The bill would not have applied to a licensed physician who uses phototherapy in the practice of medicine. Phototherapy is defined as the use of equipment that emits ultraviolet radiation for the diagnosis or treatment of disease or injury.
The Legislature moved on to another item on the agenda without taking any action on LB838. It was not scheduled for further debate.
Public benefits
An entitlement that prioritized services for high school graduates with developmental disabilities was eliminated by a bill passed this session.
The entitlement was halted for fiscal year 2017-18 and FY2018-19 during the 2017 legislative session in order to bring Nebraska into compliance with federal law. The entitlement prioritized services for graduates or those reaching age 21, which violates a federal requirement that the state first serve individuals with the highest priority status.
LB793, introduced by Ralston Sen. Merv Riepe, permanently eliminates the entitlement, which otherwise would have resumed in FY2020. The bill instead creates a trigger mechanism that requires the state Department of Health and Human Services to provide comparable services only to high school graduates if the department does not have enough funds to provide services to all eligible individuals under the federal waiver.
The provisions apply only to individuals who are transitioning from the education system upon reaching age 21 on or after July 1, 2019. The trigger mechanism is eliminated June 30, 2021.
The bill also contains provisions of Lincoln Sen. Kate Bolz’s LB1004, which makes the Aging and Disability Resource Centers a permanent program within DHHS. The pilot project was set to terminate June 30, 2018.
The provisions apply only to area agencies on aging that are awarded funding from the department to partner with an ADRC.
LB793 passed on a 46-1 vote and took effect immediately.
Lawmakers also created a new funding priority for military dependents with developmental disabilities. Current law specifies a hierarchy of funding priorities for disability services in Nebraska under the Medicaid home and community-based services waiver.
LB685, sponsored by Bellevue Sen. Carol Blood, allows dependents of a member of the U.S. Armed Forces who is a legal Nebraska resident due to the service member’s military assignment in the state to become the fifth priority in that hierarchy.
The bill passed 48-0.
Other measures
Drugs in U.S. Food and Drug Administration clinical trials may be used by eligible Nebraska patients under a bill passed this session.
LB117, introduced last year by Omaha Sen. Robert Hilkemann, allows an eligible patient under the Investigational Drug Use Act to be treated with any drug, biological product or medical device that has successfully completed Phase 1 of a clinical trial but has not yet been approved for general use by the FDA—provided that the drug remains in an FDA-approved clinical trial.
To be eligible, a patient must:
• have an advanced illness likely to result in death within six months;
• have considered all other approved treatment options;
• not be receiving inpatient treatment in a licensed hospital;
• give written, informed consent for the use of the investigational treatment; and
• have a recommendation from his or her treating physician for an investigational drug, biological product or device.
Written consent must make clear that a patient understands that he or she is liable for all expenses of the investigational treatment and contain a statement that the patient’s health insurance carrier is not obligated to pay for such treatment.
Under the bill, a manufacturer may provide an investigational treatment without compensation and is prohibited from seeking reimbursement for such treatment if an eligible patient dies while being treated.
In addition, a good-faith recommendation to an eligible patient cannot subject a health care provider to discipline or an adverse licensure action under the act. Penalties under federal law are not precluded.
LB117 passed 35-13.
LB1040, sponsored by Thurston Sen. Joni Albrecht, requires a health care practitioner, or his or her designee, who attends or diagnoses a nonviable birth prior to 20 weeks of gestation to advise the patient that they can request a commemorative certificate of nonviable birth.
The certificate will be issued by the state Department of Health and Human Services within 60 days of request for a fee not to exceed the cost of issuing the certificate.
The commemorative certificate will not result in the registration of a live birth or be used to calculate live birth statistics. The certificate also cannot be used in support of a civil action seeking damages for injury or wrongful death.
LB1040 passed on a 44-1 vote.
Senators also approved a bill that harmonizes Nebraska’s child support program with federal law.
LB702, sponsored by Seward Sen. Mark Kolterman, clarifies that children who are covered by Medicaid and other needs-based health care programs in Nebraska have health care coverage.
The bill also clarifies that incarceration is not considered voluntary unemployment for child support purposes.
DHHS is required to notify parents of their right to request a review and adjustment of a child support order within 15 days of learning that a noncustodial parent will be incarcerated for longer than 180 days.
LB702 passed on a 49-0 vote.
