Session Review: Health and Human Services
Measures to address Medicaid coverage, child care provider shortages and the opioid epidemic were among those considered by the Health and Human Services Committee this session.
Medicaid
Lawmakers passed a bill intended to increase Medicaid payments to Nebraska hospitals by accessing federal matching funds through an assessment program.
LB1087, introduced by North Platte Sen. Mike Jacobson, requires the state Department of Health and Human Services to submit a state plan amendment to the Centers for Medicare and Medicaid Services for approval to impose an assessment on Nebraska hospitals.
Under the plan, each Nebraska hospital will pay an assessment fee based on their quarterly net revenue. The total statewide assessment amount cannot exceed 6% of the total net patient revenue of all assessed hospitals.
The program will be administered by DHHS, which will receive an administration fee of 3% of the assessment amount, not to exceed $15 million per year. Of the total assessed amount, 3.5% may be used for health priorities including funding non-hospital Medicaid providers. That amount is capped at $17.5 million.
LB1087 passed on a 45-0 vote and took effect immediately.
Senators also updated provisions of the Nebraska False Medicaid Claims Act this session.
LB664, introduced by Ralston Sen. Merv Riepe, authorizes the state’s Medicaid fraud control unit — which is part of the state attorney general’s office — to investigate and prosecute cases of abuse, neglect or exploitation of Medicaid recipients who receive medical services inside and outside of institutional settings.
The measure also grants the attorney general’s office access to all applicable records of any resident living in a Medicaid funded facility when investigating and prosecuting instances of abuse, neglect or exploitation, regardless of whether the resident is a Medicaid recipient. The provision includes an expansion of existing subpoena powers.
LB664 passed on a 45-0 vote.
Also introduced by Riepe, LB905 requires DHHS to apply for a Medicaid waiver or state plan amendment with CMS by Oct. 1, 2025, to designate two medical respite facilities for individuals experiencing homelessness in Nebraska.
The facilities — one located in a primary class city and the other in a metropolitan class city — will be reimbursed for services to qualified individuals. Lincoln is the state’s only primary class city and Omaha is the only metropolitan class city.
LB905 also provides the department with authority to license adult respite care facilities and authorizes funding for the program from the Medicaid Managed Care Excess Profit Fund.
The bill passed on a 43-0 vote.
LB62, introduced by Omaha Sen. Machaela Cavanaugh and passed 34-6, requires DHHS to “take all actions necessary” to provide coverage and reimbursement for providers of translation and interpretation services for individuals who receive Medicaid.
Funding for the measure will come from the Medicaid Managed Care Excess Profit Fund.
The bill includes provisions of Cavanaugh’s LB871 that require the department to submit an annual report to the Legislature by Nov. 1 of each year detailing current and anticipated Temporary Assistance for Needy Families program expenditures.
For programs other than Aid to Dependent Children, the report will include a “clear statement” explaining how an expenditure for that program or service is more likely to help families achieve economic mobility and self-sufficiency than an increase in ADC expenditures.
The measure also includes provisions of Cavanaugh’s LB1237, which require a DHHS annual report on Medicaid redeterminations.
LB358, sponsored by Fremont Sen. Lynne Walz, increases the reimbursement rate for dental services provided under Medicaid by 12.5% for fiscal year 2024-25. The bill passed on a 47-0 vote and took effect immediately.
The committee did not advance LB1278, sponsored by Omaha Sen. Terrell McKinney, which would have required DHHS to provide Medicaid coverage for doula and full spectrum doula services, beginning no later than Jan. 1, 2026.
Children and families
Several proposals intended to increase access to child care and provide support for at-risk mothers were approved by lawmakers this session.
Under current law, Aid to Dependent Children recipients are required to surrender to the state any child support received from a noncustodial parent.
LB233, introduced by Omaha Sen. John Cavanaugh, creates a passthrough to allow a custodial parent who receives ADC to also receive up to $100 of the child support paid for one child and $200 for two or more children. Child support income from the passthrough will be disregarded when calculating ADC monthly assistance payments.
The bill passed on a vote of 46-0 and takes effect July 1, 2027.
A measure to provide an exemption under the Child Care Subsidy program for certain providers who care for their own children passed on a vote of 38-7.
Current Nebraska law prohibits DHHS from providing a child care subsidy to an eligible child care provider for direct care of their own child.
LB856, sponsored by Omaha Sen. John Fredrickson, creates an exemption if an employer has attempted to make reasonable accommodations to ensure that a provider is not caring for their own child but such an accommodation cannot be made. An eligible child care provider also may enroll their child in a program other than their own to receive a subsidy.
The measure passed on a 38-7 vote and takes effect July 1, 2025.
LB857, introduced by Sen. George Dungan of Lincoln and passed 45-0, creates the Nebraska Prenatal Plus program. The program will cover the cost of prenatal services for at-risk mothers — defined as pregnant women eligible for Medicaid or the Children’s Health Insurance program who are determined to be at risk for negative maternal or infant health outcomes.
Prenatal services under the program include nutritional counseling, psychosocial counseling and support, general client education and health promotion, breastfeeding support and targeted case management. The program will sunset June 30, 2028.
The bill also includes provisions of Lincoln Sen. Carolyn Bosn’s LB933 that expand Medicaid coverage for continuous glucose monitors to include individuals with gestational diabetes and those receiving any type of insulin therapy.
Funding for CGM coverage is capped at $600,000 annually from the Medicaid Managed Care Excess Profit Fund.
Senators also passed a bill to broaden options for determining child care provider reimbursement rates and establish intergenerational care facility grants.
Under current law, DHHS is required to conduct a market rate survey every two years to determine provider reimbursement rates under the Child Care Subsidy program.
LB904, introduced by Bennington Sen. Wendy DeBoer, gives the department authority to consider a different federally approved methodology to determine reimbursement rates or to create their own model and seek federal approval. If DHHS chooses to continue using the existing method, the bill requires that the reimbursement rate be at least the 75th percentile of the current market rate survey.
The measure also includes provisions of LB1178, introduced by Lincoln Sen. Anna Wishart, which create the Intergenerational Care Facility Incentive program to provide one-time startup grants to establish child care programs in nursing and assisted living facilities that are certified for Medicare or Medicaid.
The program will be funded through a one-time $300,000 appropriation from the Medicaid Managed Care Excess Profit Fund. Certified facilities are eligible for a grant of up to $100,000 for structural updates, outside campus space, equipment and supplies.
Facilities that have been cited for providing a substandard quality of care during their most recent survey are not eligible to receive a grant.
LB904 passed on a 45-0 vote.
Omnibus bill
Senators passed a measure that makes a number of changes to laws governing the licensure and provision of health services in Nebraska.
Among other provisions, LB1215, sponsored by Blair Sen. Ben Hansen, requires nurse renewal licenses to be registered in the DHHS electronic database and eliminates the certificate of need requirement for rehabilitation beds in hospitals.
The measure includes provisions of 10 other proposals considered by the committee this session:
● LB823, sponsored by Bellevue Sen. Carol Blood, which adopts the Physician Assistant Licensure Compact;
● LB896, introduced by Lincoln Sen. Beau Ballard, which repeals a requirement for a signed statement within 10 days when a telehealth patient gives verbal consent during an initial consultation;
● LB1009, sponsored by Walz, which allows a person who has failed the state barber examination a third time to take the test again;
● LB1106, introduced by Omaha Sen. Jen Day, which requires Medicaid to cover a minimum of 10 lactation consultations for mothers and children covered under Medicaid and increases lactation consultation provider rates by 145%;
● LB1107, also sponsored by Day, which requires DHHS to provide Medicaid coverage for electric breast pumps for qualified pregnant women, beginning no later than Jan. 1, 2025;
● LB1138, introduced by Riepe, which allows a prescriber who issues fewer than 50 prescriptions a year to not use electronic prescription technology;
● LB1171, sponsored by Gering Sen. Brian Hardin, which adds an exemption to pharmacy verification requirements for pharmacies with multiple locations that share a common electronic database;
● LB1173, introduced by Riepe, which changes requirements related to vital statistics;
● LB1181, sponsored by Ballard, which changes the Pharmacy Practice Act, Uniform Controlled Substances Act and Public Health and Welfare statutes relating to medications; and
● LB1373, introduced by Blood, which creates the Dietitian Licensure Compact, which will take effect when seven states pass enacting legislation, and adds dieticians to the list of health professions in Nebraska that require a background check.
Lawmakers passed the measure on a 45-0 vote and LB1215 took effect immediately.
Other measures
A bill to establish new tools to address the state’s opioid crisis was approved by lawmakers this session.
LB1355, introduced by Omaha Sen. Tony Vargas, renames the Nebraska Opioid Recovery Fund — which contains state settlement dollars related to the opioid crisis — as the Nebraska Opioid Recovery Trust Fund and makes a number of changes to how the fund is used.
The bill directs the state treasurer to make the following annual transfers:
● $400,000 to the state Department of Health and Human Services Cash Fund to carry out the Overdose Fatality Review Teams Act;
● $1.25 million to the Training Division Cash Fund;
● $3 million to the Opioid Prevention and Treatment Cash Fund, created by the bill; and
● an amount determined by the Legislature to the newly created Opioid Treatment Infrastructure Cash Fund.
LB1355 states legislative intent that 25% of the total settlement funds received by the state be transferred to the Opioid Prevention and Treatment Cash Fund and 75% to the Opioid Treatment Infrastructure Cash Fund.
Funds disbursed to the prevention and treatment fund will be distributed proportionally among the state’s regional behavioral health authorities. Dollars appropriated to the infrastructure fund will be used for state and local public-private partnerships for entities engaged in opioid treatment, including capital construction and renovation. Administrative costs are capped at 5%.
Also included in LB1355 is legislative intent to appropriate $500,000 in general funds to DHHS for distribution to local public health departments for opioid use prevention and mediation. Funds appropriated for this purpose will be offset by a reduction in the state’s appropriation to the Behavior Health Aid program.
An appropriation of $250,000 in general funds to support research on opioid addiction and misuse prevention at the University of Nebraska Medical Center also will be offset by a reduction in the Behavioral Health Aid appropriation.
Finally, regional behavioral health authorities and local public health departments are required to report in even-numbered years regarding the use of funds.
The bill passed on a 41-0 vote and took effect immediately.
LB1035, sponsored by Seward Sen. Jana Hughes, requires DHHS to create a program to permit the donation and dispensing of qualifying prescription drugs.
Under the bill, medications may be donated by individuals or entities, including manufacturers and health care facilities. Donations must:
● undergo inspection prior to donation;
● be in original, unopened, sealed and tamper-evident packaging;
● bear an expiration date more than six months after the donation date, except in limited cases; and
● not be restricted for distribution by the U.S. Food and Drug Administration.
Participation is voluntary and the bill includes civil and criminal protections for individuals and entities that donate medications. The department will designate a nonprofit organization to administer the program.
Lawmakers passed LB1035 on a vote of 47-0.
A measure intended to address food insecurity in Nebraska did not advance from committee. LB920, introduced by McKinney, would have required DHHS to establish a Restaurant Meals Program no later than July 1, 2025.
Under the program, Supplemental Nutrition Assistance Program recipients who are elderly, disabled or experiencing homelessness could have used their SNAP dollars to purchase pre-made meals at below-market price from participating restaurants contracted with DHHS.
