Medicaid waiver assessment bill amended, advanced

A Medicaid waiver proposal was amended to detail the assessment process for developmental disability service provision in Nebraska and to require the state to maintain the maximum amount of retroactive Medicaid coverage allowed under federal law before advancing from general file March 31.

LB958, as introduced by Omaha Sen. Machaela Cavanaugh, would have required legislative approval to seek waiver changes in service provision — including cost limit adjustments, narrowed eligibility or a reduction in aggregate service hours — to Medicaid recipients who require nursing-level care in their home or community, rather than in an institutional setting.

A Health and Human Services Committee amendment, adopted 43-0, struck those provisions and replaced the bill. Cavanaugh said the original version of LB958 was no longer needed after a proposed cap on service hours was removed from the state’s waiver by the governor.

She said the amended proposal instead seeks to address concerns from families of individuals with developmental disabilities who believe an assessment tool used by the state Department of Health and Human Services does not adequately consider the unique circumstances of each waiver participant.

Cavanaugh said the proposal would implement safeguards that improve fairness and ensure Nebraskans with disabilities receive services that best fit their needs.

“[It] simply ensures that as we move forward, we are doing so in a way that is transparent, accountable and centered on the people who rely on these services,” she said.

Under the amended proposal, DHHS’s assessment tool used to determine functional eligibility, service needs and service tier assignments for Medicaid waiver participants must be administered by an employee or contractor trained in clinical interviewing techniques that include:
• proper administration of assessment tools;
• methods for clarifying ambiguous or incomplete responses;
• procedures that ensure accurate and complete assessment results; and
• techniques for adapting questions to the comprehension and communication needs of the individual being assessed.

Additionally, services authorized under a waiver must be based on individualized assessments of medical necessity, functional need and health and safety requirements as determined through a person-centered planning process in accordance with federal home and community based services waiver regulations.

The services must be sufficient in amount, duration and scope to reasonably serve the needs of participants and prevent unnecessary institutionalization, hospitalization or risk of serious harm. The amendment also would require that determinations be communicated by DHHS to a waiver participant, or their parent or legal guardian, in a timely, clear and specific manner.

If an assessment results in a reduction of a waiver participant’s service tier, authorized service hours or service provision, the department also would be required to conduct an immediate supervisory review of the assessment and determination prior to final implementation of the reduction.

Additionally, the amendment would require DHHS to submit a report to the Legislative Oversight Committee, the Health and Human Services Committee and the Nebraska Office of Public Counsel regarding implementation and use of assessment tools for waiver participants no later than Aug. 1.

Omaha Sen. John Fredrickson supported the bill and committee amendment. He said the waiver serves as a “lifeline” for many families to ensure their loved one receives the care they deserve.

The committee amendment also includes the amended provisions of Cavanaugh’s LB777.

Those provisions would require DHHS to provide the maximum amount of retroactive coverage for each Medicaid eligibility category authorized by federal law under the One Big Beautiful Bill Act of 2025. The amendment also would require the department to include information regarding work requirements, concurrent enrollment and cost sharing in the Medicaid and Long-Term Care annual report.

Following adoption of the committee amendment, senators advanced LB958 to select file 45-0.