Session Review: Health and Human Services

Lawmakers considered a variety of uses this session related to the provision of health and human services in Nebraska, including several cost-saving measures intended to address the state’s projected budget shortfall.

Three cost-cutting bills were introduced by Lincoln Sen. Kathy Campbell at the request of the governor as part of his budget package.

Under LB464, the state Department of Health and Human Services will no longer be required to set child-care reimbursement rates at a level between the 60th and 75th percentile of a market survey.

Instead, the bill lowers to the 50th percentile the minimum rate that HHS may pay for the next two years, beginning July 1, 2011. In addition, the rate paid to child-care providers may be no lower than the rate paid in the preceding fiscal year.

The bill passed 42-2.

LB465 eliminates state-only benefits for certain noncitizen permanent residents who are in the United States legally but do not qualify for benefits under federal guidelines.

Current federal guidelines require that permanent residents be in the U.S. for five years to qualify for benefits, but states can choose to provide benefits without using federal funds.

Lawful noncitizens who met income and other requirements were eligible to participate in Nebraska’s state-option Medicaid program, Supplemental Nutrition Assistance Program, Temporary Aid to Needy Families and aid to the aged, blind and disabled regardless of when they entered the country. LB465 eliminates those benefits.

The bill passed on a 33-8 vote.

LB468 allowed HHS to establish and increase co-payments for certain Medicaid services and passed on a 34-10 vote.

A measure introduced by the Health and Human Services Committee to encourage the fiscal integrity of Nebraska’s Medicaid program also was considered.

LB541 would require HHS to contract with one or more recovery audit contractors to review provider claims, seek overpayment recovery and identify third-party liability. The bill remains on final reading.

Children’s services

Among the measures considered this session dealing with children’s health and human services were several proposals that addressed the recent child welfare reform initiative undertaken by HHS.

Lawmakers adopted a resolution that provides legislative oversight of child welfare reform in Nebraska.

In July 2009, HHS selected six private entities as lead agencies to implement the reform initiatives, which privatized some services to children and families. Currently, only two lead agencies remain under contract with HHS to assist with implementing reforms.

LR37, introduced by Campbell, grants the Health and Human Services Committee oversight of the reform process. Under the resolution, the committee is designated to review, investigate and assess the effect of the child welfare reform initiative, and has the ability to issue subpoenas and depose witnesses.

The resolution was adopted 43-0.

Senators stopped short of approving a bill that would require accreditation of agencies involved in carrying out reform efforts.

Introduced by Omaha Sen. Gwen Howard, LB95 would require any lead agency contracting with HHS to be accredited by a national accrediting entity, within 18 months of entering into a contract with HHS or of the bill’s passage, with respect to out-of-home services provided to those under the age of 19.

The bill also would prohibit the department, until June 1, 2012, from entering into any contract with a new lead agency for service coordination or case management in an area of the state where services previously were provided through a contract with Boys and Girls Home. HHS would be required to provide services to those areas during the moratorium.

Campbell offered a motion on select file to bracket the bill until Jan. 4, 2012, saying the governor had assured her that he would direct HHS to implement the moratorium outlined in the bill and cooperate fully with a legislative review of reform efforts. The bill remains on select file.

Senators approved a bill that makes several changes to the Nebraska foster care system.

LB177, introduced by Campbell, requires HHS to notify adult relatives within 30 days of a child’s removal from his or her home. An exception is provided if an adult relative’s history of domestic or family violence would make notification inappropriate.

The bill also requires that HHS and the court make reasonable efforts to place siblings together and provide visitation or ongoing interaction when siblings are not placed together. An exception is provided if joint placement or visitation would be contrary to the safety and well-being of any sibling.

Finally, the bill requires the department to develop an individual proposal for each child transitioning out of foster care into adulthood. Such a proposal will include assessment of a foster child’s educational, employment, housing, health care and other support needs.

The bill passed on a 47-0 vote.

A state policy on concussions for child athletes also was adopted this session. LB260, introduced by Omaha Sen. Steve Lathrop, provides schools and organizations with information and training about concussions. The bill passed on a 43-0 vote.

Regulation and licensure

Lawmakers voted to override the governor’s veto of a bill that institutes a provider assessment on nursing home facilities.

Under LB600, introduced by Campbell, nursing facilities will pay an assessment to the state of $3.50 per day for Medicaid and private pay patients, which then will be reimbursed to facilities through a federal match.

Senators passed the bill on a 44-1 vote. Gov. Dave Heineman subsequently vetoed the measure, calling the assessment a “shell game,” in which the federal tax dollars returned to the state are seen as “free money” when those funds actually are Nebraska citizens’ federal tax dollars.

Campbell said the financing mechanism outlined in LB600 is based on a model used by 39 other states and is a legitimate option for leveraging federal tax dollars.

Senators voted 44-0 to override the governor’s veto.

A bill that eliminates a deadline for cities and villages to opt out of Nebraska’s mandatory drinking water fluoridation provisions was approved this session.

Under a bill passed by the 2008 Legislature, cities or villages with a population of at least 1,000 were required to add fluoride to their drinking water supply unless voters approved local opt-out ordinances by June 1, 2010. The fluoridation requirement does not apply to municipalities with a population under 1,000.

LB36, sponsored by Scottsbluff Sen. John Harms, extends the opt-out deadline for cities and villages that reach the population threshold for mandatory fluoridation after June 1, 2010. The bill passed on a 41-0 vote.

Senators also passed a bill to promote the state’s Supplemental Nutrition Assistance Program (SNAP).

LB543, introduced by Omaha Sen. Tanya Cook, requires HHS to develop a state outreach plan to inform qualifying persons about SNAP.

The department may work with nonprofit organizations to seek gifts, grants and donations to assist in implementing the plan and will be exempt from administering it if sufficient federal or private funds are not secured.

Under the bill, an individual who qualifies for SNAP benefits may have no more than $25,000 in liquid assets in personal checking or savings accounts, money market or share accounts.

LB543 passed on a 42-0 vote.

Senators passed a bill allowing Nebraska pharmacies to participate in a nationwide drug disposal program. Currently, state law allows unused prescription drugs to be returned to the dispensing pharmacy for immediate disposal.

LB274, sponsored by Grand Island Sen. Mike Gloor, removes the words “dispensing pharmacy” and “immediate” from state law, allowing Nebraska to participate in a nationwide program that provides pharmacies secure containers to collect unused drugs regardless of where they were dispensed. Under the program, containers are shipped to a medical incinerator for disposal when full.

The bill passed on a 47-0 vote.

LB591, also introduced by Gloor, requires HHS to set standards for using electronic health records to analyze medical data to detect or anticipate disease outbreaks and to share immunization information with certain entities.

The bill passed on a 46-0 vote.

Lawmakers also approved a bill that prevents denial of privileges to individuals based solely on their classification as certified nurse midwives.

LB68, introduced by Lincoln Sen. Tony Fulton, adds certified nurse midwives to the list of practitioners who cannot be denied clinical privileges based on their credential by any hospital licensed under the Health Care Facility Licensure Act.

The bill passed on a 49-0 vote.

Senators passed a bill that requires HHS to establish or enhance technology for a prescription medication alert system in Nebraska.

LB237, sponsored by Howard, allows HHS to collaborate with the Nebraska Health Information Initiative to add an alert screen to its existing patient medical records system in order to track prescription drug seekers.

The bill passed on a 42-0 vote.

A measure that addresses confidentiality in the health care peer review process passed 46-0.

Under LB431, introduced by Kearney Sen. Galen Hadley, no health care provider, individual or employee who acts without malice while serving on a peer review committee or supplying information to a committee may be held liable or be subject to legal action for activities within the scope the committee.

Finally, senators passed a bill designed to broaden the pool of professionals eligible to serve on county mental health boards.

LB111, sponsored by Gloor, removes a requirement that one member be a psychiatric social worker and adds a position for a licensed independent mental health practitioner.

County mental health boards are charged with assessing the mental health status of individuals placed in emergency protective custody through an affidavit from a mental health professional or by law enforcement.

LB111 passed on a 49-0 vote.