November 2019
The 106th Nebraska Legislative session adjourned sine die on May 31, but legislative and regulatory activity has continued through the summer and into the fall at a rapid pace.
Children’s Hospital & Medical Center has actively followed all the prospective regulations changes at the Nebraska Department of Health and Human Services (DHHS). In reviewing proposed regulations, the department’s aim has been to modernize existing statute with federal law, strengthen and consolidate definitions, and remove unnecessary and duplicative language, all while increasing transparency. Children’s testified on Title 471, Chapter 9 of the Nebraska Administrative Code (NAC)- Home Health Agencies on Aug. 13, expressing concern for the new 56-hour cap on home health services and elimination of the term “respite.” Additionally, Children’s submitted comments on Title 471, Chapter 10 NAC- Hospital Services on Aug. 14. In this regulation, DHHS outlines changes to the way providers get paid, creating uncertainty in rates and methodology. Hearings will continue into November as other priority statutes are reviewed – like congenital heart screening, trauma designation and a number of medical licensure revisions. Nebraska DHHS CEO, Dannette Smith, has been responsive to concerns by providers and associations and has mentioned there will be an opportunity at a later date to engage all stakeholders.
Over the next quarter, Nebraska state senators will return to Lincoln for interim study hearings, which help define key issues for next session and gather stakeholders for feedback. A full list of interim studies can be found at www.NebraskaLegislature.gov. Among the priority interim studies for Children’s are:
- LR105– Interim study to investigate the eligibility requirements applied to children with disabilities for coverage under the Medical Assistance Act (Health and Human Services Committee);
- LR134– Interim study to examine the drug testing protocol recently changed by the Division of Children and Family Services for families involved in the child welfare system (Sen. Slama);
- LR170– Interim study to examine the DHHS’s plan to submit a demonstration project waiver for the medical assistance program under the section 1115 waiver (Sen. Morfeld);
- LR172– Interim study to analyze state and local policy and initiatives to retain and incentivize health care providers and health related business in the state to remain and expand (Sen. Williams);
- LR173– Interim study to examine the public health concerns related to the public use and secondhand exposure to electronic nicotine delivery systems (Sen. Quick);
- LR191– Interim study to evaluate the potential use of Physicians Orders for Life-Sustaining Treatment and the potential use of out-of-Hospital Do Not Resuscitate (DNR) protocols (Sen. Arch);
- LR200– Interim study to examine programming provided at the Youth Rehab and Treatment Center in Geneva and Kearney (Sen. Quick);
The next legislative session begins in early January, and Nebraska state senators will face many challenging bills with only 60 working days. Don’t forget 2020 is an election year, which can create a hyper awareness to vote counts as senators face issues like property tax relief, school-aid funding, vaping, child welfare, Medicaid expansion and a tax-incentive package for businesses. Senators are already engaging necessary stakeholders as they vet bills and begin the drafting process. Planning and organizing support early is becoming more and more necessary in the Unicameral.
In Washington, Children’s continues to prioritize funding for Children’s Hospital Graduate Medical Education (CHGME) to train future pediatricians and pediatric specialists, as well as joining the effort to delay the scheduled cuts to the Disproportionate Share Hospital (DSH) payments. Hospitals with a high-uninsured or high-Medicaid volume utilize federal DSH payments to lessen the impact of Medicaid underpayment or lack of reimbursement. The scheduled cuts were originally written into the Affordable Care Act (ACA) as it was predicted DSH would no longer be a necessity once every state expanded their Medicaid program. The reality is that due to Medicaid underpayment, DSH payments will always have a meaningful impact on providers, like Children’s. Unfortunately, Congress did not pass a FY 2020 appropriations bills ahead of the end of the fiscal year (Sept. 30), requiring the passage of a continuing resolution (CR) to fund Congress through Nov. 22. Along with the passage of the CR, Congress effectively delayed the scheduled $4 billion cut to the DSH program until lawmakers find a compromise on a long-term delay.
Prior to any impeachment proceedings, President Trump flaunted an upcoming release of his new health care plan, an expected staple and alternative option to his opponent’s “Medicare for All” strategies in his reelection campaign. The plan was expected to include proposals to lower drug prices, a provision related to protecting people with pre-existing conditions from private health insurer discrimination and a new way to provide care to the uninsured. While we don’t yet know the specifics, nor do we know if the platform is still viable, those close to his administration anticipate another Medicaid overhaul and a plan to allow the sale of insurance across state lines. Regardless, as we approach the 2020 elections, health care will undoubtedly be at the forefront of debate.
To stay current with public policy updates, please visit ChildrensOmaha.org/Advocacy-Outreach and register for weekly legislative updates and the full state and federal bill guide list.
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