Legislative Update 12/13/2021: Mental Health, Surprise Billing, & The New Year

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This is the legislative update for December 13, 2021. View all updates here.



The December 13, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

Surgeon General Calls Attention To Pediatric Mental Health Crisis

Last week, US Surgeon General Vivek H. Murthy issued a public health advisory on the mental health challenges confronting young people — a rare warning and call to action to address what he is calling an emerging crisis exacerbated by pandemic hardships.

According to Murthy’s 53-page advisory, symptoms of depression and anxiety have doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms.

A surgeon general’s advisory is a public statement intended to focus national attention on an urgent public health issue. The advisory also provides recommendations for how that issue should be addressed.

The advisory calls for a broad-based and rapid response from a range of relevant parties including:

  • The government
  • Social media companies
  • Community groups
  • Schools and teachers
  • Parents
  • Students

The surgeon general has limited direct power, but traditionally speaks with medical expertise as the voice of the executive branch — a role that can be magnified by the individual in the office and the issues that person takes on.

In order to keep up the momentum, we have invited our Congressional Delegation to join the Children’s Health Care Caucus, the Congressional Mental Health Caucus, and the Bipartisan Addiction And Mental Health Task Force, for a briefing this Tuesday, December 14 at 11:30 a.m. CST.

This hearing is titled, A National Emergency in Youth Mental Health: Strengthening Supports and Access to Care for Kids and Teens.

We have also requested each of our Representatives in Nebraska sign a Dear Colleague Letter and co-sponsor the Children’s Mental Health Infrastructure Act (H.R. 4943) and the Helping Kids Cope Act (H.R. 4944).

These acts would provide funding opportunities for pediatric mental health initiatives across the country that would:

  • Generate access to care
  • Support the workforce
  • Instill new opportunities to deliver care — with an emphasis on partnership and prevention

In The Senate: Continuing Resolution & Build Back Better Act

It’s crunch time. This week will be one to watch in the Senate as the Build Back Better Act and debt-limit increase are at the forefront of discussion.

First, it is important to celebrate the passage of a continuing resolution (CR) that extended current year funding through February 18, 2022, avoiding a government shutdown.

With that work behind them, the Senate hopes to reach an agreement on provisions of the Build Back Better Act to attract one key Democrat in opposition. At the end of the day, it all comes down to long-term spending. In the midst of increasing the debt limit, the bill faces an uphill journey.

Among its many provisions, the $1.75 trillion social spending package includes:

The Importance Of The PATCH Act

Children’s is also discussing the importance of the Pediatric Access to Critical Health Care (PATCH) Act, a $6 billion investment over 10 years for national pediatric preparedness response investments.

Under the PATCH Act, these investments would:

  • Add flexible critical care capacity: The PATCH Act would dedicate funding — combined with matching requirements — for the replacement or addition of up to 4,000 hospital beds across the country.
  • Strengthen the workforce: New investments would address pediatric workforce issues, recognizing the difference between adult and pediatric providers. It would also help address increased work stress and burnout in healthcare — which is already a major challenge to recruitment and retention.
  • Support telehealth technology and cybersecurity: Ongoing cyber threats have revealed the critical need to build strong defenses that protect the privacy and safety of patients and their health information. PATCH Act investments would enable providers to virtually connect families with high-quality, safe, and equitable healthcare.

Department of Health and Human Services

In Fiscal Year (FY) 2019, surprise billing was a Congress priority. (Translation: Surprise billing is when someone receives a medical bill that is unexpected. This can happen if someone receives medical care from a provider of medical services that is out of their insurance network).

In a rare bipartisan effort and after months of discussion, this agreement:

  • Holds patients harmless to balance billing
  • Allowed healthcare providers and payors to enter into an arbitration process to determine out-of-network payments

On September 30, 2021, the Department of Health and Human Services and other agencies, removed the process of arbitration for determining fair payment for services by out-of-network providers. This effectively overturned the requirements specified in the No Surprises Act.

The new rule relies instead on the scale of an independent dispute resolution process, unfairly benefiting commercial health insurance companies.

The American Hospital Association (AHA) and American Medical Association (AMA) filed a lawsuit over the misguided implementation of the federal surprise billing law.

Their challenge will not prevent the law’s core patient protections from moving forward or increase out-of-pocket costs to patients. It seeks only to force the federal regulators to bring the regulations in line with the law before the dispute negotiations begin.

Children’s weighed in during last week’s public comment period to outline our concerns for a process dominated by the payors in rare out-of-network situations.

More details to come as these changes unfold.

State Updates

Nebraska Legislature

The Legislature will officially convene on January 5, 2022, for a quick 60-day session. Contention will be plentiful as we are hearing issues that senators are considering proposing next month.

Of course, there is approximately $1.4 billion of American Rescue Plan Act (ARPA) funds that are creating a lot of posturing across the state, but there is also buzz about:

  • A proposed abortion ban
  • Medical marijuana
  • Critical Race Theory
  • The elimination of the State Board of Education — requiring the Commissioner to report to the Governor of the State
  • Health standards in schools
  • Organ donor bills

We are well-positioned with our ARPA funding proposals and are hoping to be considered in the Governor’s overall budget recommendation announced at the State of the State address in mid-January. These one-time investment requests include our funding for our mental health urgent care locations, a statewide access to care infrastructure bill for telehealth services, and the development of a mobile app for our Project Austin initiative.

We have confirmed the Nebraska Hospital Association and Nebraska Chamber are focusing efforts on growing the workforce in Nebraska, one of the many complimentary projects we are at the table discussing.

This week, we are anticipating a report from the Health and Human Service Committee and St. Francis Oversight Committee by December 15. The role St. Francis is playing in 2022 will likely be discussed at a press conference from the Department later in the week (December 17), as well as an update on the youth staying at the Youth Rehabilitation Treatment Centers.

(Sources: CHA, AHA, Congress.gov, Nebraska Legislature, World-Herald, Peetz & Co.)

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