Legislative Update 4/12: Discretionary funding, Nebraska budget and bills

US capitol

This is the legislative update for April 12, 2021. View all updates here.

The April 12, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

It’s been a quiet two weeks on Capitol Hill. But on Monday, the House and Senate are back in session with a heavy agenda, including several high-level federal hearings.

One of the hearings that we will be monitoring is the one on Thursday morning by the Senate Finance Committee to consider the nominations of Andrea Joan Palm to be Deputy Secretary of Health and Human Services (HHS) and Chiquita Brooks LaSure to be Administrator of the Centers for Medicare and Medicaid Services (CMS).

The American Rescue Plan and Administrative Openings

The American Rescue Plan is President Biden’s COVID-19 relief bill. Unfortunately, administrative openings are delaying parts of the bill from going into effect. For example, the status of the implementation of grants that were made available through the American Rescue Plan is unknown, since the US Health Resources & Service Administration (HRSA) doesn’t have an administrator.

There are quite a few other open administrative positions in key agencies, including the Medicaid director position.

Funding for the American Rescue Plan

On Friday, the White House released a summary of President Biden’s discretionary funding request for 2022. The request includes discretionary funding proposals only — we expect to see a proposal detailing mandatory spending requests (which includes Medicaid and Medicare) at a later date.

Key provisions outlined in the President’s budget proposal to Congress:

  • Public Health: $8.7 billion for the Centers for Disease Control and Prevention (CDC) to support:
    • Core public health capacity improvements in states and territories
    • Modernization of public health data collection nationwide
    • Training new epidemiologists and other public health experts
    • Building international capacity to detect, prepare for, and respond to emerging global threats.
  • Mental Healthcare:
    • Historic investments, including $1.6 billion for the Community Mental Health Services Block Grant
    • Funding to support the needs of those involved with the criminal justice system
    • Resources to partner mental health providers with law enforcement
    • Funds to expand suicide prevention activities
  • Early Child Care and Learning:
    • $7.4 billion for the Child Care and Development Block Grant to expand access to quality, affordable childcare for families
    • $11.9 billion investment in Head Start, which would ensure more children start kindergarten ready to learn on day one.
  • Children with Disabilities:
    • $15.5 billion for Individuals with Disabilities Education Act (IDEA) grants that would support four special education and related services for more than 7.5 million Pre-K through 12 students. This is a significant first step toward fully funding IDEA.
    • $732 million for early intervention services for infants and toddlers with disabilities or delays, funding services that have a proven record of improving academic and developmental outcomes. The $250 million increase would support reforms to expand access to these services for underserved children, including children of color and children from low-income families.
  • Physical and Mental Wellbeing of Students:
    • $1 billion to increase the number of counselors, nurses, and mental health professionals in schools
    • $430 million for Full-Service Community Schools, which play a critical role in providing comprehensive wrap-around services to students and their families, from after school, to adult education opportunities, and health and nutrition services.
  • Disparities in Healthcare and Social Determinants of Health (SDOH):
    • Additional funding to expand access to culturally competent care.
    • $153 million for the CDC’s SDOH program to support states and territories in improving health equity and data collection for racial and ethnic populations.
  • Maternal Mortality: More than $200 million to:
  • Nutrition: $6.7 billion for critical nutrition programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

State Updates

Nebraska Legislature

Nebraska lawmakers have two-thirds of the legislative session behind them, but temporarily fell behind last week after an announcement from the Executive Committee, naming the state senators that would serve on the St. Francis Ministries child welfare oversight committee. The senator who introduced the oversight committee proposal (LR29), Senator Machaela Cavanaugh (D-Dist. 6, Omaha), was not included — despite her knowledge and efforts to protect the children involved.

Nebraska State Budget

There were numerous motions to delay passing the budget, LB380. However, it was advanced unanimously on Thursday evening. The budget includes a 2% provider rate increase for each year over the next two years.

The budget bill package contains nine different bills — eight of which have advanced to Select File (Translation: second round ). We anticipate that the Select File debate will take place on Tuesday, with a Final Reading on Thursday, April 15th. Then, the package will be presented to Governor Ricketts (R-NE) for his consideration. Once he receives the bills, he will have five days (excluding Sunday) to act on them.

The two-year budget holds growth to a minimal 1.7% increase, an attractive rate for a conservative governor. However, it makes some significant adjustments to the Governor’s proposed budget, including:

  • $351 million transferred to the cash reserve fund (Translation: rainy day fund)
  • $63 million to the property tax credit fund
  • $32 million for job training and economic development.
  • $83.5 million — the largest single increase in the budget — for the 2%rate increase in Medicaid, Child Welfare, and juvenile justice and child care service providers.

Based on budget forecasts and the committee amendments, there will be $211.3 million available for other pending legislation before the legislature this year. Revenue forecasts are made in Nebraska by the Nebraska Economic Forecasting Advisory Board, whose members are appointed by the Governor. The board’s next meeting is April 29th and may result in additional adjustments.

Telehealth Bill (LB400)

The Legislature advanced Senator John Arch’s (R-Dist. 14, Ralston) telehealth bill, LB400, to Final Reading.

The bill was a product of months of work with the Senator to maintain key flexibilities for telehealth post-public health emergencies. The bill would allow individuals to receive audio-only telehealth for behavioral health services, and to receive telehealth services with verbal approval during a patient’s first telehealth visit (written approval be received within 10 days of a patient giving verbal consent).

In addition, LB400 would prohibit insurers from excluding coverage solely based on a patient’s originating location.

An amendment adopted on General File narrowed the definition of audio-only behavioral health services to individual services provided to established patients only.

Telehealth Payment Parity Bill for Behavioral Health (LB487)

The telehealth payment parity for behavioral health, LB487, — also introduced by Sen. Arch, and prioritized by the Banking, Commerce, and Insurance Committee — advanced this week to the third (and final) stage of debate.

The bill prohibits insurance plans which provide mental health coverage from limiting access to telehealth services for treatment of mental health conditions. It also requires such plans to reimburse telehealth or telemonitoring services at the same or comparable rate of the same service provided in-person.

Crisis Hotline Bill (LB247)

Lawmakers gave first-round approval to Senator Pansing Brooks’ (D-Dist. 28, Lincoln) LB247, a bill to create a task force to study the implementation of a crisis hotline in Nebraska.

The new 988 number — like 911 — will be rolled out nationwide to help individuals in crisis and lessen the burden of non-law enforcement related calls currently placed to 911. Callers to the new 988 line will be connected to a qualified mental health provider. The task force would issue a report to the Legislature by December 2021, regarding implementation plans and recommendations.

Sharing of Clinical Information Bill (LB411)

Senator Steve Lathrop’s (D-Dist. 12, La Vista) bill (LB411) to require sharing of clinical information with the health information exchange (Translation: Electronic means for healthcare providers and patients to securely access and share a patient’s vital medical data, improving speed, safety, quality, and cost of care) advanced to Select File.

The Legislature adopted a Health and Human Services Committee amendment that made changes requested by NHA and other stakeholders:

“Provides that on or before Sept. 30, 2021, certain health care facilities and health care payors shall participate in the designated health information exchange by sharing clinical information, that is clinical data captured in existing electronic health records, and such data shall be protected by HIPAA and state and federal law.”

Medical Marijuana Bill (LB474)

There is growing anticipation about the medical marijuana discussion this year in the Legislature. The Judiciary Committee voted 5-2-1 to favorably report Senator Anna Wishart’s (D-Dist. 27, Lincoln) medical marijuana bill (LB474).

A committee amendment includes changes related required medical diagnoses and continuing medical education. While this bill is being considered, Senator Wishart is circulating a petition to place the decision on the 2022 ballot.

Consumption Tax and Tax Prohibitions Amendment (LR11CA)

The Revenue Committee voted 6-2 to advance Senator Steve Erdman’s (R-Dist. 47, Bayard) priority resolution, LR11CA. LR11CA is a constitutional amendment to require enactment of a consumption tax and prohibit certain other forms of taxation.

Under this proposed amendment, effective Jan. 1, 2024, the State of Nebraska and all political subdivisions would be prohibited from imposing a tax on income, property inheritances, and estates, and a tax on sales of goods and services. The Legislature would then enact a consumption tax, which shall apply to purchases of services and new goods, except for fuel. Hospital services would be among the newly taxed items outlined in the legislative resolution.

Children’s continues to monitor over 300 legislative bills that directly or indirectly impact the overall well-being of the children in Nebraska. For more information on how you can help advocate for the needs of children or to collaborate with Children’s, please contact Liz Lyons at llyons@childrensomaha.org or 402-955-4139.

(Sources: CHA, Modern Healthcare, NHA, AHA, Nebraskalegislature.gov, Peetz & Co.)


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