Legislative Update 4/19/2021: Mental Health Services, Telehealth Bills, and Nebraska Budget

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This is the legislative update for April 19, 2021. View all updates here.



The March April 19, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

Congress

“Strengthening Kids’ Mental Health Now” Legislative Proposal

Children’s Hospital & Medical Center (Children’s) has been working closely with Children’s Hospital Association (CHA) to develop the Strengthening Kids’ Mental Health Now — a legislative proposal to improve mental health for children.

Across the country, COVID-19 has intensified the mental health stress on children and youth, highlighting the nation’s shortage of mental health services. It has also shed light on the need to reinforce and expand the pediatric mental health delivery system and infrastructure.

The bill addresses shortcomings in the current delivery system. It proposed three urgent solutions:

  1. Extend relief to the pediatric healthcare safety net — a net which was badly damaged by the effects of the pandemic. The bill proposes relief to improve access to mental health services for all children, including those facing significant health disparities.
  2. Policy action: Medicaid FMAP increase for pediatric mental health services

  3. Improve access to children’s mental health services. This will be done through more integrated and coordinated screening, care, and treatment to mitigate crisis and ensure children’s access to the “right care in the right place at the right time.”
  4. Policy action: Health Resources and Services Administration (HRSA) funding to help bridge the continuum-of-care coordination from community settings to pediatrician practices to children’s hospitals’ specialized services.

  5. Build new and different national capacity to address mental health throughout children’s development. The bill includes a greater emphasis on community-based workforce that’s focused on prevention, and building a more responsive system to help kids with mental and behavioral issues at every stage of development.
  6. Policy action: Fund expanded development of pediatric workforce, facilities and technology strengthening mental health care for children.

We hope to advance these policies amid the discussions on Capitol Hill around an infrastructure package.

Senate Confirmations

Last week, the Senate Finance Committee held confirmation hearings for:

  • Andrea Palm, President Biden’s nominee for deputy Health and Human Services (HHS) Secretary
  • Chiquita Brooks-LaSure, nominee for the Centers for Medicare and Medicaid Services (CMS) Administrator

The women promised to work with Congress on a timely implementation of the Accelerating Care for Extraordinary (ACE) Kids Act and the Accelerating Kids’ Access to Care Act. Implementation is currently slated for January 2022.

Additionally, they were asked about child-related health topics, including:

  • Children’s Health Graduate Medical Education (CHGME) prioritization
  • Support for telehealth
  • The concerning state of children’s and adult’s mental health due to COVID-19
  • The need to ensure the 340B program is working as it should per the statute

Further steps in the confirmation process for Ms. Palm and Ms. Brooks-LaSure have not been scheduled, but they will appear before the Senate Health Education Labor and Pensions (HELP) Committee for confirmation before a Senate vote can be held.

Medicaid Waiver

Centers for Medicare & Medicaid Services (CMS) approved the first section of the 1115 Medicaid waiver. The waiver extends postpartum Medicaid coverage from 60 days to 12 months in Illinois. It also allows the state to provide Medicaid state plan benefits to postpartum women whose incomes are up to 208% of the federal poverty level.

This comes at a time in Nebraska where state Senator Machaela Cavanaugh (D-Dist. 6, Omaha) offered a bill (LB416) to address implicit bias training and postpartum coverage for mothers. The difficulty with proposals like LB416 is talking through the $24 million fiscal note (Translation: a written estimate of costs, savings, and revenue gains or losses that could result once a bill is implemented) each year of the biennium (next two years). It is unlikely that this bill will pass this year.

State Updates

Nebraska Legislature

Advancement of Telehealth Bills

Telehealth bills are currently awaiting Governor Ricketts’ approval.

LB400 proposes making permanent some of the relaxations that were put in place during the pandemic. These include:

  • Flexibility in the originating site of the appointment (meaning patients can receive services at home or in a clinic/hospital setting)
  • Allowance for audio-only behavioral health services
  • Allowance for verbal consent instead of written consent (but written consent is needed within 10 days of the verbal consent)

LB487 offers parity for reimbursement for telehealth services (Translation: Mandates that fully-insured private plans reimburse and cover telehealth services equally to how they would do so for in-person visits). It also prohibits any health insurance plan to establish a rate, term, or condition that would put a greater financial burden on an uninsured patient for accessing mental health treatment via telehealth or telemonitoring services.

These bills will become effective 90 days following the date that the Governor signs them into law.

Nebraska Budget

Nebraska lawmakers will reconvene on Tuesday (April 20) for the third and final round of debate on the mainline budget bill (LB380) before it goes to Governor Ricketts’ desk for his signature.

The two-year budget holds growth to a minilar 1.7% increase, which is an attractive rate to a conservative governor. However, it does make some significant adjustments to Governor Ricketts’ original proposed budget, including:

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

Governor Ricketts has line item veto authority, meaning he could pick the budget apart if he disagrees with any of the modifications to his proposed budget.

Once the budget has been signed into law, the Legislature will have approximately $211.3 million available for all other bills with a fiscal note (although March’s revenue receipts increased by $57 million, or 18.6%, above the certified forecast).

The Nebraska economy is outperforming many early expectations. Receiving additional federal COVID-19 relief funds will continue to help.

The Nebraska Economic Forecasting Advisory Board will meet for the second time this year on April 29th to further revise its certified forecast, likely offering an additional increase in the revenue projections.

Tax Proposals

Next week (week of April 26) will be the main event for the Revenue Committee, as there are major tax proposals on their agenda.

One proposal we are monitoring is 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,Congress.gov, Nebraskalegislature.gov, Nebraska Department of Revenue, Peetz & Co.)

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