This is the legislative update for May 24, 2021. View all updates here.
- Governor Ricketts is rescinding several COVID-19-related executive orders.
- Last week, the Senate Finance Committee held a hearing to discuss which healthcare flexibilities enacted during the pandemic should become permanent.
- Under the American Rescue Plan, several federal organizations are releasing funds for grants that aim to improve children’s mental health.
- Friday, May 21 was the Nebraska Legislature’s last day to consider bills on final reading, and political divisiveness interrupted the passage of several bills that Children’s has been involved with.
The May 24, 2021 legislative update includes highlights from federal and state legislatures.
On Monday, May 24, Governor Pete Ricketts (R-NE) held his final COVID-19 press conference. He announced that Nebraska is moving forward, as he signed Executive Order (EO) 21-06, which rescinds the following executive orders:
- EO 20-09: Coronavirus Relief for Restaurants and Bar Operations
- EO 20-13: Coronavirus Accelerating Online Notary Access & Financial Institutions Regulator Flexibility
- EO 20-14: Coronavirus Emergency Unemployment Insurance Benefit Relief Part 2
- EO 20-19: Coronavirus Emergency Unemployment Insurance Benefit Relief Part 3
- EO 20-21: Continued Waiver of Motor Carrier Safety Regulations
- EO 20-22: Continued Emergency Unemployment Insurance Benefit Relief – Claims Processing
Several executive orders are still in effect until further notice:
- EO 20-10: Additional Healthcare Work Force Capacity
- EO 20-12: Relief for Hospitals and Health Care Facilities and Expanded Use of Telehealth Services
We are working with the Governor to ensure EO 20-10 and 20-12 remain in effect until at least August 28. This is when legislation goes into effect to maintain flexibilities — like LB400 which continues providing flexibilities in telehealth — after COVID-19.
Additionally, the Governor issued a directed health measure (DHM) cancelling all existing DHMs effective at 11:59pm on Monday, May 24, 2021. Without a DHM in place, individuals exposed to COVID-19 will no longer be required to quarantine or isolate.
Finally, Nebraska is joining a handful of other states by withdrawing from the federal unemployment insurance program, effective June 19, 2021.
Healthcare Flexibilities During COVID-19
Last week, Children’s covered a hearing held before the Senate Finance Committee titled, “COVID-19 Health Care Flexibilities: Perspectives, Experiences and Lessons Learned.” The hearing examined which flexibilities authorized during the COVID-19 public health emergency (PHE) — specifically flexibilities in telehealth — should be continued on a permanent basis after the PHE ends.
Senators Bob Casey (D-PA), Tom Carper (D-DE), and Maggie Hassan (D-NH), emphasized concerns that are specific to pediatrics, including:
- The behavioral health crisis among children
- The importance of telehealth in connecting children to healthcare services (including mental healthcare services)
- Care that may have lapsed during the PHE, such as vaccinations or in-person screenings
During the hearing, the committee considered components of the telehealth bill recently passed by the Nebraska Legislature (LB400). Senators took the discussions a step further to also maintain audio-only services for patients with limited proficiency in English. It was noted during the discussions that policymakers need to be conscious of potential inequities that could arise from this and cautioned against creating a two-tier system of digital care.
Some witnesses noted that payment parity for telehealth services (Translation: fully-insured private plans reimburse and cover telehealth services equally to how they would do so for in-person visits) and in Medicaid programs is important to supporting access to telehealth and mental healthcare services for children, which similarly reflects state Senator Rich Pahls’ (R-Dist. 31, Omaha) payment parity bill (LB314). This bill remains in committee and could be returned to the floor for discussion during next year’s legislative session.
Jessica Farb, witness from the Government Accountability Office (GAO), indicated the Centers for Medicare and Medicaid Services (CMS) is likely to issue additional guidance on telehealth for Medicaid programs. Farb’s testimony was also released by GAO and summarizes preliminary findings from monitoring and analysis of Medicare and Medicaid waivers.
GAO finds the waivers have likely benefited providers and patients, but comments that risks such as increased cost, fraud, and program integrity concerns should be considered when determining whether to continue flexibilities after the PHE.
Effective Aug. 27, 2021, Nebraska’s telehealth law will allow for flexibility in the originating site (where the patient is), audio-only for behavioral health services, and verbal patient consent. Surrounding states like Iowa and South Dakota are considering similar policies.
American Rescue Plan Act Grant Information
Pediatric Mental Health Care Access (PMHCA) Program
The Health Resources and Services Administration (HRSA) announced a notice of funding opportunity (Translation: a description of the project and who is eligible to apply) for states to apply for new area expansion funding for the Pediatric Mental Health Care Access (PMHCA) program.
PMHCA is a program that promotes integrating behavioral health into pediatric primary care. The funding from HRSA will expand PMHCA’s projects into new state or regional networks of pediatric mental healthcare teams. The teams will provide teleconsultation training, technical assistance, and care coordination pediatric primary care providers to diagnose, treat, and refer children with behavioral health conditions.
HRSA anticipates that up to $71.2 million will be available over five years to fund up to 32 cooperative agreements (for up to $445,000 each per year). These awards will have a five-year period of performance (Translation: the time period in which a grant recipient is expected to complete activities funded by the grant), beginning September 30, 2021. Applications are due July 6, 2021.
Substance Abuse and Mental Health Services Association Grants
The Substance Abuse and Mental Health Services Association (SAMHSA) announced $3 billion in additional funding for two block grants (Translation: annual amounts of money granted to state and local governments by the federal government to help fund specific programs or projects).
The additional funding will go to the Substance Abuse Prevention and Treatment Block Grant (SABG) program and the Community Mental Health Services Block Grant (MHBG) program. Under MHBG, $1.5 billion in funding will be distributed to states. The funding may support some efforts that are focused on helping children who have serious emotional disturbances. However, there are many constraints to the funding, blocking its use for prevention, infrastructure, and inpatient services.
Even with this funding, there is a need for additional funding tailored and directed toward children’s needs, as proposed in Strengthening Kids Access to Mental Health Now. Strengthening Kids Access to Mental Health Now is a set of legislative proposals for improving mental health that the Children’s Hospital Association developed with input from our team at Children’s.
Friday, May 21, 2021 was the last day for the Nebraska Legislature to consider bills on Final Reading (Translation: the last round of debate before bills go to Governor Ricketts for approval). Lawmakers will return to the Capitol on Wednesday and Thursday if there is a motion to override a veto from the Governor.
Many will argue this has been the most challenging legislative session yet, but COVID-19 isn’t totally to blame. There has been a divisiveness in the body unlike any before — a divisiveness that has unfortunately interrupted the passage of significant bills that Children’s has been involved with.
The two bills that suffered the greatest due to political and personal angst are:
1. LB529, the Education Committee priority bill that would have created a registry of all social workers/ healthcare professionals in each school building across the state. This would be an excellent resource for providers to better collaborate with schools on behalf of our patients and families. Additionally, among the many great provisions, the bill would have used lottery funds to afford mental and behavioral health training for teachers and administrators, and generated scholarships for children in need. Unfortunately, a group of senators tried to further extend the bill by adding an amendment allowing teachers to physically restrain students that were harming themselves or others — a bill that was previously indefinitely postponed. The bill failed to advance for cloture (Translation: the procedure used to end a debate and take a final vote) by 5 votes.
2. LB376, a bill that would have:
- Supplemented the continuum of developmental disability services and other state programming for children with disabilities
- Decreased the state’s current waiting list for home and community based services
- Offered a pathway for children with disabilities to gain access to the medical assistance program and capped long-term services and supports.
Additional Legislative Activity
The Governor is expected to publicly sign bills into law Tuesday afternoon at 2 p.m. Among the dozens of bills on his desk are:
- LB139, adopt the COVID-19 Liability Act and the Health Care Crisis Protocol Act
- LB108, extending SNAP benefits to families within 160% of the federal poverty level (FPL)
- LB322, adopt the School Safety and Security Reporting System Act
- LB26, provide a sales tax exemption for residential water service
- LB100, provide limits on provider contracts pertaining to multiple procedure payment
- LB247, create the Mental Health Crisis Hotline Task Force
- LB639, adopt the Seizure Safe Schools Act
- LB273, change provisions relating to youth rehabilitation and treatment centers and provide for immediate changes of placement
- LB388, adopt the Nebraska Broadband Bridge Act
- LB411, require sharing of information with the designated health information exchange and change provisions related to the Health Information Technology Board
- LB428, juveniles at YRTCs are to receive an appropriate education equivalent to educational opportunities offered in public schools
- LB452, adopt the Financial Literacy Act and provide graduation requirements and academic content standards
- LB485, expanding eligibility for the Child Care Subsidy Program to families less than 185% of the FPL
- LB527, change provisions relating to transition services for students with a developmental disability
- LB630, provide for a study of the efficacy of commercial air filters in classrooms
(Sources: CHA, Congress.gov, NHA, DHHS, Nebraskalegislature.gov, Peetz & Co.)