Legislative Update 9/27/2021: Budget, mental health, report from the Inspector General of Nebraska Child Welfare

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This is the legislative update for September 27, 2021. View all updates here.



The September 27, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

In Congress

Both the Senate and the House will be in session this week.

The House Energy & Commerce (E&C) Committee held an oversight committee hearing on September 22 dedicated to the impact of COVID-19 on children.

Because this is an oversight committee, there is no specific legislation the committee will be considering, but it is a prime opportunity to inform Congress of the perfect storm pediatric providers are facing:

  • The Delta strain of COVID-19 impacting children
  • An early spike in other respiratory illnesses
  • A growing crisis in mental health
  • A serious staffing shortage across the nation

Recommendations were made by the pediatric testifiers, including the President of the American Academy of Pediatrics (AAP) and the CEO of Children’s Hospital at Vanderbilt, which emphasized existing public policy that needs to be considered, likely in the Reconciliation bill. This would include a robust increase in Children’s Hospital Graduate Medical Education (CHGME) funding to increase the pediatric pipeline and investment in pediatric mental health infrastructure, amongst others.

Budget Developments

This week, the Senate has a test vote set for Monday to keep the government funded and avert a federal debt default before Thursday’s fiscal year-end deadline. That package stands to run into a blockade by Republican senators due to the attached increase in the country’s debt ceiling — all but ensuring lawmakers will have to try again later in the week.

Last week, the House passed a Continuing Resolution (CR) that would maintain current FY 2021 spending levels through the September 30 deadline until December 3, a play used to buy more time as negotiations on the budget and all other packages (e.g. Reconciliation and Infrastructure) dominate the political divide.

The Build Back Better Act

The House committee markups are complete for the Reconciliation package — named the Build Back Better Act — and the House Budget Committee is expected (maybe this week) to build one large bill for the House to consider. The process of Reconciliation is executed to achieve simple majority passage on a package, requiring party lines to stick together to either pass or combat the advancement.

Over the last week, we have begun to hear potential cracks in the Democrats’ unity, specifically related to how to pay for the nearly $4 billion package.

The major provisions related to children’s health are:

  • A permanent extension of funding for the Children’s Health Insurance Program (CHIP)
  • Mandating that all states provide 12-month continuous eligibility to children under Medicaid
  • Extensive investments in maternal health

Helping Kids Cope Act

Not included in the Reconciliation package, but being pushed by Children’s Hospital Association (CHA) member hospital, is the Helping Kids Cope Act of 2021 (H.R. 4944). Introduced by Rep. Lisa Blunt Rochester (D-DE), this legislation addresses nearly all of our pediatric mental health priorities at Children’s.

Among the many provisions, this legislation would fund hospital initiatives via a grant including, but not limited to:

  • Increasing training, recruitment, and retention for behavioral health workforce
  • Addressing surge capacity for pediatric mental health needs
  • Expanding the use of providing behavioral health virtually
  • Establishing initiatives to decompress the emergency department
  • Improving crisis intervention services
  • Establishing a pediatric mental health urgent care
  • Expanding School-based initiatives

We have meetings this week and next to further discuss this priority with our congressional delegation and to remind them of our current request to the Nebraska Legislature to advance these same ideas at the state level.

State Updates

Nebraska Legislature

Redistricting

The Nebraska Legislature seems to have found a compromise in its efforts to redraw the political lines throughout the state. Monday is a much-needed recess day for the Legislature as they finalize their redistricting maps this week for Final Reading. The Governor is expected to have the bills on his desk this week.

Weekly Hearing Schedule

Next week will be an extremely heavy lift in the Nebraska Legislature as the following interim study hearings are scheduled:

Tuesday, October 5

  • LR178, Senator Wishart: Interim study to solicit input from Nebraskans regarding funds from the federal American Rescue Plan Act (ARPA) of 2021.
    • Children’s will formally submit our ARPA funding requests and will be included in other stakeholder’s testimonies as we highlight our highly collaborative efforts to make the most of every available dollar.
  • LR179, Senator Cavanaugh: Interim study to examine funding mechanisms in the American Rescue Plan Act of 2021.
    • Likely will be a joint hearing with Senator Wishart who is the Vice Chair of the Appropriations Committee.
  • LR213, Senator Day: Interim study to examine the mental and behavioral health needs of Nebraska students and the role of school psychologists.
    • Working with Senator Day on both of her requests as she highlights this opportunity.
  • LR149, Senator Day: Interim study to examine the potential for statewide early childhood autism spectrum disorder screening.

Wednesday, October 6

  • LR209, Senator McDonnell: Interim study to examine the appropriations necessary for creating public health crisis zones.
  • LR210, Senator McKinney: Interim study to examine poverty and incarceration and the appropriations necessary to reduce both.
  • LR212, Senator McDonnell: Interim study to examine the health care workforce shortage in Nebraska.
    • Getting Children’s figures to Senator McDonnell and associations asked to testify.

Friday, October 8

  • A hearing for the Eastern Service Area Contract (St. Francis Ministries) Special Investigative and Oversight Committee and the Health and Human Services Committee
    • This hearing is for the Department only. We will be monitoring their feedback from the August hearing where the public testified.

You can livestream the public hearings and live debate at www.nebraskalegislature.gov.

Nebraska Department of Health and Human Services (DHHS)

Amplifying the upcoming October 8 hearing, even more, was a report last Thursday from the Inspector General of Nebraska Child Welfare, Jennifer Carter. Carter officially made the recommendation for the Nebraska Department of Health and Human Services (DHHS) to end its contract with St. Francis Ministries.

The report outlined the multiple times St. Francis was unable to meet key terms of their contract with the State over the course of two years.

Specific examples included:

  • Caseload volume for case managers
  • Failure to meet monthly with children in foster care
  • Failure to document case plans within 60 days

Carter also recommends the 12-year experiment to privatize child welfare services for the eastern service area should be concluded, “yielding no measurable improvement and demonstrated unacceptable risk.”

Dannette Smith, the CEO of HHS, and William Clark, interim president and CEO of St. Francis, have rejected the report and their recommendations.

The special investigative committee of the Legislature will meet for a hearing on October 8 where they are charged with determining the best path forward for child welfare in Nebraska.

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

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