LEGISLATIVE UPDATE March 29, 2021 Liz Lyons, Director of Advocacy and Government Affairs, ext. 4139

FEDERAL Congress The House and Senate are on recess this week and next.

On March 22, Children’s Hospital Association (CHA) sent a letter to President Biden outlining children's hospitals' top policy priorities. The letter thanks the president for the work to date supporting children and families and highlights additional immediate actions needed for children, including: • Prioritizing a strong and stable Medicaid program for children • Ensuring a sustainable pediatric health care safety net by providing immediate additional relief funding for pediatric providers who are all high Medicaid providers for the nation's children • Prioritizing agency support to address our growing and tragic children's behavioral health crisis now • Supporting critical pediatric workforce training through the Children's Hospital Graduate Medical Education Program (CHGME) • Leading a strong nationally coordinated vaccine plan for children, where we have over 40 million children under the age of 12, and have yet to advance vaccines for this large group of kids.

It is necessary to consistently emphasize the different priorities of a children’s hospital priorities. Las week we focused on the disparity between Children’s Hospital Graduate Medical Education (CHGME) funding compared to adult-GME. This week, the comparison is drawn between the difference in reimbursement for Medicaid compared to Medicare given the latest action in the Senate.

Last week, the Senate passed by a 90-2 vote a bill that, among other health care provisions, would eliminate the percent across-the-board cut to all Medicare payments, known as sequestration, until the end of FY 2021. To pay for the change, the bill, which was introduced by Sens. Jeanne Shaheen, D-N.H., and Susan Collins, R-Maine, would increase the fiscal year 2030 sequester cuts. The House is expected to take up the Senate-passed bill the week of April 13 when it returns to Washington D.C. While this is important for our adult systems, this does not impact Children’s Hospital & Medical Center (Children’s) and it is important to explain that to lawmakers. When provider relief funding (PRF) is coupled with rate increases at the state or federal level, it all becomes part of the larger story.

STATE Legislature We anticipate a quiet week in the legislature (famous last words) as they head into a 4 day holiday weekend.

Last week, we anticipated the final state budget proposal to be sent to the floor, but Chairman of the Appropriations Committee Senator (R-Dist. 48, Gering) took a few days to finalize amendments related to prison funding with the Governor’s office, delaying the introduction until this week. Speaker of the Legislature (R-Dist. 21, Lincoln) announced that budget debate will likely be scheduled the week of April 5th.

Advocacy partners Nebraska Association of Behavioral Health Organizations (NABHO) have floated the idea of an additional behavioral health rate increase as an amendment during budget bills’ floor debate, however, senators were hesitant to go above the already proposed 2 percent rate increase for all Medicaid providers (including behavioral health) each year of the biennium- an expensive ($90 million) request.

Meanwhile, 15 bills have been signed into law by Governor Ricketts with another 17 on his desk awaiting a signature. Of particular interest to Children’s: • LB337- Adopt the Step Therapy Reform Act-Thursday morning the Legislature voted 43-0 to pass the Step Therapy Reform Act introduced by Senator Mark Kolterman (R-Dist. 24, Seward). The bill has been sent to the Governor who now has five days (excluding Sunday) to sign the bill. The bill will be effective 90-days after it is signed into law. • LR25- A legislative resolution introduced by the HHS Committee to provide an appointment by the Executive Board of a special committee of the Legislature to be known as the Youth Rehabilitation and Treatment Center Special Oversight Committee of the Legislature. Last week, Speaker Hilgers signed the legislative resolution after the one (and only) round of debate, a rule for resolutions as LR’s make a formal expression of opinion, intent or recognition or amend the state or federal constitution.

Amendments to be aware of: • LB390- Provide for credentials based on reciprocity and change requirements for credentials under the Uniform Credentialing Act. The Legislature advanced Senator Dave Murman’s (R-Dist. 38, Glenvil) bill which provides for credentials based on reciprocity for certain credentials under the Uniform Credentialing Act. Senator Murman introduced this bill at the request of the Governor to increase access to care by allowing licensed providers to immediately be able to practice in Nebraska.

As requested by the Nebraska Hospital Association (NHA), the HHS Committee amendment (which was adopted last week) AM447 requires applicants to establish Nebraska residency within 180 days of the issuance of the credential in order for the reciprocity benefits to continue. At the request of the Nebraska Medical Association (NMA), the committee amendment removes physicians from the credential reciprocity bill. The bill is now on Select File.

A comprehensive summary has been prepared to shed light on key bills Children’s is actively lobbying- green (likely to pass), orange (will require additional effort to advance), and red (unlikely to advance this year).

Active Public Policy Efforts for Children’s Hospital & Medical Center: • LB400 (Arch)- Change requirements for telehealth (Select File) o Parity for behavioral health reimbursement bills underway with LB487 (Select File) • LB89 (Morfeld)- Change the age of majority (In Committee) • LB247 (Pansing Brooks)- Create the Mental Health Task Force (General File) • LB322 (Williams)- Adopt the Safe2Help Hotline statewide (Select File) • LB281 (Albrecht)- Require sexual abuse training in schools (Select File) • LB166 (Geist)- Josh the Otter- Be Safe Around Water (General File) • LB87 (Morfeld)- Provide for mental health first aid training in schools (In Committee) • LB529 (Walz) - Change provisions for the distribution of lottery funds used for education, transfer powers and duties, create new acts, a bill that creates a registry of social workers in each school and also adds funds for behavioral health training and de-escalation techniques for teachers and school staff. (Select File) • LR25 (HHS)- Provide for appointment by the Executive Board of a special committee of the Legislature to be known as the Youth Rehabilitation and Treatment Center Special Oversight Committee of the Legislature (Speaker Signed, legislative resolutions only have one round of debate). • STATE BUDGET- Including a 2% increase in FY 21-22 and 2% increase in FY 22-23

Priority legislation preparing for debate: • LB474 (Wishart)- Adopt the Medical Cannabis Act • LB139 (Briese)- Adopt the COVID-19 Liability Protection Act (Slama priority bill) • LB258 (Vargas)- Adopt the Healthy and Safe Families and Workplaces Act • LB273 (Lowe)- Change provisions relating to youth rehabilitation and treatment centers • LB375 (Kolterman) - Adopt the Pharmacy Benefit Manager Regulation and Transparency Act • LB376 (M. Cavanaugh)- Authorize the application for and implementation of services and supports for developmentally disabled children and their families and provide duties for the Advisory Committee on Developmental Disabilities • LB388 (Friesen)- Adopt the Nebraska Broadband Bridge Act • LB411 (Lathrop)- Require sharing of information with the designated health information exchange • LB428 (HHS) - State that juveniles at youth rehabilitation and treatment centers are to receive an appropriate education equivalent to educational opportunities offered in public schools • LB251 (M. Cavanaugh)- Organ Tissue Donation for Minors (General File) • LB108 – (McCollister) Change provisions relating to the Supplemental Nutrition Assistance Program (General File) • LB154 (Wayne)- Require tracking of student discipline as prescribed (General File) • LB452 (McKinney) - Adopt the Financial Literacy Act • LB583 (Murman)- Require electronic prescriptions for controlled substances • LB630 (Bostar) - Provide for a study of the efficacy of commercial air filters in classrooms • LB639 (Day) - Adopt the Seizure Safe Schools Act • LR11CA (Erdman)- Constitutional amendment to require enactment of a consumption tax and prohibit certain other forms of taxation

Unlikely to advance during this legislative session: • LB30 (Wayne) - Limit the amount an insured pays for prescription insulin drugs • LB52 (Lathrop)- Provide for immunity for injury or death resulting from COVID-19 exposure • LB53 (Lathrop)- Provide immunity for health care providers acting in conformance with the crisis standard of care during a COVID-19 state of emergency • LB67 (Day) - Change provisions relating to school-based health centers under the Medical Assistance Act • LB117 (M. Cavanaugh) - Adopt the Hunger-Free Schools Act • LB447 (M. Cavanaugh)- Change requirements for immunizations in daycare facilities • LB643 (B. Hansen) - Protect an individual liberty right to accept or decline a vaccination under a mandatory directive • LB129 (McCollister)- Continuous eligibility for minors enrolled in Medicaid • LB115 (McCollister)-Impose sales tax on candy and soft drinks and provide for distribution of proceeds • LB392 (Stinner)- Adopt the Prescribing Psychologist Practice Act • LB459 (M. Cavanaugh)- Change provisions relating to the cigarette tax and the Tobacco Products Tax Act and distribute tax proceeds as prescribed

Child Health Champion Advocacy Team Please join Children’s Child Health Champion Advocacy Team every Thursday at 7:30am for a 30-minute public policy and community advocacy debrief and roundtable discussion.

Advocating for children is extremely important at all stages and this internal group of stakeholders- comprised of providers and experts across the continuum of care at Children’s- meets weekly to ensure we are leading the discussion on child advocacy in the region. If you are interested in joining the movement, contact Liz Lyons for more information.

(Sources: CHA, NHA, Nebraskalegislature.gov, DHHS.ne.gov, Peetz & Co.)