Health Care Highlights: Bills Introduced in the 2024 Nebraska Legislative Session
The 108th Nebraska Legislature convened for the 2024 session on January 3, 2024. On the first day alone, over eighty bills were introduced. The bill introduction period concluded on January 17, 2024 and over 500 new bills were introduced, which is an ambitious attempt by the Legislature to address myriad issues despite the fact that hundreds of bills were carried over from the 2023 session. Of the new bills introduced this year, almost fifty are related to health care services, treatment, providers, and practitioners.
Reimbursement Rates and Coverage
Notable legislation includes LB 1087 (Jacobson), the Hospital Quality Assurance and Access Assessment Act, which aims to make it possible for the state to bring in more federal Medicaid money for hospitals by increasing reimbursement rates from approximately 80% of the costs to over 90% of actual costs for inpatient and outpatient hospital care. The increase in reimbursement rates would not apply to physician charges or clinics. Under LB 1087, hospitals in Nebraska would pay an assessment of up to 6% of net patient revenue, which would be added to existing state dollars and used to match federal Medicaid dollars. Forty-four (44) other states, including Iowa, have passed similar legislation.
Several other bills were introduced to expand Medicaid coverage for certain services and items, including: colorectal cancer screenings, lung cancer screenings, obesity treatment, doula and full spectrum doula services, continuous glucose monitors, electric breast pumps, lactation consultations, and provide Medicaid coverage for aged, blind and disabled individuals who are eligible for the federal social security income program. Conversely, one bill seeks to limit DME supplier reimbursements under Medicare supplemental insurance.
340B Program and Pharmacy
Also of note, LB 984 (Hardin) would prohibit a manufacturer or wholesale distributor of drugs from interfering with the efforts of a contract 340B pharmacy to acquire or receive delivery of 340B drugs ordered by a 340B entity. The bill contemplates giving the Attorney General the ability to seek an injunction against any person who attempts such an interference. In addition to addressing the current struggles with the 340B program, there are numerous other bills that relate to the licensure and regulation of pharmacies, pharmacists, and related practitioners. LB 1138 (Riepe) would amend the Uniform Credentialing Act to exempt prescribers who issue less than fifty prescriptions per calendar year. LB 1171 (Hardin) would change the verification requirements for pharmacy technicians, while LB 1196 (Ballard) seeks to allow registered nursing students enrolled in an accredited nursing program to be medication aides upon satisfying certain requisites. Likewise, LB 1181 (Ballard) desires to lower the minimum age for a pharmacy intern to seventeen years old, while also proposing changes to inventory requirements, self-inspection, and prescription changes by a pharmacist for a Schedule II controlled substance upon consultation with the prescribing provider. LB 833 (Blood) proposes adoption of the Prescription Drug Affordability Act, and LB 990 (Bostar) makes a handful of amendments to the Pharmacy Benefit Manager Licensure and Regulation Act to remove restrictions on how retail community pharmacies dispense and deliver prescription drugs. LB 917 (Wayne) would establish a standard process for prior authorizations of prescription drugs. The rules and regulations for this process would be promulgated by the Director of Insurance, along with a form template to be used by prescribers to streamline the process.
Health Care Decisions
Another bill, LB 1168 (DeBoer), proposes adoption of the Uniform Health-Care Decisions Act for advance directive documents and health care powers of attorney. This bill stems from recent work by the Uniform Law Commission.
Health Care Practitioners
The senators introduced several bills to revise and amend requirements for various health care practitioners. Some of the early legislation focuses on compacts, which are agreements among states that simplify the interstate practice of certain professions. Legislation proposed for social workers (LB 822, Blood), physician’s assistants (LB 823, Blood), and dentists and dental hygienists (LB 824, Blood), aims to improve Nebraska’s access to such practitioners by reducing the burdens and requirements related to licensure and allowing them to obtain the privilege to practice through endorsement and reciprocity among participating states.
LB 932 (Frederickson) and LB 1130 (Raybould) would amend the Mental Health Practice Act’s provisional license requirements. Similarly, LB 834 (Blood) would provide Board-certified graduates of dental medicine and dental surgery programs the ability to obtain a temporary license to practice. Another bill seeks to expand the Rural Health Systems and Professional Incentive Act, LB 1015 (Walz), to include dentists.
Other early legislation includes LB 879 (Cavanaugh), which would repeal the Let Them Grow Act and the Preborn Child Protection Act, as well as an amendment to the Let Them Grow Act, LB 1109 (Riepe), to define “fatal fetal anomaly” and protect physicians from liability for abortions performed in those instances. LB 1060 (Hansen) would eliminate newborn screening requirements if a parent or guardian objects to such screening.
Two data privacy bills, the Data Privacy Act (LB 1294, Bostar) and the Biometric Autonomy Liberty Law (LB 954, Kauth), were introduced this year. They handle the interplay with HIPAA covered entities differently. LB 1294 includes a carve out for covered entities and business associates governed by HIPAA whereas LB 954 takes the approach of not conflicting with provisions of HIPAA. This later approach introduces some ambiguity for health care entities in trying to understand their privacy obligations. These are certainly bills to watch as they move forward.
It remains to be seen how much the Legislature can accomplish in the 2024 Session in light of the numerous bills that were carried over from the 2023 Session. Nonetheless, the Legislature has already begun its floor debates and committee hearings to determine which bills will proceed and which ones will stall, without any debate or discussion. Baird Holm will continue to monitor bills of significance as the bills move through the legislative process.