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                     LEGISLATIVE BILL 958
                    Approved by the Governor April 16, 2026
Introduced by Cavanaugh, M., 6; Conrad, 46; Rountree, 3; Dungan, 26.
A BILL FOR AN ACT relating to public health and welfare; to amend sections
     68-901, 68-908, 68-9,106, 68-9,107, and 68-1215, Revised Statutes
     Cumulative Supplement, 2024, and section 68-9,109, Revised Statutes
     Supplement, 2025; to provide for implementation of a home and community-
     based services waiver under the Medical Assistance Act; to provide for
     retroactive coverage of certain benefits under the Medical Assistance Act;
     to change reporting requirements under the Medical Assistance Act; to
     provide for reimbursement of doula services under the Medical Assistance
     Act; to change provisions relating to the Nebraska Prenatal Plus Program;
     to provide limits for crisis assistance payments under the low-income home
     energy assistance program; to harmonize provisions; to provide operative
     dates; to repeal the original sections; and to declare an emergency.
Be it enacted by the people of the State of Nebraska,
     Section 1. Section 68-901, Revised Statutes Cumulative Supplement, 2024,
is amended to read:
     68-901 Sections 68-901 to 68-9,111 and sections 2 and 4 of this act shall
be known and may be cited as the Medical Assistance Act.
     Sec. 2. (1) For purposes of this section:
     (a) Assessment tool means any standardized instrument, including the
InterRai assessment system or successor tools, used by the department to
evaluate functional eligibility, service needs, or service tier assignments for
medicaid or home and community-based services waiver participants;
     (b) Clinical interviewing means a type of directed conversation applied in
a variety of contexts, including assessment and treatment planning for persons
applying for, or receiving, services under the medical assistance program or a
home and community-based services waiver authorized under section 1915(c) of
the federal Social Security Act, as amended. Clinical interviewing may include
the use of standard assessment materials but allows the interviewer, based on
training and patient responses, to determine the questions to ask, clarify
ambiguities, and adapt the questions to the patient's comprehension in order to
enhance understanding; and
     (c) Waiver participant means an individual applying for, or receiving,
services under a home and community-based services waiver authorized under
section 1915(c) of the federal Social Security Act, as amended.
     (2) The department shall ensure that all employees and contractors who
administer or utilize assessment tools for waiver participants receive training
in clinical interviewing techniques. Such training shall include, but not be
limited to:
     (a) Proper administration of assessment tools;
     (b)   Techniques   for  adapting   questions  to  the   comprehension   and
communication needs of the individual being assessed;
     (c) Methods for clarifying ambiguous or incomplete responses; and
     (d) Procedures that ensure accurate and complete assessment results.
     (3) The department shall communicate eligibility determinations, service
tier assignments, and service hour determinations to a waiver participant, or a
parent or legal guardian of a waiver participant, in a timely, clear, and
specific manner. Such communication shall include:
     (a) A complete explanation of the assigned service tier and eligibility
determination;
     (b) A clear and precise explanation of the assessment tool results; and
     (c) Information regarding the right to appeal the determination.
     (4)(a) Services authorized under a waiver shall be based upon
individualized assessments of medical necessity, functional need, and health
and safety requirements, as determined through the person-centered planning
process in accordance with federal home and community-based services waiver
regulations.
     (b) The department shall ensure that services are sufficient in amount,
duration, and scope to reasonably serve the needs of participants and prevent
unnecessary institutionalization, hospitalization, or risk of serious harm.
     (c) Nothing in this section shall be construed to limit the state's
obligation    to   comply   with   federal   medicaid  requirements    governing
comparability, reasonable standards, and protection of the health and welfare
of waiver participants.
     (5) If a determination results in a reduction of a waiver participant's
service tier, authorized service hours, or service provision, the department
shall conduct an immediate supervisory review of the assessment and
determination prior to final implementation of the reduction.
     (6) No later than August 1, 2026, and August 1, 2027, the department shall
submit a report electronically to the Legislative Oversight Committee of the
Legislature, the Health and Human Services Committee of the Legislature, and
the office of the Public Counsel regarding the implementation and use of
assessment tools for waiver participants. The report shall only apply to the
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developmental disability waiver using intermediate level of care criteria and
shall include, but not be limited to:
     (a) The metrics used in the assessment tools;
     (b) An explanation of nonproprietary algorithms, case-mix methodologies,
or scoring matrices used to determine eligibility or service tiers;
     (c) The number and percentage of waiver participants whose service tiers
remained the same, increased, or decreased, and the reasons for such changes;
     (d) Aggregate assessment results compared to previous years' assessments
and service tier determinations;
     (e) Any identified disparities, trends, or implementation challenges;
     (f) Any other information necessary to evaluate the effectiveness,
accuracy, and fairness of the assessment tools;
     (g) The ways in which the department is complying with the federal
Ensuring Access to Medicaid Final Rule, including requirements related to
grievance procedures, critical incident reporting, and appeal processes for
waiver participants; and
     (h) The procedures implemented by medicaid managed care contractors
relating   to   grievances,  critical   incidents,  and   appeals   for  waiver
participants.
     Sec. 3. Section 68-908, Revised Statutes Cumulative Supplement, 2024, is
amended to read:
     68-908 (1) The department shall administer the medical assistance program.
     (2) The department may (a) enter into contracts and interagency
agreements, (b) adopt and promulgate rules and regulations, (c) adopt fee
schedules, (d) apply for and implement waivers and managed care plans for
services for eligible recipients, including services under the Nebraska
Behavioral Health Services Act, and (e) perform such other activities as
necessary and appropriate to carry out its duties under the Medical Assistance
Act. A covered item or service as described in section 68-911 that is furnished
through a school-based health center, furnished by a provider, and furnished
under a managed care plan pursuant to a waiver does not require prior
consultation or referral by a patient's primary care physician to be covered.
Any federally qualified health center providing services as a sponsoring
facility of a school-based health center shall be reimbursed for such services
provided at a school-based health center at the federally qualified health
center reimbursement rate.
     (3) The department shall maintain the confidentiality of information
regarding applicants for or recipients of medical assistance and such
information shall only be used for purposes related to administration of the
medical assistance program and the provision of such assistance or as otherwise
permitted by federal law.
     (4) The department shall provide the maximum amount of retroactive
coverage for each medical assistance eligibility category as permitted by
section 71112 of the federal One Big Beautiful Bill Act, Public Law 119-21, as
such section existed on January 1, 2026.
     (5) (4) The department shall prepare an annual summary and analysis of the
medical assistance program for legislative and public review. The department
shall submit a report of such summary and analysis to the Governor and the
Legislature electronically no later than December 1 of each year. The annual
summary shall include, but not be limited to:
     (a) The number and percentage of applications approved and denied;
     (b) The number of eligibility determinations, including the number and
percentage of those individuals remaining enrolled, terminations, and other
determinations;
     (c) The number of case closures in the medical assistance program and the
Children's Health Insurance Program and the specific reason for the closure
broken down by (i) eligibility category, including program type, (ii) local
public health district or other geographic area, and (iii) race or ethnicity,
if available;
     (d) The number of medical assistance program and Children's Health
Insurance Program enrollees broken down by (i) eligibility category, including
program type, (ii) local public health district or other geographic area, and
(iii) race or ethnicity, if available;
     (e) The number and percentage of redeterminations or renewals processed ex
parte, broken down by (i) eligibility category, including program type and (ii)
race or ethnicity, if available;
     (f) The average number of days required to process applications for the
medical assistance program and Children's Health Insurance Program, separating
the data by applicants with modified adjusted gross income and nonmodified
adjusted gross income eligibility;
     (g) The rate of re-enrollment within ninety days of termination and within
twelve months of termination, broken down by (i) eligibility category,
including program type, (ii) local public health district or other geographic
area, and (iii) race or ethnicity, if available;
     (h) The average client call duration;
     (i) The client call abandonment rate;
     (j) The number of requests for a fair hearing separated by (i) eligibility
category and program type, (ii) outcome, and (iii) amount of time until final
disposition; and
     (k) A link to the medical assistance program fair hearing decisions that
have been redacted to protect private and health information, which shall be
posted on the department's website; .
     (l) The status of community engagement requirements, including:
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     (i) A description of the plans to implement community engagement
requirements for medicaid recipients, including the authority and effective
date for the requirements and the recipients subject to the requirements;
     (ii) The number of denied applications and renewals for failure to meet
community engagement requirements;
     (iii) The number of applications and renewals denied because the community
engagement requirement verification could not be completed;
     (iv) The number of applications and renewals which required the recipient
to submit additional information relating to compliance with community
engagement requirements;
     (v) The number of applications and renewals approved because the
applications and renewals received an exemption, the type of exemption, whether
or not the exemption was applied automatically, and whether or not the
recipient was required to take action to receive the exemption;
     (vi) The number of applications and renewals approved because the
applications and renewals complied with the community engagement requirement,
disaggregated by the compliance activity type, whether or not compliance was
determined automatically, and whether or not the recipient was required to take
further action in order to be approved;
     (vii) The number of applications and renewals denied or terminated due to
a failure to meet community engagement requirements in which the recipient was
re-enrolled within ninety days and the number of such applications and renewals
in which the recipient was re-enrolled within twelve months;
     (viii) A list of data sources the department uses to verify compliance or
exemption status; and
     (ix) A list of external vendors contracted by the state to assess
compliance with, or exemption from, community engagement requirements,
including a link to each vendor's current contract;
     (m) The number of identified cases of concurrent enrollment and external
vendors contracted by the state to identify concurrent enrollees, including a
link to each vendor's contract. For cases terminated for concurrent enrollment,
the rate of re-enrollment within ninety days after the date of termination and
the rate of re-enrollment within twelve months after the date of termination;
and
     (n) A description of cost sharing, premiums, copays, and deductibles for
goods and services provided under the medical assistance program, including (i)
the amounts of the cost sharing, premiums, copays, and deductibles and (ii) the
payment source for collected cost sharing.
     Sec. 4.   (1) The Legislature finds that: (a) Doula services have been
proven to reduce the cost of birthing and improve outcomes for mothers and
infants; (b) one of the most effective services to improve labor and delivery
outcomes is the continuous presence of support personnel such as a doula; and
(c) support from a doula is associated with lower cesarean rates, as well as
fewer obstetric interventions, fewer complications, less pain medication,
shorter labor hours, and higher Apgar scores for infants.
     (2) No later than January 1, 2029, the department shall reimburse a
provider for doula services. Such reimbursement shall be paid by state funds at
rates determined by the department. The department shall submit a state plan
amendment, if necessary, to provide for reimbursement of doula services.
     (3)(a) The department shall establish a work group of stakeholders and
experts to develop an implementation plan, including appropriate reimbursement
rates and appropriate training, certification, or experience requirements for
doula services. The work group shall submit the implementation plan to the
department no later than January 1, 2027.
     (b) The work group shall be comprised of the following: (i) Thirty percent
of the members shall represent the doula profession; (ii) thirty percent of the
members shall represent communities of color disproportionately impacted by
poor birth outcomes; (iii) ten percent of the members shall represent rural
Nebraska; and (iv) ten percent of the members shall have utilized doula
services.
     (c) Additional members of the work group shall include, but not be limited
to:   (i)  Medical   providers;   (ii)  public   health   professionals;  (iii)
representatives of tribal organizations; and (iv) community advocates.
     (4)(a) For purposes of this section, doula means a trained professional
who provides emotional, physical, and informational support for individuals
before, during, and after labor and birth. This includes, but is not limited
to, attending prenatal visits, support during delivery, and providing resources
during the postpartum period.
     (b) A doula shall have appropriate training, certification, or experience,
as determined by the implementation plan developed by the work group described
in subdivision (3)(a) of this section.
     (c) A doula shall not perform clinical or medical tasks and shall not
diagnose or treat in any modality.
     (5) It is the intent of the Legislature to fund the state portion of
reimbursement for doula services from the vital statistics subfund of the
Health and Human Services Cash Fund.
     Sec. 5. Section 68-9,106, Revised Statutes Cumulative Supplement, 2024, is
amended to read:
     68-9,106 The Nebraska Prenatal Plus Program is created within the
Department of Health and Human Services. The purpose of the Nebraska Prenatal
Plus Program is to reduce the incidence of low birth weight, pre-term birth,
and adverse birth outcomes while also addressing other lifestyle, behavioral,
and nonmedical aspects of an at-risk mother's life that may affect the health
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and well-being of the mother or the child. This program shall terminate on June
30, 2028.
     Sec. 6. Section 68-9,107, Revised Statutes Cumulative Supplement, 2024, is
amended to read:
     68-9,107 Services eligible for reimbursement for at-risk mothers under the
Nebraska Prenatal Plus Program include, but are not limited to: (1) Six or
fewer sessions of nutrition counseling; (2) psychosocial counseling and
support; (3) general client education and health promotion; (4) a minimum of
two breastfeeding support sessions; and (5) targeted case management.
     Sec. 7. Section 68-9,109, Revised Statutes Supplement, 2025, is amended to
read:
     68-9,109 The Department of Health and Human Services shall electronically
submit a report to the Legislature on or before December 15 of each year
beginning December 15, 2024, through December 15, 2034 2029, on the Nebraska
Prenatal Plus Program which includes (1) the number of mothers served, (2) the
services offered, and (3) the birth outcomes for each mother served.
     Sec. 8. Section 68-1215, Revised Statutes Cumulative Supplement, 2024, is
amended to read:
     68-1215 (1) For purposes of determining eligibility of a household for the
low-income home energy assistance program pursuant to section 68-1201 as
administered by the State of Nebraska pursuant to the federal Energy Policy Act
of 2005, 42 U.S.C. 8621 to 8630, the Department of Health and Human Services
shall apply a household total annual income level of one hundred fifty percent
of the federal poverty level published annually by the United States Department
of Health and Human Services or such successor agency which publishes the
federal poverty level.
     (2) The Department of Health and Human Services shall make crisis
assistance payments as necessary of no more than eight hundred dollars per
program year and may authorize crisis assistance payments for more than eight
hundred dollars per program year based on extenuating circumstances.
     Sec. 9. Sections 4, 5, 6, 7, 8, and 10 of this act become operative three
calendar months after the adjournment of this legislative session. The other
sections of this act become operative on their effective date.
     Sec. 10.    Original sections 68-9,106, 68-9,107, and 68-1215, Revised
Statutes Cumulative Supplement, 2024, and section 68-9,109, Revised Statutes
Supplement, 2025, are repealed.
     Sec. 11. Original sections 68-901 and 68-908, Revised Statutes Cumulative
Supplement, 2024, are repealed.
     Sec. 12. Since an emergency exists, this act takes effect when passed and
approved according to law.
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