Transcript Be an Information Source Make a Specific “Ask”

2016 Legislative Day Webinar
Thursday, February 11, 2016
Participant Instructions
• Dial the telephone number posted on your computer screen to
listen to the audio portion of today’s webinar or listen through
your computer speakers. Telephone lines are muted.
• If you would like to ask a question of the presenter, or post a
comment any time during today’s webinar, please use the chat
feature on your computer screen. To use the chat feature, go to
the “chat” box. From the dropdown list, choose whether you
want to send your question or comment to a specific person, to
all of the presenters, or to all of the participants. Once you’ve
made that determination, simply type your question or comment
in the “chat” box, and click “send.”
Today’s Presenters
• Janet Seelhoff, Nebraska Home Care Association Executive
Director
• Lana Wood, APRN, Nebraska Home Care Association
President and Government Affairs/Reimbursement
Committee Chair – Director of Patient Care at FirstCare
Home Health of Eastern Nebraska in Lincoln
How a Bill Becomes a Law
• Be a Citizen Advocate
• Development and Process of
Legislative Bills
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Legislative Committees
General File
Select File
Final Reading
Governor’s Approval
Veto
Who is My State Senator?
Tips for Talking with Senators
• Remember that they are people too and they want to talk to you.
• Be polite/respectful even if their opinion differs from your own. “Agree to
Disagree.”
• Tell stories about how what you do impacts your patients every day. Tie in
current Legislation when applicable to help Senators understand how a
new bill may or may not impact what you do.
• If Senators start talking on tangents, politely re-direct them by say
something like, “Senator that is really interesting, but what I would really
like to discuss is…..”
• Smile and be happy that you are meeting with them.
• Ask the senator if they have a loved one, friend or someone else they
know who has home care services
• Success stories – how patients’ quality of life has improved; savings to the
state
• Invite the senator on a home care visit to experience firsthand the services
being provided to constituents (members will need to follow up with
senator’s scheduler).
Lobbying Tips
• Be an Information Source
• Make a Specific “Ask”
• Know the Opposition
• Make your Connections Known
Nowka & Edwards monitors bills
that affect:
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Your licensure
How you are reimbursed
Home and community-based services
Patient populations (home health, hospice, private duty)
Changes to the tax code ( both negative and positive) that can
affect home care and hospice providers or those you serve
• Each week a list of bills is being monitored. Their status in the
legislative process is posted on the Nebraska Home Care
Association website in the advocacy section - members only
area. Email updates are sent to the membership when the
association submits a letter or testifies at a specific hearing.
Nebraska Home Care
Association Submitted Letters
• LB698 – Adopt the Home Care Consumers Bill of Rights Act. This bill
is intended to protect the rights of individuals who receive in home
personal care services. This was a recommendation of the
Legislature's Aging Nebraskans Task Force and would help ensure
the consumer's right to participate in the approval of services and
any changes to service, the right to refuse service, information on
rights and responsibilities in the agreement between the consumer
and the provider of services, freedom of choice of service providers,
and freedom from exploitation.
Companies or individuals found not providing the information
required by LB 698 to consumers receiving in home personal care
services would be in violation of the Home Care Consumer Bill of
Rights, and would be subject to a civil penalty of $100 up to $1000
for each.
Nebraska Home Care
Association Submitted Letters
• LB849 – Adopt the Assisting Caregiver Transitions Act – to facilitate
caregiver transitions when a patient leaves a hospital following a
hospital stay. Under the bill, a patient or patient’s legal guardian will
have the opportunity to designate a caregiver upon admission to
the hospital. If a patient chooses to designate a caregiver, the
hospital shall notify the caregiver of the patient’s discharge or
transfer as soon as practicable which may be after the physician
issues a discharge or transfer order.
• As part of the discharge, the hospital shall also describe the patient’s
aftercare needs post-release or transfer in the discharge plan. This
includes a description of any aftercare tasks as well as a
demonstration of the aftercare tasks. The hospital shall also provide
an opportunity for the caregiver to ask any questions about the
aftercare tasks as part of the discharge planning process.
Bills that the Nebraska Home
Care Association Supports
• LB 1013: Increase tax on cigarettes and other tobacco products. Will
significantly decrease the number of new smokers, cancer deaths due
to smoking, and reduce by millions of dollars the amount spent on
smoking related health problems.
• The intended health care effect of LB 1013 is to reduce tobacco related
illness, creating a long-term reduction in Medicaid costs for treatment of
heart disease, lung disease and cancers caused by smoking and tobacco use.
• The bill proposes to raise the cigarette excise tax by $1.50 from the current
64 cents to $2.14 per pack of twenty cigarettes. It would also raise the
wholesale excise tax on other tobacco products by 11% from the current
20% to 31%.
• The revenue generated by the increase in cigarette excise tax would be
directed as follows:
• $45 Million to the Property Tax Relief Fund
• $45 Million to the Department of Revenue to be used to reimburse tax payers for
a personal property tax exemption of up to $25,000
• An additional $30 Million to the Health Care Cash Fund to be appropriated to a
variety of public health programs
Bills that the Nebraska Home
Care Association Supports:
• LB1007: Change and provide provisions relating to protection of vulnerable
adults and senior adults. The bill also eliminates the statute of limitations for
knowing and intentional abuse, neglect, or exploitation of a vulnerable adult.
• 3 Proposed Definition Changes:
1. Definition of exploitation to include the wrongful or unauthorized taking,
withholding, appropriation, conversion, control or use of money,
funds, securities, assets, or any other property of a vulnerable adult or senior adult
by any person by means of undue influence, breach of a fiduciary relationship,
deception, extortion, intimidation, force or threat of force, isolation, or any unlawful
means or by the breach of a fiduciary duty by the guardian, conservator, agent under
a power of attorney, trustee, or any other fiduciary of a vulnerable adult or senior
adult.
2. Adds isolation needs to the statutes for reasons to investigate cases of exploitation
of vulnerable adults and senior adults.
3. Adds the term senior adult, which is defined as any person sixty-five years of age
or older. Currently, in cases of abuse, neglect, or exploitation of adults, law
enforcement and DHHS workers have to prove vulnerability, which is very difficult
due to the high burden of proof. By treating every adult 65 years and older as
vulnerable, prosecutors will have the tool they need to prove vulnerability in cases of
exploitation.
Bills the Nebraska Home Care
Association Supports:
• LB869: Require that certain providers under the Medical
Assistance Act be subject to a national criminal history record
information check
• This would impact personal assistance and CHORE services.
• Any provider with high risk level as determined by CMS or the
Medicaid Assistance Program will be subject to a fingerprintbased criminal history record information check.
• An individual, or any individual with at least a 5% direct or
indirect ownership interest in any provider will be required to
submit fingerprints to the Nebraska State Patrol. The Nebraska
State Patrol will submit fingerprints to the Federal Bureau of
Investigation (FBI) for a federal search.
Bills the Nebraska Home Care
Association Supports:
• LB923: Appropriate funds for federally qualified health centers – the Legislature
would appropriate $5 million in general funds for FY2016-17 for individuals
currently receiving services, as well as those on waiting lists.
Nebraska has 7 federally qualified health centers that are nonprofit, communitybased organizations that provide comprehensive, high-quality primary care and
preventive care, including medical, dental, behavioral health, and pharmacy
services and support services to Nebraskans. Federally qualified health centers
are safety-net health care providers that serve low-income families, members of
racial and ethnic minority groups, the uninsured, and rural residents. In 2014,
federally qualified health centers served over 69,000 patients in Nebraska, of
which 68% were of a racial or ethnic minority, 91% percent had family incomes
at or below 200% of the federal poverty level, 50% were uninsured and 29%
were covered by the medical assistance program.
Federally qualified health centers allow low-income medically underserved
Nebraskans access to health care and to establish a medical home and currently do
not have the capacity to meet the demand of this population. Investing in health
services for low-income medically underserved Nebraskans saves health care dollars
in the long term and ensures that low-income workers can continue to support their
families and contribute to society.
Bills the Nebraska Home Care
Association Supports:
• LB471: Change prescription drug monitoring provisions and
create the Veterinary Prescription Monitoring Program Task
Force
• Appropriates $500,000 for FY2015-16 to the Department of
Health and Human Services for implementation
• This bill would require pharmacists to enter prescriptions of all
controlled substances in a system, including those for patients
paying cash or relying on a third party for payment.
• The intent is to prevent the misuse of controlled substances
that are prescribed in an efficient and cost-effective manner
and allow doctors and pharmacists to monitor the care and
treatment of patients for whom such a prescription drug is
prescribed to ensure that such prescription drugs are used for
medically appropriate purposes.
Bills the Nebraska Home Care
Association is Monitoring:
• LB952: Require availability of emergency medical services and
change membership of the Board of Emergency Medical
Services
• Impacts services in rural areas in particular
• Beginning January 1, 2017, each county board would be
responsible to ensure that emergency medical services are
available to the residents in the county. The county can
coordinate with any or all of the following: rural or suburban
fire protection districts, hospital authority, city, village or
private entity that is able to provide emergency medical
services.
• The bill also outlines who is eligible to serve on the governing
board.
Bills the Nebraska Home Care
Association is Monitoring:
• LB953: Provide protection for qualified adults from financial
exploitation
• Establishes a process where a financial advisor who suspects
that attempted financial exploitation of a senior may be
occurring may notify the firm of the suspected financial
exploitation. If the firm suspects financial exploitation, it may
temporarily refuse to execute the client's requested financial
transaction and notify the appropriate agencies.
Bills the Nebraska Home Care
Association is Monitoring:
• LB956: Provide for deficit appropriations
• This is the mid-year 2015-17 biennium budget adjustments
bill. The state is facing a deficit. At this point, the association
isn’t anticipating that the legislature would make any cuts that
impact home care providers, but it’s important to monitor this
bill and respond if that should be the case.
Bills the Nebraska Home Care
Association is Monitoring:
• LB1032: Adopt the Transitional Health Insurance Program Act
and provide duties for the Department of Health and Human
Services
• The intent of this bill is to provide access to healthcare
insurance benefits for Nebraskans who are not eligible for
Medicaid and are not provided with employer-sponsored
insurance plans.
Bills the Nebraska Home Care
Association is Monitoring:
• LB1033:Create an advisory committee relating to persons with
disabilities within the Department of Health and Human
Services
• The state of Nebraska must develop a plan necessary to meet
the integration mandate of the Americans with Disabilities Act
as a result of the U.S. Supreme Court's Olmstead v. L.C.
decision. The bill directs the Department of Health and Human
Services to consult with other agencies that administer
programs serving people with disabilities, and create a
stakeholder advisory committee to assist in the creation of a
strategic comprehensive plan to address community-based
service needs of Nebraskans with disabilities. The Department
of Health and Human Services must complete a strategic plan
by December 15, 2018 to place individuals with disabilities in
integrated community-based service settings.
Bills the Nebraska Home Care
Association is Monitoring:
• LB1095: Require employer identification numbers and the use of the
federal immigration verification system
• Every employer making payment of any wages subject to
withholding must register with the Tax Commissioner, and will be
assigned an employer identification number. Registration must be
renewed annually.
• Beginning January 1, 2017, every employer required to register with
the Tax Commissioner must register with and use the federal
immigration verification system to determine the work eligibility
status of new employees subject to withholding and physically
performing services within the State of Nebraska. After making an
offer of employment which has been accepted by an employee, the
employer must determine the employee's work eligibility status
pursuant to federal law or regulations. Employers shall not
knowingly employ an unauthorized alien.
Bills the Nebraska Home Care
Association is Monitoring:
• LB1043: Create a palliative care program and advisory council
for the Health Care Facility Licensure Act
• This bill would require the Nebraska Department of Health
and Human Services to establish a Palliative Care Consumer
and Professional Information and Education Program. A
council would be formed to oversee the program.
• Continuing education opportunities regarding palliative care
for health care professionals would include: Delivery of
palliative care in the home and in primary, secondary, and
tertiary; Best practices in palliative care delivery; Educational
materials for consumers of palliative care; and Referral
information for hospice and palliative care.
Bills the Nebraska Home Care
Association is Monitoring:
• LB1056: Adopt the Patient Choice at End of Life Act
• Individuals would be able to determine – to some extent –
how they wish to die.
Home Care vs. Home Health
• Do senators and the general public understand the differences
between home care and home health?
• Emphasize what we do and our extensive training to provide
highly skilled, quality care to patients with a variety of
healthcare needs including those with complex, long-term
care. Explain why it’s important to protect our scope of
practice.
Why are our services needed?
• Talk about that home health agencies, hospice providers and home
care companies help Nebraskans save a significant amount of money
by preventing emergency room stays and re-hospitalization.
• Home care is the most economical healthcare choice. Share
examples of services your agency provides, including telehealth if
applicable.
• We reduce long-term care costs through our expertise, and keep
people in the safety and comfort of their home where they want to
be.
• We help constituents have improved quality of life and increased
independence.
• Share examples of how your agency has helped patients’ improve
their health and quality of life.
Nebraska Home Care
Association Legislative Day
Nebraska Home Care
Association Legislative Day
Logistics
National Association for Home
Care & Hospice (NAHC)
Legislative Action Center