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With less than ten days left in this legislative session, the Legislature is in the midst of many controversial issues. The budget bills were given final approval this past week. If the Governor uses his authority to line-item veto funding from various programs in the budget bills, the Legislature will have the chance to decide whether to override the items vetoed by the Governor.
LB 916, which would eliminate the integrated practice agreements (IPA) for nurse practitioners, was given first-round approval this past week. In its place, a nurse practitioner would submit evidence of completion of 2,000 hours of practice or a “transition-to-practice agreement”, which requires a nurse practitioner and the supervising provider to practice collaboratively within the framework of their respective scopes of practice. I designated LB 916 as my priority bill because it enhances access to care for all Nebraskans.
Current law requires a nurse practitioner to sign an IPA agreement with a collaborating physician. However, the IPA is not working as intended. Oftentimes, nurse practitioners in rural areas of the state have difficulty securing an IPA. In some cases, physicians may charge a fee to sign the agreement, even though the nurse practitioner may never meet or speak to the physician. The difficulty in finding physicians willing to sign an IPA and the desire to practice independently has prompted nurse practitioners to move to other states. Eighteen other states allow nurse practitioners to practice without an IPA.
For over 30 years, nurse practitioners have provided high-quality, cost-effective care. Nurse practitioners currently diagnose, prescribe, and treat without supervision. Removal of the IPA will not change this, as it is currently within the nurse practitioner’s scope of practice. Collaboration is crucial to successful healthcare and it will continue to exist between nurse practitioners and other health care professionals.
Forty-eight states allow bond financing for road construction. LB 1092 would add Nebraska to the list of states allowed to borrow money to build roads. Committee amendments reduced the amount of bonding authority given to the State Highway Commission from $400 million to $200 million and specified that the interest rate could be no greater than 5%.
Proponents stressed the importance of transportation infrastructure to our state and emphasized that the ability to issue bonds will accelerate the construction of our high priority road projects. Opponents argued that it tied the hands of future legislators and pointed out that Nebraska is top-ranked for their management of finances by a well-known financial magazine, primarily due to our practice to “pay as you go” for roads projects. After eight hours of debate, the motion to invoke cloture and allow for a vote on the advancement of a bill was successful and the bill advanced to the second stage of debate on a 32-14-3 vote.
The Legislature also gave first-round approval to two bills that would increase alternatives to incarceration for nonviolent offenders in an effort to relieve prison overcrowding and avoid the necessity of building another prison. The legislation also works towards better preparing inmates for a successful re-entry into society. As amended, LB 907 would provide funding for vocational and life skills programs within prisons, would expand a successful alternative to prison program for drug offenders, and would expand services for mentally ill inmates and those newly released. The bill also creates a prison reform task force to work with the Council of State Governments, who has successfully helped other states with prison reform. Finally, it would appropriate funding to UNO to continue their work with CSG. LB 999 would appropriate funding to study the feasibility of adding more behavioral health treatment beds.
If you would like to inform me of your opinions on legislation during the final two weeks of this legislative session, I can be reached at District #1, P.O. Box 94604, State Capitol, Lincoln, NE 68509. My telephone number is (402) 471-2733 and my email address is firstname.lastname@example.org.
This past week marked the deadline for priority bill designation. Every senator is allowed to designate one bill as a priority bill, every committee can designate two bills, and the speaker is authorized to choose up to twenty-five bills as speaker priority bills. Typically after the deadline date, only bills with priority status are debated by the Legislature.
Topics of bills chosen as priorities include proposals to lower income taxes, reduce the valuation of agricultural land, authorize the issuance of highway construction bonds, restructure the process used when releasing inmates from prison, and to expand Medicaid to newly eligible adults with incomes below 138% of the federal poverty level. A priority designation does not assure that a bill will advance from committee, meaning that some of the bills designated as priority bills may not be debated by the Legislature.
I designated LB 916 as my priority bill. LB 916, which was introduced by Bellevue Senator Sue Crawford, would eliminate the integrated practice agreement (IPA) between a nurse practitioner and a physician. Under the 407 review process, which studies proposals for change in scope of practice for health professionals, both the Technical Review Board and the State Board of Health supported this proposal for nurse practitioners. As a member of the Health and Human Services Committee, I heard about the difficulties nurse practitioners face in securing an IPA, particularly in rural communities.
LB 916, as amended by committee amendments, requires that in order to practice as a nurse practitioner, such person shall submit a “transition-to-practice agreement” or evidence of completion of 2,000 hours of practice. Under the “transition-to-practice agreement”, a nurse practitioner and the supervising provider shall practice collaboratively within the framework of their respective scopes of practice. A supervising provider could be a physician or a nurse practitioner with 10,000 hours of practice.
Nurse practitioners have full practice authority in nineteen states, including neighboring Iowa, Colorado, and Wyoming. Kansas currently has a collaborative agreement for the first year of practice, similar to what is proposed in the amended version of LB 916.
I believe that nurse practitioners are providing safe and effective health care and that they will continue to consult with other professionals when needed. I also believe that this change will help alleviate the current health care shortage problem that many rural areas of the state are experiencing.
The public hearings were held before the Appropriations Committee this past week on LB 1046, which would appropriate $50 million annually in general funds for water projects, and LB 940, which proposes a one-time transfer of $50 million from the cash reserve to fund projects this first year. Many testifiers expressed their support for the bills and stressed the importance of achieving water sustainability. Only one person testified against the bills. However, the chairman of the Appropriations Committee made it clear that this proposal would be competing against other requests, including increasing the property tax credit, income tax cuts, state park maintenance, and prison reform.
The public hearing process will be completed by the end of February. Beginning March 4, legislators will meet in full-day session. The Appropriations Committee must present their recommendations for mid-biennium adjustments in the budget to the Legislature by March 10. We have just hit the half-way mark in this legislative session and will have a full agenda for the next thirty days.
If you have any comments on the legislation that has been designated as priority bills, I encourage you to contact me. I can be reached at District #1, P.O. Box 94604, State Capitol, Lincoln, NE 68509. My e-mail address is email@example.com and my telephone number is (402) 471-2733.