As introduced: The bill would clarify the definition of medical necessity and Nebraska’s obligation not to discriminate the availability of appropriate services on the basis of age or diagnosis. In making a medical necessity determination, there would be a presumption in favor of the treating physician. It would also reemphasize federal obligation to provide early and periodic screening, diagnostic and treatment services.
As amended: Guidelines and criteria for determining medical necessity will be published by the department on its web site. Notice of changes to treating guidelines and criteria shall be given to providers and time for public comment at least 60 days prior to implementation. The department will report to HHS Committee on utilization controls every six months.
Introducing Senator(s): Cook
Committee: HHS
Committee Hearing Date: January 18, 2012
Current Status: Approved by Governor on April 11, 2012
Estimated Fiscal Impact: none
Voices for Children Position: Support
Voices supported LB1063 because it aimed to address the growing concern that children are not receiving necessary and timely health services, especially in the area of behavioral health. In the introduced copy, LB1063 would clarify Nebraska’s obligations under federal law, improve Nebraska’s definition of medical necessity, and ensure all kids get the right care at the right time. Voices strongly supported the bill in its original form, but after significant amendments and no funding, we have concerns that the bill will not be able to enforce what it was first intended to do.
Research:
Center on the Developing Child at Harvard University
Journal of the American Academy of Child and Adolescent Psychiatry
Archives of Pediatrics & Adolescent Medicine
Health Policy and Planning
American Psychologist
