LB 958 — Provide for implementation of a home and community-based services waiver, retroactive coverage of certain benefits, and reimbursement of doula services and change reporting requirements under the Medical Assistance Act, change provisions relating to the Nebraska Prenatal Plus Program, and provide limits for crisis assistance payments under the low-income home energy assistance program

The report shall only apply to the -1- LB958 LB958 2026 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:

-2- LB958 LB958 2026 (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 -3- LB958 LB958 2026 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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