ER13 ER13 LB527 LB527 MLU2025 -LEGISLATIVE 02/19/2025BILL MLU527 -Approved 02/19/2025by Ethe ANDGovernor RApril AMENDMENTS7, TO2025 LB 527   Introduced by Guereca,Jacobson, 7,42; Chairman Enrollment and Review 1.

StrikeCavanaugh, theM., original6. sections and all amendments thereto and insert the following new sections:

Section  1.A BILL FOR AN ACT relating to insurance;

Sections 1 to 7amend ofsections this44-32,180 actand shall44-4726, beReissue knownRevised andStatutes mayof beNebraska, citedand assection the77-908, MedicaidRevised AccessStatutes andCumulative QualitySupplement, Act.2024;

to adopt the Medicaid Access and Quality Act;

to change provisions relating to taxes on health maintenance organizations, prepaid limited health service organizations, and insurance companies;

to repeal the original sections;

and to declare an emergency.

Be it enacted by the people of the State of Nebraska, Section 1.

 Sections 1 to 8 of this act shall be known and may be cited as the Medicaid Access and Quality Act.

(1) Nonhospital provider means a provider of physical health services that does not hold a license as a hospital under the Health Care -1- ER13 ER13 LB527 LB527 MLU - 02/19/2025 MLU - 02/19/2025 Facility Licensure Act;

(1) No later than January 1, 2026, the Director of Insurance shall establish a schedule for the collection of a tax of six percent of the gross amount of non-medicare direct writing premiums written under a health maintenance organization certificate of authority pursuant to section 44-32,115, to the extent not preempted by federal law, during the precedingcurrent calendar year for business done in the state.

(3) The tax established by this section shall be effective January 1, 2026, and applies to premiums received during the previouscurrent calendar year forand alleach contractualyear obligationsthereafter. that remain in force by continuing obligation, renewal, or new issuance on or after January 1, 2026.

The tax established by this section shall not apply to a premium received during calendar year 2025 that is attributable to an individual contract or policy held by an entity not offering that contract or policy in calendar year 2026.

Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska -2- ER13 ER13 LB527 LB527 MLU - 02/19/2025 MLU - 02/19/2025 State Funds Investment Act.

(1) The Department of Health and Human Services shall use the Medicaid Access and Quality Fund for the following purposes:

(1)(a) Beginning January 1, 2026, forty million dollars annually shall be used to obtain federal financial participation for the purpose of enhancing rates paid to nonhospital providers of physical health services, as published in the medicaid practitioner fee schedule.

This funding shall not be used to replace or offset existing state funds paid to providers for providing services under the medical assistance program:program.

(a) In calculating a rate enhancement under subdivision (1)(a) of this section,subdivision, the department shall work with a statewide association exempt from taxation under section 501(c)(6) of the Internal Revenue Code of 1986 that primarily represents health care providers in multiple specialties who are licensed to practice medicine and surgery under the Uniform Credentialing Act;Act.

and (b) It is the intent of the Legislature that a rate enhancement provided by subdivision (1) of this sectionsubdivision should aim to improve access to care through increasing rates across a broad range of physical health services provided by nonhospital providers, with an emphasis on evaluation and management services, labor and -1- LB527 LB527 2025 delivery services, and rural services;

(2)(b) Beginning no later than January 1, 2027, five million dollars annually shall be used to obtain federal financial participation to pay a monthly per-memberper- member fee of not less than seventy-five dollars to qualified primary care providers who meet criteria established by the Department of Health and Human Services to serve as a primary care medical home for target populations;

(3)and (c) Any remaining funds shall be transferred to the medical assistance program and the Children's Health Insurance Program;Program.

and(2) (4) Use of the funds described in this section areis subject to all required federal approvals including any approvals necessary for the use -3- ER13 ER13 LB527 LB527 MLU - 02/19/2025 MLU - 02/19/2025 of thesuch funds to obtain federal financial participation.

The Department of Health and Human Services may adopt and promulgate rules and regulations necessary to implement the Medicaid Access and Quality Act.

Sec.

9.

9.10.

10.11.

77-908 (1) Every insurance company organized under the stock, mutual, assessment, or reciprocal plan, except fraternal benefit societies, which is transacting business in this state shall, on or -4- ER13 ER13 LB527 LB527 MLU - 02/19/2025 MLU - 02/19/2025 before March 1 of each year, pay a tax to the director of one percent of the gross amount of direct writing premiums received by it during the preceding calendar year for business done in this state, except that (a) (1) for group sickness and accident insurance the rate of such tax shall be five-tenths of one percent, (b) and (2) for property and casualty insurance, excluding individual sickness and accident insurance, the rate of such tax shall be one percent, and (c) in addition to the tax paid under this section, for health maintenance organizations subject to the Health Maintenance Organization Act, the tax levied by section 4 of this act.act shall be in addition to the tax paid under this section.

Any such insurance company shall receive a credit on the tax imposed, except the tax paid under subdivision (1)(c) of this -5- ER13 ER13 LB527 LB527 MLU - 02/19/2025 MLU - 02/19/2025 section, as provided in the Creating High Impact Economic Futures Act, the Nebraska Job Creation and Mainstreet Revitalization Act, the New Markets Job Growth Investment Act, the Nebraska Higher Blend Tax Credit Act, the Relocation Incentive Act, the Sustainable Aviation Fuel Tax Credit Act, the Nebraska Shortline Rail Modernization Act, and the Affordable Housing Tax Credit Act.

11.12.

12.13.

2.-2-

On page 1, strike beginning with "44-2702" in line 1 through line 8 and insert "44-32,180 and 44-4726, Reissue Revised Statutes of Nebraska, and section 77-908, Revised Statutes Cumulative Supplement, 2024;

to adopt the Medicaid Access and Quality Act;

to change provisions relating to taxes on health maintenance organizations, prepaid limited health service organizations, and insurance companies;

to repeal the original sections;

and to declare an emergency.".

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