Public Meetings on
Nebraska Licensing & Regulatory Affairs Reform Proposals
- Five public meetings held in Nebraska during the fall, 2002.
- Presentation and feedback on two proposals: Proposal for Structuring Fees and Proposal for Licensing & Regulatory Affairs Review
Included here are a description of the Nebraska Licensing & Regulatory Affairs Reform Implementation Project,
public meeting handouts, and a summary of the feedback received at the public meetings.
Licensing & Regulatory Affairs means licensure, registration, or certification by the
Department of Health and Human Services Regulation and Licensure.
Click here for a description of the Nebraska Licensing & Regulatory Affairs Reform (NCR) Implementation Project
Meeting Handout: Proposal for Licensing & Regulatory Affairs Reviews of Health Professions & Occupations
Meeting Handout: Licensing & Regulatory Affairs Reviews Criteria
Meeting Handout: : Proposal for Structuring Fees of Health Professions & Occupations
Click here for Summary of Frequently Asked Questions or Issues at the Public Meetings
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Nebraska Licensing & Regulatory Affairs Reform (NCR) Implementation Project description
A study of the professions credentialed by the Health and Human Services regulatory system was completed by the NCR 2000 Steering Committee in 1998. The report published in January 1999 included more than 140 recommendations. The Department of HHS Regulation and Licensure is very interested in and committed to making progress on implementation of the recommendations while recognizing that doing this right will take time. The NCR project is a long-term approach to assuring one element of public safety.
The Department appointed an internal team to work on this project. Stakeholder involvement is essential for the implementation phase and efforts are being made to keep boards, professions and occupations, and the public informed about the implementation plans. To have on-going active involvement draft implementation plans are regularly reviewed and critiqued by a Committee representative of professions, occupations, regulatory system and the public.
Implementation of Nebraska Licensing & Regulatory Affairs Reform (NCR) has been divided into nine focus areas. Some focus areas or parts of focus areas can be implemented by administrative action but for others legislation will be necessary. Each of the focus areas are briefly described below.
- Determining Who Should Be Regulated And At Which Level: Includes several of the fundamental NCR recommendations and is the foundation for Licensing & Regulatory Affairs review.
- Compliance Assurance: Compliance assurance means the efforts that are necessary to have well governed health professions and occupations for the protection of the public. NCR recommendations in this area include striving for consistency and uniformity of processes.
- Fee Structure: The intent of NCR recommendations is to ensure that resources allocated to the regulatory system are and remain adequate to carry out the system's mission of protecting the public.
- Continuing Competency: NCR recommendations were to assure as a part of the renewal process the qualifications and competency of credentialed individuals by using mechanisms including continuing competency appropriate for the scope and/pr type of practice.
- Licensing & Regulatory Affairs Reviews for Professions and Occupations: The NCR intent was to have one process for all Licensing & Regulatory Affairs reviews (new professions/occupations, existing professions/occupations, and scope of practice reviews).
- Rewrite of the Uniform Licensing Law (ULL) and integration with individual practice acts: All focus areas have a direct or indirect link to the ULL and individual practice acts. Working toward on ULL for all the professions and occupations regulated by the Department that would cover common topics, be uniform and easier to use.
- Communication: NCR recommendations were to enhance public and credentialed professionals access to information, and to improve communication
- Evaluation Process (Quality Assurance): The NCR recommendations referenced work team reports that are very detailed about evaluation processes and quality assurance
- Other: Telehealth, Data Collection, Rules and Regulations. Telehealth guidelines established regarding credentialed individuals and practice issues; Data collection analysis and interpretation developed appropriate to meet demands; Rules and regulations are adequate without being overwhelming.
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Summary of Frequently Asked Questions or Issues at the Public Meetings
Questions or comments are in italic and are followed by an answer or explanation.
Proposal for Structuring Fees.
- Why change anything? Putting a formula into statute will mean a more flexible, fair and systematic process for setting fees. The formula will improve efficiency, allow for timely changes in fees so that resources support Licensing & Regulatory Affairs activities. The formula calculates the costs but a professional board sets the fees – or the department sets the fees when a professional board does not exist.
- Is it fair to include investigations in base or fixed costs? Some professions have many more investigations than others do. Likewise, some professions have more staff assigned to their work. How is this reflected in base costs? Investigation costs and salaries and benefits are included in base costs for three reasons: 1) Represent a necessary cost to protect the public and every credentialed person should understand that the State is Licensing & Regulatory Affairs an individual for the purpose of protecting the public. 2) To have a systemic approach, all salaries and benefits for employees carrying out Licensing & Regulatory Affairs activities is included in base cost. This means that staff can be allocated as necessary to protect the public without concern about the profession’s ability to pay or time-consuming documentation of time reports. Salaries and benefits are the major element of investigation costs. 3) It is true that some professions and occupations have many more investigations and some have more staff doing work. However, there is no guarantee that a profession or occupation will not need to have an investigation or need expensive temporary help. Salaries and benefits included in base allow flexibility for resource allocation to appropriate tasks for all Licensing & Regulatory Affairs activities and the flexibility to accommodate unique situations without undue costs. A one-time investigation or court judgement against a profession or occupation could force that profession or occupation to significantly raise fees or even have a deficit fund balance. Putting investigation, salary and benefit cost into the base costs shared by all professions and occupations prevents that from happening in the same way an insurance policy protects someone from unnecessary financial risk caused by unpredictable circumstances or a retainer assures legal representation when needed.
- How would the budgeting process work – what role would the professional boards have? The formula is: base costs + variable costs + or – adjustments. The base costs are 83% of all Licensing & Regulatory Affairs costs and will be set using actual costs documented by the department. Variable costs are those expenses specific to the profession or occupation. The department will provide the actual variable costs from the previous budgeting period then the board must determine what variable expenses they will have in the next budgeting period (will the same types of activities take place, will there be additional costs, etc). Adjustments are provided based on the Department’s records and applied (deduct other revenue generated, deduct other sources of funds, add resources needed to support the required cash reserve as outlined in the Cash Management Plan, etc.). With this information, the board has the total amount of revenue their Licensing & Regulatory Affairs fees need to generate. Many professions and occupations have more than one credential for which a fee is paid. The board may decide that all their Licensing & Regulatory Affairs fees will be the same or may set their fees however appropriate so long as the board balances the total amount generated from Licensing & Regulatory Affairs fees and the total amount of revenue necessary from fees .
- Does this mean that the fees for a profession or occupation with a small number of individuals will go down? Possibly. Generally speaking, those professions and occupations with smaller numbers of individuals receiving credentials have had higher fees because they needed to be self-supporting as a profession and there were fewer individuals to pay the costs. However, the base costs are the same for everyone receiving a credential--it does not cost any more to print a credential for one profession than it does for another. The proposed formula is a fair and equitable method so everyone pays a fair share.
- The proposal would generate less revenue than is currently generated. Will this support the Licensing & Regulatory Affairs system? Yes. The proposed formula calculates actual costs of Licensing & Regulatory Affairs. A cash management plan provides the method that will be used to maintain a cash reserve – sort of an emergency savings account that we hope is not needed but is there just in case. Between these two, the proposed fees formula and the cash management plan, the Department will have adequate funds to carry out Licensing & Regulatory Affairs activities. Right now there is a need for the Department to reduce cash balances because over the years the fees have generated more revenue than needed. In part, this is because of the reasons given in (a). To be self-supporting, a profession or occupation had to build in funds to cover all contingencies. Plus since many fees are set in statute it was not easy to change. The proposed formula would mean fees are reviewed regularly and can be easily adjusted.
- There are five occupations that have been identified as "partial or no fees – to be determined". Who determines if there are partial or no fees? If no fees are paid by these five then who will pay? (Who will pay these fees was raised several times, especially for medication aides and nurse aides.) Right now money comes from other sources to pay Licensing & Regulatory Affairs costs for EMS, nurse aides, medication aides, swimming pool operators, and water operators. The formula identifies the cost of Licensing & Regulatory Affairs. Where the fee comes from is another matter. For example, the department receives federal money to cover the Licensing & Regulatory Affairs expenses of nurse aides and general fund money has a significant role in paying the Licensing & Regulatory Affairs expenses of EMS. The department will continue to apply resources as appropriate but the legislature will have to determine if general funds will be used to support any of the five. The proposal identifies the actual costs of Licensing & Regulatory Affairs but does is not intended to address where the revenue comes from.
- What about the professions or occupations that do not have a professional board. Who sets the fees? Will there be a role for that professional association? When there is not a professional board, the Department would set the fees. Communication is essential in the department’s work so efforts will be made to communicate appropriately .
- Does the proposed formula take into consideration the income impact that some credentials have (a doctor makes more money than a nurse aide)? No. This was considered and discussed. However, the proposed formula is only looking at the cost of Licensing & Regulatory Affairs and does not have anything to do with the revenue making ability of a person. .
- Is there a maximum to how high the boards can raise fees? No. But, the fees must be based on the formula and there are safeguards built into the process (board meetings are open public meetings; fees are reviewed by the department; etc.)
- What’s next for the proposal? The department is drafting legislative language and hopes to have a bill introduced next legislative session (January 2003). Probably by December we will have some kind of draft language. Once the draft language is available we will make it available and would like support for the legislation .
- Comments from a manager of swimming pools did agree that the swimming pool operators fees should be raised but suggested that moving the fee from $9 to $25 would be a reasonable compromise.
Proposal for Licensing & Regulatory Affairs Review
- There is a Licensing & Regulatory Affairs review process existing (407) that is working so why make any changes? The 407 process was put into place in 1985 and it has worked for the most part so it is very important to keep what has worked. But for any process there are ways to improve and an evaluation of the process and some changes after 17 years is not unrealistic. Proposed changes include: make the process applicable to ALL professions and occupations credentialed by the Department instead of only some; Clarify confusing criteria; and Add a periodic Licensing & Regulatory Affairs review that focuses on achieving an outcome for public protection. This is a very early draft and there is still a great deal of work to be done. The desire was for early feedback on the concepts and direction.
- Committee membership will be critical to the process. The Director would appoint seven to thirteen committee members. A variety of concerns were expressed including: 1) public members would not be neutral, there are too many and they have too much power; 2) the profession or occupation under review would only have one representative on the committee and always be outvoted and/or not have the knowledge necessary for a complex profession with diverse specialties; 3) the profession or occupation would have six of the thirteen appointments and overwhelm the other committee members; 4) an educator for the profession or occupation under review should be on the committee - other committee members often do not know the current educational processes; 5) balanced committee; 6) director has too much power in appointment process; 7) what about geographic considerations. Implementation of the proposal would have meant very little change from what is actually happening with 407 committee appointment. Reconsider committee appointments: number and representation of appointment; process of appointment.
- How long would periodic reviews take and how often would they occur? Currently the 407 review process is on a nine month schedule so certainly a calendar year at most for the periodic reviews. An estimate (has not been discussed) would be the periodic reviews would occur every 5 to 8 years.
- Will there be an opportunity for public review of the committee work? Committee meetings would be public meetings and there will at least one public hearing. The professional board for the profession or occupation under review would have the opportunity to provide feedback.
- What is meant by appropriate level of regulation? Right now the State recognizes several types (license, certification, registration, and permits) and in some cases it is not clear what level applies. The Department is working toward a goal of standardized terminology of the regulation levels and to define the levels but this work is not yet ready.
- Any consideration for self-directed reviews to save the Department money and time? Certain parts of the review would lend themselves to this. The Department anticipates a test using one or two volunteer professions or occupations. This will help show opportunities and yes, there are parts of the review where self-directed reviews could apply .
- What about legislative review or process? You’ve described a process of how a review would be conducted and a report created but would there need to be legislative involvement? A group going through the Licensing & Regulatory Affairs process does not preclude or guarantee legislation passing or not – and it could be introduced without a Licensing & Regulatory Affairs review taking place. That is not a change because it can happen now. If a profession goes through a Licensing & Regulatory Affairs review process the legislature would have information – under the proposal the legislature would have information. This is the same. The proposal's impact on the legislative process is essentially none. What does change is that there would be greater and better information for the legislature and others using the proposed Licensing & Regulatory Affairs review process.
- Compared to the 407 process, which seems to work and is relatively open and public, the proposal does not seem to compare and there would only be one report. This proposal is intented to be totally open and it attempts to clarify the criteria. With the three separate reports, we have heard concern about mixed messages. There are often questions about the current criteria with explanation/clarification necessary. The committee would have broad representation and use a public meeting process.
- Not sure that the same process can work for all professions and occupations. Think it will work. The three criteria do apply to all professions and occupations. Most people do not know if a well driller is doing his job right any more than if the doctor is doing his job right. So a process that uses the same criteria (risk to the public, ability of the public to protect themselves, and amount of the practitioner's independent judgement) should work.
- What safeguards would be out there to prevent someone who is upset with a profession from requesting a Licensing & Regulatory Affairs review in an attempt to just cause problems. Specific safeguards are not in place. There are other mechanisms available to that individual and these would be encouraged if the circumstances justified. Plus, the work of putting together an issue statement might discourage this type of situation.
- Most professions have been in place and managed without problems. Why is there a need for periodic reviews all of a sudden? Reminiscent of the sunset reviews. Seems to be better ways to use limited resources than to dilutes the 407 process that has worked very well. See (a). The requirement for periodic Licensing & Regulatory Affairs reviews is in statute (71-1,343) but has never been implemented. Providing a method for a periodic review that would allow for evaluation and implementation of potential quality improvements is a critical part of the Licensing & Regulatory Affairs review process. What we are hearing from you is that the process is too cumbersome and may not be necessary for all professions and occupations so this is something we will be studying.
- Why is there a need for a significant change Licensing & Regulatory Affairs review at all? Most professions have reached consensus before legislation is proposed on any significant changes. The intent was to have the opportunity to look at significant statute changes that would have a potential impact on other statutes. We need to look at a definition for significnat changes and see if this type of review is necessary.
- Seem to be trying to set out a process to use for every review and every profession but not every profession and review would go through every step of the process. Would seem that if there were a problem with a profession or occupation the answer would be a directed review. The purpose of doing the Licensing & Regulatory Affairs review would be to identify what is best for public protection. The scope of a review for every profession may not be the same. This is an area where there is still a great deal of work to be done.
- Is there a way to not have a cumbersome periodic review for every profession or occupation? Perhaps the issue definition statement is key. It may be possible for staff to put together an issue definition statement after conducting one-on-one interviews with professional board members, representations from the association, staff, key contacts for that profession, a survey sample of the credential profession, some combination of these, etc. The purpose of the periodic Licensing & Regulatory Affairs review would a kind of performance accountability for public safety. Staff could evaluate the results and identify issues (or the lack of issues) that should be a focus of the periodic review. This would set a direction for the Committee and may limit the periodic review to certain topics.
- Can alternatives to conducting periodic reviews all professions and occupations be developed? Maybe. We could define some criteria or measures that would be used to determine a profession or occupation should undergo a periodic review and how often.
- Comment about whether the Licensing & Regulatory Affairs review process provided a mechanism for resolving conflicts from two boards. The Licensing & Regulatory Affairs review process does not address this. But the BOH is proposing a change that might .
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For more information contact:
Department of Health & Human Services Regulation & Licensure
Administrative Services Division
P.O. Box 95026
Lincoln, NE 68509
Phone: (402) 471-6515
Fax: (402) 471-0383
email contact: Mary Maahs Becker
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