The Mental Health Practice Board also decided to keep draft language requiring certain mental health practitioners to give referrals if the practitioners feel providing therapeutic services to patients would conflict with their moral or religious beliefs.

The gender identity measure passed 6-2.

The Nebraska State Board of Health is scheduled to review the case Monday. If approved, it would go through several more layers of approval, including the state’s chief medical officer, Attorney General Jon Bruning and Gov. Dave Heineman.

Board member Susan Meyerle said she was pessimistic that the proposed regulations will ultimately be adopted because of the gender identity clause.

“Personally, I would love to see it in there,” said Meyerle, one of two dissenting votes. “Politically, we can’t get it done.”

Carla Cecilia Ruiz, who identifies as transgender, was one of two transgender people to speak on behalf of the gender identity protection clause.

“If it weren’t for the help from a very competent mental health practitioner who was very, very helping with gender identity, I would truly not be here,” Ruiz said.

The proposed regulations have been under consideration for seven years. Controversy over whether to include gay and transgender protection clauses and the referral language have prevented the entire set of regulations from being adopted by the state.

The Nebraska Catholic Conference has expressed concerns over the referral language in the past, which the group said would make therapists complicit in providing treatment to which they had moral objections.

Two representatives attended Thursday’s meeting and the earlier public testimony period. Neither spoke in objection to the draft proposal.

“This has been going on for an extensive period of time, and the board worked hard over a period of time and developed a response to our concern that we found to be satisfactory or adequate,” Nebraska Catholic Conference representative Jim Cunningham said. “Something that we can live with so there was no need for us to voice any objection to the hearing draft that was being heard (Thursday).”

Cunningham said the proposed referral language was acceptable. He said the Catholic Conference does not necessarily agree with the gender identity clause, but it is not one of its main concerns.

More than 20 people shared what they thought of the proposed changes. The speakers overwhelmingly supported including the gender identity clause. Only one speaker spoke against adding the gender identity bias protection because of concerns that it would cause the entire proposal to be rejected down the line.

The proposed referral language would require practitioners to provide patients with “a list or directory” of other practitioners who could help them.

Many who testified supported language that would require a referral to specific practitioners.