1-1                                   AN ACT
 1-2     relating to the establishment of a newborn hearing screening,
 1-3     tracking, and intervention program.
 1-5           SECTION 1.  Subtitle B, Title 2, Health and Safety Code, is
 1-6     amended by adding Chapter 47 to read as follows:
 1-7                    CHAPTER 47.  HEARING LOSS IN NEWBORNS
 1-8           Sec. 47.001.  DEFINITIONS.  In this chapter:
 1-9                 (1)  "Birth admission" means the time after birth that
1-10     a newborn remains in the birthing facility before the newborn is
1-11     discharged.
1-12                 (2)  "Birthing facility" means:
1-13                       (A)  a hospital licensed under Chapter 241 that
1-14     offers obstetrical services and is located in a county with a
1-15     population of more than 50,000; or
1-16                       (B)  a birthing center licensed under Chapter 244
1-17     that is located in a county with a population of more than 50,000
1-18     and that has 100 or more births per year.
1-19                 (3)  "Health care provider" means a registered nurse
1-20     recognized as an advanced practice nurse by the Board of Nurse
1-21     Examiners or a physician assistant licensed by the Texas State
1-22     Board of Physician Assistant Examiners.
1-23                 (4)  "Hearing loss" means a hearing loss of 30 dB HL or
1-24     greater in the frequency region important for speech recognition
 2-1     and comprehension in one or both ears, approximately 500 through
 2-2     4,000 Hz.  As technological advances permit the detection of less
 2-3     severe hearing loss, the department may modify this definition by
 2-4     rule.
 2-5                 (5)  "Infant" means a child who is at least 30 days but
 2-6     who is younger than 24 months old.
 2-7                 (6)  "Intervention or follow-up care" means the early
 2-8     intervention services described in Part C, Individuals with
 2-9     Disabilities Education Act (20 U.S.C. Sections 1431-1445), as
2-10     amended by Pub. L. No. 105-17.
2-11                 (7)  "Newborn" means a child younger than 30 days old.
2-12                 (8)  "Parent" means a natural parent, stepparent,
2-13     adoptive parent, legal guardian, or other legal custodian of a
2-14     child.
2-15                 (9)  "Physician" means a person licensed to practice
2-16     medicine by the Texas State Board of Medical Examiners.
2-17                 (10)  "Program" means a newborn hearing screening,
2-18     tracking, and intervention program certified by the department
2-19     under this chapter.
2-20           Sec. 47.002.  APPLICABILITY OF CHAPTER.  This chapter does
2-21     not apply to a facility operated by a midwife as defined by Section
2-22     1, Texas Midwifery Act (Article 4512i, Vernon's Texas Civil
2-23     Statutes).
2-25     INTERVENTION PROGRAM.  (a)  A birthing facility, through a program
2-26     certified by the department under Section 47.004, shall offer the
2-27     parents of a newborn a hearing screening for the newborn for the
 3-1     identification of hearing loss.  The screening shall be offered
 3-2     during the birth admission, and the parents shall be informed that
 3-3     information may be provided to the department upon their written
 3-4     consent.
 3-5           (b)  The department or the department's designee shall
 3-6     approve program protocols.
 3-7           (c)  The department may maintain data and information on each
 3-8     newborn who receives services under a program.
 3-9           (d)  The department shall ensure that intervention is
3-10     available to families for a newborn identified as having hearing
3-11     loss and that the intervention is managed by state programs
3-12     operating under the Individuals with Disabilities Education Act (20
3-13     U.S.C. Section 1400 et seq.).
3-14           (e)  The department shall ensure that the intervention
3-15     described by Subsection (d) is available for a newborn identified
3-16     as having hearing loss through the time the child is an infant.
3-17           Sec. 47.004.  CERTIFICATION OF SCREENING PROGRAMS.  (a)  The
3-18     department or the department's designee shall establish
3-19     certification criteria for implementing a program.
3-20           (b)  In order to be certified, the program must:
3-21                 (1)  provide hearing screening using equipment
3-22     recommended by the department;
3-23                 (2)  use appropriate staff to provide the screening;
3-24                 (3)  maintain and report data electronically as
3-25     required by the department;
3-26                 (4)  distribute family, health care provider, and
3-27     physician educational materials standardized by the department; and
 4-1                 (5)  provide information, as recommended by the
 4-2     department, to the parents on follow-up services for newborns and
 4-3     infants with abnormal screening results.
 4-4           (c)  The department may certify a program that meets and
 4-5     maintains the certification criteria.
 4-6           (d)  The department may renew the certification of a program
 4-7     on a periodic basis as established by board rule in order to ensure
 4-8     quality services to newborns and families.
 4-9           (e)  A fee may not be charged to certify or recertify a
4-10     program.
4-12     FOLLOW-UP CARE.  (a)  A birthing facility that operates a program
4-13     shall distribute to the parents of each newborn who is screened
4-14     educational materials that are standardized by the department
4-15     regarding screening results and follow-up care.
4-16           (b)  A birthing facility that operates a program shall report
4-17     screening results to the parents, the newborn's attending physician
4-18     or health care provider, and the department.
4-19           (c)  Appropriate and necessary care for the infant who needs
4-20     follow-up care should be directed and coordinated by the infant's
4-21     physician or health care provider, with support from appropriate
4-22     ancillary services.
4-23           Sec. 47.006.  TECHNICAL ASSISTANCE BY DEPARTMENT.  The
4-24     department may consult with a birthing facility and provide to the
4-25     facility technical assistance associated with the implementation of
4-26     a certified program.
 5-1     SYSTEM.  (a)  The department shall provide each birthing facility
 5-2     that provides newborn hearing screening under the state's medical
 5-3     assistance program provided under Chapter 32, Human Resources Code,
 5-4     with the appropriate information management, reporting, and
 5-5     tracking software for the program.  The information management,
 5-6     reporting, and tracking system must be capable of providing the
 5-7     department with information and data necessary to plan, monitor,
 5-8     and evaluate the program, including the program's screening,
 5-9     follow-up, diagnostic, and intervention components.
5-10           (b)  A qualified hearing screening provider, hospital,
5-11     audiologist, or intervention specialist may access the information
5-12     management, reporting, and tracking system to provide information,
5-13     where available, to the department, including information relating
5-14     to:
5-15                 (1)  infants who receive follow-up care;
5-16                 (2)  infants identified with hearing loss;
5-17                 (3)  infants who are referred for intervention
5-18     services; and
5-19                 (4)  case level information necessary to report
5-20     required statistics to the Maternal and Child Health Bureau on an
5-21     annual basis.
5-22           (c)  The department shall ensure that the written consent of
5-23     a parent is obtained before any information individually
5-24     identifying the newborn or infant is released through the
5-25     information management, reporting, and tracking system.
5-27     (a)  The information management, reporting, and tracking system
 6-1     provided in accordance with this chapter must meet confidentiality
 6-2     requirements in accordance with required state and federal privacy
 6-3     guidelines.
 6-4           (b)  Data obtained through the information management,
 6-5     reporting, and tracking system under this chapter are for the
 6-6     confidential use of the department, the department's designee, and
 6-7     the persons or public or private entities that the department
 6-8     determines are necessary to carry out the functions of the tracking
 6-9     system.
6-10           (c)  The department by rule shall develop guidelines to
6-11     protect the confidentiality of patients in accordance with Section
6-12     5.08, Medical Practice Act (Article 4495b, Vernon's Texas Civil
6-13     Statutes), and require the written consent of a parent or guardian
6-14     of a patient before any individually identifying information is
6-15     provided to the department as set out in this chapter.  The
6-16     department shall permit a parent or guardian at any time to
6-17     withdraw information provided to the department under this chapter.
6-18           Sec. 47.009.  IMMUNITY FROM LIABILITY.  A birthing facility,
6-19     a clinical laboratory, an audiologist, a health care provider, a
6-20     physician, a registered nurse, or any other officer or employee of
6-21     a birthing facility, a laboratory, a physician, or an audiologist
6-22     is not criminally or civilly liable for furnishing information in
6-23     good faith to the department or its designee as required by this
6-24     chapter.  This section does not apply to information gathered and
6-25     furnished after a parent of a newborn or infant declined screening
6-26     offered through a program.
6-27           SECTION 2.  Section 36.004, Health and Safety Code, is
 7-1     amended by adding Subsection (i) to read as follows:
 7-2           (i)  A hearing screening performed under this section is in
 7-3     addition to any hearing screening test performed under Chapter 47.
 7-4           SECTION 3.  Section 32.024, Human Resources Code, is amended
 7-5     by adding Subsection (v) to read as follows:
 7-6           (v)  The department by rule shall provide a screening test
 7-7     for hearing loss in accordance with Chapter 47, Health and Safety
 7-8     Code, and any necessary diagnostic follow-up care related to the
 7-9     screening test to a child younger than 30 days old who receives
7-10     medical assistance.
7-11           SECTION 4.  Article 21.53F, Insurance Code, as added by
7-12     Chapter 683, Acts of the 75th Legislature, Regular Session, 1997,
7-13     is amended by amending Sections 3 and 4 and adding Sections 5, 6,
7-14     and 7 to read as follows:
7-16     A health benefit plan that provides benefits for a family member of
7-17     the insured shall provide coverage for each covered child described
7-18     by Section 5 of this article [Subsection (b) of this section], from
7-19     birth through the date the child is six years of age, for:
7-20                 (1)  immunization against:
7-21                       (A)  diphtheria;
7-22                       (B)  haemophilus influenzae type b;
7-23                       (C)  hepatitis B;
7-24                       (D)  measles;
7-25                       (E)  mumps;
7-26                       (F)  pertussis;
7-27                       (G)  polio;
 8-1                       (H)  rubella;
 8-2                       (I)  tetanus; and
 8-3                       (J)  varicella; and
 8-4                 (2)  any other immunization that is required by law for
 8-5     the child.
 8-7     IMPAIRMENT.  (a)  A health benefit plan that provides benefits for
 8-8     a family member of the insured shall provide coverage for each
 8-9     covered child described by Section 5 of this article for:
8-10                 (1)  a screening test for hearing loss from birth
8-11     through the date the child is 30 days old, as provided by Chapter
8-12     47, Health and Safety Code; and
8-13                 (2)  necessary diagnostic follow-up care related to the
8-14     screening test from birth through the date the child is 24 months
8-15     old.
8-16           (b)  The commissioner may adopt rules to implement the
8-17     requirement of this section.
8-18           (c)  This section applies to any health benefit plan that
8-19     provides coverage or benefits to a resident of this state, without
8-20     regard to whether the issuer of the health benefit plan is located
8-21     within or outside this state. This section does not require the
8-22     issuer of a health benefit plan to provide coverage under this
8-23     section for the child of a resident of this state who:
8-24                 (1)  is employed outside of this state; and
8-25                 (2)  is covered under a health benefit plan maintained
8-26     for the individual by the individual's employer as an employment
8-27     benefit.
 9-1           Sec. 5.  COVERED CHILDREN.  [(b)]  A child is entitled to
 9-2     benefits under this article [section] if the child, as a result of
 9-3     the child's relationship to an enrollee in the health benefit plan,
 9-4     would be entitled to benefits under an accident and sickness
 9-5     insurance policy under Subsection (K), (L), or (M), Section 2,
 9-6     Chapter 397, Acts of the 54th Legislature, 1955 (Article 3.70-2,
 9-7     Vernon's Texas Insurance Code).
9-10     Benefits required under Section 3 of this article may not be made
9-11     subject to a deductible, copayment, or coinsurance requirement.
9-12     This subsection [(b) Subsection (a) of this section] does not
9-13     prohibit the application of a deductible, copayment, or coinsurance
9-14     requirement to another service provided at the same time as the
9-15     immunization.
9-16           (b)  Benefits required under Section 4 of this article may be
9-17     subject to copayment and coinsurance requirements, but may not be
9-18     subject to a deductible requirement or dollar limit.  The
9-19     requirements of this subsection must be stated in the coverage
9-20     document.
9-21           Sec. 7.  RULES.  The commissioner may adopt rules as
9-22     necessary to implement this article.
9-23           SECTION 5.  The heading of Article 21.53F, Insurance Code, as
9-24     added by Chapter 683, Acts of the 75th Legislature, Regular
9-25     Session, 1997, is amended to read as follows:
 10-1          SECTION 6.  (a)  This Act takes effect September 1, 1999.
 10-2          (b)  Not later than May 1, 2000, each birthing facility that
 10-3    operates a program with at least 1,000 births in a year shall offer
 10-4    newborn hearing screening during the birth admission as provided by
 10-5    Section 47.003, Health and Safety Code, as added by this Act.
 10-6          (c)  Not later than April 1, 2001, each birthing facility
 10-7    that operates a program shall offer the hearing screening during
 10-8    the birth admission in accordance with Section 47.003, Health and
 10-9    Safety Code, as added by this Act.
10-10          SECTION 7.  The Texas Board of Health shall adopt the rules
10-11    required by Section 47.004, Health and Safety Code, as added by
10-12    this Act, not later than December 1, 1999.
10-13          SECTION 8.  (a)  Except as provided by Subsection (b) of this
10-14    section, not later than January 1, 2000, the Health and Human
10-15    Services Commission and each appropriate health and human services
10-16    agency that operates part of the state medical assistance program
10-17    under Chapter 32, Human Resources Code, shall adopt the rules
10-18    required by Section 32.024(v), Human Resources Code, as added by
10-19    this Act.
10-20          (b)  If, before implementing Section 32.024(v), Human
10-21    Resources Code, as added by this Act, the Health and Human Services
10-22    Commission determines that a waiver or authorization from a federal
10-23    agency is necessary  for implementation, the commission shall
10-24    request the waiver or authorization and may delay implementing that
10-25    provision until the waiver or authorization is granted.
10-26          SECTION 9.  The change in law made by Section 4 of this Act
10-27    applies only to a health benefit plan that is delivered, issued for
 11-1    delivery, or renewed on or after January 1, 2000.  A health benefit
 11-2    plan that is delivered, issued for delivery, or renewed before
 11-3    January 1, 2000, is governed by the law as it existed immediately
 11-4    before the effective date of this Act, and that law is continued in
 11-5    effect for that purpose.
 11-6          SECTION 10.  This Act takes effect only if a specific
 11-7    appropriation for the implementation of this Act is provided in
 11-8    H.B. No. 1 (General Appropriations Act), Acts of the 76th
 11-9    Legislature, Regular Session, 1999.  If no specific appropriation
11-10    is provided in H.B. No. 1, the General Appropriations Act, this Act
11-11    has no effect.
11-12          SECTION 11.  The importance of this legislation and the
11-13    crowded condition of the calendars in both houses create an
11-14    emergency and an imperative public necessity that the
11-15    constitutional rule requiring bills to be read on three several
11-16    days in each house be suspended, and this rule is hereby suspended.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I certify that H.B. No. 714 was passed by the House on May 8,
         1999, by a non-record vote; and that the House concurred in Senate
         amendments to H.B. No. 714 on May 26, 1999, by a non-record vote.
                                                 Chief Clerk of the House
               I certify that H.B. No. 714 was passed by the Senate, with
         amendments, on May 21, 1999, by a viva-voce vote.
                                                 Secretary of the Senate
         APPROVED:  _____________________