1-1 AN ACT
1-2 relating to the establishment of a newborn hearing screening,
1-3 tracking, and intervention program.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
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
1-12 (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
2-5 (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
2-15 (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
2-24 Sec. 47.003. NEWBORN HEARING SCREENING, TRACKING, AND
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
3-5 (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
4-11 Sec. 47.005. INFORMATION CONCERNING SCREENING RESULTS AND
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.
4-27 Sec. 47.007. INFORMATION MANAGEMENT, REPORTING, AND TRACKING
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
5-15 (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.
5-26 Sec. 47.008. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
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
6-4 (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
6-10 (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:
7-15 Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. [
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.
8-6 Sec. 4. REQUIRED BENEFITS FOR SCREENING TEST FOR HEARING
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
8-16 (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
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).
9-8 Sec. 6 [ 4]. APPLICATION OF DEDUCTIBLE, COPAYMENT, OR
9-9 COINSURANCE REQUIREMENT [ FIRST DOLLAR COVERAGE REQUIRED]. (a)
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
9-16 (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
9-21 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:
9-26 Art. 21.53F. COVERAGE FOR CERTAIN BENEFITS FOR CHILDREN
9-27 [ CHILDHOOD IMMUNIZATIONS]
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