1-1 By: Naishtat, et al. (Senate Sponsor - Moncrief) H.B. No. 714
1-2 (In the Senate - Received from the House May 10, 1999;
1-3 May 10, 1999, read first time and referred to Committee on Health
1-4 Services; May 14, 1999, reported favorably, as amended, by the
1-5 following vote: Yeas 5, Nays 0; May 14, 1999, sent to printer.)
1-6 COMMITTEE AMENDMENT NO. 1 By: Moncrief
1-7 Amend H.B. No. 714, adding an appropriately numbered SECTION
1-8 to read as follows:
1-9 "SECTION 10. This Act takes effect only if a specific
1-10 appropriation for the implementation of this Act is provided in
1-11 H.B. No. 1 (General Appropriations Act), Acts of the 76th
1-12 Legislature, Regular Session, 1999. If no specific appropriation
1-13 is provided in H.B. No. 1, the General Appropriations Act, this Act
1-14 has no effect."
1-15 Renumber subsequent section.
1-16 A BILL TO BE ENTITLED
1-17 AN ACT
1-18 relating to the establishment of a newborn hearing screening,
1-19 tracking, and intervention program.
1-20 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-21 SECTION 1. Subtitle B, Title 2, Health and Safety Code, is
1-22 amended by adding Chapter 47 to read as follows:
1-23 CHAPTER 47. HEARING LOSS IN NEWBORNS
1-24 Sec. 47.001. DEFINITIONS. In this chapter:
1-25 (1) "Birth admission" means the time after birth that
1-26 a newborn remains in the birthing facility before the newborn is
1-27 discharged.
1-28 (2) "Birthing facility" means:
1-29 (A) a hospital licensed under Chapter 241 that
1-30 offers obstetrical services and is located in a county with a
1-31 population of more than 50,000; or
1-32 (B) a birthing center licensed under Chapter 244
1-33 that is located in a county with a population of more than 50,000
1-34 and that has 100 or more births per year.
1-35 (3) "Health care provider" means a registered nurse
1-36 recognized as an advanced practice nurse by the Board of Nurse
1-37 Examiners or a physician assistant licensed by the Texas State
1-38 Board of Physician Assistant Examiners.
1-39 (4) "Hearing loss" means a hearing loss of 30 dB HL or
1-40 greater in the frequency region important for speech recognition
1-41 and comprehension in one or both ears, approximately 500 through
1-42 4,000 Hz. As technological advances permit the detection of less
1-43 severe hearing loss, the department may modify this definition by
1-44 rule.
1-45 (5) "Infant" means a child who is at least 30 days but
1-46 who is younger than 24 months old.
1-47 (6) "Intervention or follow-up care" means the early
1-48 intervention services described in Part C, Individuals with
1-49 Disabilities Education Act (20 U.S.C. Sections 1431-1445), as
1-50 amended by Pub. L. No. 105-17.
1-51 (7) "Newborn" means a child younger than 30 days old.
1-52 (8) "Parent" means a natural parent, stepparent,
1-53 adoptive parent, legal guardian, or other legal custodian of a
1-54 child.
1-55 (9) "Physician" means a person licensed to practice
1-56 medicine by the Texas State Board of Medical Examiners.
1-57 (10) "Program" means a newborn hearing screening,
1-58 tracking, and intervention program certified by the department
1-59 under this chapter.
1-60 Sec. 47.002. APPLICABILITY OF CHAPTER. This chapter does
1-61 not apply to a facility operated by a midwife as defined by Section
1-62 1, Texas Midwifery Act (Article 4512i, Vernon's Texas Civil
1-63 Statutes).
2-1 Sec. 47.003. NEWBORN HEARING SCREENING, TRACKING, AND
2-2 INTERVENTION PROGRAM. (a) A birthing facility, through a program
2-3 certified by the department under Section 47.004, shall offer the
2-4 parents of a newborn a hearing screening for the newborn for the
2-5 identification of hearing loss. The screening shall be offered
2-6 during the birth admission, and the parents shall be informed that
2-7 information may be provided to the department upon their written
2-8 consent if hearing loss is identified.
2-9 (b) The department or the department's designee shall
2-10 approve program protocols.
2-11 (c) The department may maintain data and information on each
2-12 newborn who receives services under a program.
2-13 (d) The department shall ensure that intervention is
2-14 available to families for a newborn identified as having hearing
2-15 loss and that the intervention is managed by state programs
2-16 operating under the Individuals with Disabilities Education Act (20
2-17 U.S.C. Section 1400 et seq.).
2-18 (e) The department shall ensure that the intervention
2-19 described by Subsection (d) is available for a newborn identified
2-20 as having hearing loss through the time the child is an infant.
2-21 Sec. 47.004. CERTIFICATION OF SCREENING PROGRAMS. (a) The
2-22 department or the department's designee shall establish
2-23 certification criteria for implementing a program.
2-24 (b) In order to be certified, the program must:
2-25 (1) provide hearing screening using equipment
2-26 recommended by the department;
2-27 (2) use appropriate staff to provide the screening;
2-28 (3) maintain and report data electronically as
2-29 required by the department;
2-30 (4) distribute family, health care provider, and
2-31 physician educational materials standardized by the department; and
2-32 (5) provide information, upon the parents' consent, as
2-33 recommended by the department, on follow-up services for newborns
2-34 and infants with abnormal screening results.
2-35 (c) The department may certify a program that meets and
2-36 maintains the certification criteria.
2-37 (d) The department may renew the certification of a program
2-38 on a periodic basis as established by board rule in order to ensure
2-39 quality services to newborns and families.
2-40 (e) A fee may not be charged to certify or recertify a
2-41 program.
2-42 Sec. 47.005. INFORMATION CONCERNING SCREENING RESULTS AND
2-43 FOLLOW-UP CARE. (a) A birthing facility that operates a program
2-44 shall distribute to the parents of each newborn who is screened
2-45 educational materials that are standardized by the department
2-46 regarding screening results and follow-up care.
2-47 (b) A birthing facility that operates a program shall report
2-48 screening results to the parents, the newborn's attending physician
2-49 or health care provider, and the department.
2-50 (c) Appropriate and necessary care for the infant who needs
2-51 follow-up care should be directed and coordinated by the infant's
2-52 physician or health care provider, with support from appropriate
2-53 ancillary services.
2-54 Sec. 47.006. TECHNICAL ASSISTANCE BY DEPARTMENT. The
2-55 department may consult with a birthing facility and provide to the
2-56 facility technical assistance associated with the implementation of
2-57 a certified program.
2-58 Sec. 47.007. INFORMATION MANAGEMENT, REPORTING, AND TRACKING
2-59 SYSTEM. (a) The department shall provide each birthing facility
2-60 that provides newborn hearing screening under the state's medical
2-61 assistance program provided under Chapter 32, Human Resources Code,
2-62 with the appropriate information management, reporting, and
2-63 tracking software for the program. The information management,
2-64 reporting, and tracking system must be capable of providing the
2-65 department with information and data necessary to plan, monitor,
2-66 and evaluate the program, including the program's screening,
2-67 follow-up, diagnostic, and intervention components.
2-68 (b) A qualified hearing screening provider, hospital,
2-69 audiologist, or intervention specialist may access the information
3-1 management, reporting, and tracking system to provide information,
3-2 where available, to the department, including information relating
3-3 to:
3-4 (1) infants who receive follow-up care;
3-5 (2) infants identified with hearing loss;
3-6 (3) infants who are referred for intervention
3-7 services; and
3-8 (4) case level information necessary to report
3-9 required statistics to the Maternal and Child Health Bureau on an
3-10 annual basis.
3-11 (c) The department shall ensure that the written consent of
3-12 a parent is obtained before a newborn is included in the
3-13 information management, reporting, and tracking system or any
3-14 information relating to the newborn or infant is released through
3-15 the system.
3-16 Sec. 47.008. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
3-17 (a) The information management, reporting, and tracking system
3-18 provided in accordance with this chapter must meet confidentiality
3-19 requirements in accordance with required state and federal privacy
3-20 guidelines.
3-21 (b) Data obtained through the information management,
3-22 reporting, and tracking system under this chapter are for the
3-23 confidential use of the department, the department's designee, and
3-24 the persons or public or private entities that the department
3-25 determines are necessary to carry out the functions of the tracking
3-26 system.
3-27 (c) The department by rule shall develop guidelines to
3-28 protect the confidentiality of patients in accordance with Section
3-29 5.08, Medical Practice Act (Article 4495b, Vernon's Texas Civil
3-30 Statutes), and require the written consent of a parent or guardian
3-31 of a patient before any information is provided to the department
3-32 as set out in this chapter. The department shall permit a parent
3-33 or guardian at any time to withdraw information provided to the
3-34 department under this chapter.
3-35 Sec. 47.009. IMMUNITY FROM LIABILITY. A birthing facility,
3-36 a clinical laboratory, an audiologist, a health care provider, a
3-37 physician, a registered nurse, or any other officer or employee of
3-38 a birthing facility, a laboratory, a physician, or an audiologist
3-39 is not criminally or civilly liable for furnishing information in
3-40 good faith to the department or its designee as required by this
3-41 chapter. This section does not apply to information gathered and
3-42 furnished after a parent of a newborn or infant declined screening
3-43 offered through a program.
3-44 SECTION 2. Section 36.004, Health and Safety Code, is
3-45 amended by adding Subsection (i) to read as follows:
3-46 (i) A hearing screening performed under this section is in
3-47 addition to any hearing screening test performed under Chapter 47.
3-48 SECTION 3. Section 32.024, Human Resources Code, is amended
3-49 by adding Subsection (v) to read as follows:
3-50 (v) The department by rule shall provide a screening test
3-51 for hearing loss in accordance with Chapter 47, Health and Safety
3-52 Code, and any necessary diagnostic follow-up care related to the
3-53 screening test to a child younger than 30 days old who receives
3-54 medical assistance.
3-55 SECTION 4. Article 21.53F, Insurance Code, as added by
3-56 Chapter 683, Acts of the 75th Legislature, Regular Session, 1997,
3-57 is amended by amending Sections 3 and 4 and adding Sections 5, 6,
3-58 and 7 to read as follows:
3-59 Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. [(a)]
3-60 A health benefit plan that provides benefits for a family member of
3-61 the insured shall provide coverage for each covered child described
3-62 by Section 5 of this article [Subsection (b) of this section], from
3-63 birth through the date the child is six years of age, for:
3-64 (1) immunization against:
3-65 (A) diphtheria;
3-66 (B) haemophilus influenzae type b;
3-67 (C) hepatitis B;
3-68 (D) measles;
3-69 (E) mumps;
4-1 (F) pertussis;
4-2 (G) polio;
4-3 (H) rubella;
4-4 (I) tetanus; and
4-5 (J) varicella; and
4-6 (2) any other immunization that is required by law for
4-7 the child.
4-8 Sec. 4. REQUIRED BENEFITS FOR SCREENING TEST FOR HEARING
4-9 IMPAIRMENT. (a) A health benefit plan that provides benefits for
4-10 a family member of the insured shall provide coverage for each
4-11 covered child described by Section 5 of this article for:
4-12 (1) a screening test for hearing loss from birth
4-13 through the date the child is 30 days old, as provided by Chapter
4-14 47, Health and Safety Code; and
4-15 (2) necessary diagnostic follow-up care related to the
4-16 screening test from birth through the date the child is 24 months
4-17 old.
4-18 (b) The commissioner may adopt rules to implement the
4-19 requirement of this section.
4-20 (c) This section applies to any health benefit plan that
4-21 provides coverage or benefits to a resident of this state, without
4-22 regard to whether the issuer of the health benefit plan is located
4-23 within or outside this state. This section does not require the
4-24 issuer of a health benefit plan to provide coverage under this
4-25 section for the child of a resident of this state who:
4-26 (1) is employed outside of this state; and
4-27 (2) is covered under a health benefit plan maintained
4-28 for the individual by the individual's employer as an employment
4-29 benefit.
4-30 Sec. 5. COVERED CHILDREN. [(b)] A child is entitled to
4-31 benefits under this article [section] if the child, as a result of
4-32 the child's relationship to an enrollee in the health benefit plan,
4-33 would be entitled to benefits under an accident and sickness
4-34 insurance policy under Subsection (K), (L), or (M), Section 2,
4-35 Chapter 397, Acts of the 54th Legislature, 1955 (Article 3.70-2,
4-36 Vernon's Texas Insurance Code).
4-37 Sec. 6 [4]. APPLICATION OF DEDUCTIBLE, COPAYMENT, OR
4-38 COINSURANCE REQUIREMENT [FIRST DOLLAR COVERAGE REQUIRED]. (a)
4-39 Benefits required under Section 3 of this article may not be made
4-40 subject to a deductible, copayment, or coinsurance requirement.
4-41 This subsection [(b) Subsection (a) of this section] does not
4-42 prohibit the application of a deductible, copayment, or coinsurance
4-43 requirement to another service provided at the same time as the
4-44 immunization.
4-45 (b) Benefits required under Section 4 of this article may be
4-46 subject to copayment and coinsurance requirements, but may not be
4-47 subject to a deductible requirement or dollar limit. The
4-48 requirements of this subsection must be stated in the coverage
4-49 document.
4-50 Sec. 7. RULES. The commissioner may adopt rules as
4-51 necessary to implement this article.
4-52 SECTION 5. The heading of Article 21.53F, Insurance Code, as
4-53 added by Chapter 683, Acts of the 75th Legislature, Regular
4-54 Session, 1997, is amended to read as follows:
4-55 Art. 21.53F. COVERAGE FOR CERTAIN BENEFITS FOR CHILDREN
4-56 [CHILDHOOD IMMUNIZATIONS]
4-57 SECTION 6. (a) This Act takes effect September 1, 1999.
4-58 (b) Not later than May 1, 2000, each birthing facility that
4-59 operates a program with at least 1,000 births in a year shall offer
4-60 newborn hearing screening during the birth admission as provided by
4-61 Section 47.003, Health and Safety Code, as added by this Act.
4-62 (c) Not later than April 1, 2001, each birthing facility
4-63 that operates a program shall offer the hearing screening during
4-64 the birth admission in accordance with Section 47.003, Health and
4-65 Safety Code, as added by this Act.
4-66 SECTION 7. The Texas Board of Health shall adopt the rules
4-67 required by Section 47.004, Health and Safety Code, as added by
4-68 this Act, not later than December 1, 1999.
4-69 SECTION 8. (a) Except as provided by Subsection (b) of this
5-1 section, not later than January 1, 2000, the Health and Human
5-2 Services Commission and each appropriate health and human services
5-3 agency that operates part of the state medical assistance program
5-4 under Chapter 32, Human Resources Code, shall adopt the rules
5-5 required by Section 32.024(v), Human Resources Code, as added by
5-6 this Act.
5-7 (b) If, before implementing Section 32.024(v), Human
5-8 Resources Code, as added by this Act, the Health and Human Services
5-9 Commission determines that a waiver or authorization from a federal
5-10 agency is necessary for implementation, the commission shall
5-11 request the waiver or authorization and may delay implementing that
5-12 provision until the waiver or authorization is granted.
5-13 SECTION 9. The change in law made by Section 4 of this Act
5-14 applies only to a health benefit plan that is delivered, issued for
5-15 delivery, or renewed on or after January 1, 2000. A health benefit
5-16 plan that is delivered, issued for delivery, or renewed before
5-17 January 1, 2000, is governed by the law as it existed immediately
5-18 before the effective date of this Act, and that law is continued in
5-19 effect for that purpose.
5-20 SECTION 10. The importance of this legislation and the
5-21 crowded condition of the calendars in both houses create an
5-22 emergency and an imperative public necessity that the
5-23 constitutional rule requiring bills to be read on three several
5-24 days in each house be suspended, and this rule is hereby suspended.
5-25 * * * * *