By: Moncrief S.B. No. 458 99S0049/1 A BILL TO BE ENTITLED AN ACT 1-1 relating to the establishment of a newborn and infant hearing 1-2 screening, tracking, and intervention program. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Subtitle B, Title 2, Health and Safety Code, is 1-5 amended by adding Chapter 47 to read as follows: 1-6 CHAPTER 47. HEARING LOSS IN NEWBORNS AND INFANTS 1-7 Sec. 47.001. PURPOSES. The purposes of this chapter are to: 1-8 (1) provide detection of hearing loss in newborns 1-9 during their birth admission; 1-10 (2) prevent delays in language and communication 1-11 caused by late-identified hearing loss that lead to academic 1-12 failure and illiteracy; 1-13 (3) provide the department with the information 1-14 necessary to plan, establish, and evaluate a comprehensive system 1-15 of appropriate services for newborns and infants who have hearing 1-16 loss; and 1-17 (4) provide the department with the information 1-18 necessary to track the incidence and prevalence of hearing loss 1-19 within the state to improve public health. 1-20 Sec. 47.002. DEFINITIONS. In this chapter: 1-21 (1) "Birth admission" means the time after birth that 1-22 a newborn remains in the birthing hospital nursery prior to 1-23 discharge. 1-24 (2) "Health insurance policy" means a group health 2-1 insurance policy, contract, or plan, or an individual policy, 2-2 contract, or plan, with dependent coverage for children that 2-3 provides medical coverage on an expense-incurred service or prepaid 2-4 basis. The term includes: 2-5 (A) a health insurance policy or contract issued 2-6 by a nonprofit corporation or fraternal benefit society; 2-7 (B) a health service plan operating as a health 2-8 maintenance organization, a preferred provider organization, an 2-9 exclusive provider organization, or any other managed care plan, as 2-10 those terms are described in state law; or 2-11 (C) an employee welfare benefit plan as defined 2-12 in Section 3(1), Employee Retirement Income Security Act of 1974 2-13 (29 U.S.C. Section 1002(1)). 2-14 (3) "Hearing loss" means a hearing loss of 30 dB HL or 2-15 greater in the frequency region important for speech recognition 2-16 and comprehension in one or both ears (approximately 500 through 2-17 4,000 Hz). However, as technological advances permit the detection 2-18 of less severe hearing loss, the department shall have the 2-19 authority to modify this definition by rule. 2-20 (4) "Infant" means a child 30 days to 24 months old. 2-21 (5) "Intervention or follow-up care" means the early 2-22 intervention services described in Subchapter III, Individuals with 2-23 Disabilities Education Act (20 U.S.C. Section 1431-1445), as 2-24 amended by Pub. L. No. 105-17. 2-25 (6) "Newborn" means a child from birth to 29 days old. 2-26 (7) "Parent" means a natural parent, stepparent, 3-1 adoptive parent, legal guardian, or other legal custodian of a 3-2 child. 3-3 (8) "Program" means a newborn and infant hearing 3-4 screening, tracking, and intervention program. 3-5 Sec. 47.003. NEWBORN AND INFANT HEARING SCREENING, TRACKING, 3-6 AND INTERVENTION PROGRAM. (a) A birthing hospital, through a 3-7 program certified by the department, shall offer the parents of a 3-8 newborn a hearing screening for the newborn for the identification 3-9 of hearing loss. The screening shall be offered during the birth 3-10 admission. 3-11 (b) The department or its designee shall approve program 3-12 protocols. 3-13 (c) The department shall begin its implementation phase on 3-14 September 1, 1999, for birthing hospitals with 1,000 births or more 3-15 per year. 3-16 (d) By April 1, 2001, all birthing hospitals shall offer the 3-17 hearing screening during the birth admission. 3-18 (e) The department shall maintain data and information on 3-19 all newborns and infants who receive services under a program. 3-20 (f) The department shall ensure that appropriate follow-up 3-21 care is available to families throughout the state, including 3-22 diagnostic evaluation and referral to intervention service programs 3-23 for all newborns and infants who require follow-up services. 3-24 Children identified as having hearing loss will be managed by 3-25 existing state programs, as required by the Individuals with 3-26 Disabilities Education Act (20 U.S.C. Section 1400 et seq.). 4-1 Sec. 47.004. CERTIFICATION OF BIRTHING HOSPITALS. (a) The 4-2 department or its designee shall establish certification criteria 4-3 that a birthing hospital must meet in implementing a newborn 4-4 hearing screening program. 4-5 (b) In order to be certified the birthing hospital shall: 4-6 (1) provide competent hearing screening; 4-7 (2) utilize appropriate staff and physiological 4-8 equipment for hearing screening; 4-9 (3) maintain and report data electronically as 4-10 required by the department; 4-11 (4) provide effective family and physician education; 4-12 and 4-13 (5) refer newborns and infants with abnormal screening 4-14 results for appropriate follow-up services. 4-15 (c) The department shall designate birthing hospitals that 4-16 meet and maintain certification criteria as qualified newborn 4-17 hearing screening providers. 4-18 (d) The department shall recertify birthing hospitals as 4-19 qualified newborn hearing screening providers on a periodic basis 4-20 in order to assure quality services to newborns, infants, and 4-21 families. 4-22 Sec. 47.005. INFORMATION CONCERNING SCREENING RESULTS AND 4-23 FOLLOW-UP CARE. A birthing hospital shall prepare for the parents 4-24 of all newborns and infants who are screened written information on 4-25 the screening results and the necessary steps for follow-up care. 4-26 Sec. 47.006. INSURANCE COVERAGE. (a) Except as otherwise 5-1 provided by this section, a health insurance policy that is 5-2 delivered, issued for delivery, renewed, extended, or modified in 5-3 this state by a health care insurer shall provide coverage for an 5-4 initial newborn hearing screening and for necessary diagnostic 5-5 follow-up care related to the screening. 5-6 (b) Except as otherwise provided by this section, if a 5-7 health insurance policy provides coverage or benefits to a resident 5-8 of this state, the policy shall be deemed to be delivered in this 5-9 state within the meaning of this chapter regardless of whether the 5-10 health care insurer issuing or delivering the policy is located 5-11 within or outside this state. 5-12 (c) Benefits for a newborn and infant hearing screening test 5-13 and any necessary audiological follow-up care shall be subject to 5-14 copayment and coinsurance provisions of a health insurance policy 5-15 to the extent that other medical services covered by the policy are 5-16 subject to those provisions, except that benefits for the screening 5-17 test shall be exempt from deductible or dollar-limit provisions in 5-18 the health insurance policy. This exemption must be explicitly 5-19 provided for in the policy. 5-20 (d) Notwithstanding Subsections (a) and (b), this section 5-21 shall not be construed to require a health insurance policy to 5-22 include coverage for a newborn and infant hearing screening test 5-23 for an individual who is a resident of this state if the individual 5-24 is employed outside this state and the individual's employer 5-25 maintains a health insurance policy for the individual as an 5-26 employment benefit. 6-1 Sec. 47.007. RULES. The commissioner of insurance shall 6-2 adopt rules necessary for the implementation of this chapter. The 6-3 commissioner of insurance may consult with the commissioner and 6-4 other appropriate entities in adopting rules under this section. 6-5 Sec. 47.008. TECHNICAL ASSISTANCE BY DEPARTMENT. The 6-6 department shall establish the infrastructure to provide technical 6-7 assistance and consultation to birthing hospitals with regard to 6-8 preimplementation and implementation planning, information 6-9 management, ongoing program performance, and follow-up services. 6-10 Sec. 47.009. INFORMATION MANAGEMENT, REPORTING, AND TRACKING 6-11 SYSTEM. (a) The department shall provide all birthing hospitals 6-12 with the appropriate information management, reporting, and 6-13 tracking software for the program. The information management, 6-14 reporting, and tracking system shall be capable of providing the 6-15 department with information and data necessary to plan, monitor, 6-16 and evaluate the program, including the program's screening, 6-17 follow-up, diagnostic, and intervention components. 6-18 (b) All qualified newborn hearing screening providers, 6-19 hospitals, audiologists, and intervention specialists, as specified 6-20 by the department, shall have access to the information management, 6-21 reporting, and tracking system to provide information to the 6-22 department including: 6-23 (1) newborns born in each birthing hospital; 6-24 (2) newborns screened during birth admission; 6-25 (3) newborns passing the birth admission screening; 6-26 (4) families refusing the birth admission screening; 7-1 (5) newborns who need follow-up care; 7-2 (6) infants who receive follow-up care; 7-3 (7) infants identified with hearing loss; 7-4 (8) infants at risk for progressive hearing loss; 7-5 (9) infants who are referred for intervention 7-6 services; and 7-7 (10) case level information necessary to report 7-8 required statistics to the Maternal and Child Health Bureau on an 7-9 annual basis. 7-10 Sec. 47.010. CONFIDENTIALITY AND GENERAL ACCESS TO DATA. 7-11 (a) The information management, reporting, and tracking system 7-12 required by this chapter must meet confidentiality requirements in 7-13 accordance with required state and federal privacy guidelines. 7-14 (b) Data obtained through the information management, 7-15 reporting, and tracking system under this chapter are for the 7-16 confidential use of the department, its designee, and the persons 7-17 or public or private entities that the department determines are 7-18 necessary to carry out the functions of the tracking system. 7-19 Sec. 47.011. IMMUNITY FROM LIABILITY. A health facility, a 7-20 clinical laboratory, an audiologist, a physician, a registered 7-21 nurse, or any other officer or employee of a health facility 7-22 laboratory, a physician, or an audiologist shall not be criminally 7-23 or civilly liable for furnishing information to the department or 7-24 its designee pursuant to the requirements of this chapter. 7-25 SECTION 2. This Act takes effect September 1, 1999, and 7-26 applies to all insurance policies, individual and otherwise, 8-1 subscriber contracts, and group insurance certificates issued under 8-2 any group master policy that are delivered, issued for delivery, or 8-3 renewed on or after January 1, 2000. A policy delivered, issued 8-4 for delivery, or renewed before January 1, 2000, is governed by the 8-5 law as it existed immediately before the effective date of this 8-6 Act, and that law is continued in effect for this purpose. 8-7 SECTION 3. The importance of this legislation and the 8-8 crowded condition of the calendars in both houses create an 8-9 emergency and an imperative public necessity that the 8-10 constitutional rule requiring bills to be read on three several 8-11 days in each house be suspended, and this rule is hereby suspended.