1-1 By: Moncrief, Wentworth S.B. No. 458
1-2 (In the Senate - Filed February 10, 1999; February 15, 1999,
1-3 read first time and referred to Committee on Health Services;
1-4 May 7, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 5, Nays 0; May 7, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 458 By: Nixon
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the establishment of a newborn hearing screening,
1-11 tracking, and intervention program.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Subtitle B, Title 2, Health and Safety Code, is
1-14 amended by adding Chapter 47 to read as follows:
1-15 CHAPTER 47. HEARING LOSS IN NEWBORNS
1-16 Sec. 47.001. DEFINITIONS. In this chapter:
1-17 (1) "Birth admission" means the time after birth that
1-18 a newborn remains in the birthing facility before the newborn is
1-19 discharged.
1-20 (2) "Birthing facility" means:
1-21 (A) a hospital licensed under Chapter 241 that
1-22 offers obstetrical services and is located in a county with a
1-23 population of more than 50,000; or
1-24 (B) a birthing center licensed under Chapter 244
1-25 that is located in a county with a population of more than 50,000
1-26 or that has 100 births or more per year.
1-27 (3) "Health care provider" means a registered nurse
1-28 recognized as an advanced practice nurse by the Board of Nurse
1-29 Examiners or a physician assistant licensed by the Texas State
1-30 Board of Physician Assistant Examiners.
1-31 (4) "Hearing loss" means a hearing loss of 30 dB HL or
1-32 greater in the frequency region important for speech recognition
1-33 and comprehension in one or both ears, approximately 500 through
1-34 4,000 Hz. As technological advances permit the detection of less
1-35 severe hearing loss, the department may modify this definition by
1-36 rule.
1-37 (5) "Infant" means a child who is at least 30 days but
1-38 who is younger than 24 months old.
1-39 (6) "Intervention" or "follow-up care" means the early
1-40 intervention services described in Subchapter III, Individuals with
1-41 Disabilities Education Act (20 U.S.C. Sections 1431-1445), as
1-42 amended by Pub. L. No. 105-17.
1-43 (7) "Newborn" means a child younger than 30 days old.
1-44 (8) "Parent" means a natural parent, stepparent,
1-45 adoptive parent, legal guardian, or other legal custodian of a
1-46 child.
1-47 (9) "Physician" means a person licensed to practice
1-48 medicine by the Texas State Board of Medical Examiners.
1-49 (10) "Program" means a newborn hearing screening,
1-50 tracking, and intervention program operated in accordance with this
1-51 chapter.
1-52 Sec. 47.002. NEWBORN HEARING SCREENING, TRACKING, AND
1-53 INTERVENTION PROGRAM. (a) A birthing facility, through a program
1-54 certified by the department under Section 47.003, may offer the
1-55 parents of a newborn a hearing screening for the newborn for the
1-56 identification of hearing loss. The screening must be offered
1-57 during the birth admission.
1-58 (b) The department or the department's designee may approve
1-59 program protocols.
1-60 (c) The department may maintain data and information on each
1-61 newborn who receives services under a program.
1-62 (d) The department shall ensure that intervention is
1-63 available to families for a newborn identified as having hearing
1-64 loss and that the intervention is managed by state programs
2-1 operating under the Individuals with Disabilities Education Act (20
2-2 U.S.C. Section 1400 et seq.).
2-3 (e) The department shall ensure that the intervention
2-4 described by Subsection (d) is available for a newborn identified
2-5 as having hearing loss through the time the child is an infant.
2-6 Sec. 47.003. CERTIFICATION OF SCREENING PROGRAMS. (a) The
2-7 department or the department's designee shall establish
2-8 certification criteria for implementing a program.
2-9 (b) Certification criteria adopted under Subsection
2-10 (a) must require that a certified program:
2-11 (1) provide hearing screening using equipment
2-12 recommended by the department;
2-13 (2) use appropriate staff to provide the screening;
2-14 (3) maintain and report data electronically if
2-15 required by the department;
2-16 (4) distribute standardized family, health care
2-17 provider, and physician educational materials standardized by the
2-18 department; and
2-19 (5) provide information, as recommended by the
2-20 department, on follow-up services for newborns and infants with
2-21 abnormal screening results.
2-22 (c) The department may certify a program that meets and
2-23 maintains the certification criteria.
2-24 (d) The department may renew the certification of a program
2-25 on a periodic basis as established by board rule in order to ensure
2-26 quality services to newborns and families.
2-27 (e) A fee may not be charged to certify or recertify a
2-28 program.
2-29 Sec. 47.004. INFORMATION CONCERNING SCREENING RESULTS AND
2-30 FOLLOW-UP CARE. (a) A birthing facility shall distribute to the
2-31 parents of each newborn who is screened educational materials that
2-32 are standardized by the department regarding screening results and
2-33 follow-up care.
2-34 (b) A birthing facility shall report screening results to
2-35 the parents, the newborn's attending physician or health care
2-36 provider, and, if required by the department, the department.
2-37 (c) Appropriate and necessary care for an infant who needs
2-38 follow-up care should be directed and coordinated by the infant's
2-39 physician or health care provider, with support from appropriate
2-40 ancillary services.
2-41 Sec. 47.005. TECHNICAL ASSISTANCE BY DEPARTMENT. The
2-42 department may consult with a birthing facility that operates a
2-43 program and provide to the facility technical assistance associated
2-44 with the implementation of a program.
2-45 Sec. 47.006. INFORMATION MANAGEMENT, REPORTING, AND TRACKING
2-46 SYSTEM. (a) The department shall provide each birthing facility
2-47 that provides newborn screening under the medical assistance
2-48 program provided under Chapter 32, Human Resources Code, with
2-49 appropriate information management, reporting, and tracking system
2-50 software for the program. The information management, reporting,
2-51 and tracking system must be capable of providing the department
2-52 with information and data necessary to plan, monitor, and evaluate
2-53 the program, including the program's screening, follow-up,
2-54 diagnostic, and intervention components.
2-55 (b) A qualified hearing screening provider, hospital,
2-56 audiologist, or intervention specialist may access the information
2-57 management, reporting, and tracking system to provide information,
2-58 where available, to the department, including information relating
2-59 to:
2-60 (1) newborns born in each birthing facility that
2-61 operates a program;
2-62 (2) newborns screened during birth admission;
2-63 (3) newborns passing the birth admission screening;
2-64 (4) families refusing the birth admission screening;
2-65 (5) newborns who need follow-up care;
2-66 (6) infants who receive follow-up care;
2-67 (7) infants identified with hearing loss;
2-68 (8) infants at risk for progressive hearing loss;
2-69 (9) infants who are referred for intervention
3-1 services; and
3-2 (10) case level information necessary to report
3-3 required statistics to the Maternal and Child Health Bureau on an
3-4 annual basis.
3-5 (c) The department shall ensure that the written consent of
3-6 a parent is obtained before a newborn is included in the
3-7 information management, reporting, and tracking system or any
3-8 information relating to the newborn or infant is released through
3-9 the system.
3-10 Sec. 47.007. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
3-11 (a) The information management, reporting, and tracking system
3-12 provided in accordance with this chapter must meet confidentiality
3-13 requirements in accordance with required state and federal privacy
3-14 guidelines.
3-15 (b) Data obtained through the information management,
3-16 reporting, and tracking system under this chapter are for the
3-17 confidential use of the department, the department's designee, and
3-18 the persons or public or private entities that the department
3-19 determines are necessary to carry out the functions of the tracking
3-20 system.
3-21 Sec. 47.008. IMMUNITY FROM LIABILITY. A birthing facility,
3-22 a clinical laboratory, an audiologist, a health care provider, a
3-23 physician, a registered nurse, or any other officer or employee of
3-24 a birthing facility, a laboratory, a physician, or an audiologist
3-25 is not criminally or civilly liable for furnishing information to
3-26 the department or its designee in connection with a program
3-27 provided in accordance with this chapter.
3-28 SECTION 2. Section 36.004, Health and Safety Code, is
3-29 amended by adding Subsection (i) to read as follows:
3-30 (i) A hearing screening performed under this section is in
3-31 addition to any hearing screening test performed under Chapter 47.
3-32 SECTION 3. Section 32.024, Human Resources Code, is amended
3-33 by adding Subsection (v) to read as follows:
3-34 (v) The department by rule shall provide a screening test
3-35 for hearing loss in accordance with Chapter 47, Health and Safety
3-36 Code, and any necessary diagnostic follow-up care related to the
3-37 screening test to a child younger than 30 days old who receives
3-38 medical assistance.
3-39 SECTION 4. Subsection (b), Section 2, Article 21.53F,
3-40 Insurance Code, as added by Chapter 683, Acts of the 75th
3-41 Legislature, Regular Session, 1997, is amended to read as follows:
3-42 (b) This article does not apply to:
3-43 (1) a plan that provides coverage:
3-44 (A) only for a specified disease or other
3-45 limited benefit;
3-46 (B) only for accidental death or dismemberment;
3-47 (C) for wages or payments in lieu of wages for a
3-48 period during which an employee is absent from work because of
3-49 sickness or injury;
3-50 (D) as a supplement to liability insurance;
3-51 (E) for credit insurance;
3-52 (F) only for dental or vision care; [or]
3-53 (G) only for indemnity for hospital confinement;
3-54 or
3-55 (H) only for hospital expenses;
3-56 (2) a small employer health benefit plan written under
3-57 Chapter 26 of this code;
3-58 (3) a Medicare supplemental policy as defined by
3-59 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
3-60 (4) workers' compensation insurance coverage;
3-61 (5) medical payment insurance issued as part of a
3-62 motor vehicle insurance policy; [or]
3-63 (6) a long-term care policy, including a nursing home
3-64 fixed indemnity policy, unless the commissioner determines that the
3-65 policy provides benefit coverage so comprehensive that the policy
3-66 is a health benefit plan as described by Subsection (a) of this
3-67 section; or
3-68 (7) a CHAMPUS (Civilian Health and Medical Program of
3-69 the Uniformed Services) supplemental policy.
4-1 SECTION 5. Article 21.53F, Insurance Code, as added by
4-2 Chapter 683, Acts of the 75th Legislature, Regular Session, 1997,
4-3 is amended by amending Sections 3 and 4 and adding Sections 5, 6,
4-4 and 7 to read as follows:
4-5 Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS.
4-6 [(a)] A health benefit plan that provides benefits for a family
4-7 member of the insured shall provide coverage for each covered child
4-8 described by Section 5 of this article [Subsection (b) of this
4-9 section], from birth through the date the child is six years of
4-10 age, for:
4-11 (1) immunization against:
4-12 (A) diphtheria;
4-13 (B) haemophilus influenzae type b;
4-14 (C) hepatitis B;
4-15 (D) measles;
4-16 (E) mumps;
4-17 (F) pertussis;
4-18 (G) polio;
4-19 (H) rubella;
4-20 (I) tetanus; and
4-21 (J) varicella; and
4-22 (2) any other immunization that is required by law for
4-23 the child.
4-24 Sec. 4. REQUIRED BENEFITS FOR SCREENING TEST FOR HEARING
4-25 IMPAIRMENT. (a) A health benefit plan that provides benefits for
4-26 a family member of the insured shall provide coverage for each
4-27 covered child described by Section 5 of this article for:
4-28 (1) a screening test for hearing loss from birth
4-29 through the date the child is 30 days old, as provided by Chapter
4-30 47, Health and Safety Code; and
4-31 (2) necessary diagnostic follow-up care related to the
4-32 screening test from birth through the date the child is 24 months
4-33 old.
4-34 (b) The commissioner may adopt rules to implement the
4-35 requirement of this section.
4-36 (c) This section applies to any health benefit plan that
4-37 provides coverage or benefits to a resident of this state, without
4-38 regard to whether the issuer of the health benefit plan is located
4-39 within or outside this state. This section does not require the
4-40 issuer of a health benefit plan to provide coverage under this
4-41 section for the child of a resident of this state who:
4-42 (1) is employed outside of this state; and
4-43 (2) is covered under a health benefit plan maintained
4-44 for the individual by the individual's employer as an employment
4-45 benefit.
4-46 Sec. 5. COVERED CHILDREN. [(b)] A child is entitled to
4-47 benefits under this article [section] if the child, as a result of
4-48 the child's relationship to an enrollee in the health benefit plan,
4-49 would be entitled to benefits under an accident and sickness
4-50 insurance policy under Subsection (K), (L), or (M), Section 2,
4-51 Chapter 397, Acts of the 54th Legislature, 1955 (Article 3.70-2,
4-52 Vernon's Texas Insurance Code).
4-53 Sec. 6 [4]. APPLICATION OF DEDUCTIBLE, COPAYMENT, OR
4-54 COINSURANCE REQUIREMENT [FIRST DOLLAR COVERAGE REQUIRED].
4-55 (a) Benefits required under Section 3 of this article may not be
4-56 made subject to a deductible, copayment, or coinsurance
4-57 requirement. This subsection [(b) Subsection (a) of this section]
4-58 does not prohibit the application of a deductible, copayment, or
4-59 coinsurance requirement to another service provided at the same
4-60 time as the immunization.
4-61 (b) Benefits required under Section 4 of this article may be
4-62 subject to copayment and coinsurance requirements, but may not be
4-63 subject to a deductible requirement or dollar limit. The
4-64 requirements of this subsection must be stated in the coverage
4-65 document.
4-66 Sec. 7. RULES. The commissioner may adopt rules as
4-67 necessary to implement this article.
4-68 SECTION 6. The heading to Article 21.53F, Insurance Code, as
4-69 added by Chapter 683, Acts of the 75th Legislature, Regular
5-1 Session, 1997, is amended to read as follows:
5-2 Art. 21.53F. COVERAGE FOR CERTAIN BENEFITS FOR CHILDREN
5-3 [CHILDHOOD IMMUNIZATIONS]
5-4 SECTION 7. This Act takes effect September 1, 1999.
5-5 SECTION 8. The Texas Board of Health shall adopt the rules
5-6 required by Section 47.003, Health and Safety Code, as added by
5-7 this Act, not later than December 1, 1999.
5-8 SECTION 9. (a) Except as provided by Subsection (b) of this
5-9 section, not later than January 1, 2000, the Health and Human
5-10 Services Commission and each appropriate health and human services
5-11 agency that operates part of the state medical assistance program
5-12 under Chapter 32, Human Resources Code, shall adopt the rules
5-13 required by Subsection (v), Section 32.024, Human Resources Code,
5-14 as added by this Act.
5-15 (b) If, before implementing Subsection (v), Section 32.024,
5-16 Human Resources Code, as added by this Act, the Health and Human
5-17 Services Commission determines that a waiver or authorization from
5-18 a federal agency is necessary for implementation, the commission
5-19 shall request the waiver or authorization and may delay
5-20 implementing that provision until the waiver or authorization is
5-21 granted.
5-22 SECTION 10. The change in law made by Sections 4 and 5 of
5-23 this Act applies only to a health benefit plan that is delivered,
5-24 issued for delivery, or renewed on or after January 1, 2000. A
5-25 health benefit plan that is delivered, issued for delivery, or
5-26 renewed before January 1, 2000, is governed by the law as it
5-27 existed immediately before the effective date of this Act, and that
5-28 law is continued in effect for that purpose.
5-29 SECTION 11. This Act takes effect only if a specific
5-30 appropriation for the implementation of this Act is provided in
5-31 H.B. No. 1 (General Appropriations Act), Acts of the 76th
5-32 Legislature, Regular Session, 1999. If no specific appropriation
5-33 is provided in H.B. No. 1, the General Appropriations Act, this Act
5-34 has no effect.
5-35 SECTION 12. The importance of this legislation and the
5-36 crowded condition of the calendars in both houses create an
5-37 emergency and an imperative public necessity that the
5-38 constitutional rule requiring bills to be read on three several
5-39 days in each house be suspended, and this rule is hereby suspended.
5-40 * * * * *