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Section 1. Title. This Act shall be known and may be cited as the
"Universal Newborn and Infant Hearing Screening Act".
Section 2.
Legislative findings and purpose.
(a) The legislature hereby finds and declares that:
(1) Significant hearing impairment is one of the most common major abnormalities present at birth and, if undetected, will impede the child's speech, language, and cognitive development.
(2) Screening by high-risk characteristics alone (e.g., family history of deafness) only identifies approximately 50% of newborns with significant hearing impairment.
(3) Reliance solely on physician and/or parental observation fails to identify many cases of significant hearing loss in newborns and infants.
(4) There is evidence that children with hearing loss who are identified at birth and receive intervention services shortly thereafter, have significantly better learning capacity than children who are identified with hearing loss later than six months after birth.
(5) Legislation is needed to provide for the early detection of hearing loss in newborns and infants and to prevent or mitigate the developmental delays associated with late identification of hearing loss.
Section 3.
Definitions.
(a) "Child" means a person up to 21 years of age.
(b)
"False positive rate" means the proportion of infants identified as having a significant
hearing impairment by the screening process who are ultimately found to not have
a significant hearing impairment.
(c) "False negative rate" means the proportion
of infants not identified as having a significant hearing impairment by the screening
process who are ultimately found to have a significant hearing impairment.
(d)
"Health Care Insurer" means any entity regulated by the Insurance Commissioner,
including, but not limited to, health care insurers; health, hospital or medical
service plan corporations; or health maintenance organizations. Health care insurer
does not include self-insured plans or groups regulated by the Employment Retirement
Income Security Act of 1974 ("ERISA"), to the extent that state regulation of
such plans is preempted by ERISA.
(e) "Health Insurance Policy" means any health
insurance policy, contract, plan, or evidence of coverage issued by a health care
insurer, which provides medical coverage on an expense incurred, service or prepaid
basis.
(f) "Hearing screening test" means auditory brain stem response, otoacoustic
emissions, or another appropriate screening test approved by the state Department
of Health.
(g) "Hospital" means a health care facility or birthing center licensed
in this state that provides obstetrical services.
(h) "Infant" means a child
who is not a newborn and has not attained the age of one year.
(i) "Newborn"
means a child up to 28 days old.
(j) "Parent" means a natural parent, stepparent,
adoptive parents, guardian, or custodian of a newborn or infant.
(k) "Significant
hearing impairment" means a hearing impairment equivalent to or greater than a
35-decibel hearing loss (35-dB HL) in the better ear.
Section
4. Newborn and Infant Hearing Screening Programs.
(a) As a condition
of its licensure, each hospital shall establish a Newborn and Infant Hearing Screening
Program ("NIHSP"). Each NIHSP shall:
(1) In advance of any hearing screening testing, provide to the newborn's or infant's parent(s) information concerning the nature of the screening procedure, applicable costs of the screening procedure (including information concerning insurance coverage and copayment obligations), the potential risk and effects of hearing loss, and the benefits of early detection and intervention.
(2) Consistent with informed consent obtained from the parent(s) pursuant to subsection (a)(1), provide a hearing screening test for every newborn born in the hospital, for identification of hearing loss, regardless of whether or not the newborn has known risk factors suggesting hearing impairment.
(3) Develop screening protocols and select screening method(s) designed to detect newborns and infants with a significant hearing impairment.
(4) Provide for appropriate training and monitoring of the performance of individuals responsible for performing hearing screening tests shall be trained properly in:(a) the performance of the tests,
(b) the risks of the tests, including psychological stress for the parent(s),
(c) infection control practices, and
(d) the general care and handling of newborns and infants in hospital settings.
(5) Perform the hearing testing prior to the newborn's discharge; if the newborn is expected to remain in the hospital for a prolonged period, testing shall be performed prior to the date on which he or she attains the age of three months.(6) Develop and implement procedures for documenting the results of all hearing screening tests.
(7) Inform the newborn's or infant's parents and primary care physician if a newborn or infant fails to pass the hearing screening test, or if the newborn or infant was not successfully tested. Whenever possible, such notification shall occur prior to discharge; if this is not possible, notification shall occur no later than ten days following the date of testing. Notification shall include information regarding appropriate follow-up for a screening failure or a missed screening, and referral information for confirmatory testing. If a hearing screening test indicates the possibility of a significant hearing impairment, the hospital shall ensure that the physician or other person attending the newborn or infant is made aware of the community resources available for confirmatory testing and process of referral to early intervention services.
(8) Collect performance data specified by the state Department of Health to ensure that each NIHSP is in compliance with this section, including the number of infants born, the proportion of all infants screened, the referral rate, the follow-up rate, the false-positive rate, and the false-negative rate.(a) Testing Performance Standards.
(1) Each NIHSP should have a false-positive rate of 3% or less.
(2) Each NIHSP should have a false-negative rate of 3% or less.(b) Oversight Responsibility. The state Department of Health shall exercise oversight responsibility for NIHSPs, including establishing a performance data set and reviewing performance data collected pursuant thereto by each hospital.
Section
5. Civil and Criminal Immunity and Penalties.
(a) No physician
shall be civilly or criminally liable for failure to conduct hearing screening
testing.
(b) No physician or hospital acting in compliance with this Act shall
be civilly or criminally liable for any acts taken in conformity herewith, including
without limitation furnishing information required to be furnished hereunder.
(c)
A hospital that has not established or implemented an NIHSP in accordance with
this Act shall be subject to sanction by the Department of Health as provided
by law for licensure violations.
(d) A health care insurer that violates section
7(b) shall be subject to a civil money penalty of [up to $25] for each affected
insured who has not received the required notice.
Section 6. Confidentiality.
The Department of Health and all other persons to whom data is submitted
in accordance with this Act shall keep such information confidential. No publication
or disclosure of information shall be made except in the form of statistical or
other studies which do not identify individuals, except as specifically consented
to in writing the by the parent(s) of a tested child.
Section 7.
Coverage and Reimbursement.
(a) Any health insurance policy which
is delivered, issued for delivery, renewed, extended, or modified in this state
by any health care insurer and which provides coverage for a child shall be deemed
to provide coverage for hearing loss screening tests of newborns and infants provided
by a hospital before discharge.
(b) A health care insurer delivering a health
insurance policy regulated under this Act shall provide each insured with notice
of the provisions of this Act upon the effective date of coverage and annually
thereafter.
(c) The amount of reimbursement for newborn or infant hearing screening
provided under such a policy shall be consistent with reimbursement of other medical
expenses under the policy, including the imposition of copayment, coinsurance,
deductible, or any dollar limit or other cost-sharing provisions otherwise applicable
under the policy.
Section 8. Delivery of Policy. If a health
insurance policy provides coverage or benefits to a resident of this state, it
shall be deemed to be delivered in this state within the meaning of this Act,
regardless of whether the health care insurer issuing or delivering said policy
is located inside or outside of the state.
Section 9. Applicability.
This Act applies to health insurance policies delivered, issued for delivery,
renewed, extended or modified, after the effective date of this Act.
Section
10. Effective Date. This act is effective upon passage and approval.
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December 2000.
©2000 by the American Academy of Pediatrics.
No part of this statement may
be reproduced in any form or by any means without prior written permission from
the American Academy of Pediatrics except for one copy for personal use.