HBA-NMO C.S.H.B. 714 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 714 By: Naishtat Public Health 4/11/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Current law requires newborns in this state to be blood-screened for a variety of conditions. However, the law does not require the screening of newborns for congenital loss of hearing. Lack of early detection of hearing loss may have social and financial impacts on individuals, families, and this state. C.S.H.B. 714 requires that a screening test for hearing loss be administered to newborn children, and establishes a newborn hearing, tracking, and screening program. This bill also requires a state medical assistance program or a private health benefit plan to provide coverage for the screening test, as appropriate. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health in SECTION 1 (Section 47.003, Health and Safety Code); the Health and Human Services Commission or an agency operating part of the medical assistance program, as appropriate, in SECTION 3 (Section 32.024, Human Resources Code); and the commissioner of insurance in SECTION 4 (Sections 4 and 7, Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997), of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subtitle B, Title 2, Health and Safety Code, by adding Chapter 47, as follows: CHAPTER 47. HEARING LOSS IN NEWBORNS Sec. 47.001. DEFINITIONS. Defines "birth admission," "birthing facility," and "hearing loss." Defines "infant" as a child who is at least 30 days but who is younger than 24 months old. Defines "intervention follow-up care." Defines "newborn" as a child younger than 30 days old. Defines "parent," "physician," and "program." Sec. 47.002. NEWBORN HEARING SCREENING, TRACKING, AND INTERVENTION PROGRAM. Requires a birthing facility, through a program certified by the Texas Department of Health (TDH) under Section 47.003, to offer the parents of a newborn a hearing loss screening for the newborn. Requires that the screening by offered during birth admission. Requires TDH or its designee to approve program protocols. Requires TDH to maintain data and information on each newborn who receives services under a program. Requires TDH to ensure that intervention is available to families for a newborn identified as having hearing loss and that the intervention is managed by state programs operating under the Individuals with Disabilities Education Act (20 U.S.C. Section 1400 et seq.). Requires TDH to ensure that the intervention described by Subsection (d) is available for a newborn identified as having hearing loss through the time the child is an infant. Sec. 47.003. CERTIFICATION OF SCREENING PROGRAMS. Requires TDH or its designee to establish certification criteria for implementing a program. Sets forth certification criteria. Requires TDH to certify a program that meets and maintains the certification criteria. Requires TDH to renew the certification of a program on a periodic basis as established by board rule in order to ensure quality services to newborns and families. Prohibits a fee from being charged to certify or recertify a program. Sec. 47.004. INFORMATION CONCERNING SCREENING RESULTS AND FOLLOWUP CARE. Requires a birthing facility to distribute to the parents of each newborn who is screened educational materials that are standardized by TDH regarding screening results and follow-up care. Requires a birthing facility to report screening results to the parents, the physician, and TDH. Provides that appropriate and necessary care for the infant who needs follow-up care should be directed and coordinated by the infant's physician, with support from appropriate ancillary services. Sec. 47.005. TECHNICAL ASSISTANCE BY DEPARTMENT. Requires TDH to consult with a birthing facility and provide to the facility technical assistance associated with the implementation of a certified program. Sec. 47.006. INFORMATION MANAGEMENT, REPORTING, AND TRACKING SYSTEM. (a) Requires TDH to provide each birthing facility with the appropriate information management, reporting, and tracking software for the program. Provides that the information management, reporting, and tracking system must by capable of providing TDH with information and data necessary to plan, monitor, and evaluate the program, including the program's screening, follow-up, diagnostic, and intervention components. (b) Authorizes a qualified hearing screening provider, hospital, audiologist, or intervention specialist to access the information management, reporting, and tracking system to provide certain information, where available, to TDH. Sec. 47.007. CONFIDENTIALITY AND GENERAL ACCESS TO DATA. Provides that the information management, reporting, and tracking system required by this chapter must meet confidentiality requirements in accordance with required state and federal privacy guidelines. Provides that data obtained through the system is for the confidential use of TDH, its designee, and the persons or public or private entities that TDH determines are necessary to carry out the functions of the tracking system. Sec. 47.008. IMMUNITY FROM LIABILITY. Provides that certain person are not criminally or civilly liable for furnishing information to TDH or its designee as required by this chapter. SECTION 2. Amends Section 36.004, Health and Safety Code, by adding Subsection (i), as follows: (i) Provides that a hearing screening performed under this section is in addition to any hearing screening test performed under Chapter 34. SECTION 3. Amends Section 32.024, Human Resources Code, by adding Subsection (v), as follows: (v) Requires the Health and Human Services Commission or an agency operating part of the medical assistance program, as appropriate, by rule, to provide a screening test for hearing impairments as required by Texas Board of Health rule under Chapter 34, Health and Safety Code, to a child younger than 181 days old who receives medical assistance. SECTION 4. Amends Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, by amending Sections 3 and 4 and adding Sections 5 and 6, as follows: Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. Makes conforming changes. Sec. 4. REQUIRED BENEFITS FOR SCREENING TEST FOR HEARING IMPAIRMENT. (a) Requires a health benefit plan to provide coverage for each child described by Section 5 of this article for a screening test for hearing loss, from birth through the date the child is 30 days old, required under Chapter 47, Health and Safety Code, and necessary diagnostic follow-up care related to the screening test from birth through the date the child is 24 months old. (b) Authorizes the commissioner of insurance to adopt rules to implement the requirement of this section. (c) Provides that this section applies to any health benefit plan that provides coverage or benefits to a resident of this state, without regard to whether the issuer of the plan is located within the state. Provides that this section does not require the issuer of a health benefit plan to provide coverage under this section for the child of a resident of this state who is employed outside of this state and is covered under a health benefit plan maintained for the individual by the individual's employer as an employment benefit. Sec. 5. COVERED CHILDREN. Creates from existing language in existing Section 3(b). Entitles a child to benefits under this article if the child, as a result of the child's relationship to an enrollee in the health benefit plan, would be entitled to benefits under an accident and sickness insurance policy under Subsection (K), (L), or (M), Section 2, Article 3.70-2, Insurance Code (Form of Policy). Makes conforming changes. Sec. 6. New title: APPLICATION OF DEDUCTIBLE, COPAYMENT, OR COINSURANCE REQUIREMENT. (a) Creates from language in existing Section 4. Prohibits benefits required under Sections 3 from being made subject to a deductible, copayment, or coinsurance requirement. Provides, however, that this subsection does not prohibit the application of a deductible, copayment, or coinsurance requirement to another service provided at the same time as the immunization or hearing screening. Makes a conforming change. (b) Authorizes that benefits under Section 4 of this article be subject to copayment and coinsurance requirements, but prohibits such benefits from being subject to a deductible requirement or dollar limit. Provides that the requirements of this subsection must be stated in the coverage document. Sec. 7. RULES. Authorizes the commissioner of insurance to adopt rules as necessary to implement this article. SECTION 5. Amends the heading of Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, as follows: Art. 21.53F. COVERAGE FOR CERTAIN BENEFITS FOR CHILDREN. Deletes "childhood immunizations" from existing title. Adds "certain benefits for children." SECTION 6. Effective date: September 1, 1999. Requires each birthing facility with at least 1,000 births in a year, not later than May 1, 2000, to offer newborn hearing screening during the birth admission as required by Section 47.002, Health and Safety Code. Requires each birthing facility, not later than April 1, 2001, to offer the hearing screening during the birth admission as required by Section 47.002. SECTION 7. Requires the Texas Board of Health to adopt the rules required by Section 47.003, Health and Safety Code, not later than December, 1, 1999. SECTION 8. Requires the Health and Human Services Commission and each appropriate health and human services agency that operates part of the state medical assistance program under Chapter 32, Human Resources Code (Medical Assistance Program), not later than January 1, 2000, to adopt rules required by Section 32.024(v), Human Resources Code. Requires the commission, if before implementing Section 32.024(v) it determines that a waiver or authorization from a federal agency is necessary for implementation, to request the waiver or authorization and authorizes it to delay implementing that provision until the waiver or authorization is granted. SECTION 9. Makes application of the change in law made by SECTION 4 prospective beginning with a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2000. SECTION 10. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute differs from the original in the caption. The substitute differs from the original in SECTION 1 in the amendment of Subtitle B, Title 2, Health and Safety Code, by adding Chapter 47 (Hearing Loss in Newborns), rather than Chapter 34 (Hearing Impairments), as proposed. Chapter 47 essentially requires a birthing facility to offer the parents of a newborn, during birth admission, hearing loss screening for the newborn, and establishes a newborn hearing screening, tracking, and intervention program. The proposed Chapter 34 essentially requires the physician attending a newborn child or the person attending the delivery of a newborn child that is not attended by a physician to ensure that the child is subject to a screening test. The substitute differs from the original in SECTION 4, as follows: Modifies Section 4, Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, by requiring a health benefit plan to provide coverage for each child described by Section 5 of this article for a screening test for hearing loss, from birth through the date the child is 30 days old, rather than 180 days old, required under Chapter 47, rather than 34, Health and Safety Code, and by requiring the plan to provide necessary diagnostic follow-up care related to the screening test from birth through the date the child is 24 months old. The substitute adds Subsection (c) to Section 4, Article 21.53F, relating to applicability and nonapplicability of health benefit plan coverage. Modifies Section 6, Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, to provide the new title of "Application of Deductible, Copayment, or Coinsurance Requirement." Prohibits benefits under Section 3, rather than Sections 3 and 4, Article 21.53F, as proposed, from being made subject to a deductible, copayment, or coinsurance requirement. The substitute adds Subsection (b) to authorize that benefits under Section 4, Article 21.53F, be subject to copayment and coinsurance requirements, but prohibits such benefits from being subject to a deductible requirement or dollar limit. Provides that the requirements of this subsection must be stated in the coverage document. Adds Section 7 (Rules), Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, to authorize the commissioner of insurance to adopt rules as necessary to implement this article. The substitute differs from the original in SECTION 5 by not redesignating Article 21.53F, Insurance Code, as added by Chapter 683, Acts of the 75th Legislature, Regular Session, 1997, to Article 21.53J, as proposed. The substitute differs from the original in SECTION 6 in Subsection (b) by requiring each birthing facility with at least 1,000 births in a year, not later than May 1, 2000, to offer newborn hearing screening during the birth admission as required by Section 47.002, Health and Safety Code, rather than providing that a physician or other person attending the birth of a child is not required to comply with Section 34.011, Health and Safety Code, before September 1, 2000. The substitute adds Subsection (c) to require each birthing facility, not later than April 1, 2001, to offer the hearing screening during the birth admission as required by Section 47.002. The substitute differs from the original in SECTION 7 by requiring the Texas Board of Health to adopt the rules required by Section 47.003, Health and Safety Code, rather than 34.011, as proposed, not later than December, 1, 1999, rather than August 31, 2000. The substitute differs from the original in SECTION 8 by requiring the Health and Human Services Commission and each appropriate health and human services agency that operates part of the state medical assistance program under Chapter 32, Human Resources Code (Medical Assistance Program), not later than January 1, 2000, rather than August 31, 2000, to adopt rules required by Section 32.024(v), Human Resources Code.