Model Universal Newborn/Infant Hearing Screening, Tracking,
and Intervention Bill
The Model Universal Newborn/Infant Hearing
Screening, Tracking, and Intervention Bill was prepared with
input from the American Speech-Language-Hearing Association, the
American Academy of Audiology, and the Alexander Graham Bell
Association for the Deaf, Inc.
An Act establishing a statewide universal
Newborn/ Infant hearing screening, tracking, and intervention
program; establishing an advisory board; and for other
Be it enacted by the senate and general assembly
of the State of ______________:
This Act shall be known as the Universal Newborn/
Infant Hearing Screening, Tracking, and Intervention Act.
(A) Findings. The General Assembly finds as
- Hearing Loss occurs in Newborns more frequently than any
other health condition for which Newborn screening is currently
- Early detection of Hearing Loss in a child and early
intervention and treatment before six months of age has been
demonstrated to be highly effective in facilitating a
child's healthy development in a manner consistent with the
child's age and cognitive ability;
- Eighty percent (80%) of a child's ability to learn
speech, language and related cognitive skills is established by
the time the child is thirty-six months of age, and hearing is
vitally important to the healthy development of such language
- Children of all ages can receive reliable and valid
screening for Hearing Loss in a cost-effective manner;
- Appropriate screening and identification of Newborns and
Infants with Hearing Loss will facilitate early intervention
and treatment in the critical time period for language
development, and may therefore serve the public purposes of
promoting the healthy development of children, and reducing
public expenditure for health care and special education, and
(B) Purposes. The purpose of this legislation
- To provide early detection of Hearing Loss in Newborn
children at the birthing facility or as soon after birth as
possible, to enable these children and their families/
care-givers to obtain needed multi-disciplinary evaluation,
treatment, and intervention services at the earliest
opportunity; and to prevent or mitigate the developmental
delays and academic failures associated with late
identification of Hearing Loss; and
- To provide the State with the information necessary to
effectively plan, establish, and evaluate a comprehensive
system of appropriate services for Newborns and Infants who
have a Hearing Loss or are deaf.
(A) The following terms used in this ACT shall have the
meanings ascribed to them in this section unless expressly
"Birth Admission" means the time after birth that
the Newborn remains in the hospital nursery prior to
"Board" means the State Newborn Hearing Screening,
Tracking, and Intervention Advisory Board.
"Department" means the State Department of
"Health Insurance Policy" means any group health
insurance policy, contract, plan or any individual policy,
contract or plan with dependent coverage for children, which
provides medical coverage on an expense-incurred service or
prepaidbasis. The term includes all of the following:
- A health insurance policy or contract issued by a nonprofit
corporation or Fraternal Benefit Society.
- A health service plan operating as a Health Maintenance
Organization, a Preferred Provider Organization, an Exclusive
Provider Organization, or other managed care plan, as these
terms may be defined in State law;
- An employee welfare benefit plan as defined in section 3 of
the Employee Retirement Income Security Act of 1974
(Public Law 93-406, 88 Stat. 829).
"Hearing Loss" means a Hearing Loss of 30 dB HL or
greater in the frequency region important for speech recognition
and comprehension in one or both ears (approximately 500 through
4000 Hz). However, as technology allows for changes to this
definition to allow for the detection of less severe Hearing
Loss, the Board shall have the authority to modify it by
"Infant(s)" means a child 30 days to 24 months
"Intervention and/or Follow-up Care" means the early
intervention services described in Part H of the Individuals with
Disabilities Education Act (IDEA) as amended by P.L. 105-17.
"Medical Assistance Program" means the State
administered Medicaid program.
"Newborn(s)" means a child up to 29 days old.
"Parent(s)" means a natural Parent(s),
stepparent(s), adoptive Parent(s), legal guardian(s) or other
legal custodian of a child.
"Program" means the Universal Newborn/ Infant
Hearing Screening, Tracking, and Intervention Program.
"Secretary" (Commissioner) means the Secretary (or
Commissioner) of Health of this State.
(A) There is established the Newborn Hearing Screening
and Intervention Advisory Board under the jurisdiction of the
(A) The Board shall advise the Secretary on issues
relating to the Newborn hearing screening test, diagnostic
hearing evaluation, intervention, treatment, and Follow-up care
of Newborn children with a Hearing Loss. The Board shall act by
majority vote, and as required by this State's
Administrative Procedures Act. The Board shall have the
authority to adopt rules to implement this Act.
(B) By November 1, 1999, Newborn hearing screening must
be conducted on no fewer than eighty-five percent (85%) of the
Newborns born in hospitals in this State on Birth Admission,
using procedures recommended by the Board or their equivalent.
Where a Newborn is delivered in a facility other than a
hospital, the Parents must be instructed on the merits of
having the hearing screening performed and be given information
to assist them in having it performed within three months of
the date of the child's birth.
(C) On or after November 1, 1997, every hospital in
this State shall educate the Parents of Newborns born in such
hospitals of the importance of screening the hearing of
Newborns, and of receiving Follow-up care. This educational
information shall explain, in lay terms, the process of hearing
screening, the likelihood of their child having a Hearing Loss,
Follow-up procedures, and community resources. The educational
information also shall include a description of the normal
auditory, speech, and language developmental process in
children. Education shall not be considered a substitute for
the hearing screening. The Board shall determine the
appropriate screening venue(s) for infants who are born in
facilities other than hospitals.
(D) Every hospital shall report annually to the Board
concerning the following:
- The number of Newborns born in the hospital;
- The number of Newborns and Infants recommended for
diagnostic audiologic evaluation; and
- The number of Newborns screened on Birth Admission;
- The number of Newborns who passed the Birth Admission
screening, if administered;
- The number of Newborns who did not pass the Birth Admission
screening, if administered; and
- The number of Newborns recommended for monitoring,
intervention, and Follow-up care.
- The number of Newborns and Infants who return for Follow-up
- The number of Newborns and Infants who pass the Follow-up
(E) The Board shall determine which hospitals or other
health care institutions in this State are administering
hearing screening to Newborns and Infants on a voluntary basis
and the number of Newborns and Infants screened. The Board
shall report to the General Assembly by December 1, 1998,
concerning the following:
- The number of hospitals and other health care institutions
administering voluntary screenings during Birth Admission;
- The number of Newborns screened as compared to the total
number of Newborns born in such hospitals and institutions;
- The number of Newborns who passed the Birth Admission
screening, if administered; and
- The number of Newborns who did not pass the Birth Admission
screening, if administered.
- The number of Newborns recommended for Follow-up care.
(F) The Board shall meet as often as necessary to
collect the information necessary and report to the General
Assembly by December 1, 1998, and annually thereafter. In
addition, the Board shall develop and make recommendations in a
sufficiently timely manner to allow for Statewide universal
hearing screening of Newborns and Infants by November 1,
(G) Subject to available appropriations, the Board
shall make the report described in paragraphs E and F of this
section available throughout the State, and specifically
available to physicians whose practice includes the practice of
obstetrics, neonatology, or the care of Newborns and Infants,
to consumer groups, to managed care organizations, other third
party payers, and to the media.
(H) If the number of Newborns and Infants screened does
not equal or exceed eighty-five percent (85%) of the total
number of Newborns born in this State on or before November 1,
1999, or falls below eighty-five percent (85%) at any time
thereafter, the Department shall administer the screening of
Newborns and Infants pursuant to this Act, and shall be
reimbursed for such screenings from health insurance policies
as defined herein. Notwithstanding the aforementioned, it shall
be the goal of this State to achieve a one hundred percent
(100%) screening rate.
(I) The Department shall provide administrative support
services required by the Board. The members of the Board shall
receive no compensation for their services as members, but may
receive reimbursement for travel expenses incurred as a result
of their duties as members of the Board.
(A) The board shall be composed of an odd numbered
membership of at least eleven members, appointed by the
governor, from the following professions or
Health Care Systems/ Government
An adult who is deaf or hard of hearing,
representing consumer organizations of deaf and hard of
A Representative of the Health Insurance
Parents of children with Hearing
The Secretary of Health and/or
Teacher of children with Hearing
A Representative from the designated
government agency responsible for IDEA Part C.
Family Medical Practitioner (family
(A) In the event that eighty-five percent (85%) of
Newborns and Infants born in this State are not being screened
by November 1, 1999, or if at any time after that date the
number of screenings drops below eighty five percent (85%) of
all Newborns and Infants born in this State, then the
Department shall immediately implement a program to provide the
- A hearing screening test that every Newborn child shall
undergo for identification of Newborn child Hearing Loss. A
person properly trained, and supervised by a State-licensed
audiologist may perform the hearing screening test.
- The hearing screening test should be completed before
discharge from a Newborn nursery unit, but no later than three
months after birth. The test shall include the use of at least
one of the following physiologic technologies: automated or
diagnostic auditory brainstem response (ABR), otoacoustic
emissions (OAE). New physiologic technologies or improvements
to existing physiologic technologies that substantially enhance
Newborn hearing assessment should be incorporated into this
program as the Board finds appropriate.
(A) The Board shall establish guidelines for the
provision of Follow-up services for Newborn children in this
State who have or are at risk of developing a Hearing Loss and
are so identified. These services shall include, but are not
limited to, confirmatory pediatric audiologic assessment and
diagnosis of Newborns with abnormal or inconclusive test
results, counseling and educational services for the Parent(s),
and an explanation of the potential effects of the identified
Hearing Loss on the development of the Newborn's speech,
language, and cognitive skills as well as the potential
benefits of early identification and intervention.
(B) The General Assembly recognizes that it is
necessary to track children identified with a Hearing Loss for
a period of time in order to render appropriate Follow-up care.
Consequently, the Board is hereby authorized and directed to
study and recommend to the Secretary, on or before December 31,
1998, the preferred methods currently available to track
Newborns identified with a Hearing Loss. From the choice(s)
provided by the Board, the Secretary shall then determine the
most appropriate system for this State, and implement the
Board's recommendation on or before November 1, 1999. It is
the purpose of this subsection to facilitate the reporting of
Newborns and Infants who may have or are at risk of developing
a Hearing Loss. The reporting requirements shall be designed to
be as simple as possible and easily completed by
nonprofessional persons when necessary. It is the intent of the
General Assembly that the tracking system, at a minimum, does
- Provide the Board, Department, and General Assembly with
the information necessary to effectively plan and establish a
comprehensive system of developmentally appropriate services
for Newborns and Infants who are deaf or hard of hearing;
- Reduce the likelihood of associated disabling conditions
for such children; and
- Develop the tracking system contemplated by this section in
conjunction with other similar national systems, such as the
system required by Part C of the IDEA.
(C) Once the tracking system is operational, all
hospitals in the State and other providers of services that
have established hearing screening procedures for Newborns and
Infants and ages birth through three years shall report the
existence of Newborns and Infants who fail to pass hearing
(D) The information compiled and maintained in the
tracking system shall be kept confidential in accordance with
the applicable requirements and provisions of Part C of IDEA.
Parents of all registrants will be provided information on the
availability of resources and services in the State for
children with Hearing Loss, including those provided in
accordance with IDEA through the Statewide tracking system
created by this Act.
(E) Data obtained by the establishment of the tracking
system that is taken directly from the medical records of a
patient is for the confidential use of the Department and the
persons or public or private entities that the Department
determines are necessary to carry out the intent of the
tracking system. The data is privileged and may not be divulged
or made public in a manner that discloses the identity of an
individual whose medical records have been used for obtaining
data for the registry. Notwithstanding the above, anonymous
statistical information collected under this section is public
- (1) This tracking system should be integrated with any
national database or similar system developed by the federal
(F) The following persons who act in compliance with
this section are not civilly or criminally liable for
furnishing information required by this section: a hospital,
clinical laboratory or other health care facility, an
audiologist, an administrator, officer or employee of a
hospital or other health care facility, and a physician or
employee of a physician.
(A) Except as provided below, any health insurance
policy which is delivered, issued for delivery, renewed,
extended or modified in this State by any health care insurer
shall provide that the health insurance benefits applicable
under the health insurance policy shall include coverage for
initial screening and for any necessary audiologic diagnostic
Follow-up care related to the Newborn hearing screening test
described in this Act.
(B) Except as provided below, 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 the policy is located within or
outside this State.
(C) Benefits for the Newborn child hearing screening
test and any necessary audiologic Follow-up care shall be
subject to co-payment and coinsurance provisions of a health
insurance policy to the extent that other medical services
covered by the policy are subject to those provisions, except
that benefits for the Newborn child hearing screening test
shall be exempt from deductible or dollar limit provisions in
the health insurance policy. This exemption must be explicitly
provided for in the policy.
(D) Notwithstanding subsections (a) and (b), this
section shall not be construed to require a health insurance
policy to include coverage for the Newborn child hearing
screening test for an individual who is a resident of this
State if the individual is employed outside this State and the
individual's employer maintains a health insurance policy
for the individual as an employment benefit.
(E) This act shall apply to all insurance policies,
individual and otherwise, subscriber contracts and group
insurance certificates issued under any group master policy,
delivered or issued for delivery on or after the effective date
of this act. This act shall also apply to all renewals of
contracts on any renewal date, which is on or after the
effective date of this act.
(A) The agency responsible for the administration of
this State's Medicaid program shall pay for the Newborn/
Infant child hearing screening test, if the child is eligible
for medical assistance as determined by State and federal
(B) The Governor shall ensure that any contract for the
provision of Medical Assistance negotiated with a managed care
organization as authorized by State law, shall include payment
for Newborn/ Infant hearing screening testing and necessary
audiologic Follow-up care.
(A) No test is to be performed if the Parent of a
Newborn dissents on the ground that the test conflicts with a
personal religious belief or practice.
(B) The Secretary shall promulgate regulations as may
be necessary to implement the provisions under Sections 4
(C) The Insurance Commissioner shall promulgate
regulations necessary to implement the provisions under section
(A) The General Assembly shall make any necessary
appropriations to carry out the purposes of this Act.
(A) This Act shall take effect immediately.