00 CS FOR HOUSE BILL NO. 109(L&C) 01 "An Act relating to establishing a screening, tracking, and intervention program related 02 to the hearing ability of newborns and infants; providing an exemption to licensure as 03 an audiologist for certain persons performing hearing screening; relating to insurance 04 coverage for newborn and infant hearing screening; and providing for an effective 05 date." 06 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 07 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 08 to read: 09 LEGISLATIVE FINDINGS. The legislature finds that 10 (1) hearing loss occurs in newborns and infants more frequently than any other 11 health condition for which newborn or infant screening is required; 12 (2) 80 percent of the language ability of a child is established by the time the 13 child is 18 months of age, and appropriate language training is vitally important to the healthy 01 development of cognitive, social, emotional, and academic skills; 02 (3) early detection of hearing loss in a child and early intervention and 03 treatment have been demonstrated to be highly effective in facilitating a child's healthy 04 development in a manner consistent with the child's age and cognitive ability; 05 (4) children with hearing loss who do not receive early intervention and 06 treatment frequently require special education services, and these services are publicly funded 07 for the vast majority of children with hearing needs in the state; and 08 (5) appropriate screening and identification of newborns and infants with 09 hearing loss will facilitate early intervention and treatment and may serve the public purpose 10 of promoting the healthy development of children while reducing public expenditures. 11 * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 12 read: 13 LEGISLATIVE INTENT. Subject to the availability of appropriations to implement 14 AS 47.20.300 - 47.20.390, enacted by sec. 6 of this Act, the Department of Health and Social 15 Services shall implement the program required by this Act so that 100 percent of all newborns 16 and infants in the state are being screened for hearing loss by January 1, 2008. 17 * Sec. 3. AS 08.11.120(b) is amended to read: 18 (b) Notwithstanding the provisions of this chapter, 19 (1) a nurse licensed under AS 08.68 may perform hearing sensitivity 20 evaluations; 21 (2) an individual licensed as a hearing aid dealer under AS 08.55 may 22 deal in hearing aids; 23 (3) an individual holding a class A certificate issued by the Conference 24 of Executives of American Schools of the Deaf may teach the hearing impaired; 25 (4) an individual may engage in the testing of hearing as part of a 26 hearing conservation program that complies with the regulations of the Occupational 27 Safety and Health Administration of the federal government if the individual is 28 certified to do the testing by a state or federal agency acceptable to the Occupational 29 Safety and Health Administration; 30 (5) an individual may perform hearing screening under 31 AS 47.20.310 if authorized to do so under a protocol adopted under 01 AS 47.20.310(e) by the Department of Health and Social Services. 02 * Sec. 4. AS 18.50 is amended by adding a new section to read: 03 Sec. 18.50.162. Notification about hearing screening. When the bureau 04 receives a certificate of live birth under AS 18.50.160 for a newborn who was 05 delivered outside of a hospital, the bureau shall forward the names and addresses of 06 the parents to the department employees who administer the screening program set out 07 in AS 47.20.310 - 47.20.390. Those department employees shall notify the child's 08 parents of the merits of having the child screened for hearing ability. 09 * Sec. 5. AS 21.42 is amended by adding a new section to read: 10 Sec. 21.42.349. Coverage for newborn and infant hearing screening. (a) 11 Except for a fraternal benefit society, a health care insurer that offers, issues for 12 delivery, delivers, or renews in this state a health care insurance plan shall provide 13 coverage for newborn and infant hearing screening under the schedule described in (b) 14 of this section if the plan covers services provided to women during pregnancy and 15 childbirth and the dependents of a covered individual. 16 (b) The minimum coverage required under (a) of this section includes 17 (1) a newborn or infant hearing screening to be performed within 30 18 days after the child's birth; and 19 (2) if the initial screening under (1) of this subsection determines that 20 the child may have a hearing impairment, a confirmatory hearing diagnostic 21 evaluation. 22 (c) The coverage required by this section may be subject to standard policy 23 provisions that are applicable to other benefits, such as deductible or copayment 24 provisions. 25 * Sec. 6. AS 47.20 is amended by adding new sections to read: 26 Article 2. Newborn and Infant Hearing Screening, Tracking, and Intervention 27 Program. 28 Sec. 47.20.300. Department to implement program. The department shall 29 plan, develop, and implement a hearing screening, tracking, and intervention program 30 to facilitate compliance with the requirements of AS 47.20.310 - 47.20.390. 31 Sec. 47.20.310. Screening requirements. (a) Subject to (b) of this section, 01 the physician in attendance at or immediately after the birth of a child in a hospital in 02 this state, or, if a physician is not in attendance at or immediately after the birth, the 03 person attending the newborn child in a hospital in this state, shall, unless medically 04 contraindicated, cause the child to be screened to determine whether the child has a 05 potential hearing impairment using the methods determined by the department under 06 (e) of this section. Unless medically contraindicated, the screening shall occur before 07 the newborn is released from the hospital or before the infant is 30 days old, 08 whichever is earlier. Each birthing center that provides maternity and newborn care 09 services shall provide that each newborn in the center's care is referred for an 10 appointment to a licensed audiologist or to a hospital or other newborn hearing 11 screening provider before discharge. Unless medically contraindicated, the screening 12 shall occur before the infant is 30 days old. 13 (b) Notwithstanding (a) of this section, the physician or other person at or 14 immediately after the birth of a child in a hospital or birthing center that averages less 15 than 20 births a year is not required to screen the child as described in (a) of this 16 section but shall, before the newborn is released from the hospital or birthing center, 17 refer the child for screening at another facility or with another provider. Unless 18 medically contraindicated, the screening shall occur before the child is 30 days old. 19 (c) If it is determined by screening that a newborn child may have a hearing 20 impairment, the physician or other person who is required under (a) of this section to 21 cause the child to be screened shall 22 (1) refer the child for confirmatory diagnostic evaluation; 23 (2) make reasonable efforts to promptly notify the child's parent that 24 the child may have a hearing impairment and explain to the parent the potential effect 25 of the impairment on the development of the child's speech and language skills and 26 psychosocial and cognitive development; and 27 (3) notify the department of the hearing screening results on a form 28 approved by the department. 29 (d) When the Bureau of Vital Statistics receives a certificate of live birth 30 under AS 18.50.160 for a newborn who was delivered at a place other than a hospital, 31 the bureau shall notify the department employees who administer AS 47.20.310 - 01 47.20.390. The department employees shall notify the child's parents of the merits of 02 having a hearing screening performed, and the department shall provide information to 03 the parents to assist the parents in accomplishing the hearing screening within 30 days 04 after the child's birth. 05 (e) The hearing screening required under this section shall use protocols 06 established by the department. At a minimum, the protocols must include the use of at 07 least one of the following physiologic technologies: automated or diagnostic auditory 08 brainstem response (ABR) or otoacoustic emissions (OAE). The department shall 09 consider updating the protocols as information is provided to the department that new 10 physiologic technologies or improvements to existing physiologic technologies will 11 substantially enhance newborn and infant hearing assessment. 12 (f) Notwithstanding (a) of this section, a physician or other person required to 13 cause a newborn hearing screening under this section is exempt from this requirement 14 if the parent of the newborn child objects to the screening procedure on the grounds 15 that the procedure conflicts with the religious tenets and practices of the parent. The 16 parent shall sign a statement that the parent knowingly refuses the services, and the 17 physician or other person shall have a copy of the signed statement retained in the 18 hospital records of the birth and sent to the department for tracking under 19 AS 47.20.320. 20 (g) The physician or other person required to cause a newborn hearing 21 screening under this section shall report the results of newborn hearing screening as 22 required by the department under AS 47.20.320. 23 Sec. 47.20.320. Reporting and tracking program. (a) The department shall 24 develop and implement a reporting and tracking system for newborns and infants 25 screened for hearing loss in order to provide the department with information and data 26 to effectively plan, establish, monitor, and evaluate the newborn and infant hearing 27 screening, tracking, and intervention program. Evaluation of the program must 28 include evaluation of the initial hearing screening, follow-up components, and the use 29 and availability of the system of services for newborns and infants who are deaf or 30 hard of hearing and their families. 31 (b) A physician or other person attending the birth in the state, or a hospital on 01 behalf of a physician or other person attending the birth, shall report information 02 related to hearing screening required under (a) of this section as specified by the 03 department. A person who provides audiological confirmatory evaluation and 04 diagnostic services for newborns and infants whose hearing was screened under 05 AS 47.20.310 shall report information as specified by the department in regulation. 06 (c) The information received under (b) of this section shall be compiled and 07 maintained by the department in the tracking system. The information shall be kept 08 confidential in accordance with the applicable provisions of 20 U.S.C. 1439 09 (Individuals with Disabilities Education Act), as amended by P.L. 105-17. Data 10 collected by the department that was obtained from the medical records of the 11 newborn or infant shall be for the confidential use of the department and are not public 12 records subject to disclosure under AS 40.25.110. Aggregate statistical data without 13 identifying information compiled from the information received is public information. 14 (d) A hospital or other health facility, clinical laboratory, audiologist, 15 physician, registered nurse, certified nurse midwife, direct-entry midwife, officer or 16 employee of a health facility or clinical laboratory, or an employee of an audiologist, 17 physician, or registered nurse is not criminally or civilly liable for furnishing 18 information in good faith to the department or its designee under this section. The 19 furnishing of information in accordance with this section is not a violation of AS 08 or 20 AS 18 or regulations adopted under AS 08 or AS 18 for licensees under those statutes. 21 Sec. 47.20.330. Intervention program. (a) The department shall establish 22 guidelines for the provision of follow-up care for newborn and infant children in the 23 state who have been identified as having or being at risk of developing a hearing loss. 24 The services recommended must include appropriate follow-up care for newborns and 25 infants with abnormal or inconclusive screening results, such as diagnostic evaluation, 26 referral, and coordination of early intervention service programs if the newborn or 27 infant is found to have a hearing loss. 28 (b) The parents of all newborns and infants diagnosed with a hearing loss, as 29 reported to the department, shall be provided by the department with written 30 information on the availability of follow-up care through community resources and 31 government agencies, including those provided in accordance with 20 U.S.C. 1400 - 01 1491 (Individuals with Disabilities Education Act), as amended. Information provided 02 by the department must include listings of local and statewide nonprofit deaf and hard 03 of hearing consumer-based organizations, parent support organizations affiliated with 04 deafness, counseling and educational services, and programs offered through the 05 department and the Department of Education and Early Development. 06 Sec. 47.20.340. Outreach campaign. The department shall conduct a 07 community outreach and awareness campaign to inform medical providers, pregnant 08 women, and families of newborns and infants of the newborn and infant hearing 09 screening, tracking, and intervention program and the value of early hearing screening, 10 tracking, and intervention. 11 Sec. 47.20.350. Report. The department shall prepare an annual report for the 12 governor about the newborn and infant hearing screening, tracking, and intervention 13 program administered under AS 47.20.310 - 47.20.390. The report must include 14 recommendations on improving the early screening, tracking, and intervention 15 program, including strategies to increase the rate of early screening and the use of 16 appropriate early intervention techniques. The department shall notify the legislature 17 that the report is available. 18 Sec. 47.20.360. Performance evaluation. (a) The department shall collect 19 and compile performance data on the early hearing screening, tracking, and 20 intervention program established under AS 47.20.300 - 47.20.390 to ensure that the 21 program is in compliance with AS 47.20.300 - 47.20.390 and the regulations adopted 22 under AS 47.20.300 - 47.20.390. The performance evaluation must include 23 (1) a comparison of the number of infants born in the state to the 24 number of infants screened; 25 (2) the referral rate for confirmatory diagnostic evaluation; 26 (3) the follow-up rate for intervention; and 27 (4) the number of false screening results. 28 (b) In conducting a performance evaluation, the department shall 29 establish hearing screening performance standards that must include a false positive 30 rate and a false negative rate for screening results of less than or equal to three percent. 31 Sec. 47.20.390. Definitions. In AS 47.20.300 - 47.20.390, 01 (1) "commissioner" means the commissioner of health and social 02 services; 03 (2) "department" means the Department of Health and Social Services; 04 (3) "follow-up care" means all of the following: 05 (A) services necessary to diagnose and confirm a hearing loss; 06 (B) ongoing audiological services to monitor hearing; 07 (C) communication services, including aural rehabilitation, 08 speech, language, social, and psychological services; 09 (D) support services for the infant and family; and 10 (E) early intervention services described in 20 U.S.C. 1431 - 11 1445 (Individuals with Disabilities Education Act), as amended; 12 (4) "health care insurer" means an entity regulated by the director of 13 insurance, Department of Commerce, Community, and Economic Development, and 14 includes a health, hospital, or medical service plan corporation, and a health 15 maintenance organization; 16 (5) "hearing loss" means a hearing loss of 40 decibels or greater in the 17 frequency region important for speech recognition and comprehension in one or both 18 ears, approximately 500 through 4000 Hz; 19 (6) "hearing screening" means automated auditory brain stem 20 response, otoacoustic emissions, or other appropriate screening procedure approved by 21 the department; 22 (7) "infant" means a child 30 days to 24 months old; 23 (8) "newborn" means a child less than 30 days old; 24 (9) "parent" means a natural parent, stepparent, adoptive parent, legal 25 guardian, or other legal custodian of the child; 26 (10) "program" means the newborn and infant hearing, tracking, and 27 intervention screening program established under AS 47.20.310 - 47.20.390. 28 * Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to 29 read: 30 TRANSITION: REGULATIONS. Notwithstanding sec. 9 of this Act, the 31 Department of Health and Social Services may proceed to develop and adopt regulations 01 required to implement this Act. The regulations take effect under AS 44.62 (Administrative 02 Procedure Act), but not before the effective date of the relevant provision of this Act. 03 * Sec. 8. The uncodified law of the State of Alaska is amended by adding a new section to 04 read: 05 INSTRUCTION TO REVISOR. In AS 47.20.060 - 47.20.290, the revisor shall delete 06 "this chapter" and insert "AS 47.20.060 - 47.20.290." 07 * Sec. 9. AS 47.20.300, enacted by sec. 6 of this Act, and secs. 7 and 8 of this Act take 08 effect immediately under AS 01.10.070(c). 09 * Sec. 10. Except as provided in sec. 9 of this Act, this Act takes effect January 1, 2006.