Legislature(2001 - 2002)

04/17/2001 03:02 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 173-SCREENING NEWBORNS FOR HEARING ABILITY                                                                                 
CHAIR DYSON  announced that the  next order of business  would be                                                               
HOUSE  BILL  NO.   173,  "An  Act  relating   to  establishing  a                                                               
screening,  tracking, and  intervention  program  related to  the                                                               
hearing ability  of newborns and infants;  providing an exemption                                                               
to  licensure as  an audiologist  for certain  persons performing                                                               
hearing  screening  tests;  relating to  insurance  coverage  for                                                               
newborn  and  infant  hearing screening;  and  providing  for  an                                                               
effective date."   [Before the  committee was the  original bill;                                                               
although there  was a proposed  committee substitute (CS)  in the                                                               
packets; version  22-LS0003\B, Lauterbach, 4/11/01, it  was never                                                               
Number 2199                                                                                                                     
CHAIR DYSON called  for an at-ease at 3:55 p.m.   The meeting was                                                               
called back to order at 3:56 p.m.                                                                                               
REPRESENTATIVE JOULE  stated, as sponsor  of the bill,  that each                                                               
year in Alaska  approximately 10,000 babies are born.   Around 30                                                               
to  40  of these  children  will  have  some sort  of  congenital                                                               
hearing loss.  Hearing loss, he  said, is more prevalent than any                                                               
other  congenital abnormality  for which  newborns are  routinely                                                               
screened.   Without newborn screening,  the average age  at which                                                               
children in  the United States  are identified with  hearing loss                                                               
is 12  to 25  months -  after critical  windows of  learning have                                                               
passed.  If left undetected,  hearing loss can result in lifelong                                                               
delays  in  language,  cognitive, socio-emotional,  and  academic                                                               
REPRESENTATIVE JOULE  explained that [HB 173]  does three things.                                                               
It requires testing of infants  before release from a hospital or                                                               
within 30  days, except if hospitals  have less than 50  births a                                                               
year or birthing centers refer  for screening within 30 days; the                                                               
development of  a reporting and  tracking system for  newborn and                                                               
infants; and  intervention by providing parents  with information                                                               
through  which they  could  get  services if  their  child has  a                                                               
hearing  loss, as  well as  providing  general information  about                                                               
hearing testing of infants.                                                                                                     
REPRESENTATIVE JOULE explained that in  the last several years 32                                                               
states   have  passed   legislation  requiring   newborn  hearing                                                               
screening.  Three  or more states test on a  voluntary basis, and                                                               
four  states are  considering legislation  this year.   He  added                                                               
that there is a new fiscal  note for [the bill], which is $90,000                                                               
a year, whereas the old fiscal note, was over $500,000.                                                                         
REPRESENTATIVE JOULE offered Amendment 1, which read:                                                                           
          Page 5, subsection (g), lines 14-18                                                                                   
TAPE 01-44, SIDE B                                                                                                              
CHAIR   DYSON  asked,   if  [the   committee]   were  to   accept                                                               
Representative Joule's  amendment, whether the fiscal  note would                                                               
go away.                                                                                                                        
REPRESENTATIVE  JOULE responded  that  the change  in the  fiscal                                                               
note is  the result of deleting  the one section [referred  to in                                                               
the amendment].                                                                                                                 
CHAIR DYSON asked how much the old fiscal note was.                                                                             
Number 2275                                                                                                                     
CHRISTINE  HESS, Staff  to  Representative  Reggie Joule,  Alaska                                                               
State Legislature, answered that it was almost $600,000.                                                                        
REPRESENTATIVE  JOULE   explained  that   if  newborns   who  are                                                               
otherwise covered by some form  of insurance, such as IHS (Indian                                                               
Health Service) or  Denali KidCare, are born in  a hospital where                                                               
there  are 50  or more  births, they  automatically get  screened                                                               
within the first 30  days.  The cost that goes  away is for those                                                               
children  who  were  not  covered  by  one  form  or  another  of                                                               
insurance, which is about four to six children yearly.                                                                          
CHAIR  DYSON asked  if Denali  KidCare covers  hearing screenings                                                               
for newborns.                                                                                                                   
MS. HESS answered yes.                                                                                                          
CHAIR  DYSON asked  if  most  of the  health  care policies  that                                                               
families have in Alaska cover it.                                                                                               
MS.  HESS responded  that several  hospitals are  screening right                                                               
now and  have reported  that they haven't  had any  problems with                                                               
the  insurance covering  it.    It has  been  part  of a  newborn                                                               
hearing-screening  package.   The hearing  screening is  included                                                               
with everything that  is done now with the  newborn.  Eventually,                                                               
she said,  it will get its  own medical code.   However, the bill                                                               
provides that in certain circumstances  the insurance is going to                                                               
have to provide that as part of the insurance coverage.                                                                         
CHAIR DYSON asked what those circumstances would be.                                                                            
MS. HESS responded that on page  3, lines 9 through 14, it states                                                               
that  if  the  plan  covers services  provided  to  women  during                                                               
pregnancy  and  childbirth  and   the  dependents  of  a  covered                                                               
individual,  it  should  include  the  hearing  screening  and  a                                                               
follow-up if  required.   She added that  the test  is relatively                                                               
inexpensive,  ranging from  $45  to $100,  and  takes about  five                                                               
CHAIR DYSON  asked about the deletion  Representative Joule wants                                                               
to make on page 5.                                                                                                              
REPRESENTATIVE JOULE  stated that the deletion  of subsection (g)                                                               
eliminates  a large  part of  the  fiscal note  for a  relatively                                                               
small group of  children.  He said he felt  it was more important                                                               
at this point to get the larger  number of kids taken care of and                                                               
to get the bill moving.   In discussing the bill with [committee]                                                               
members, he  said, there is a  huge concern about a  large fiscal                                                               
CHAIR DYSON asked if most hospitals are already doing this.                                                                     
REPRESENTATIVE JOULE answered no.                                                                                               
CHAIR DYSON asked  if by deleting [subsection]  (g), coverage for                                                               
the people who fall through that crack would be eliminated.                                                                     
REPRESENTATIVE JOULE said he was correct.                                                                                       
MS. HESS stated that from  discussions the Department of Health &                                                               
Social Services  (DHSS), a  couple of things  would happen.   She                                                               
said    [DHSS] is  not  actually  sure  of the  statistical  data                                                               
regarding how many  kids are uninsured with Denali  KidCare.  She                                                               
said "we're"  hoping it's  only two  to four  kids and  that some                                                               
nonprofit groups  such as the  Lion's Club and Rotary  will help.                                                               
The hospitals will  help with the hearing screenings.   The other                                                               
good news,  she said,  is that ILP  (Infant Learning  Program) is                                                               
currently funded for $700,000; therefore,  those kids would go on                                                               
to the ILP waitlist and hopefully get services through that.                                                                    
Number 2028                                                                                                                     
REPRESENTATIVE  WILSON  said  she  is thinking  about  her  area,                                                               
Wrangell,  and asked  how much  the  machines that  do the  tests                                                               
cost; she noted that right  now Wrangell's hospital does not have                                                               
anything like  that.  She also  said she is concerned  that since                                                               
the hospital doesn't  [have the machine] but has 30  days to make                                                               
sure the patient  gets referred, the patient would  have to spend                                                               
money to fly someplace else.                                                                                                    
MS.  HESS responded  that the  testing  equipment costs  anywhere                                                               
from $9,000  to $15,000.   There is  a program with  the National                                                               
Hearing Association  whereby hospitals can [lease]  the equipment                                                               
while they  get started, for  free.  There  is also, she  said, a                                                               
portable device, which  can be easily transported.   Therefore, a                                                               
couple  of hospitals  could  get together  and  share a  hearing-                                                               
screening device.   Some  rural states  are actually  doing this,                                                               
and other states use volunteers  to do the testing, which reduces                                                               
the cost.  She  added that there is a lot  of federal grant money                                                               
available now.                                                                                                                  
REPRESENTATIVE  STEVENS  asked, since  the  old  fiscal plan  was                                                               
$600,000 and this fiscal plan  is $95,000 and the only difference                                                               
is two  to four  children who  will not  be tested,  whether that                                                               
means it costs $500,000 for two to four children.                                                                               
MS. HESS  responded yes, but it  is not only for  the testing; it                                                               
is  for  the  intervention,  all  follow  ups,  and  any  hearing                                                               
Number 1931                                                                                                                     
KAREN PEARSON, Director of Public  Health, Department of Health &                                                               
Social Services, came  forth and explained that the  title of the                                                               
initial  bill states  that it  provides for  screening tests  and                                                               
intervention.   The three  to four children  would have  been the                                                               
ones without  insurance who  needed the  full-blown intervention.                                                               
There  is  an  unknown  number  of  kids,  represented  by  about                                                               
$200,000 in  the original fiscal  note, who don't have  a payment                                                               
source for  their screening.   The remainder for the  fiscal note                                                               
was for the  intervention as well as travel for  kids who live in                                                               
a place  where screening or  intervention is not available.   She                                                               
stated that the current fiscal note  is what is needed to put the                                                               
data system  together to do  the tracking.  Then,  she explained,                                                               
in 2005 the grant  for the staff goes away so  there is a request                                                               
for half a staff person to keep the project going.                                                                              
REPRESENTATIVE  COGHILL  asked  how   many  screenings  would  be                                                               
mandated to Alaska right now under this bill.                                                                                   
MS. Pearson responded that she does not have that information.                                                                  
REPRESENTATIVE COGHILL  stated that  he is concerned  that places                                                               
like Wrangell, Kotzebue,  or Barrow, where they  have health care                                                               
facilities, will be  mandated a $9,000 to  $12,000 machine, which                                                               
seems like a pretty heavy load.   He added that this is not going                                                               
to have a small impact on health care facilities.                                                                               
MS. PEARSON stated that the  technology is changing quite rapidly                                                               
and she  thinks the costs  will be coming  down.  She  added that                                                               
there is  a lot  of interest  in this area  at the  federal level                                                               
because they  understand the impact  on the education  system and                                                               
justice system of children not being able to hear.                                                                              
REPRESENTATIVE  STEVENS asked  what  would  be accomplished  with                                                               
this equipment  that a good  family doctor  would not be  able to                                                               
tell when examining a baby.                                                                                                     
Number 1787                                                                                                                     
HEATHER ALLIO,  Parent, came  forth and stated  that to  test for                                                               
[hearing loss, doctors] originally put  a sound into a baby's ear                                                               
and then measured  the amount of sound that came  back out.  That                                                               
can tell whether or not a child  has a hearing loss, but it can't                                                               
tell the degree of  the hearing loss.  A second  test can then be                                                               
performed, which  is called an ABR  (auditory brainstem response)                                                               
test or a BAER (brainstem  auditory evoked response) test, during                                                               
which electrodes  are put on  the head.   Sound is  admitted into                                                               
the ear and the brain's response to the sound is tested.                                                                        
CHAIR DYSON asked how that has gone for her family.                                                                             
MS. ALLIO shared her story with the committee:                                                                                  
     My first  son was  diagnosed at six  months.   In fact,                                                                    
     [apart from]  a family dog  that barked and  barked and                                                                    
     barked and  my son never  responded, he was  not tested                                                                    
     at birth.   He was  then fitted with the  hearing aids.                                                                    
     Since then  - he's three  - he [knows] well  over 1,500                                                                    
     signs [of sign  language]; he's got sounds  that he can                                                                    
     make  that  represent words.    Had  he not  had  those                                                                    
     hearing aids  at six  months, he  would have  missed an                                                                    
     awful  lot of  that.   My  second son,  Brady (ph)  was                                                                    
     tested at  one week old,  here at the  audiologist, and                                                                    
     found that he had a loss of  some sorts.  So we went to                                                                    
     Seattle and had the second test done.                                                                                      
CHAIR DYSON asked if this is hereditary in her family.                                                                          
MS. ALLIO answered no.  She  continued stating that most kids are                                                               
not caught at six  months like her son was.   Most are not caught                                                               
until age two;  therefore, they have missed out  on that two-year                                                               
window  of the  ability to  hear and  the ability  to learn  sign                                                               
Number 1675                                                                                                                     
CHAIR DYSON asked Ms. Pearson  what [Alaska's] situation would be                                                               
if parents were  unwilling to have their kids tested  and if that                                                               
would be considered a child-in-need-of-aid case.                                                                                
MS. PEARSON responded that there  is the potential of being asked                                                               
what the  impact on the child  is if there is  no religious basis                                                               
for the choice of medical care.                                                                                                 
CHAIR DYSON  asked if it would  be the same situation  if it were                                                               
diagnosed and [the parents] refused to do anything remedial.                                                                    
MS. PEARSON stated that she thinks so.                                                                                          
MS. HESS  responded that  the bill provides  for an  exemption if                                                               
the  parent objects,  for example,  due  to religious  practices.                                                               
She  added that  DFYS  (Division of  Family  and Youth  Services)                                                               
could step  in if  a parent refuses  to take  appropriate medical                                                               
Number 1574                                                                                                                     
LISA  OWENS, Audiologist  and Speech  Pathologist, testified  via                                                               
teleconference.   She explained that there  is audiology coverage                                                               
for almost  every area of the  state right now, and  almost every                                                               
audiologist has one of the types  of systems being used, that can                                                               
travel.   She said  she thinks  there are  three areas  right now                                                               
that have the  equipment available; however, they  are working on                                                               
getting  grants to  cover the  costs through  state task  forces.                                                               
The second point  is that for 50 percent of  children there is no                                                               
known cause for hearing loss.   The average age of identification                                                               
right now, in states that  do not have newborn hearing screening,                                                               
is  18 months  to 2  years.   In states  such as  Colorado, Rhode                                                               
Island,  and   Hawaii  that  have  been   doing  newborn  hearing                                                               
screenings for  the past six or  seven years, the average  age of                                                               
identification is  lowered to 3  months of  age.  She  said there                                                               
are many  studies showing that  children who are identified  by 3                                                               
months of age  and given hearing aids and  early intervention are                                                               
developing language  and communication skills  at age-appropriate                                                               
levels,  versus children  who are  identified at  18 months  to 2                                                               
years who end up having a reading level of third grade.                                                                         
MS. OWENS  explained that a  child being identified at  18 months                                                               
to 2 years  hears virtually nothing for those first  18 months or                                                               
2 years of life.  Information  on brain research shows that there                                                               
is a  critical time for  brain development, and if  children miss                                                               
that  window it  is hard  for them  to ever  fully develop  those                                                               
skills.  In states that have  been doing these programs, kids are                                                               
going on to preschool and  kindergarten and are not requiring the                                                               
special assistance that  they would need if  they were identified                                                               
later in life, which is a huge cost savings.                                                                                    
CHAIR DYSON  asked, if this  passes, whether Ms. Owens  would get                                                               
more business.                                                                                                                  
MS.  OWENS answered  probably  not; she  said  [her practice]  is                                                               
pretty full  as it is.   She stated that this  would protect kids                                                               
who are missing out on hearing.                                                                                                 
CHAIR DYSON  asked what  percentage of  the newborns  in [Alaska]                                                               
are not getting screened now.                                                                                                   
MS. OWENS  responded that  right now  Providence Hospital  is the                                                               
primary  birthing center  and  is screening  all  babies, as  are                                                               
Columbia National  Regional and the  Native hospitals.   She said                                                               
Nome is  now screening and  Kotzebue is going to  start screening                                                               
within  the next  month.   She said  the problem  in some  of the                                                               
rural areas is not necessarily  the equipment but the training of                                                               
the  hospital staff.   Therefore,  most of  the audiologists  are                                                               
trying to get to those  areas to provide appropriate training and                                                               
help them to get the funding for equipment.                                                                                     
CHAIR DYSON asked who pays [the audiologists] to do that.                                                                       
MS.  OWENS  stated  that  nobody  does; she  is  doing  it  on  a                                                               
volunteer basis.                                                                                                                
Number 1320                                                                                                                     
REPRESENTATIVE COGHILL asked how the follow-up works now.                                                                       
MS.  OWENS explained  that typically  babies are  screened during                                                               
their  first  day of  life  in  a hospital.    If  they fail  the                                                               
screening,  the hospital  will try  to rescreen  before they  are                                                               
discharged or  they are  screened within the  first week  of life                                                               
when the parents  bring them back to the hospital.   Children who                                                               
fail both screenings,  are referred to an audiologist  for a full                                                               
diagnostic  test,   who  would  then  confirm   the  [hospital's]                                                               
diagnostic testing.   From that point, they would  be referred to                                                               
the ILP  and to  the Alaska  Early Intervention  Hearing Resource                                                               
Program,   which  provides   parents  with   sign  language   and                                                               
educational support.                                                                                                            
[HB 173 was held over.]                                                                                                         

Document Name Date/Time Subjects