Legislature(2005 - 2006)SENATE FINANCE 532
05/08/2006 01:00 PM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB109 | |
| HB190 | |
| Rfp 432 Executive Session | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 109 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | HB 190 | ||
CS FOR HOUSE BILL NO. 109(FIN)
"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; relating to insurance coverage for newborn and
infant hearing screening; and providing for an effective
date."
This was the first hearing for this bill in the Senate Finance
Committee.
1:32:23 PM
JANE PIERSON, Staff to Representative Jay Ramras, the bill's
sponsor, read the sponsor statement as follows.
Each year in Alaska approximately 10,000 babies are born.
30 or 40 of these children will be born with congenital
hearing defects. Hearing loss is more prevalent than any
other birth defect. Studies have shown that children with a
hearing impairment not detected at birth, will likely not
have their impairment detected until two to three years of
age. Unfortunately, studies have also show that the most
critical time for speech and cognitive development is from
birth to three years of age.
HB 109 will require infants to be screened for hearing loss
before leaving the hospital, or within thirty-one days of
being born, if not born in a hospital. HB 109 will further
provide diagnostic intervention. A child who fails an
initial hearing screening will be referred for re-
screening. Once a child has been diagnosed with a hearing
impairment, parents will be provided by the Department of
Health and Social Services with written information on the
availability of services through community resources,
government agencies, parent support organization affiliated
with deafness, counseling and educational services, and
programs offered through the Department of Health and
Social Services and the Department of Education and Early
Development.
Ultimately, this bill will save the state of Alaska money
due to the fact that when infants are not identified with a
hearing impairment and aided early, the special educations
costs for a child with a hearing loss may cost the state an
additional $420,000.
When hearing impaired children reach school age they become
the fiscal responsibility of their respective school
districts. The cost of educating a special needs student
can range up to $12,000 per year versus the Base Student
Allocation amount of $4,919 (proposed FY 06) per student.
Sooner or later children identified with hearing loss
become the financial responsibility of the state's
education system.
Ms. Pierson encouraged the passage of the bill.
1:34:50 PM
Senator Olson asked whether a penalty would be imposed were the
screening not conducted.
Ms. Pierson responded that hospitals would be required to
conduct the screening unless the parents opted out of it. No
penalty would be levied against a doctor.
Senator Olson understood therefore that this would be a
voluntary program.
Ms. Pierson affirmed.
1:35:31 PM
Senator Olson, a medical doctor, asked whether this bill could
assist children who might suffer hearing impairment after being
affects the inner ear. In his experience, this was a more common
issue than newborn hearing impairment.
Ms. Pierson deferred to the Department of Health and Social
Services.
Co-Chair Green understood the bill would limit the screening to
newborns. In her opinion, the bill would create "too much
bureaucracy in the Department of Health and Social Services".
Co-Chair Green noted that, due to time constraints, testimony on
this bill was by invitation only.
1:36:18 PM
DR. RICHARD MANDSAGER, Director, Division of Public Health,
Department of Health and Social Services, testified via
teleconference from Nome in support of the bill. It would assist
in providing Alaska's children a brighter future.
Dr. Mandsager informed the Committee the bill would be specific
to congenital hearing screening for newborns, rather than
screening for acquired hearing loss later in life. However,
follow-up efforts would be conducted on high-risk infants, such
as those receiving critical care nursery treatment.
Dr. Mandsager stated that the increased bureaucracy issue raised
by Co-Chair Green has been a frequent topic of discussion. The
discussion has included such things as whether the benefits
provided by the program would warrant the costs of the program.
In his opinion, the bill would ensure newborn hearing screening
and would allow the Department to connect parents with newborn
hearing services within the first six months of a child's life.
Prior to newborn hearing screening being conducted in the State,
the average age of a congenital hearing loss diagnosis was
between the ages of two and three. Since 80 percent of infants
in the State undergo voluntary screening today, the age of
diagnosis has decreased to less than one year. The goal is to
connect parents with hearing loss services before their child is
six months old, as the earlier parents and kids receive
services, the better for the child's educational and life needs.
Dr. Mandsager concluded that this bill would present "the
appropriate balance between the cost and the services and
helping parents make the choices that are appropriate for them
as to what communication technology they choose for them and
their family".
1:38:32 PM
Senator Olson communicated that his remarks were made in
consideration of the fact that a school's special education
expense for a child not diagnosed with hearing loss as an infant
could amount to approximately $420,000. He asked the percent of
children diagnosed with congenital hearing loss compared to
those with acquired hearing loss.
1:38:54 PM
Dr. Mandsager replied that children with mild hearing loss tend
to suffer acquired hearing loss due to such things as chronic
otitismedia. The majority of profound hearing loss in children
would typically be the result of congenital hearing issues
before birth.
Senator Dyson recalled a discussion in which Dr. Mandsager had
communicated that newborns were currently being screened for
approximately 70 different kinds of conditions.
Dr. Mandsager stated that, in the past two years, screenings
conducted on infants increased from nine to approximately 40.
Additional screenings would be expected in the years ahead as
technology advances.
Senator Dyson asked how much the hearing screen would cost per
child.
1:40:10 PM
Dr. Mandsager expected the cost to be $30 to $40 per child were
the screening conducted during the first month of the child's
life. The "diagnostic confirmatory testing" that would be
conducted on infants who failed the initial screening would be
"substantially more".
Senator Dyson asked the cost of the equipment and training
required for the initial screening.
Dr. Mandsager understood the "typical screening machines"
utilized by hospitals and public health centers range from
$1,500 to $2,000. Approximately two hours of training time was
required when the equipment was installed at the Alaska Native
Medical Center. Since then, experienced staff nurses have
trained others on a one on one basis.
1:41:17 PM
Co-Chair Wilken first heard this bill in March in the Senate
Health, Education, & Social Services Committee (Senate HESS).
While he was not opposed to newborn screening, the additional
bureaucracy this bill would create troubled him. It might "feel
good" to pass such legislation, but the question is whether it
was really necessary.
1:41:46 PM
Co-Chair Wilken referred members to a handout titled "Locations
of Newborn Hearing Screening Hospitals, 2003 births" [copy on
file] which depicted the location of each hospital or clinic
offering newborn screening in the State. The screening was
widely available. Thus, his question during the Senate HESS
hearing was "then … what newborns are we not capturing?" as the
hospital/clinic screening, complemented by the screening of home
birth infants by midwifes, left few if any children born in the
State not being tested.
1:43:02 PM
Co-Chair Wilken pursued this issue and on May 5, 2006, he
received a letter from the Department of Health and Social
Services [copy not provided], which presented "averages and
statistics that aren't particularly relevant to Alaska itself".
The data mirrored information [copy not provided] he received in
March from Debbie Golden, Director of Program Services for the
Alaska Chapter of March of Dimes. Therefore he questioned
whether "the Department has done their homework as to where we
think these children are slipping through the cracks." Thus,
since newborn hearing screening is already being conducted, he
could not support implementing a law that would increase
bureaucracy.
1:44:24 PM
Co-Chair Green also shared concern about the bill; specifically
the mandatory insurance coverage requirement included in Sec. 5,
page 3 lines 9 through 24. The insurance requirement would
negatively affect those who participate in small group plans or
who purchase individual insurance coverage. Self-covered plans
would be exempt from the requirement. She would not be
supporting this bill were it advanced to the Senate floor
because the State would be required to participate in any
mandate adopted by the Legislature.
Co-Chair Green stated her biggest concern is the bureaucracy the
bill would create in the Department of Health and Social
Services, specifically as the result of reporting, tracking, and
correspondence. While the Department's $39,400 fiscal note is
not substantial, she viewed such activity as being outside of
the Department's role.
1:46:02 PM
Senator Stedman suggested more work be conducted on the bill.
Co-Chair Green nodded in agreement.
Co-Chair Green noted a tremendous amount of people were in
support of the bill. She declared that she was "not insensitive"
to the issue as her father had hearing loss and one of her
grandchildren had congenital hearing problems. Nonetheless, she
viewed the proposed procedure as "cumbersome".
Senator Dyson asked the bill's sponsor to identify "the problem"
the bill would be "curing" since the majority of infants are
currently screened.
1:47:14 PM
Senator Dyson also questioned what information would be lost
were the tracking proposed in this bill not in place.
Ms. Pierson communicated that approximately 80 percent of the
infants born in the State are receiving hearing screening. One
of the issues the bill would address is the follow-up re-
screening for a child identified with a hearing impairment.
Oftentimes, parents are unsure of where to go or what to do once
their child has been initially identified. The cards the State
sends to such parents urging them to get their child re-screened
has prompted many parents to pursue further treatment.
Co-Chair Green asked what follow-up contact is currently being
conducted.
Ms. Pierson communicated that the Department currently receives
federal grant money, which is used to provide information to
parents following the initial screening.
1:49:32 PM
REPRESENTATIVE JAY RAMRAS, the bill's sponsor, thanked the
Committee for hearing the bill. School is "difficult" for a
child who suffers from a disability. Identifying hearing
impairments in newborns would allow them "to pursue treatment"
in some manner. The incorporation of this screening into the
"birthing package" should be the standard rather than being an
extra. It would result in healthier children. Hearing loss
identified at birth would lessen "the burden" on the State's K-
12 education process. It would be "good public policy" and the
program would "pay for itself many times over" in both
intangible and monetary ways.
1:51:40 PM
Senator Bunde asked whether the bill would allow "those who have
the means to pay for the initial screening" to do so, rather
than the program expense being borne by the State.
Ms. Pierson clarified that the initial hearing screening was
already included in the cost of the birthing package.
Senator Bunde ascertained therefore that the additional expense
would result from the follow up screening.
Co-Chair Green understood the follow-up screening expense would
be subject to the insurance mandate specified in Sec. 5(b)(2)
page 3 lines 19 through 21.
1:52:51 PM
Senator Olson explained that, absent insurance coverage, the
parents of any child identified during the initial screening
with a potential hearing problem, would be responsible for the
expense of the follow-up care.
Co-Chair Green understood that most insurance plans would cover
the treatment. She characterized "the idea that we mandate a
product that's to be sold to a customer" as bad public policy.
1:53:36 PM
Co-Chair Wilken moved to adopt Version 24-LS0450\I as the
working document.
Co-Chair Green identified the effective date of January 1, 2008
as the primary difference between CS FOR HB 109(FIN) and Version
"I".
Co-Chair Wilken agreed with Senator Stedman that the bill
required more work; however, he was in a quandary as to how to
improve it. Neither the Department nor the bill's sponsor "have
made a case that it's needed". Thus, no benefit would be derived
from keeping the bill in Committee.
Senator Bunde moved to report the bill from Committee with
individual recommendations and accompanying fiscal notes.
There being no objection, SCS CS HB 109(FIN) was REPORTED from
Committee with three previous fiscal notes: zero fiscal note #2
dated April 11, 2005 from the Department of Commerce, Community
and Economic Development, zero fiscal note #3 dated April 12,
2005 from Department of Education and Early Development, and
$39,400 fiscal note #5 dated March 7, 2006 from the Department
of Health and Social Services.
1:55:01 PM
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