02/17/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB109 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 109 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 17, 2005
3:10 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Vic Kohring
Representative Lesil McGuire
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 109
"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."
- MOVED CSHB 109(L&C) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 109
SHORT TITLE: SCREENING NEWBORNS FOR HEARING ABILITY
SPONSOR(S): REPRESENTATIVE(S) RAMRAS
01/26/05 (H) READ THE FIRST TIME - REFERRALS
01/26/05 (H) L&C, HES, FIN
02/04/05 (H) L&C AT 3:15 PM CAPITOL 17
02/04/05 (H) Heard & Held
02/04/05 (H) MINUTE(L&C)
02/07/05 (H) L&C AT 3:15 PM CAPITOL 17
02/07/05 (H) Moved CSHB 109(L&C) Out of Committee
02/07/05 (H) MINUTE(L&C)
02/09/05 (H) L&C RPT CS(L&C) NT 5DP 1NR
02/09/05 (H) DP: LYNN, LEDOUX, GUTTENBERG, CRAWFORD,
ANDERSON;
02/09/05 (H) NR: ROKEBERG
02/17/05 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE JAY RAMRAS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as the sponsor of HB 109.
GERI BENSHOOF
Alaska Speech-Language-Hearing Association
North Pole, Alaska
POSITION STATEMENT: Testified in support of HB 109.
CHERYL SCOTT
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
STEPHANIE BIRCH, Manager
Newborn Screening Program
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Stated that she would answer questions
concerning hearing screening.
DEBBIE GOLDEN
March of Dimes
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
DIANE INGLE, Manager
Community Health Services
Municipality of Anchorage
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
LISA OWENS, Speech Pathologist and Audiologist
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
PAMELA S. MUELLER-GUY, Coordinator
Deaf Services & Interpreter Referral
Southeast Alaska Independent Living, SAIL
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 109.
JODI RUMPH
Governors Council Disabilities and Special Education
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 109.
MARTIN BEALS, M.D.,
American Academy of Pediatrics
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
JACK MCGRAY, Senior Vice President
Premera Blue Cross
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 109.
JEAN MISCHEL, Attorney
Legislative Legal and Research Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Provided legal assistance concerning
language within HB 109 and related amendment.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:10:21 PM
Representatives Kohring, McGuire, and Cissna were present at the
call to order. Representatives Seaton, Anderson, and Gardner
arrived as the meeting was in progress.
HB 109-SCREENING NEWBORNS FOR HEARING ABILITY
CHAIR WILSON announced that the only order of business would be
HOUSE BILL NO. 109 "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."
3:11:36 PM
REPRESENTATIVE JAY RAMRAS, sponsor to HB 109, stated that each
year, in Alaska, about 10,000 babies are born and 30 to 40
percent of those children have some congenital hearing defect.
He said that hearing loss is more prevalent than any other
congenital abnormality for which newborns are routinely screened
and studies have shown that children born with a hearing
impairment often are not discovered until they are two to three
years old. He explained that many of the [facial] muscles
around the jaws atrophy because [hearing impaired] children are
not able to respond to sound and don't develop good speech
patterns. He related that studies have shown that the most
critical time for speech development and cognitive development
is from birth to three years of age.
REPRESENTATIVE RAMRAS said that this bill will save the state
money. The average expense for each child going through K-12
programs that is undiscovered for some degree of hearing loss,
he related, is about $400,000. He explained that future
liability of $12 to $16 million, in addition to the harm of the
psyche of that child, justifies the $30 or $40,000 a year
established in the fiscal note. He stated that HB 109 does
three things: it requires the testing of infants for hearing
loss before they leave the hospital or within thirty days; it
insures the development of a reporting and tracking system for
newborns that are deemed at risk; it will provide diagnostic
information and the parents will be provided [by the Department
of Health and Social Services] with written information on the
available services through community resources, government
agencies, parent support organizations affiliated with deafness,
and counseling and education services offered through the
Department of Education and Early Development. It gives
families that are of means and those that are in a lower
socioeconomic position, plenty of opportunities to address
issues with their children, he related.
REPRESENTATIVE RAMRAS mentioned that one of the things
Representative Anderson [Chair of House Committee of Labor &
Commerce] was so helpful with was advocating for those who
weren't audiologists to be able to perform the [screening] exam
since many of the smaller communities only have nurses. He
explained that there is some degree of specialization in
administering the "ABR" test [Automated Auditory Brain Stem
Response Test] where devices are placed in a child's ear and
sensors pick up the infants' brain response. He concluded by
describing the fiscal impact of HB 109 as modest, and explained
that grants can be reapplied for maintaining the $30,000 range
which equates to $3 dollars per child. In prior years when
similar bills did not pass, he said, the fiscal notes were
$600,000. Presently, he related, through grants and through
service organizations like "quota club," hearing machines have
been purchased, are portable and nurses that have been trained
can administer the test in the smaller rural and bush
communities.
REPRESENTATIVE RAMRAS said that money for the services requested
in this bill are in place for the infant learning programs and
federal grant monies have been extended through the next three
years. He noted that these grants may be extended and the
additional monies may not be required. Most insurers are paying
for these costs, he explained, because Medicaid regulations and
most private insurers are paying the $20 to $60 fee associated
with infant hearing screening at birth and it would not be
feasible for the Department of Health and Social Services to
take on these charges.
3:19:17 PM
GERI BENSHOOF, Alaska Speech-Language-Hearing Association,
stated her support of HB 109 and added that Alaska is one of
only six states that the "Deafness Research Foundation" has
found to have less than 80 percent of babies screened [for
hearing]. She said that the goal of 100 percent [screening] is
excellent and often, if screening legislation exists, there are
higher percentages of babies being screened. She opined that
Representative Ramras effectively explained why this screening
and early detection are important.
3:21:14 PM
CHERYL SCOTT stated that her son, Justin, is 18 years old and
experiences bilateral hearing loss in addition to other
disabilities. She explained that her son was born in March of
1987 and was 26 weeks premature; she met him when he was 5
months old. She said:
He came as a medical needs foster baby to our home and
we adopted him when he was about 3 and a half.
Currently, his diagnoses include Fetal Alcohol
Syndrome, cerebral palsy, mental retardation,
epilepsy, vision impairment, hearing impairment and
cleft palate. He wasn't diagnosed with hearing loss
until he was 10 and a half years old. As a result, he
never did hear clearly in the early years of his life,
he never developed much in the way of spoken
communication. At this point, after 15 plus years of
weekly speech therapy, and a couple of different oral
surgeries and now, hearing aids, he has about 50
usable words. Even the majority of those words are
very difficult for people that don't understand how he
communicates ... to really figure out what he is
saying.
For us, one of the biggest challenges early on, was
knowing how to communicate with him and how to teach
other people to communicate with him. We ended up
teaching him sign language because he didn't have a
diagnosis of hearing impairment at that time, we
didn't have any support from the school district to
... help him learn that, so that was something that we
really pushed throughout his school career. We were
really devastated when he was finally diagnosed at 10
and a half, and that came about because the speech
therapist that he saw privately, finally said, "this
isn't going anywhere, I have gone as far as I can go
with him. I really don't think he is going to learn
to speak."
MS. SCOTT said that in spite of years of speech therapy, his
speech was not adequate for regular conversation. The cost for
private speech therapy has ranged between $90 and $125 per hour,
40 visits per year, over 15 years. She said that [her family]
has a combination of private insurance and Medicaid coverage but
for many years had huge out of pocket expenses.
MS. SCOTT stated that, "because he didn't get an early
diagnosis, and didn't get that early intervention when it really
was critical, when his brain was able to easily learn the sounds
... and for him to be able to learn to produce those sounds back
to people, that never happened ... and as a result, he isn't
able to communicate easily with his peers, he doesn't have a lot
of friends and it's not going to be easy for him to find a job
because he can't communicate with a job coach or a teacher
easily unless they know American Sign Language and even that
with his cerebral palsy can be a real challenge ... he will
always need to have someone intervening for him in a job
setting, in any kind of home setting that he has when he is away
from his family because really no one else, except for family
members, can understand him clearly." She stated her belief
that this is something that could have been prevented with early
identification and intervention.
3:26:55 PM
CHAIR WILSON asked if [Justin Scott] can use American Sign
Language.
MS. SCOTT replied that he can sign, and that he was taught
through the early intervention program for infants and children
in Anchorage.
STEPHANIE BIRCH, Manager, Newborn Screening Program, Division of
Public Health, stated that she was available to answer any
relevant questions.
DEBBIE GOLDEN, March of Dimes, stated that the mission of March
of Dimes is to improve the health of babies by preventing birth
defects and infant mortality. She said that [March of Dimes] is
a big promoter of newborn hearing screening, monitoring and
tracking and supports HB 109. She said that 39 states
[excluding Alaska] have active legislation mandating newborn
hearing screening. She related that for 50 years experts have
been emphasizing the importance of detecting hearing problems
early and intervening
3:31:48 PM
DIANE INGLE, Manager, Community Health Services, Municipality of
Anchorage, stated that the Municipality of Anchorage strongly
supports HB 109 and has included it in its 2005 legislative
[priorities]. She explained that Anchorage has slightly more
than half of the annual births in the State of Alaska and
identifies 15 to 20 children with hearing loss each year. She
added that about 75 percent of the children who are enrolled in
the early intervention program for hearing loss are residents of
the Anchorage area. She related that [the early intervention
program] is something that makes a difference for the long-term
quality of life and for the lifelong amount of resources
required for special education and additional resources.
LISA OWENS, Speech Pathologist and Audiologist, stated the she
is in support of HB 109. She commented that this legislation
can change opportunities for children affected. She said that
HB 109 would give parents the opportunity to change things for
their children and would provide a tracking system.
[The committee took an at-ease from 3:36:42 PM to 3:37:27 PM.]
3:39:15 PM
JODI RUMPH, Governor's Council on Disabilities and Special
Education, stated that this Council firmly supports HB 109,
including the amendment.
3:40:44 PM
PAMELA MUELLER-GUY, Coordinator, Deaf Services & Interpreter
Referral, Southeast Alaska Independent Living, SAIL, read her
written testimony for the committee [original punctuation
provided]:
Hello my name is Pam Mueller-Guy. I work for
Southeast Alaska Independent Living as the Deaf
Services & Interpreter Referral Coordinator. I am
representing for SAIL in support for the Newborn
Hearing Screening test, House Bill 109 and Senate Bill
68.
I was born as a hearing child. However, I had to have
a blood transfusion from a stranger when I was five
days old, due to my rare blood type. Due to this
blood transfusion, I became deaf, but no one realized
it till I was about 2 years old.
Even as a toddler, I could speak a little bit and
mimicked by brother while playing with toys. My
grandmother finally figured out that I could not hear,
realizing I never responded when they called my name.
Only when a loud noise occurred, such as a stomp on
the floor, did I look their way.
They finally took me to have a hearing test and I was
diagnosed with severe profound nerve deafness. They
were in shock and wept for me because they didn't know
what to do. They asked, "How can she can hear music?"
My whole family is musical! They had grief until they
realized I could experience music.
I started speech classes at 2 1/2 years old then
started wearing hearing aids at 3 1/2 years old and
started half days till four years old to stay at
boarding parents house during the week because deaf
school was 25 miles away from my home.
I was held back in school twice due to my hearing
disability. One time, just because they wanted to
keep all the students who were deaf together in one
grade. I had to make friends all over again.
If this bill is passed, it will also allow parents of
newborn babies with hearing loss to get information
immediately and begin preparing for life with a child
who is deaf. It is difficult for organizations like
SAIL to identify and assist persons who have hearing
loss; a much better way to do this is to catch the
baby and family at the beginning of life. I do not
want to see people with hearing loss have to go the
hard way like me.
I hope for the new generation that they can be
diagnosed early and begin to learn early so they may
be capable of writing English easy instead of the hard
way. I see most deaf and hard of hearing have a hard
time in Alaska for jobs. Schools also should have
programs specifically for children who are deaf so
they won't be isolated. I am hopeful children who are
deaf will be able to communicate in both the hearing
world and the deaf world.
The newborn hearing screen would be best for all needs
so the parents of the baby can start early to learn to
cope with the child and their lives would be easier!
This bill will save a lot of money for the government,
schools, and insurance, including Medicaid, in the
long run. Thank you for taking your time to listen to
me. Keep passing those bills for better lives in
Alaska!
3:45:31 PM
MARTIN BEALS, M.D., Alaska Chapter of the American Academy of
Pediatrics, stated his support of HB 109. He explained that
hearing loss is the most common birth defect and it can have a
significant negative impact on children, but early detection and
intervention can help. He said that HB 109 has provisions for
tracking when children fail the screening, so they can be
followed and appropriate diagnostic testing is completed.
CHAIR WILSON asked how many children a year are born with
hearing loss.
DR. BEALS stated that the incidents of hearing loss diagnosable
at birth is about 3 in 1,000 live births and there are about
10,000 live births in Alaska per year. He estimated that there
are about 30 children a year born [in Alaska] who would be
diagnosed using this technology.
3:47:58 PM
JACK MCGRAY, Senior Vice President, Premera Blue Cross, began
discussion of Amendment 1 [submitted by Premera Blue Cross,
labeled as 2/16/05, 4:07 p.m.] which read [original punctuation
provided]:
CSHB 109(L&C) Version "F" page 3, lines 9-24:
Sec. 5. AS 21.42 is amended by adding a new section to read:
Sec.21.42.349. Coverage for newborn and infant hearing
screening. (a)If a health care insurer offers, issues for
delivery, delivers, or renews in this state a health care
insurance plan that covers services provided to women during
pregnancy and childbirth and the dependents of a covered
individual, including routine newborn care, the health care
insurer must comply with the requirements of this subsection.
(1)The health care insurer may not deny coverage for a
newborn or infant screening to be performed within 30 days
after the child's birth; and
(2)If the initial screening under (1) of this section
determines that the child may have a hearing impairment,
the plan may not deny coverage for a confirmatory hearing
diagnosis evaluation.
(b)The coverage required by this section may be subject to
standard policy provisions, such as deductible or copayment
provisions.
Rationale: (a): Deletes exception for fraternal benefit
societies. Because the intent of the bill is to assure that
100% of newborns are screened, no sources of payment should be
excluded from the requirements. (a)(1) through (b): Under
current practice, any costs for the initial screening are
typically included in the hospital or other facility's charge
for newborn care or in the physician or other practitioner's
charge for routine follow-up care. Diagnostic tests, including
hearing examinations, are covered under existing medical
benefits. The amendment changes the bill language to reflect
standard practice and health plan design.
MR. MCGRAY said:
we're supporting HB 109 ... we cover this hearing test
now ... in a pediatric setting or in a hospital or
birthing center ... what our amendment will do is it
will change the bill to reflect the standard practices
in the health plan design ... it will only modify the
bill so it will come into sync with standard practices
in health plan designs that we have up in Alaska, now.
CHAIR WILSON inquired as to the specific changes included in
Amendment 1.
MR. MCGRAY explained that the amendment is technical and it will
allow [Premera Blue Cross] to utilize existing contracts.
Without the amendment, he said, administration costs would rise
due to the creation of new contracts.
REPRESENTATIVE SEATON inquired as to the HB 109 requirements for
testing being covered under existing procedures.
MR. MCGRAY stated that they are covered now under "hearing
screening."
CHAIR WILSON inquired as to the purpose of Amendment 1 if there
is coverage [for screening] now.
MR. MCGRAY said that this is a technical issue that deals with
how the contract is written in relation to how the legislation
is written.
3:50:21 PM
REPRESENTATIVE GARDNER clarified that the Alaska State
Legislature makes the law and insurance company contracts comply
with the law.
MR. MCGRAY stated that one of the goals [of Premera Blue Cross]
is to keep administrative costs low; this amendment will not
modify the intent of HB 109.
REPRESENTATIVE ANDERSON stated:
if you look at Version F of the bill ... page 3 ...
lines 22 through 24 ... section 5, subsection 6 ... it
states, "The coverage required by this section may be
subject to standard policy provisions that are
applicable to other benefits, such as deductible or
co-payment provisions." Your amendment, as proposed
... states ... "the coverage required by this
subsection may be subject to standard policy
provisions, such as deductible or co-payment
provisions." ... you have deleted, "that are
applicable to other benefits" and that was bought up
in the Labor & Commerce Committee, can you explain ...
why that was deleted.
MR. MCGRAY stated that the intent [of Amendment 1]:
if the language went through as is presently listed in
the bill, we'd modify our contracts and have a stand-
alone benefit for this, for the hearing screen. Now
what we do is we include that in the benefit package
that the hospitals and physicians used when they're
screening for hearing. So, ... the amendment changes
won't reflect anything different than our standard
practices ... instead of having a stand-alone benefit
that states "hearing specific," it's part of the
package that's used that the doctors and hospitals use
in screening and we pay for it that way.
3:54:13 PM
CHAIR WILSON stated that she needs to be convinced as to why the
language, "that are applicable to other benefits" should be
deleted from HB 109.
MR. MCGRAY stated that [Premera Blue Cross] consulted with its
legal department and concluded that if the language in HB 109
remains as it is now, all contracts in Alaska will require
revision. He explained that the submitted amendment does not
change [Premera Blue Cross] practices in Alaska or the intent of
HB 109.
CHAIR WILSON offered comments concerning the language used
within the submitted amendment:
at the end of that first paragraph [of Amendment 1]
where it says "care insurer must comply with the
requirements of this subsection," I would suggest that
we change that to say "care insurer shall comply [with
the requirements of this subsection]." ... under
number 1 ... leave out "The health insurer may not
deny" and ... [insert] "Coverage for a newborn or
infant screening to be performed within 30 days of the
child's birth" ... number 2 ... in the middle line,
"the plan may not deny" ... [insert] "the plan shall
provide coverage for confirmatory hearing diagnostic
evaluation."
MR. MCGRAY said that he has no problem with Representative
Wilson's comments and corrections to Amendment 1.
3:57:30 PM
REPRESENTATIVE CISSNA inquired as to the availability of an
attorney to assist with the questions brought up by
Representative Anderson.
CHAIR WILSON stated that "Bill Drafting" has been contacted and
the person who drew up HB 109 will be able to provide guidance.
CHAIR WILSON asked if someone would move the amendment before
the committee [in an attempt to make Representative Wilson's
aforementioned corrections].
REPRESENTATIVE MCGUIRE stated her concerns about the moving the
amendment and questioned phrasing within HB 109.
4:02:34 PM
REPRESENTATIVE SEATON offered Amendment 1 [labeled 2/16/05, 4:07
p.m.] to be brought before the committee.
REPRESENTATIVE ANDERSON objected for the purpose of discussion.
REPRESENTATIVE SEATON offered a Conceptual Amendment to amend
Amendment 1, as follows:
In Subsection (1), remove "the health care insurer may
not deny"
Insert "Provide"
In Subsection (2), remove "may not deny"
Insert "shall provide"
In first paragraph, remove "must"
Insert "shall"
4:04:03 PM
CHAIR WILSON stated that hearing no objection, those changes
have been made to read, "the health care insurer shall comply
with the requirements of this subsection ... they shall provide
coverage for a newborn infant and they shall provide coverage
for confirmatory hearing diagnostic evaluation."
4:05:17 PM
REPRESENTATIVE SEATON offered Amendment 2, to amend Amendment 1,
as follows:
Remove Subsection (b)
Adopt the rest of the Amendment 1.
REPRESENTATIVE MCGUIRE objected for the purpose of discussion.
4:06:35 PM
JEAN MISCHEL, attorney, Legislative Legal and Research Services,
Legislative Affairs Agency, stated that there is a structural
problem with Amendment 1.
CHAIR WILSON explained the specific changes the House Health,
Education and Social Services Standing Committee have made to
Amendment 1.
4:08:39 PM
REPRESENTATIVE ANDERSON, for the benefit of Jean Mischel,
clarified the changes within HB 109 [and Amendment 1] that the
committee had been discussing.
4:10:29 PM
JEAN MISCHEL stated that Amendment 1 could significantly change
HB 109. She explained that what the current language change
does, in Subsection C, Section 5, of HB 109, is limit it to
standard policy provisions that are applicable to other
benefits. If the standard policy provision were changed, with
respect to infant hearing and screening assessments, other
benefits would also have to be changed. She stated that what is
being proposed in Amendment 1 is a much broader limitation.
CHAIR WILSON asked Jean Mischel to review Amendment 1 and inform
Representative Ramras of the effects of the changes. She stated
that the House Health, Education and Social Services Standing
Committee will pass HB 109 to the next committee. In the
meantime, she said, legal counsel will provide information
concerning language changes.
REPRESENTATIVE SEATON withdrew his aforementioned amendments.
4:13:06 PM
REPRESENTATIVE ANDERSON moved to report CSHB 109(L&C), Version
F, with individual recommendations, attached fiscal note and
with supplemental legal comments. There being no objection,
CSHB 109(L&C) was reported from the House Health, Education and
Social Services Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:14:29 PM.
| Document Name | Date/Time | Subjects |
|---|