MINUTES OF THE meeting

of the

ASSEMBLY subCommittee on Health and Human Services

 

Seventy-First Session

March 20, 2001

 

 

The Subcommittee on Health and Human Services was called to order at 3:30 p.m., on Tuesday, March 20, 2001.  Chairman Sheila Leslie presided in Room 1214 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Agenda.  Exhibit B is the Guest List.  All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

 

 

SUBCOMMITTEE MEMBERS PRESENT:

 

Mrs.                     Sheila Leslie, Chairman

Ms.                     Kathy McClain

Ms.                     Dawn Gibbons

 

 

SUBCOMMITTEE MEMBERS ABSENT:

 

None

 

GUEST LEGISLATORS PRESENT:

 

None

 

STAFF MEMBERS PRESENT:

 

Marla McDade Williams, Committee Policy Analyst

Darlene Rubin, Committee Secretary

 

OTHERS PRESENT:

 

Bill Welch, President, Nevada Hospital Association

Yvonne Sylva, Administrator, State Health Division

Dr. Gary Yup, Neonatologist, Washoe Medical Center

Janine Hansen, Lobbyist, Nevada Eagle Forum

Susan Lloyd, Audiologist, Las Vegas

Erin Hand, Audiologist, Las Vegas

Jean Irwin, Teacher for the deaf

Guy Perkins, Chief Insurance Examiner, Division of Insurance

Mary Carpi, Audiologist, Las Vegas

Helen Foley, Pacific Care Health Plan

Janice Pine, Saint Mary’s Health Network

Kay Bennett, R.N., Carson-Tahoe Hospital

Richard Spain, Registered Technologist, Carson-Tahoe Hospital

 

Note:  Simultaneous videoconference held in Room 4412 of the Grant Sawyer Office Building, 555 East Washington Avenue, Las Vegas, Nevada.

 

Chairman Leslie opened the subcommittee on A.B. 250 and called the first witness.

 

Assembly Bill 250:  Requires screening of newborn children and infants for hearing impairments. (BDR 40-155)

 

 

Bill Welch, President and CEO, Nevada Hospital Association, presented several amendments to A.B. 250.  He provided Exhibit C, which outlined the recommended amendments as follows:

 

• The first amendment referenced hospitals and recommended specifying those facilities that were certified as having and providing for organized obstetric services.  Mr. Welch noted there were many facilities in the state licensed as hospitals that did not provide obstetrical services, yet might in an emergency deliver a baby.  However they would not have all the customary services to support obstetrical situations as a certified facility.

 

• Mr. Welch reported that Section 6 was a concern as it referred to an infant being an individual 30 days to 12 months in age, which would suggest any time an infant was admitted to a hospital it would be necessary to go through the hearing test process.  He had no opposition to newborns having the test, however, felt it would be impossible to track every infant admitted to the hospital just in the market area that included Carson-Tahoe Hospital, Saint Mary’s, Washoe Medical Center, and Northern Nevada Medical Center.  Therefore, he recommended the language referring to infants be deleted.

 

• Section 10.3, and referenced throughout numerous other sections of the bill, referred to information that would be compiled and submitted to the State Board of Health.  It did not specify the frequency or manner of submission.  Mr. Welch had no problem with submitting the required information however would like the language clarified to indicate it would be compiled and submitted to the State Board of Health on an annual basis.

 

• Section 11.2 referred to “hospitals, obstetrics” but it did not specifically say licensed hospital, which it should state.

 

• Section 15.1 referred to providing a brochure stating the benefits of the hearing test, which Mr. Welch supported, however he recommended that the state identify one specific brochure to be uniformly distributed to those who would be benefiting from the service.

 

• Section 16.2 referred to the facility or the provider giving a list of providers that would perform the screening free of cost.  Mr. Welch said he was not aware of any providers who would do that, therefore if such providers were known they should identified and a standard list be made available to all.  That list should include southern, northern, and rural Nevada.

 

• Section 17 discussed the child or newborn identified as having a hearing impairment to be referred for ongoing clinical diagnostic evaluation and treatment.  Mr. Welch felt it was important to clarify that the provider who diagnosed the status of the child be the one who is responsible. As written the bill did not specify who would refer the newborn. 

 

Yvonne Sylva, Administrator, State Health Division, provided Exhibit D, a copy of A.B. 250 on which she had marked out the objectionable portions and inserted recommended language.  Those recommendations, Ms. Sylva, said, would treat obstetric centers no differently than other facilities, such as hospitals.  She agreed with Mr. Welch on the need to uniformly describe a newborn and not include words like “infant” or “child” because they had different meanings.  The recommendations were as follows:

 

• Page 2, Section 9 (a):  A licensed hospital should include a licensed obstetric center and be held to the same standard as a hospital.

 

• Section 9 line 2:  A licensed obstetric center shall not discharge a newborn child until the newborn child had, line 28, “undergone a hearing screening for the detection of hearing loss to prevent the consequences of unidentified disorders.”  The remainder of that sentence would be deleted as well as number (2).

 

• Section 10, Subsection 2, line 41, should state, “a licensed hospital and a licensed obstetric center shall hire, contract with or enter into” deleting the words “that chooses to carry out a program.”  Ms. Sylva felt it should not be a choice.

 

• Section 10, Subsection 2(a), line 45, should read “conduct a program for hearing screenings on newborns in accordance with Section 2 to 17, deleting “children and infants.”

 

• Page 3, line 4, delete number 3 entirely and replace it with 3(a)”not later than 24 hours after a hearing screening is conducted on a newborn, appropriate documentation concerning the hearing screening, including, without limitation, results, interpretations, and recommendations must be placed in the medical file of the newborn.”  Thus, deleting “and submitted to the State Board of Health in accordance with regulations.”  Also insert (b) “Report to the State Health Division the number of newborn infants screened and the results of the screenings in accordance with regulations adopted by the State Board of Health.”

 

Chairman Leslie asked if those changes addressed the concerns raised at the hearing about privacy of people’s records and if so, how would it do that.  Ms. Sylva felt that recommendation had addressed the privacy concern and would place it into regulations so there would be opportunities for exclusions in the regulations rather than placing them in a statute.

 

Assemblywoman McClain asked when the information was reported to the State Health Division would it be in a statistical format.  Ms. Sylva answered the information would be prescribed in the regulations and would be dependent upon what the Board of Health adopted as regulations, however they would be open for public hearing.  There would be exclusion language for a parent, for example, who chose to opt out, as had been done in the Birth Defects Registry.

 

Ms. Sylva returned to the recommended changes:

 

• Page 3, line 10, Section 4, instead of the state, it should read “State Health Division.” 

 

• Line 20, Section 11, delete “child” after “newborn.” 

 

• Line 26, after “newborn” delete “child,” and the remainder of that paragraph, and Subsection 2 entirely.

 

Assemblywoman Leslie asked the rationale behind that deletion.  Ms. Sylva explained that most all the births in Nevada occurred in hospitals or other birthing centers and the language of Subsection 2 referred to home births, which were few.  Mrs. Leslie asked if the thought was there were so few babies born at home that it was not practical to expect those babies to get a hearing test.  Ms. Sylva felt the logistical problems would be much greater.  However, the goal of having newborns born at home tested could be accomplished through an education campaign and working with midwives.  Mrs. Leslie asked how many babies were born at home.  Ms. Sylva did not know but felt the number of home births was small.

 

Ms. Sylva continued with the recommended changes:

 

• Line 36, Section 12, should read “a follow up” diagnostic screening that is conducted on a newborn, delete “child or infant.”

 

• Line 42, delete “children and infants.”

 

• Line 45, delete the entire paragraph 2.

 

• Page 4, line 19, delete the entire paragraph 2, which was in conflict with Section 9.

 

Mrs. Leslie asked for an explanation of the conflict.  Ms. Sylva said if a hospital or birthing center was aware of a child whose family could not afford to pay for a hearing screening, the newborn could be discharged without receiving a screening.  However, that conflicted with the intent of the legislation which had been to make sure no newborn would be discharged without a screening being performed, regardless of the parents’ ability to pay.  Mrs. Leslie asked if there were providers who would perform the test at no charge.  Ms. Sylva said the Special Children’s Clinic, in Reno and Las Vegas, would provide services based on the family’s ability to pay but not necessarily in the hospital setting.  She added that she was not aware of any newborn being selectively not screened because of the parents’ inability to pay. 

 

Dr. Gary Yup, neonatologist, Washoe Medical Center, believed Special Children’s Clinic was on a referral basis but not for all children, only for higher risk infants.  Ms. Sylva said any child could be treated with an appropriate referral.   Dr. Yup countered that he believed the referral had to be because of a special need.  Ms. Sylva said the contractual agreement Dr. Yup referred to was related to referrals from the neonatal intensive care unit, but there were children outside of that unit who were referred to the Special Children’s Clinic for a variety of reasons. Essentially the situation was that every newborn in the hospital would receive a hearing screening.  If that screening revealed a problem the infant could be referred for follow up to the Special Children’s Clinic, regardless of the parents’ ability to pay.

 

Ms. Sylva said the remainder of her recommended changes was the deletion of the words “child and infant” wherever they appeared in the bill text.

 

Assemblywoman McClain asked if the wording on page 3, “follow-up screening that is conducted on a newborn because the initial hearing screening failed” meant that the infant failed to pass the test or the test itself failed.  Ms. Sylva was not certain of the intent, however, she interpreted it to mean the initial screening had not worked.  Dr. Yup felt the meaning to be that an infant who had not passed the screening would then be referred for a follow-up diagnostic.  If the technician performing the test was unable to say “this child can hear” then it should be referred for follow-up.

 

Mrs. Leslie asked those who had raised the privacy concern to comment on whether the concern had been addressed by the amendment Mrs. Sylva suggested.

 

Janine Hansen, Nevada Eagle Forum, who had raised the issue at the first hearing of the bill, felt the amendment addressed her concern.  However, she asked what the regulations were that Ms. Sylva referred to in connection with the Birth Defects Registry.  She asked for a copy of those regulations to make sure, and Mrs. Leslie asked Ms. Sylva to provide those to Ms. Hansen.  Mrs. Leslie asked if she had understood correctly that those regulations would be developed, or were they the existing regulations for the Birth Defects Registry.  Ms. Sylva said regulations would have to be drafted for the specific purpose.  She noted that Ms. Hansen’s group had a representative who had participated with the Board of Health in developing those regulations.

 

Susan Lloyd, audiologist, from Las Vegas, returned to the question of failed screenings and rescreenings, and said some hospitals chose to do a single stage screening.  If the child did not pass, either due to a hearing loss or some technical difficulty, the child was referred out for diagnostic testing.  The language in the bill, she noted, seemed to use “screening” and “diagnostics” without differentiation and it was important those words be clearly differentiated in the final language.  “Diagnostics” were much more time- consuming and more involved and attempted to determine what hearing level the child had, as well as what conditions the child had that needed to be addressed.  “Screening” was simply a pass/fail.  Some hospitals chose to do a two-stage screening if the child failed the first one and return another day or use a different technician, as an attempt to keep the referral rate low. 

 

Chairman Leslie asked Ms. Lloyd to look at the bill and advise the committee if those words were used incorrectly and in what sections.  Ms. Lloyd said she would do that.

 

Erin Hand, audiologist, Las Vegas, was in agreement with Ms. Lloyd about the need to differentiate between “screening” and “diagnostic.”

 

Assemblywoman McClain asked if the intent was to have a simple screening of newborns or more intensive testing.  Mrs. Leslie said the intent was for a screening but with enough substance in the bill so that the follow-up was made for those who failed the screening test.

 

Dr. Gary Yup felt the bill should be flexible as to whether an audiologist or technician performed the screening test.  He noted that a “wider” screening or diagnostic workup could be done in an inpatient setting if time permitted.  A technician could do it and a physician would then interpret it.  In an inpatient setting it did not necessarily have to be done by an audiologist.  Mrs. Leslie asked if the bill was written to Dr. Yup’s satisfaction.  Dr. Yup said Ms. Sylva had been referring to Section 12, line 38, “conducted by an audiologist,” and he suggested the wording be changed to “conducted by an audiologist or qualified technician.”  Mrs. Leslie said the committee would look into that.

 

Next to speak was Jean Irwin, a teacher for the deaf, who had the same concerns as Ms. Sylva.  She provided Exhibit E, an article in the Journal of the American Academy of Audiology, February 2001, pertaining to the cost of a hearing test.  The article explained two tests were available, one less expensive than the other and many times that less expensive test was done.  However, that test was less accurate.  Therefore, hospitals knew because of the failure rate of that test a follow-up test would be necessary.  The same technicians who performed the first test could be trained to perform the second test, which kept the cost down.  The test cost was approximately $30.  If the combined tests were used, over a period of five years the cost was reduced to $12.38 per test.  Ms. Irwin noted there was a caveat in the conclusion of the article that stated:

 

Although this would appear that universal newborn hearing screening could be provided for a reasonable cost, under most circumstances the extent to which it becomes a reality will likely be related to the level of reimbursement health care providers receive for these services.

 

Ms. Irwin felt the cost of the test could be kept down and the article was evidence of that, and she suggested whoever prepared the cost analysis use the article for reference.

 

Ms. Irwin also provided Exhibit F, the text of a similar bill from the State of Colorado.  She noted Colorado had the highest testing rate of any state.  The state mandated the hearing test be performed and gave hospitals the time to describe the details of how the testing would be done.  As long as the hospitals tested at 85 percent they were able to set the rules for how it would be done.  In conclusion, Ms. Irwin applauded the work Yvonne Sylva had done in the suggested amendments.

 

Guy Perkins, Chief Insurance Examiner, Division of Insurance, provided information in response to the subcommittee’s request to determine how many insurers would pay for the newborn screening coverage.  He received responses from seven of the larger carriers in the state, being 52.64 percent of the market share in Nevada.  He pointed out that hearing screenings for newborns was a new benefit.  Insurance companies were not regularly receiving claims on well-born infants for hearing screenings.  The division also talked to insurers about screenings on children who were not well.

 

The question asked each carrier was:

 

Does your company currently provide coverage for hearing screenings of newborn children and infants?  Is it covered regardless of whether or not there is a diagnosis of a sickness, illness, or well-baby routine care?

 

The seven responses were as follows:

 

• An HMO said they “do pay for newborn history and physical of newborn children and hearing screening if it was bundled under the newborn care regardless of the diagnosis.”  Mr. Perkins explained that meant if it was part of the per diem of that hospital then it would be covered.

 

• Another HMO said that they “will cover hearing screenings for newborn children and infants but not routine hearing screenings.”  They also went on to mention they were not particularly in favor of health insurance mandates.

 

Chairman Leslie said she was unclear if that company would do the screenings or would not.  Mr. Perkins felt the HMO would decide on a case-by-case basis.  An “at risk” child would probably be covered, but a routine test on a well baby would not.

 

Mr. Perkins returned to the respondents’ answers:

 

• Another HMO stated “normally these procedures are not done unless there is an apparent reason to perform the procedures.”  In other words, premature babies, babies exposed to drugs, and so on.  The HMO currently considered the cost of the hearing screen to be part of the hospital case rate; the per diem or per delivery rate already negotiated and in effect.  That HMO also said they “have been paying for hearing screenings for newborn children and infants in most cases.”

 

• Another HMO said “they currently paid for hearing screenings of newborn children and infants regardless of the diagnosis, including well-born children.”

 

• Another HMO stated “as long as the provider was a network provider hearing screening on newborn children and infants was covered regardless of the diagnosis.”  Mr. Perkins noted, however, that with an HMO if the patient had not gone to one of their providers there was no coverage.

 

• An indemnity carrier, that was also a managed care organization (MCO) because of the way they were structured with a Preferred Physician Organization (PPO) network, said “hearing screening of newborn children and infants is covered as long as it is medically necessary and appropriate for the diagnosis given.  If done for routine purposes they would fall under any limitations and exclusions the policy would have for routine services.”  Mr. Perkins gathered from that there might be some policies the company issued that excluded routine services and some that did not.

 

• The next company had both an indemnity company and an HMO and their response was that “based on what type of policy was being sold, whether or not routine screenings for hearing would be covered.”  However, benefits were covered under the policy for their HMO plan and had a benefit for coverage for every 24 months under their preventive provision.

 

Chairman Leslie thanked Mr. Perkins for his tremendous effort in obtaining the requested information on such short notice.  She was particularly interested in the fact that hospitals with HMOs had a rate for the whole delivery.  She asked, therefore, if the bill mandated that hospitals had to provide the hearing screening for all babies, would it be likely the hospitals would incorporate that cost into their next negotiations with the HMOs.  Mr. Perkins felt that would be the case.  Mrs. Leslie said it might be less of a fight if the insurance mandate was removed.  In which case, if the hospitals that were not currently providing the coverage picked that up in their negotiated rate it might be a way to eliminate the payment problems without having a mandate that would be opposed by the industry.  Mr. Perkins agreed.

 

There was general discussion about the issue of Medicaid.  Mr. Perkins noted HMOs did provide Medicaid coverage.  In that regard, Assemblywoman McClain asked if taking the mandate out for the insurance companies but leaving it in for hospitals that had to do the testing would it “catch” all the newborns.  Mrs. Leslie said she had discussed the issue with Bill Welch, Nevada Hospital Association, and he said as long as the hospitals were allowed to bill back the patient or Medicaid, the hospitals in his group would be agreeable.  Mr. Perkins believed there were some rural hospitals that did not have contracts with HMOs or MCOs.

 

Mrs. Leslie asked Ms. Sylva about Medicaid, noting that although Ms. Sylva was not the Medicaid specialist she had a fiscal note that had included Medicaid, and Mrs. Leslie wanted to make sure Medicaid provided coverage for the newborn screening.  She pointed out that Medicaid recipients were the least likely to be able to afford the screening and she did not want the hospitals to have to pick up all that cost.  Ms. Sylva had included in the fiscal note a portion for those Medicaid babies; however, she said Charles Duarte, Health Care Financing and Policy (HCFP), would be better able to discuss the details.  Mrs. Leslie assumed that if the insurance provision were removed from the bill, a specific provision would have to be included for Medicaid.  Mr. Perkins said insofar as delivery of managed care to Medicaid recipients, the regulation of Medicaid under those HMOs was not handled by the Division of Insurance.

 

Mrs. McClain said if the mother was on Medicaid the baby was automatically covered, and for those parents with insurance the majority of carriers were providing coverage.  With the carriers who were not providing coverage, it would be whatever the hospital negotiated in their contract.  However, for those not on Medicaid and without private insurance, she asked if the newborn would automatically qualify for Nevada Check-Up.  Mrs. Leslie said the parents would have to apply and qualify based on income. 

 

Marla McDade Williams, Committee Policy Analyst, believed some of the contracts for Medicaid under Nevada Check-Up were handled by HMOs and the HCFP Division, in its development of the rate structure, would have to consider whether or not that was part of what they required of the HMO.  Mrs. McClain asked if the committee, as a policy-making body, could decide that should be included.  Mrs. Leslie said that was correct, but the money would have to be provided. 

 

Mrs. Leslie concluded the subcommittee wanted to explore the entire Medicaid option.

 

Dr. Gary Yup said when insurance companies were billed for the screening, in his experience only one company had paid.  If the screening was necessitated by the fact the newborn was in the intensive care nursery then it would be paid for because there was a predisposing factor, but from a newborn point of care the screening had not been paid for.  He felt the screening could be part of newborn care then the hospitals could negotiate that as being included in the “bundled” services.  He was concerned, however, that if insurance carriers said that was not part of newborn care would that become a mandate.  Mrs. Leslie said if it was mandated, the hospitals provided the screening for every newborn, it was the same as saying that was the expected standard of care.  Dr. Yup countered that from an insurance company perspective, that was not necessarily what they considered well-baby newborn care.  Mrs. Leslie believed that if the bill was passed the argument could be made that was the standard of care expected.  Dr. Yup was still concerned insurance companies might not consider that as routine newborn care, even if the hospitals said it was.

 

Assemblywoman McClain felt that what the policy needed to state unequivocally that was the standard for newborn care.  Chairman Leslie was not sure that would make a difference to the insurance companies, which was Dr. Yup’s point.  Mr. Perkins stated that if a hospital had that service built in as a standard part of their “bundle” of services and they then negotiated a contract with an MCO, the MCO automatically accepted that as part of the newborn “bundle.”  It became part of the standard package that came with the contract.  Mrs. Leslie felt it was a plausible means of achieving the goal without fighting the mandate battle.  Mr. Perkins noted that Medicaid’s Early Periodic Screening Diagnosis and Treatment (EPSDT) did not currently cover the screening, even though their program stated “newborn hearing screening.”   That screening, Mr. Perkins said, consisted of (he demonstrated) a clap of hands.

 

Assemblywoman Gibbons wondered if a standard of care for newborns was defined in statute.  No one was aware of a definition.

 

Next, Helen Foley, representing Pacific Care, noted that her group and many other HMOs took pride in their programs for children and all manner of screening, diagnostic, laboratory, and radiological procedures.  They were dogged in their efforts to make sure children had their immunizations.   She said their concerns would be resolved if the insurance provisions were eliminated.  Although it would still mandate that the procedure be done in the hospital, it would be part of that “bundle” where the carrier negotiated a per diem rate for the birth of the child.  If it was the policy of the state of Nevada that that was part of birth, then it would be negotiated in.  The cost would probably be higher because it was an additional service provided.  Her group took maternity and newborn care seriously and would be happy to work with the committee on the solution.  

 

Mrs. Leslie asked Ms. Foley if she had an amendment or was she satisfied with what Ms. Sylva had suggested.  Ms. Foley was satisfied with Ms. Foley’s similar amendment, however, provided her proposed amendment (Exhibit G) to make sure the concern was addressed.

 

Mrs. McClain commented that if the issue was the simple, initial screening, the cost was certainly not high, perhaps $40 or $50, and should not raise the premium.  Ms. Foley noted that in negotiations both sides were a little “heavy handed,” and the cost and the bill were not the same.  Mrs. McClain said that was her point, it should be made clear that was not a mechanism to raise prices artificially.

 

Next to speak, from Las Vegas, was Mary Carpi, a community audiologist and provider of contract services to Special Children’s Clinic.  She requested changes as follows:

 

• Page 2, Section 10, line 47, regarding appropriate training for the staff of the hospital or obstetric center.  Ms. Carpi felt a number of course hours for that training should be specified as well as the need for staff to be monitored.  In other words, the term “appropriate training” was not sufficient. 

 

• Page 3, Section 12, line 36, she wanted to see a compromise between what Ms. Sylva had suggested and what the other audiologists who testified.  There could not be a “diagnostic screening”; they were separate tests and the CPT codes, which would be used for billing, also specified the difference between a screening and a diagnostic.  Ms. Carpi recommended the wording “follow-up screening” rather than a “follow-up diagnostic screening.” 

 

Mrs. Leslie asked if the “diagnostic” was considered to be the more comprehensive test.  Ms. Carpi said typically the current practice was children were being screened in the hospital and then rescreened by the same person in the hospital within two weeks after release.  They were having a follow-up screening, not a follow-up diagnostic.  Some hospitals ran two screenings before they made a referral for a diagnostic.  Ms. Carpi said that should be addressed to make sure the desired test was being done.  Mrs. Leslie asked for her suggested wording.  Ms. Carpi said she would prefer a two-test screen; an initial screen and then be brought back for a rescreen.  That would keep the nonpassing numbers down so that fewer children would be referred.

 

Mrs. Leslie asked if the goal was for every baby to have two screenings, or a second screen if they failed the first one.  Ms. Carpi said that was correct and, if they failed the second screen they would be referred for a follow-up diagnostic by an audiologist for a full battery of tests.

 

Dr. Yup said that when an infant failed the first screen they were retested in an effort to decrease false/positive referrals.  He was not certain the bill could specify the infant had to have two failed screens first, because a parent might not return for the rescreen.  If the infant failed the screen, they needed to be referred for a diagnostic.  It was up to the facility’s policy as to whether they screened a second time before a referral for diagnostics.

 

Again Erin Hand, from Las Vegas, said that she and other audiologists strongly disagreed with the suggestion that the diagnostic evaluation be conducted by an audiologist or certified technician.  A certified technician could conduct the initial screenings but if the child failed they had to be seen by an audiologist for a comprehensive battery of audiological assessments, in order to determine the degree of hearing loss and counsel the parent regarding amplification and other follow-up.  Chairman Leslie further clarified that if the language was amended to read “diagnostic test” in Section 12, the test should be conducted by an audiologist.  Ms. Hand said that was correct.

 

Dr. Yup voiced concern about that if there was a mandate that the hospital had to do that test, then the hospital might have to hire an audiologist.  If the hospital chose to do so they wanted to have the full workup done and a technician could do that; because they often contracted with physicians to evaluate or to interpret the test.  Mrs. Leslie said that if Section 12 stated the hospital had to do that, by that time the infant would be released.  Dr. Yup felt that was not necessarily the case, the infant could be referred back to the hospital in an outpatient setting.  The hospital might want to conduct that test itself to decrease cost, but, if the bill stated an audiologist had to conduct the test then the hospital might not want to do that and instead refer it out.  That laced a heavier load on the state because it was referred to Special Children’s Clinic.  In Reno, at present, the numbers would not be high, but if it started to happen in Las Vegas he felt the numbers would be very high.

 

Next to speak was Stacy Ziegler, as a concerned parent and not on behalf of the Nevada Hospital Association, her employer.  She believed there had been confusion on the cost of the screening.  She was the parent of a newborn daughter delivered in September 2000.  At the time she was covered by Sierra Health and Life who had not covered that test.  When a staff person talked to her in the hospital she stressed how important the newborn screen was and Mrs. Ziegler said she felt vulnerable and said to do whatever needed to be done for her child.  Upon discharge she received a bill for pediatrics for $172, not the $12 or $30, or even $50 that had been mentioned earlier, which her insurer had not covered.  Her husband also had insurance and the company had not covered that charge either.  Moreover, because her husband was Native American, they also qualified for coverage through the Indian Health Service (IHS), but they had not covered the charge either.  She said had she known the cost she would have authorized the test anyway, however, knowing the cost in advance would have softened the blow.  If she had a choice between the less expensive test and the more expensive one, which would have ultimately told her the same thing, it would have been beneficial, she felt.  Additionally, she would have liked more information; was the test conducted by an audiologist, was that person on staff at the hospital, had the physician prescribed the test, and was it covered by insurance.  Then she could have researched it and decided whether she should see her pediatrician for a referral, at which point her insurance would have covered it.

 

Chairman Leslie said Mrs. Ziegler’s testimony was extremely helpful.

 

Janice Pine, representing Saint Mary’s Health Network, noted in reference to Section 12, the way her HMO worked was that if a screening test indicated a hearing problem, the baby was referred to ear, nose and throat (ENT) specialist.  In specifying only an “audiologist or technician” in the bill, there might not be either on a panel, or the baby might not need an audiologist but might need an ENT.  Therefore, she felt more options were needed.  She said she would include “qualified physician” or something more flexible than limited, or what would be in an HMO or MCO contract.

 

Kay Bennett, R.N., representing Carson-Tahoe Hospital, testified as a registered nurse with more than 12 years of operating room nursing experience and as a hospital trustee for 10 years.  Regarding Section 17, she noted the language “any newborn child or other child who is diagnosed as having a permanent hearing impairment must be referred” and asked who was eligible to diagnose.  If the intent was to look at early screening, perhaps language such as “any newborn who was determined to have a hearing impairment must be referred,” should be considered, because the goal was the early screening process.  She applauded the committee for its effort.

The final witness was Richard Spain, a registered technologist at Carson-Tahoe Hospital, who reported they were in the process of setting up a hearing screening program.  They had a capital budget set aside for the equipment.  He said that no baby would be turned down.  If someone moved into the area from out-of-state and their child needed a test, or if they had no insurance, the test would be done with no follow-up billing.  Mrs. Leslie applauded that effort.  Mr. Spain said he was in agreement with everything Dr. Yup stated. Also, he felt that what had been done in 32 states was where Nevada needed to be headed.  Mrs. Leslie recalled Senator Rawson had said in the Budget Subcommittee that he was tired of Nevada being at the bottom of the list on all the important issues, and she added that many of their colleagues felt the same.  Therefore, the legislation needed to move forward so Nevada could move up from 48^th position in the very important issue of newborn screening.

 

Mr. Spain noted Carson-Tahoe did not have an audiologist on staff.  He reported he was a registered technologist and would be performing the diagnostic studies at the hospital.  They might also perform the screening and would follow up with diagnostics.  Staff was trained and certified in brain-stem auditory evoked response and other types of testing.  He added there were no laws or regulations that stated technologists had to be registered or certified, only properly trained, but they were working on that aspect.  He preferred the word “technologist,” because there was more training involved, to “technician.”

 

Chairman Leslie thanked all participants for their testimony and excellent amendments.  Another committee meeting would be scheduled soon because Committee Chair Ellen Koivisto wanted a report back as soon as possible.  At that meeting a decision to refer back to the full committee.

 

The meeting was adjourned at 5:00 p.m.

RESPECTFULLY SUBMITTED:

 

Darlene Rubin

Committee Secretary

 

 

APPROVED BY:

                       

Assemblywoman Sheila Leslie, Chairman

 

DATE: