Assembly Bill No. 250–Assemblymen Leslie, McClain, Manendo, Anderson, Freeman, Koivisto, Parnell, Smith, Tiffany and Williams

 

February 28, 2001

____________

 

Joint Sponsor: Senator Care

____________

 

Referred to Committee on Health and Human Services

 

SUMMARY—Requires screening of newborn children and infants for hearing impairments. (BDR 40‑155)

 

FISCAL NOTE:            Effect on Local Government: Yes.

                                    Effect on the State: Yes.

 

CONTAINS UNFUNDED MANDATE (§ 9)

(Not Requested by Affected Local Government)

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to health care; requiring hearing screenings for newborn children and infants unless objected to in writing by the parent or legal guardian of the newborn child or infant; establishing the duties of hospitals, midwives and providers of health care concerning the provision of hearing screenings; requiring the state board of health to adopt certain regulations; requiring policies of health insurance and certain other health care plans to provide coverage for hearing screenings; prohibiting such policies and plans from requiring prior authorization for such coverage; providing for the referral of children who are diagnosed as having permanent hearing impairment; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1    Section 1. Chapter 442 of NRS is hereby amended by adding thereto

1-2  the provisions set forth as sections 2 to 17, inclusive, of this act.

1-3    Sec. 2.  As used in sections 2 to 17, inclusive, of this act, unless the

1-4  context otherwise requires, the words and terms defined in sections 3 to

1-5  8, inclusive, of this act have the meanings ascribed to them in those

1-6  sections.

1-7    Sec. 3.  “Hearing impairment” means a loss of hearing of 30

1-8  decibels or greater in the range of frequencies necessary for speech

2-1  recognition and comprehension in one or both ears, as set forth in the

2-2  most current guidelines established by the American Speech-Language

2-3  Hearing Association.

2-4    Sec. 4.  “Hearing screening” means a test or battery of tests

2-5  administered to determine the need for an in-depth hearing diagnostic

2-6  evaluation.

2-7    Sec. 5.  “Hospital” has the meaning ascribed to it in NRS 449.012.

2-8    Sec. 6.  “Infant” means a child who is 30 days of age or older but not

2-9  more than 12 months of age.

2-10    Sec. 7.  “Newborn child” means a child who is less than 30 days of

2-11  age.

2-12    Sec. 8.  “Provider of hearing screenings” means a health care

2-13  provider who, within the scope of his license or certificate, provides for

2-14  hearing screenings of newborn children and infants in accordance with

2-15  sections 2 to 17, inclusive, of this act. The term includes a licensed

2-16  audiologist, a licensed physician or an appropriately supervised person

2-17  who has documentation that demonstrates to the state board of health

2-18  that he has completed training specifically for conducting hearing

2-19  screenings of newborn children.

2-20    Sec. 9.  1.  Except as otherwise provided in section 11 of this act:

2-21    (a) A licensed hospital in this state that provides services for maternity

2-22  care and the care of newborn children shall not discharge a newborn

2-23  child until the newborn child has undergone a hearing screening for the

2-24  detection of hearing loss to prevent the consequences of unidentified

2-25  disorders.

2-26    (b) A licensed obstetric center shall not discharge a newborn child

2-27  until the newborn child has:

2-28      (1) Undergone a hearing screening for the detection of hearing loss

2-29  to prevent the consequences of unidentified disorders if the obstetric

2-30  center has a program for conducting hearing screenings of newborn

2-31  children; or

2-32      (2) Been referred to a provider of hearing screenings for the

2-33  detection of hearing loss to prevent the consequences of unidentified

2-34  disorders. Such a referral must be scheduled in accordance with the

2-35  regulations of the state board of health.

2-36    2.  The state board of health shall adopt such regulations as are

2-37  necessary to carry out the provisions of sections 2 to 17, inclusive, of this

2-38  act.

2-39    Sec. 10.  1.  A hearing screening required by section 9 of this act

2-40  must be conducted by a provider of hearing screenings.

2-41    2.  A licensed hospital, and a licensed obstetric center that chooses to

2-42  carry out a program for conducting hearing screenings, shall hire,

2-43  contract with or enter into a written memorandum of understanding with

2-44  a provider of hearing screenings to:

2-45    (a) Conduct a program for hearing screenings on newborn children

2-46  and infants in accordance with sections 2 to 17, inclusive, of this act;

2-47    (b) Provide appropriate training for the staff of the hospital or

2-48  obstetric center;

3-1    (c) Render appropriate recommendations concerning the program for

3-2  hearing screenings; and

3-3    (d) Coordinate appropriate follow-up services.

3-4    3.  Not later than 24 hours after a hearing screening is conducted on

3-5  a newborn child or an infant, appropriate documentation concerning the

3-6  hearing screening, including, without limitation, results, interpretations

3-7  and recommendations, must be placed in the medical file of the newborn

3-8  child or infant and submitted to the state board of health in accordance

3-9  with its regulations.

3-10    4.  The state board of health shall annually prepare and submit to the

3-11  governor a written report relating to hearing tests for newborn children

3-12  and infants. The written report must include, without limitation:

3-13    (a) A summary of the results of hearing screenings administered to

3-14  newborn children and infants and any other related information

3-15  submitted in accordance with its regulations;

3-16    (b) An analysis of the effectiveness of the provisions of sections 2 to

3-17  17, inclusive, of this act in identifying loss of hearing in newborn

3-18  children and infants; and

3-19    (c) Any related recommendations for legislation.

3-20    Sec. 11.  1.  A newborn child may be discharged from a licensed

3-21  hospital or obstetric center without having undergone a required hearing

3-22  screening or having been referred for a hearing screening if a parent or

3-23  legal guardian of the newborn child objects in writing to the hearing

3-24  screening. The hospital or obstetric center shall place the written

3-25  objection of the parent or legal guardian to the hearing screening in the

3-26  medical file of the newborn child. If the newborn child is born at home

3-27  and the parent or legal guardian objects to the hearing screening, the

3-28  physician or midwife attending the birth or, if no physician or midwife

3-29  attended the birth, the primary care physician of the newborn child, shall

3-30  place the written objection of the parent or legal guardian in the medical

3-31  file of the newborn child.

3-32    2.  In addition to the provisions of subsection 1, a newborn child may

3-33  be discharged from a hospital, or an obstetric center, if applicable,

3-34  without having undergone a required hearing screening in accordance

3-35  with regulations adopted by the state board of health.

3-36    Sec. 12.  A diagnostic screening that is conducted on a newborn

3-37  child or an infant because the initial hearing screening failed must be

3-38  conducted by an audiologist.

3-39    Sec. 13.  1.  A licensed hospital shall formally designate a lead

3-40  physician or audiologist to be responsible for:

3-41    (a) The administration of the program for conducting hearing

3-42  screenings of newborn children and infants; and

3-43    (b) Monitoring the scoring and interpretation of the test results of the

3-44  hearing screenings.

3-45    2.  A licensed obstetric center that has a program for conducting

3-46  hearing screenings of newborn children and infants shall operate the

3-47  program in accordance with regulations adopted by the state board of

3-48  health.

4-1    Sec. 14.  A hearing screening must include auditory brainstem

4-2  responses, evoked otocoustic emissions or any other appropriate

4-3  technology that has been approved for newborn hearing screenings by

4-4  the Food and Drug Administration or the American Speech-Language

4-5  Hearing Association.

4-6    Sec. 15.  1.  A licensed hospital shall provide information to the

4-7  parents or legal guardian of a newborn child concerning the importance

4-8  of screening the hearing of newborn children and of receiving follow-up

4-9  care.

4-10    2.  Information provided to the parents or legal guardian of a

4-11  newborn child or an infant pursuant to this section must:

4-12    (a) Be made in terms that are easily understandable; and

4-13    (b) Include a description of the normal development of auditory

4-14  processes, speech and language in children.

4-15    Sec. 16.  1.  An initial hearing screening of a newborn child or an

4-16  infant and any medically necessary follow-up evaluations leading to a

4-17  diagnosis is a covered benefit pursuant to section 20, 22, 23 or 24 of this

4-18  act, as appropriate.

4-19    2.  A licensed hospital or obstetric center which, and a physician or

4-20  midwife who, is aware that a newborn child or an infant is not covered by

4-21  any kind of health insurance and that the parents or legal guardian of

4-22  the newborn child or infant cannot afford the cost of a hearing screening

4-23  shall give to the parents or legal guardian a list of providers of hearing

4-24  screenings who provide such screenings free of charge.

4-25    Sec. 17.  1.  Any newborn child, infant or other child who is

4-26  diagnosed as having a permanent hearing impairment must be referred

4-27  to a primary care physician for medical management, treatment and

4-28  follow-up services and to an audiologist for diagnostic testing.

4-29    2.  As used in this section, “management” means the habilitation of a

4-30  child diagnosed with a hearing impairment.

4-31    Sec. 18.  NRS 287.010 is hereby amended to read as follows:

4-32    287.010  1.  The governing body of any county, school district,

4-33  municipal corporation, political subdivision, public corporation or other

4-34  public agency of the State of Nevada may:

4-35    (a) Adopt and carry into effect a system of group life, accident or health

4-36  insurance, or any combination thereof, for the benefit of its officers and

4-37  employees, and the dependents of officers and employees who elect to

4-38  accept the insurance and who, where necessary, have authorized the

4-39  governing body to make deductions from their compensation for the

4-40  payment of premiums on the insurance.

4-41    (b) Purchase group policies of life, accident or health insurance, or any

4-42  combination thereof, for the benefit of such officers and employees, and

4-43  the dependents of such officers and employees, as have authorized the

4-44  purchase, from insurance companies authorized to transact the business of

4-45  such insurance in the State of Nevada, and, where necessary, deduct from

4-46  the compensation of officers and employees the premiums upon insurance

4-47  and pay the deductions upon the premiums.

4-48    (c) Provide group life, accident or health coverage through a self-

4-49  insurance reserve fund and, where necessary, deduct contributions to the

5-1  maintenance of the fund from the compensation of officers and employees

5-2  and pay the deductions into the fund. The money accumulated for this

5-3  purpose through deductions from the compensation of officers and

5-4  employees and contributions of the governing body must be maintained as

5-5  an internal service fund as defined by NRS 354.543. The money must be

5-6  deposited in a state or national bank or credit union authorized to transact

5-7  business in the State of Nevada. Any independent administrator of a fund

5-8  created under this section is subject to the licensing requirements of

5-9  chapter 683A of NRS, and must be a resident of this state. Any contract

5-10  with an independent administrator must be approved by the commissioner

5-11  of insurance as to the reasonableness of administrative charges in relation

5-12  to contributions collected and benefits provided. The provisions of NRS

5-13  689B.030 to 689B.050, inclusive, and section 22 of this act, apply to

5-14  coverage provided pursuant to this paragraph, except that the provisions of

5-15  NRS 689B.0359 do not apply to such coverage.

5-16    (d) Defray part or all of the cost of maintenance of a self-insurance fund

5-17  or of the premiums upon insurance. The money for contributions must be

5-18  budgeted for in accordance with the laws governing the county, school

5-19  district, municipal corporation, political subdivision, public corporation or

5-20  other public agency of the State of Nevada.

5-21    2.  If a school district offers group insurance to its officers and

5-22  employees pursuant to this section, members of the board of trustees of the

5-23  school district must not be excluded from participating in the group

5-24  insurance. If the amount of the deductions from compensation required to

5-25  pay for the group insurance exceeds the compensation to which a trustee is

5-26  entitled, the difference must be paid by the trustee.

5-27    Sec. 19.  NRS 687B.225 is hereby amended to read as follows:

5-28    687B.225  1.  Except as otherwise provided in NRS 689A.0405,

5-29  689A.0413, 689B.031, 689B.0374, 695B.1912, 695B.1914, 695C.1713,

5-30  695C.1735 and 695G.170, and sections 20, 22, 23 and 24 of this act, any

5-31  contract for group, blanket or individual health insurance or any contract

5-32  by a nonprofit hospital, medical or dental service corporation or

5-33  organization for dental care which provides for payment of a certain part of

5-34  medical or dental care may require the insured or member to obtain prior

5-35  authorization for that care from the insurer or organization. The insurer or

5-36  organization shall:

5-37    (a) File its procedure for obtaining approval of care pursuant to this

5-38  section for approval by the commissioner; and

5-39    (b) Respond to any request for approval by the insured or member

5-40  pursuant to this section within 20 days after it receives the request.

5-41    2.  The procedure for prior authorization may not discriminate among

5-42  persons licensed to provide the covered care.

5-43    Sec. 20.  Chapter 689A of NRS is hereby amended by adding thereto a

5-44  new section to read as follows:

5-45    1.  A policy of health insurance must provide coverage for benefits

5-46  payable for expenses incurred for a hearing screening conducted on

5-47  newborn children and infants pursuant to sections 2 to 17, inclusive, of

5-48  this act, and any medically necessary follow-up leading to a diagnosis as

5-49  to whether the newborn child or infant has a hearing impairment.

6-1    2.  A policy of health insurance must not require an insured to obtain

6-2  prior authorization for any service provided pursuant to subsection 1.

6-3    3.  A policy subject to the provisions of this chapter that is delivered,

6-4  issued for delivery or renewed on or after October 1, 2001, has the legal

6-5  effect of including the coverage required by subsection 1, and any

6-6  provision of the policy or the renewal which is in conflict with subsection

6-7  1 is void.

6-8    4.  As used in this section:

6-9    (a) “Hearing impairment” has the meaning ascribed to it in section 3

6-10  of this act.

6-11    (b) “Hearing screening” has the meaning ascribed to it in section 4 of

6-12  this act.

6-13    Sec. 21.  NRS 689A.330 is hereby amended to read as follows:

6-14    689A.330  If any policy is issued by a domestic insurer for delivery to a

6-15  person residing in another state, and if the insurance commissioner or

6-16  corresponding public officer of that other state has informed the

6-17  commissioner that the policy is not subject to approval or disapproval by

6-18  that officer, the commissioner may by ruling require that the policy meet

6-19  the standards set forth in NRS 689A.030 to 689A.320, inclusive[.] , and

6-20  section 20 of this act.

6-21    Sec. 22.  Chapter 689B of NRS is hereby amended by adding thereto a

6-22  new section to read as follows:

6-23    1.  A policy of group health insurance must provide coverage for

6-24  benefits payable for expenses incurred for a hearing screening conducted

6-25  on newborn children and infants pursuant to sections 2 to 17, inclusive,

6-26  of this act, and any medically necessary follow-up leading to a diagnosis

6-27  as to whether the newborn child or infant has a hearing impairment.

6-28    2.  A policy of group health insurance must not require an insured to

6-29  obtain prior authorization for any service provided pursuant to

6-30  subsection 1.

6-31    3.  A policy subject to the provisions of this chapter that is delivered,

6-32  issued for delivery or renewed on or after October 1, 2001, has the legal

6-33  effect of including the coverage required by subsection 1, and any

6-34  provision of the policy or the renewal which is in conflict with subsection

6-35  1 is void.

6-36    4.  As used in this section:

6-37    (a) “Hearing impairment” has the meaning ascribed to it in section 3

6-38  of this act.

6-39    (b) “Hearing screening” has the meaning ascribed to it in section 4 of

6-40  this act.

6-41    Sec. 23.  Chapter 695B of NRS is hereby amended by adding thereto a

6-42  new section to read as follows:

6-43    1.  A policy of health insurance issued by a hospital or medical

6-44  service corporation must provide coverage for benefits payable for

6-45  expenses incurred for a hearing screening conducted on newborn

6-46  children and infants pursuant to sections 2 to 17, inclusive, of this act,

6-47  and any medically necessary follow-up leading to a diagnosis as to

6-48  whether the newborn child or infant has a hearing impairment.

7-1    2.  A policy of health insurance issued by a hospital or medical

7-2  service corporation must not require an insured to obtain prior

7-3  authorization for any service provided pursuant to subsection 1.

7-4    3.  A policy subject to the provisions of this chapter that is delivered,

7-5  issued for delivery or renewed on or after October 1, 2001, has the legal

7-6  effect of including the coverage required by subsection 1, and any

7-7  provision of the policy or the renewal which is in conflict with subsection

7-8  1 is void.

7-9    4.  As used in this section:

7-10    (a) “Hearing impairment” has the meaning ascribed to it in section 3

7-11  of this act.

7-12    (b) “Hearing screening” has the meaning ascribed to it in section 4 of

7-13  this act.

7-14    Sec. 24.  Chapter 695C of NRS is hereby amended by adding thereto a

7-15  new section to read as follows:

7-16    1.  A health maintenance plan must provide coverage for benefits

7-17  payable for expenses incurred for a hearing screening conducted on

7-18  newborn children and infants pursuant to sections 2 to 17, inclusive, of

7-19  this act, and any medically necessary follow-up leading to a diagnosis as

7-20  to whether the newborn child or infant has a hearing impairment.

7-21    2.  A health maintenance plan must not require an insured to obtain

7-22  prior authorization for any service provided pursuant to subsection 1.

7-23    3.  A policy subject to the provisions of this chapter that is delivered,

7-24  issued for delivery or renewed on or after October 1, 2001, has the legal

7-25  effect of including the coverage required by subsection 1, and any

7-26  provision of the policy or the renewal which is in conflict with subsection

7-27  1 is void.

7-28    4.  As used in this section:

7-29    (a) “Hearing impairment” has the meaning ascribed to it in section 3

7-30  of this act.

7-31    (b) “Hearing screening” has the meaning ascribed to it in section 4 of

7-32  this act.

7-33    Sec. 25.  NRS 695C.050 is hereby amended to read as follows:

7-34    695C.050  1.  Except as otherwise provided in this chapter or in

7-35  specific provisions of this Title, the provisions of this Title are not

7-36  applicable to any health maintenance organization granted a certificate of

7-37  authority under this chapter. This provision does not apply to an insurer

7-38  licensed and regulated pursuant to this Title except with respect to its

7-39  activities as a health maintenance organization authorized and regulated

7-40  pursuant to this chapter.

7-41    2.  Solicitation of enrollees by a health maintenance organization

7-42  granted a certificate of authority, or its representatives, must not be

7-43  construed to violate any provision of law relating to solicitation or

7-44  advertising by practitioners of a healing art.

7-45    3.  Any health maintenance organization authorized under this chapter

7-46  shall not be deemed to be practicing medicine and is exempt from the

7-47  provisions of chapter 630 of NRS.

7-48    4.  The provisions of NRS 695C.110, 695C.170 to 695C.200, inclusive,

7-49  695C.250 and 695C.265 do not apply to a health maintenance organization

8-1  that provides health care services through managed care to recipients of

8-2  Medicaid under the state plan for Medicaid or insurance pursuant to the

8-3  children’s health insurance program pursuant to a contract with the division

8-4  of health care financing and policy of the department of human resources.

8-5  This subsection does not exempt a health maintenance organization from

8-6  any provision of this chapter for services provided pursuant to any other

8-7  contract.

8-8    5.  The provisions of NRS 695C.1694 and 695C.1695 , and section 24

8-9  of this act, apply to a health maintenance organization that provides health

8-10  care services through managed care to recipients of Medicaid under the

8-11  state plan for Medicaid.

8-12    Sec. 26.  NRS 695C.330 is hereby amended to read as follows:

8-13    695C.330  1.  The commissioner may suspend or revoke any

8-14  certificate of authority issued to a health maintenance organization

8-15  pursuant to the provisions of this chapter if he finds that any of the

8-16  following conditions exist:

8-17    (a) The health maintenance organization is operating significantly in

8-18  contravention of its basic organizational document, its health care plan or

8-19  in a manner contrary to that described in and reasonably inferred from any

8-20  other information submitted pursuant to NRS 695C.060, 695C.070 and

8-21  695C.140, unless any amendments to those submissions have been filed

8-22  with and approved by the commissioner;

8-23    (b) The health maintenance organization issues evidence of coverage or

8-24  uses a schedule of charges for health care services which do not comply

8-25  with the requirements of NRS 695C.170 to 695C.200, inclusive, or

8-26  695C.1694, 695C.1695 or 695C.207[;] , or section 24 of this act;

8-27    (c) The health care plan does not furnish comprehensive health care

8-28  services as provided for in NRS 695C.060;

8-29    (d) The state board of health certifies to the commissioner that the

8-30  health maintenance organization:

8-31      (1) Does not meet the requirements of subsection 2 of NRS

8-32  695C.080; or

8-33      (2) Is unable to fulfill its obligations to furnish health care services as

8-34  required under its health care plan;

8-35    (e) The health maintenance organization is no longer financially

8-36  responsible and may reasonably be expected to be unable to meet its

8-37  obligations to enrollees or prospective enrollees;

8-38    (f) The health maintenance organization has failed to put into effect a

8-39  mechanism affording the enrollees an opportunity to participate in matters

8-40  relating to the content of programs pursuant to NRS 695C.110;

8-41    (g) The health maintenance organization has failed to put into effect the

8-42  system for complaints required by NRS 695C.260 in a manner reasonably

8-43  to dispose of valid complaints;

8-44    (h) The health maintenance organization or any person on its behalf has

8-45  advertised or merchandised its services in an untrue, misrepresentative,

8-46  misleading, deceptive or unfair manner;

8-47    (i) The continued operation of the health maintenance organization

8-48  would be hazardous to its enrollees; or

9-1    (j) The health maintenance organization has otherwise failed to comply

9-2  substantially with the provisions of this chapter.

9-3    2.  A certificate of authority must be suspended or revoked only after

9-4  compliance with the requirements of NRS 695C.340.

9-5    3.  If the certificate of authority of a health maintenance organization is

9-6  suspended, the health maintenance organization shall not, during the period

9-7  of that suspension, enroll any additional groups or new individual

9-8  contracts, unless those groups or persons were contracted for before the

9-9  date of suspension.

9-10    4.  If the certificate of authority of a health maintenance organization is

9-11  revoked, the organization shall proceed, immediately following the

9-12  effective date of the order of revocation, to wind up its affairs and shall

9-13  conduct no further business except as may be essential to the orderly

9-14  conclusion of the affairs of the organization. It shall engage in no further

9-15  advertising or solicitation of any kind. The commissioner may by written

9-16  order permit such further operation of the organization as he may find to be

9-17  in the best interest of enrollees to the end that enrollees are afforded the

9-18  greatest practical opportunity to obtain continuing coverage for health care.

9-19    Sec. 27.  The provisions of subsection 1 of NRS 354.599 do not apply

9-20  to any additional expenses of a local government that are related to the

9-21  provisions of this act.

9-22    Sec. 28.  The state board of health shall adopt regulations to carry out

9-23  the provisions of this act by January 1, 2002.

9-24    Sec. 29.  1.  This section becomes effective on July 1, 2001.

9-25    2.  Sections 1 to 28, inclusive, become effective:

9-26    (a) On July 1, 2001, for the purpose of adopting regulations by the state

9-27  board of health to carry out the provisions of this act; and

9-28    (b) On January 1, 2002, for all other purposes.

 

9-29  H