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Last Modifed: 09/30/2010 
Return to State Mandate Summaries by Provision

Mandate Provision: Covered Benefit of Health Insurance
 
Excerpts from Legislation/Rules & Regulations

ALASKA

Statute: Sec.5
Coverage for newborn and infant hearing screening.(a) Except for a fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan shall provide coverage for newborn and infant hearing screening under the schedule described in (b) of this section if the plan covers services provided to women during pregnancy and childbirth and the dependents of a covered individual. (b) The minimum coverage required under (a) of this section includes (1) a newborn or infant hearing screening to be performed within 30 days after the child's birth; and (2) if the initial screening under (1) of this subsection determines that the child may have a hearing impairment, a confirmatory hearing diagnostic evaluation. (c) The coverage required by this section may be subject to standard policy provisions that are applicable to other benefits, such as deductible or copayment provisions.

Source: HB 109

ARKANSAS

Statute: Sec.4. (a) ... Medicaid shall reimburse the birthing hospital for the physiological screening the reimbursement equal to that amount paid outpatient providers for the same service in addition to the current rate of per diem paid to the hospital ... [Source: SB 819, 1999]

CALIFORNIA

Statute: Sec.23. 124117. The department or its designee shall approve hospitals for participation as newborn hearing screening providers. These facilities shall then receive payment from the department for the newborn hearing screening services provided to newborns and infants eligible for the Medi-Cal or CCS programs in accordance with this article. [Source: AB2780, 1998]

DELAWARE

Statute: Sec.1, 807A
807A. Delivery of Policy.

If a health insurance policy provides coverage or benefits to a resident of this state, it shall be deemed to be delivered in this state within the meaning of this Chapter, regardless of whether the health care insurer issuing or delivering said policy is located inside or outside of the state.”…

Sec.2 & 3

3352. Newborn and Infant Hearing Screening; Coverage and Reimbursement. (a) Any individual health insurance policy which is delivered, issued for delivery, renewed, extended, or modified in this state by any health care insurer and which provides coverage for a child shall be deemed to provide coverage for hearing loss screening tests of newborns and infants provided by a hospital before discharge.

(b) A health care insurer delivering a health insurance policy regulated under this Chapter shall provide each insured with notice of the provisions of this Chapter upon the effective date of coverage and annually thereafter.

(c) The amount of reimbursement for newborn or infant hearing screening provided under such a policy shall be consistent with reimbursement of other medical expenses under the policy, including the imposition of co-payment, coinsurance, deductible, or any dollar limit or other cost-sharing provisions otherwise applicable under the policy.”

Section 3. Amend Chapter 35, Title 18 of the Delaware Code, by inserting therein a new section as follows: Ҥ 3568. Newborn and Infant Hearing Screening; Coverage and Reimbursement.

(a) Any group or blanket insurance health insurance policy which is delivered, issued for delivery, renewed, extended, or modified in this state by any health care insurer and which provides coverage for a child shall be deemed to provide coverage for hearing loss screening tests of newborns and infants provided by a hospital before discharge.

(b) A health care insurer delivering a health insurance policy regulated under this Chapter shall provide each insured with notice of the provisions of this Chapter upon the effective date of coverage and annually thereafter.

(c) The amount of reimbursement for newborn or infant hearing screening provided under such a policy shall be consistent with reimbursement of other medical expenses under the policy, including the imposition of co-payment, coinsurance, deductible, or any dollar limit or other cost-sharing provisions otherwise applicable under the policy.”Source: HB 205

DISTRICT OF COLUMBIA

Statute: Sec. 4.
All health insurer health benefit plans shall reimburse for newborn hearing screenings conducted under this act.

Source: A13-0572

FLORIDA

Statute: Sec.1, (3), j)The initial procedure for screening the hearing of the newborn or infant and any medically necessary followup reevaluations leading to diagnosis shall be a covered benefit, reimbursable under Medicaid as an expense compensated supplemental to the per diem rate for Medicaid patients enrolled in MediPass or Medicaid patients covered by a fee for service program. For Medicaid patients enrolled in HMOs, providers shall be reimbursed directly by the Medicaid Program Office at the Medicaid rate. This service may not be considered a covered service for the purposes of establishing the payment rate for Medicaid HMOs. All health insurance policies and health maintenance organizations as provided under ss. 627.6416, 627.6579, and 641.31(30), Florida Statutes, except for supplemental policies that only provide coverage for specific diseases, hospital indemnity, or Medicare supplement, or to the supplemental polices, shall compensate providers for the covered benefit at the contracted rate. Non-hospital-based providers shall be eligible to bill Medicaid for the professional and technical component of each procedure code. [Source: HB 399]

INDIANA

Statute: Sec. 4. Except as provided in section 5 of this chapter, every policy or group contract that provides maternity benefits must provide minimum benefits to a mother and her newborn child that cover: Y (2) the examinations to the newborn child required under IC 16-41-17-2.

MAINE

Statute: Sec. 4. 24 MRSA '2319-A is enacted to read: " '2319-A. Newborn hearing services. All individual and group nonprofit hospital and medical service organization contracts must provide that benefits are payable with respect to newborn children hearing screening, evaluation, treatment and intervention services under Title 22, chapter 1687 and necessary audiologic diagnostic follow-up care related to hearing. Newborn hearing screening may not be subject to a deductible or copayment. Other newborn children hearing services may be subject to the same deductibles and copayments that are applicable to other health care services."

Sec. 5. 24-A MRSA '2743-B is enacted to read: "'2743-B. Newborn hearing services. Individual health insurance policies must provide benefits for newborn hearing screening, evaluation, treatment and intervention services under Title 22, chapter 1687 and necessary audiologic diagnostic follow-up care related to hearing. Newborn children hearing screening benefits may not be subject to a deductible or copayment. Other newborn children hearing services benefits may be subject to the same deductibles and copayments that are applicable to other health care services benefits."

Sec. 6. 24-A MRSA '2843-A is enacted to read: "'2843-A. Newborn hearing services. Group health policies providing coverage for medical and surgical benefits, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, must provide benefits for newborn children hearing screening, evaluation, treatment and intervention services under Title 22, chapter 1687 and necessary audiologic diagnostic follow-up care related to hearing. Newborn hearing screening benefits may not be subject to a deductible or copayment. Other newborn children hearing services benefits may be subject to the same deductibles and copayments that are applicable to other health care services benefits."

Sec. 7. 24-A MRSA '4234-F is enacted to read: "'4234-F. Newborn hearing services. Individual and group health maintenance organization contracts must provide benefits for newborn children hearing screening, evaluation, treatment and intervention services under Title 22, chapter 1687 and necessary audiologic diagnostic follow-up care related to hearing. Newborn hearing screening benefits may not be subject to a deductible or copayment. Other newborn hearing services benefits may be subject to the same deductibles and copayments that are applicable to other health care services benefits."

[Source: LD 1814, 1999]

MARYLAND

Statute: SECTION 3. AND BE IT FURTHER ENACTED That all health insurance carriers subject to the provisions of this Act shall make the benefits for universal hearing screening of newborns available on and after July 1, 2000, notwithstanding any policy or benefit statement to the contrary. [Source: SB 624, 1999]

MASSACHUSETTS

Statute: Section 67F. The cost of providing the newborn hearing screening test shall be a covered benefit reimbursable by all health insurers, except for supplemental policies which only provide coverage for specific diseases, hospital indemnity, Medicare supplement, or other supplemental policies. In the absence of a third party payer, the charges for the newborn hearing screening test shall be paid by the commonwealth. [Source: Chapter 243 of the Acts of 1998]

OHIO

Statute: Sec.1, Sec. 3923.55, (B)-(F),
(B) Notwithstanding section 3901.71 of the Revised Code, each policy of individual or group sickness and accident insurance delivered, issued for delivery, or renewed in this state on or after the effective date of this amendment, that provides coverage for family members of the insured shall provide, with respect to that coverage, that any benefits applicable for children shall include benefits for child health supervision services from the moment of birth until age nine.
(C) A policy that provides the benefits described in division (B) of this section may limit the benefits to cover only the expenses of child health supervision services that are performed by one physician or by a health care professional under the supervision of one physician during the course of any one visit.
(D) Copayments and deductibles shall be reasonable and shall not be a barrier to the necessary utilization of child health supervision services by covered persons.
(E) Benefits for child health supervision services that are provided to a child during the period from birth to age one shall not exceed a maximum limit of five hundred dollars, including benefits for the hearing screening required by the program established under section 3701.504 of the Revised Code. The benefits for the hearing screening shall not exceed a maximum limit of seventy-five dollars. Benefits for child health supervision services that are provided to a child during any year thereafter shall not exceed a maximum limit of one hundred fifty dollars per year.
(F) This section does not apply to any policy that provides coverage for specific diseases or accidents only, or to any hospital indemnity, medicare supplement, or other policy that offers only supplemental benefits.
Sec. 3923.56. (A) Notwithstanding section 3901.71 of the Revised
Code, each employee benefit plan established or maintained in this state on or after the effective date of this amendment that provides coverage for family members of the employee shall provide, with respect to that coverage, that any benefits applicable for children shall include benefits for child health supervision services from the moment of birth until age nine.
(B) A plan that provides the benefits described in division (A) of this section may limit the benefits to cover only the expenses of child health supervision services that are performed by one physician or by a health care professional under the supervision of one physician during the course of any one visit.
(C) Copayments and deductibles shall be reasonable and shall not be a barrier to the necessary utilization of child health supervision services by covered persons.
(D) Benefits for child health supervision services that are provided to a child during the period from birth to age one shall not exceed a maximum limit of five hundred dollars, including benefits for the hearing screening required by the program established under section 3701.504 of the Revised Code. The benefits for the hearing screening shall not exceed a maximum limit of seventy-five dollars. Benefits for child health supervision services that are provided to a child during any year thereafter shall not exceed a maximum limit of one hundred fifty dollars per year.

Source: HB 150

RHODE ISLAND

Rule: Section 5.0 Designation of Metabolic Disease Testing and Newborn Screening for Hearing Impairments as a Covered Benefit5.1 Metabolic Disease Testing and Newborn Screening for Hearing Impairments shall be a covered benefit reimbursable by all health insurers, as defined in section 27-38-6 of the general laws, except for supplemental policies which only provide coverage for specific diseases, hospital indemnity, Medicare supplement, or other supplemental policies.

[Source: (R23-13-MET/HRG)]

Section 5.0 Designation of Metabolic Disease Testing and Newborn Screening for Hearing Impairments as a Covered Benefit.

5.1 Metabolic Disease Testing and Newborn Screening for Hearing Impairments shall be a covered benefit reimbursable by all health insurers, as defined in section 27-38-6 of the general laws, except for supplemental policies which only provide coverage for specific diseases, hospital indemnity, Medicare supplement, or other supplemental policies.

5.2 The RHODE ISLAND Department of Human Services shall pay for testing/screening when the patient is eligible for medical assistance under the provisions of chapter 40 8.

5.3 The Department of Health shall pay for such testing when the patient is eligible for the Rite Start Program pursuant to the provisions of section 23-13-18.

5.4 In the absence of a third party payor the costs for such testing, including the Coordination fee, shall be paid by the hospital or other health care facility where the birth occurred. Nothing herein shall preclude the hospital or health care facility from billing the patient directly. Said fee shall be deposited into a restricted receipt account within the Division of Laboratories in the Department of Health.

Source: (R23-13-MET/HRG)

TENNESSEE

Statute: Section 8: (b) Any individual, franchise, blanket or group health insurance policy, medical service plan contract, hospital service corporation contract, hospital and medical service corporation contract, managed health insurance issuer contract, fraternal benefits society plan, or health maintenance organization plan that provides coverage for hospital and surgical expense insurance and which is delivered, issued for delivery, amended or renewed in this state on or after July 1, 2008, shall provide coverage for infant hearing screening tests as provided in Section 5 of this act.

(c) The coverage required by this section may be subject to annual deductible, co-pays, co-insurance and contractual requirements established for other similar benefits within the policy or contract; provided, that the annual deductible, co-pays, co-insurance and contractual requirements for the coverage required by this section are no greater or more restrictive than those established for other similar benefits within the policy or contract of insurance.

(d) Nothing in this section shall apply to accident only, specified disease, hospital indemnity, medicare supplemental, long-term care, disability or other limited benefit insurance policies or to any employer plan exempt from regulation under Title 56 due to Section 514 of the Employee Retirement Income Security Act of 1974 ("ERISA").

[Source: Tennessee Code Annotated, Section 37-3-703; Title 56, Chapter 7,
Part 25 and Title 68, Chapter 5, relative to health screening of children.]

TEXAS

Statute: Sec. 4. REQUIRED BENEFITS FOR SCREENING TEST FOR HEARING IMPAIRMENT.

(a) A health benefit plan that provides benefits for a family member of the insured shall provide coverage for each covered child described by Section 5 of this article for: (1) a screening test for hearing loss from birth through the date the child is 30 days old, as provided by Chapter 47, Health and Safety Code; and

(2) necessary diagnostic follow-up care related to the screening test from birth through the date the child is 24 months old. (b) The commissioner may adopt rules to implement the requirement of this section. (c) This section applies to any health benefit plan that provides coverage or benefits to a resident of this state, without regard to whether the issuer of the health benefit plan is located within or outside this state. This section does not require the issuer of a health benefit plan to provide coverage under this section for the child of a resident of this state who: (1) is employed outside of this state; and (2) is covered under a health benefit plan maintained for the individual by the individual's employer as an employment benefit.

Sec. 5. COVERED CHILDREN. [(b)] A child is entitled to benefits under this article [section] if the child, as a result of the child's relationship to an enrollee in the health benefit plan, would be entitled to benefits under an accident and sickness insurance policy under Subsection (K), (L), or (M), Section 2, Chapter 397, Acts of the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas Insurance Code).

[Source: HB714, 1999]

Rule: RULE '37.512 Authorized Medicaid Newborn Hearing Services

(a) A newborn hearing screening test performed by a birthing facility in accordance with Health and Safety Code, Chapter 47 and the requirements of this subchapter for a newborn who receives medical assistance or who is Medicaid-eligible is a covered service of the Texas Medical Assistance (Medicaid) Program. (b) Any necessary diagnostic follow-up care related to the newborn hearing screening test provided to a newborn who receives medical assistance or who is Medicaid-eligible is a covered service of the Texas Medical Assistance Program. (c) The reimbursement rates and methodology for covered services described in this section shall be established by the Texas Health and Human Services Commission. (d) A Medicaid birthing facility described in '37.502(2)(A) or (B) of this title (relating to Definitions) shall implement its newborn hearing screening program by the dates required by Chapter 1347, '6, Acts of the 76th Legislature, 1999 (HB 714).

[Source: Rules (Title 25 - Part 1 - Chapter 37 - Subchapter S Newborn Hearing Screening)]

VIRGINIA

Statute: ' 38.2-3411.4. Coverage for infant hearing screening and related diagnostics.

A. Notwithstanding the provisions of ' 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall provide coverage for infant hearing screenings and all necessary audiological examinations provided pursuant to ' 32.1-64.1 and as prescribed herein for newborn children under each such policy, contract or plan delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 2001.

B. For purposes of this section, such coverage shall provide coverage for infant hearing screenings and all necessary audiological examinations provided pursuant to ' 32.1-64.1 using any technology approved by the United States Food and Drug Administration, and as recommended by the national Joint Committee on Infant Hearing in its most current position statement addressing early hearing detection and intervention programs. Such coverage shall include benefits for any follow-up audiological examinations as recommended by a physician or audiologist and performed by a licensed audiologist to confirm the existence or absence of hearing loss.

C. Nothing contained in this section shall abrogate any obligation to provide coverage for hearing screening tests or any other hearing screening test or audiological diagnostic procedure pursuant to this section or any other law or regulation of the Commonwealth or of the United States or under the terms or provisions of any policy or plan issued, renewed, reissued or extended in the Commonwealth.

D. The provisions of this section shall not apply to short-term travel, accident only, limited or specified disease policies, or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans, or to short-term nonrenewable policies of not more than six months' duration.

[Source: S1200, 2001]

WEST VIRGINIA

Statute: ARTICLE 22A.

'16-22A-3. Fees for testing; payment of same.

(a) Testing required under this article shall be a covered benefit reimbursable by all health insurers except for health insurers that offer only supplemental coverage policies or policies which cover only specified diseases. All policies issued pursuant to articles fifteen, sixteen, twenty-four and twenty-five-a of chapter thirty-three of this code shall provide coverage for the testing required under this article.

(b) The Department of Health and Human Resources shall pay for testing required under this article when the newborn infant is eligible for medical assistance under the provisions of section twelve, article five, chapter nine of this code.

(c) In the absence of a third-party payer, the parents of a newborn infant shall be informed of the testing availability and its costs and they may refuse to have the testing performed. Charges for the testing required under this article shall be paid by the hospital or other health care facility where the infant's birth occurred: Provided, That nothing contained in this section may be construed to preclude the hospital or other health care facility from billing the infant's parents directly.

[Source: HB2388, 1998]


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