Appendix C NEWBORN HEARING SCREENING PROJECT

Appendix C NEWBORN HEARING SCREENING PROJECT I. WEST VIRGINIA STATE LAW All newborns born in the State of West Virginia must be screened for hearing impairment as required in WV Code 16-22A and 16-1-7, except when the parent(s) refuse to have the screening performed (see copy of code included at the end of this appendix). II. RESPONSIBILITIES OF THE BIRTHING FACILITIES After the birth of an infant, the birthing facility must perform, or arrange for a hearing screening to be performed before discharge. When an infant is born in a non-licensed facility, including the home, the health care provider shall inform the parents of the need to obtain the screening within the first month of the infant s life. The screening protocol is as follows: The facility may use either an Otoacoustic Emissions Test (OAE) or Auditory Brainstem Response (ABR) to perform the screen in both ears following the equipment manufacturer s guidelines. The screening must be performed by trained personnel, according to the American Academy of Pediatrics standards. If the infant does not pass the initial screening test, the health care provider shall perform a second screening prior to the infant s hospital discharge. The birthing facility shall record the hearing screening results in the infant s medical record and on the Birth Score Developmental Risk Screen. All birthing facilities are responsible for reporting screening results to the Birth Score Office (BSO), located within West Virginia University. It is the responsibility of the BSO to refer all infants who either fail the newborn hearing screen or are not screened to the RFTS Program for follow-up. The birthing facility shall report all screening results to the infant s legal guardian and primary care provider prior to discharge. III. IV. RESPONSIBILITIES OF THE PRIMARY CARE PROVIDER If the birthing facility is unable to screen the infant before discharge, the primary care provider (PCP) is responsible for referring the infant for a non-hospital administered hearing screening. If the infant fails the initial and second screening, the PCP shall arrange for diagnostic testing with a local audiological testing facility. The PCP is ultimately responsible for follow-up on Newborn Hearing Screening (NHS) results. RESPONSIBILITIES OF THE BIRTH SCORE OFFICE The Birth Score Office (BSO) will receive the results of the hospital newborn hearing screenings on the Birth Score Card. If the infant is a resident of another state, the BSO will refer the baby to the appropriate state officials for tracking within their state. If the infant is a WV resident and has private insurance/other/self-pay: A. The BSO completes initial tracking of the case up to the second screening; and B. If the infant passes the second screen, then the completed tracking is sent to Right From The Start Program Policy & Procedures Manual Page 1

the RCC for filing; or C. If the infant fails the second screen, then the tracking will be sent to the RCC for follow-up. If the infant is a Medicaid eligible WV resident: A. The BSO makes an immediate referral to the RCC for enrollment in care coordination; B. The BSO completes initial tracking of the case up to the second screening; and C. If the infant passes the second screen, then the completed tracking is sent to the RCC for filing; or D. If the infant fails the second screen, then the tracking will be sent to the RCC for follow-up. The BSO will provide the NHS Coordinator with a report of the NHS cases both complete and referred on a monthly basis. V. RESPONSIBILITIES OF THE REGIONAL CARE COORDINATOR The RCC will ensure that completed cases forwarded by the BSO are data entered into the electronic data system and filed accordingly. The RCC will direct all NHS referrals to the DCC within 48 hours after receipt. Once a referral is made to the DCC, the RCC will ensure the case is opened and closed per protocols. The RCC will serve as the point of contact between the NHS Coordinator and DCCs. The RCC will ensure that all cases not coded as tracking complete are forwarded to the NHS Coordinator, including the DCC progress notes on the case. The RCC will receive NHS invoices to be paid by OMCFH from the billing departments, review for accuracy, attach necessary documentation, and submit to the NHS Coordinator for payment. VI. RESPONSIBILITIES OF THE DESIGNATED CARE COORDINATOR This section identifies RFTS involvement in the case management and referral processes for NHS referrals. The RFTS Program will provide case management and client education services for the NHS Project. A. FOLLOW-UP FOR ALL INFANTS The DCC will make a determination as to whether all RFTS infant clients have been screened for hearing impairment. An infant has not been screened for hearing loss if: 1. Parent/guardian has no knowledge or documentation of hearing screening (e.g. a copy of the Birth Score Developmental Risk Screen or birthing facility discharge papers); 2. PCP has no documentation of newborn hearing screen; 3. RCC has no documentation of NHS referral; 4. WV Birth Score Office has no Birth Score Developmental Risk Screen for infant; 5. If the WV Birth Score Office cannot obtain this information, document the absence of hearing screening in the NHS Progress Notes (HS003) and proceed with care coordination to arrange for hearing screening/evaluation to avoid any delay in need for possible intervention. B. 1-3-6 PLAN In all cases, the DCC should attempt to adhere to the goals of the 1-3-6 plan: (1) Before one month of age: hearing screening Page 2 Right From The Start Program Policy & Procedures Manual

(3) Before three months of age: diagnostic exam or hearing evaluation (6) Before six months of age: early intervention C. SCREENING AND DIAGNOSTIC TERMINOLOGY DCC should be aware of the differences in the following terms and use them appropriately: 1. Newborn hearing screening - a procedure typically performed shortly after birth on an inpatient or outpatient basis. Serving as only an indicator for possible hearing loss, any qualified staff can conduct the screening. 2. Diagnostic exam or hearing evaluation - a procedure performed by a licensed audiologist or ear, nose, and throat (ENT) physician if an infant fails to pass a second screening. The result of the hearing evaluation will verify a hearing impairment and identify the cause and severity. D. DCC INITIAL CONTACT WITH THE FAMILY 1. Within 14 working days of receipt of the NHS Follow-Up Tracking Sheet (HS001), the DCC makes contact with the infant s family to assess diagnostic hearing evaluation needs and provide education to the parents. Since the BSO will have already established contact with the parent or guardian of the infant, or the PCP, it is imperative that the DCC follow-up in a timely manner. a. If upon initial contact with the parent or guardian of the infant, the DCC is notified that the infant has already been rescreened and passed, the DCC will close the case as complete and notify the infant s PCP. A home visit is not necessary in this scenario. b. If upon initial contact with the parent or guardian of the infant it is determined that the infant failed the hearing screening or was not screened at birth, the DCC will schedule a home visit. The DCC will provide the parent or guardian of the infant with information on the importance of further evaluation and collaborate with the infant s PCP to facilitate an audiological evaluation. Upon either scheduling an audiological evaluation or learning of a future appointment, the DCC will complete the top portion of the Audiological Evaluation Form (HS005), and mail it to the testing center along with NHS Form Letter 2. 2. All DCCs have access to the WV Audiology Services Resource Guide, a listing of audiological services providers statewide. 3. If the infant has an active Medicaid card, every effort should be made to enroll the infant into the RFTS Program. E. DCC FOLLOW-UP AND REFERRALS 1. Upon completion of the outpatient screening or diagnostic evaluation, the DCC will follow-up with the parent or guardian of the infant by home visit, phone call, or a call to the medical provider s office to assure that the infant was screened or diagnostic testing was completed. 2. If diagnostic testing finds that the infant has a hearing loss, the DCC will make referrals to WV Birth to Three (BTT) and Children with Special Health Care Needs (CSHCN), either by telephone (1-800-642-8522 or 304-558-5388) or via program forms. A referral should also be made to Ski*Hi Preschool Program for Deaf and Hard of Hearing Children at (304) 822-4843 (additional Right From The Start Program Policy & Procedures Manual Page 3

information on those programs, including copies of application forms, are included in Appendix C). 3. If the referral to CSHCN is made using the Specialty Care Intake Form (SCIF), indicate on the top of the form Newborn Hearing Referral so that it is recognized by OMCFH as priority status. VII. PAYMENT OF DIAGNOSTIC TESTING AND HEARING AIDS The Children with Special Health Care Needs (CSHCN) Program will pay for the initial hearing aid(s) for children less than three (3) years of age who are eligible for Medicaid, are not insured, or have insurance that does not cover needed audiological services. Diagnostic testing may be paid by OMCFH if the CSHCN Program orders the testing and no other payment source is available to the child. VIII. NEWBORN HEARING SCREENING CASE CLOSURE In all instances, the NHS Tracking Sheet (HS001) and Provider Follow-up Letter (HS002) must be completed and sent to the appropriate entities upon case closure. The DCC must make at least three (3) attempts to establish contact/complete NHS protocols before case closure. All attempts must be documented in the Progress Notes (HS003). For those cases where the parent or guardian of the infant cannot be reached, the DCC should attempt contact with the PCP and/or audiologist. The NHS initial contact Form Letter 1 must be mailed to all clients with whom contact has not been established. The mailing will contain both NHS and RFTS brochures. Cases may remain open for a maximum period of ninety (90) days after the RCC has referred the case. Extreme cases may be held open for an extended period, but it must be documented in the Progress Notes (HS003) as to why it was deemed necessary. IX. CASE CLOSURE CODES A. NHS TRACKING COMPLETE DCC has successfully completed NHS protocols and documented a date and outcome for the hearing screen and/or diagnostic evaluation. B. UNABLE TO ESTABLISH CONTACT The client either cannot be found or the parent or guardian of the infant has not responded to contact attempts. This closure should only be used after all methods of location and contact are exhausted. C. REFUSED SERVICES NHS services were presented but the family refused to participate. D. MOVED OUT OF COUNTY/REGION Client has moved. DCC should send all case information to the RCC for a follow-up referral to the appropriate DCC or RCC. E. MOVED OUT OF STATE The DCC should make note of any new contact information. NHS will make a referral to the new state of residence. Page 4 Right From The Start Program Policy & Procedures Manual

F. LOST TO FOLLOW-UP After NHS services began, the DCC was no longer able to locate or establish contact with the parent or guardian of the infant. G. INFANT DEATH Death of client. H. UNABLE TO COMPLETE PROGRAM PROTOCOLS Any closure that does not fit into the above categories. Document reason for closure in the Progress Notes (HS003). X. INVOICING A. CMS-1500 1. All required fields on the form must be completed. 2. Box 1a a. If Medicaid eligible, list Medicaid or HMO ID. b. If non-medicaid or HMO, list the BSO assigned ID number. 3. All invoices to be submitted to OMCFH are to be sent first to the RCCs for review and submission to the NHS Project Coordinator with any necessary paperwork attached. B. BILLABLE SERVICES 1. Care coordination services provided by DCCs (code T1016 HD) reimbursed at $12.78 per unit (15 minute increments). 2. Please note that Medicaid does not reimburse for letters. However, if the client s care coordination is to be paid by the NHS Project, one unit per required form letter is permitted. C. WHERE TO SUBMIT CLAIMS 1. Medicaid eligible infants - submit invoices to Molina or the appropriate HMO. 2. Non-Medicaid eligible infants - submit invoices to: Newborn Hearing Screening Project Office of Maternal, Child & Family Health 350 Capitol Street, Room 427 Charleston, WV 25301 D. BILLING TIMELINES 1. The provider may submit invoices as often as deemed appropriate for the volume of services being delivered, but no less frequently than monthly. 2. An individual invoice may not include services provided in more than one calendar month. 3. Submit all invoices within 60 days of the end of the month in which the service was performed. For example, all invoices with a January date of service must be submitted on or before March 31. Right From The Start Program Policy & Procedures Manual Page 5

WEST VIRGINIA CODE CHAPTER 16. PUBLIC HEALTH. ARTICLE 22A. TESTING OF NEWBORN INFANTS FOR HEARING IMPAIRMENTS. 16-22A-1. Testing required. The physician or midwife in attendance at, or present immediately after, a live birth shall perform, or cause to be performed, a test for hearing loss in the infant unless the infant's parents refuse under subsection (c), section three of this article to have the testing performed. For any infant delivered at a nonlicensed facility, including home births, the physician or other health care provider shall inform the parents of the need to obtain testing within the first month of life. The director of the division of health shall prescribe the test or tests to be administered in accordance with this article. 16-22A-2. Rule making authorized. The director of the division of health shall propose legislative rules for promulgation in accordance with the provisions of article three, chapter twenty-nine-a of this code to: (1) Establish a reasonable fee schedule for tests administered pursuant to this article, which shall be used to cover program costs not otherwise covered by federal grant funds specifically secured for this purpose; (2) establish a cost-effective testing protocol based upon available technology and national standards; (3) establish reporting and referral requirements; and (4) establish a date for implementation of the testing protocol, which shall not be later than the first day of July, one thousand nine hundred ninety-nine. 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 payor, 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. 16-22A-4. Hearing impairment testing advisory committee established. (a) There is hereby established a West Virginia hearing impairment testing advisory committee which shall advise the director of the division of health regarding the protocol, validity, monitoring and cost of testing procedures required under this article. This committee is to meet four times per year for the initial two years and on the call of the director thereafter. The director Page 6 Right From The Start Program Policy & Procedures Manual

shall serve as the chair and shall appoint twelve members, one representing each of the following groups: (1) A representative of the health insurance industry; (2) An otolaryngologist or otologist; (3) An audiologist with experience in evaluating infants; (4) A neonatologist; (5) A pediatrician; (6) A hospital administrator; (7) A speech or language pathologist; (8) A teacher or administrative representative from the West Virginia school of the deaf; (9) A parent of a hearing-impaired child; (10) A representative from the office of early intervention services within the department of health and human resources; (11) A representative from the state department of education; and (12) A representative from the West Virginia commission for the deaf and hard-of-hearing. (b) Members of this advisory committee shall serve without compensation. A majority of members constitutes a quorum for the transaction of all business. Members shall serve for twoyear terms and may not serve for more than two consecutive terms. Note: WV Code updated with legislation passed through the 2011 4th Special Session Right From The Start Program Policy & Procedures Manual Page 7