REPRESENTATIVES Schuring, Hollister, Kearns, Womer Benjamin, Willamowski, Goodman, Boccieri, D. Miller, Redfern, Carmichael, Cirelli, S. Smith, Metelsky, Ford, DePiero, Barrett, Allen, Woodard, Ogg, Barnes, Britton, Young, Patton, Sullivan, R. Miller, Jolivette, Fessler, Evans, Hagan, Strahorn, Peterson, Kilbane, Metzger, Seitz, Flannery, Coates, Schmidt, White, Setzer, Sykes, Latell, Rhine, Widowfield, G. Smith, Lendrum, Olman, Krupinski, Clancy, Key, Niehaus, Hoops, Salerno, Wilson, Faber, Driehaus, Oakar, Beatty, Jones

To amend sections 3701.503, 3701.504, 3701.505,

1

3701.506, 3701.507, 3923.55, and 3923.56 and to

2

enact sections 3701.508 and 3701.509 of the Revised

3

Code to require universal hearing screening for

4

newborns and infants.

5

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1.  That sections 3701.503, 3701.504, 3701.505,	6
3701.506, 3701.507, 3923.55, and 3923.56 be amended and sections	7
3701.508 and 3705.509 of the Revised Code be enacted to read as	8
follows:	9

Sec. 3701.503.  As used in sections 3701.504 to 3701.507	10
3701.509 of the Revised Code:	11

(A) "Parent" means either parent, unless the parents are	12
separated or divorced or their marriage has been dissolved or	13
annulled, in which case "parent" means the parent who is the	14
residential parent and legal custodian.	15

(B) "Guardian" has the same meaning as in section 2111.01 of	16
the Revised Code.	17

(C) "Custodian" means, except as used in division (A) of	18
this section, a government agency or an individual, other than the	19
parent or guardian, with legal or permanent custody of a child as	20
defined in section 2151.011 of the Revised Code.	21

(D) "Address," in the case of an individual, means the	22
individual's residence and, in the case of a government agency,	23
means the office at which the records pertaining to a particular	24
child are maintained.	25

(E) "RiskHearing screening" means the identification of	26
newborns and infants who are at risk ofmay have a hearing	27
impairment, through the use of a high-risk questionnaire developed	28
by the department of health under division (A) of section 3701.504	29
of the Revised Codea physiologic test.	30

(F)(E) "Hearing assessmentevaluation" means evaluation	31
through the use of audiological procedures by or under the	32
supervision of an audiologist licensed under section 4753.07 of	33
the Revised Code, or by a neurologist or otolaryngologist, to	34
identify infants who are at risk of hearing impairmentphysician.	35

(F) "Hearing impairment" means a loss of hearing in one or	36
both ears in the frequency region important for speech recognition	37
and comprehension.	38

(G) "Newborn" means a child who is less than thirty days	39
old.	40

(H) "Infant" means a child who is at least thirty days but	41
less than twenty-four months old.	42

(I) "Freestanding birthing center" has the same meaning as	43
in section 3702.51 of the Revised Code.	44

(J) "Physician" means an individual authorized under Chapter	45
4731. of the Revised Code to practice medicine and surgery or	46
osteopathic medicine and surgery.	47

(K) "Audiologist" means an individual authorized under	48
section 4753.07 of the Revised Code to practice audiology.	49

(L) "Hospital" means a hospital that has a maternity unit or	50
newborn nursery.	51

(M) "Maternity unit" means any unit or place in a hospital	52
where women are regularly received and provided care during all or	53
part of the maternity cycle, except that "maternity unit" does not	54
include an emergency department or similar place dedicated to	55
providing emergency health care.	56

(N) "Board of health" means the board of health of a city or	57
general health district or the authority having the duties of a	58
board of health under section 3709.05 of the Revised Code.	59

Sec. 3701.504.  (A) The department of health shall establish	60
and maintain newborn infant hearing-impairment risk criteria and	61
shall develop a high-risk questionnairea statewide hearing	62
screening, tracking, and early intervention program to identify	63
infants who are at risk ofnewborn and infant hearing impairment.	64
The department shall also establish appropriate protocols for the	65
treatment and follow-up care of newborns and infants with hearing	66
impairment.	67

(B) The public health council shall adopt rules under Chapter	68
119. of the Revised Code establishing a program to be administered	69
by the department of health that requires risk screening of each	70
infant in a hospital nursery to determine if the infant meets the	71
hearing-impairment risk criteria established by the department of	72
health under division (A) of this sectionIn the case of a child	73
born in a hospital or freestanding birthing center, both of the	74
following apply:	75

(1) The program shall provide for a hearing screening of the	76
newborn or infant before discharge, unless the newborn or infant	77
is being transferred to another hospital.	78

(2) If the newborn or infant is transferred to another	79
hospital, the program shall provide for a hearing screening of the	80
newborn or infant when determined to be medically appropriate. The	81
rules adopted under this division shall include a provision that	82
no infant shall be required to undergo risk screening if the	83
infant's parent, guardian, or custodian, if an individual, objects	84
on the grounds that the screening conflicts with his religious	85
tenets and practices.	86

(C) The public health council shall adopt, and may amend or	87
rescind, rules to carry out the purposes of sections 3701.503 to	88
3701.507department of health shall ensure that the program	89
established under this section is incorporated into early	90
intervention activities of the department in compliance with the	91
"Individuals with Disabilities Education Act," 20 U.S.C.A. 1400 et	92
seq.	93

(D) The department of health may assist hospitals and	94
freestanding birthing centers in acquiring hearing screening	95
equipment by providing information on grant opportunities or	96
loans, and, if funds are available, by mass purchasing equipment	97
or establishing a grant system with department funds.	98

(E) The department of health shall administer the program	99
established under this section pursuant to rules adopted under	100
section 3701.508 of the Revised Code.	101

Sec. 3701.505.  (A)(1) Each hospital and each freestanding	102
birthing center, in accordance with rules adopted by the public	103
health council under section 3701.504 of the Revised Code, shall	104
provide riskdo all of the following:	105

(a) Conduct a hearing screening ofoneach newborn infants	106
and shall promptlyor infant born in the hospital or center unless	107
the newborn or infant is transferred to another hospital;	108

(b) Promptly notify anthe newborn's or infant's primary	109
careattending physician andof the screening results;	110

(c) Notify the department of health of the name of any	111
infant who is identified by a risk screening as at risk for	112
hearing impairment under the criteria established by the	113
department of health under division (A) of section 3701.504 of the	114
Revised Code, and of the name and address of the infant's parent,	115
guardian, or custodianscreening results for each newborn or	116
infant screened.	117

(2) A hearing screening conducted under this section shall	118
be conducted under the direction of an audiologist or physician or	119
in collaboration with a physician. Notwithstanding the licensure	120
requirements of Chapter 4753. of the Revised Code, a screening may	121
be conducted by a person who is not licensed under that chapter.	122

(3) Each hospital and freestanding birthing center shall take	123
the actions required by divisions (A)(1) and (2) of this section	124
in accordance with the rules adopted under section 3701.508 of the	125
Revised Code. A hospital or freestanding birthing center may	126
commence taking these actions at any time after the effective date	127
of the rules but not later than June 30, 2004, unless an extension	128
is granted. The director may grant an extension to delay for up	129
to one year after June 30, 2004, the requirement of compliance	130
with the rules if the hospital or freestanding birthing center	131
requesting the extension demonstrates justifiable cause for the	132
extension. Justifiable cause may include having ordered but not	133
yet received hearing screening equipment, ongoing efforts to	134
obtain financing for the equipment, or any other cause accepted by	135
the director.	136

(B)(1) If an infant is identified as at risk for hearing	137
impairment and the hospital at which the identification was made	138
also provides hearing assessment, the hospital shall provide a	139
hearing assessment for the infant; if the hospital does not	140
provide hearing assessment, the hospital shall provide the	141
infant's parent, guardian, or custodian with a list of hospitals,	142
clinics, or other facilities located within a reasonable distance	143
of the parent's, guardian's, or custodian's address that provide	144
hearing assessment.	145

(2) Each hospital that provides a hearing assessment shall	146
prepare and provide to the infant's parent, guardian, or	147
custodian a list of hospitals, clinics, or other facilities	148
located within a reasonable distance of the parent's, guardian's,	149
or custodian's address that provide follow-up hearing evaluations.	150

(3) Whenever a hearing assessment identifies an infant as	151
being hearing impaired, the hospital, clinic, or other facility	152
providing the assessment shall promptly notify the infant's	153
primary care physician and the department of health of the	154
infant's name and the name and address of the infant's parent,	155
guardian, or custodian.	156

(C) Any hospital, clinic, or other facilityfreestanding	157
birthing center providing a hearing assessmentscreening in	158
accordance with division (B)(A) of this section shall be	159
reimbursed by the department of health at a rate determined by the	160
director of health, if both of the following are the case:	161

(1) The assessmentscreening is performed before the newborn	162
or infant attains nine months of age;is discharged from the	163
hospital or freestanding birthing center.	164

(2) The parent, guardian, or custodian is financially unable	165
to pay for the hearing assessmentscreening and the hospital,	166
clinic, or other facilityfreestanding birthing center is not	167
reimbursed by a third-party payer as determined pursuant to rules	168
adopted under section 3701.508 of the Revised Code.	169

The public health council shall adopt rules pursuant to	170
Chapter 119. of the Revised Code for determining whether a person	171
is financially unable to pay for a hearing assessment and defining	172
third-party payer for the purpose of this section.	173

(C) A hospital, clinic, or other health care facility at	174
which a hearing evaluation is performed on a newborn or infant	175
shall report the results of the evaluation to the attending	176
physician of the newborn or infant.	177

Sec. 3701.506.  The department of health shall prepare and	178
distribute to all hospitals and freestanding birthing centers	179
required to provide infant riskhearing screenings under the	180
program established under section 3701.504 of the Revised Code and	181
each board of health, information describing factors or conditions	182
of hearing loss and the effect of such a loss on an infant or	183
child's language development, and information on the importance of	184
hearing screening, hearing evaluation, early intervention, and	185
follow-up care for newborns and infants. This information shall	186
be updated as the department determines necessary. Upon the	187
discharge of an at-risk newborn infant, each such	188

Each hospital or freestanding birthing center shall provide	189
the infant's parent, guardian, or custodian of each newborn or	190
infant born in the hospital or freestanding birthing center with	191
this hearing lossthe information prepared by the department	192
pursuant to this section.	193

Each board of health shall provide the parent, guardian, or	194
custodian of each newborn or infant born in the area served by the	195
board who is not born in a hospital or freestanding birthing	196
center with the information prepared by the department pursuant to	197
this section.	198

Sec. 3701.507.  (A) To assist in implementing sections	199
3701.503 to 3701.5073701.509 of the Revised Code, the medically	200
handicapped children's medical advisory council created in section	201
3701.025 of the Revised Code shall appoint a permanent infant	202
hearing screening subcommittee. The subcommittee shall consist of	203
the following members:	204

(1) One otolaryngologist;

205

(2) One neonatologist;

206

(3) One pediatrician;

207

(4) One neurologist;

208

(5) One hospital administrator;

209

(6) OneTwo or more audiologists licensed under section	210
4753.07 of the Revised Code who are experienced in infant hearing	211
assessmentscreening and evaluation;	212

(7) One speechspeech-language pathologist licensed under	213
section 4753.07 of the Revised Code;	214

(8) OneTwo persons who are each a parent of a	215
hearing-impaired child;	216

(9) One geneticist;

217

(10) One epidemiologist;

218

(11) One adult who is deaf or hearing impaired;

219

(12) One representative from an organization for the deaf or	220
hearing impaired;	221

(13) One family advocate;

222

(14) One nurse from a well-baby neonatal nursery;

223

(15) One nurse from a special care neonatal nursery;

224

(16) One teacher of the deaf who works with infants and	225
toddlers;	226

(17) One representative of the health insurance industry;

227

(18) One representative of the bureau for children with	228
medical handicaps;	229

(19) One representative of the department of education;

230

(20) One representative of the Ohio department of job and	231
family services who has responsibilities regarding medicaid;	232

(21) Any other person the advisory council appoints.

233

(B) The infant hearing subcommittee shall:

234

(1) Consult with the director of health regarding the	235
administration of sections 3701.503 to 3701.5073701.509 of the	236
Revised Code;	237

(2) Advise and make recommendations regarding proposed rules	238
prior to their adoption by the public health council under section	239
3701.5043701.508 of the Revised Code;	240

(3) Consult with the director of health and advise and make	241
recommendations regarding program development and implementation	242
under sections 3701.503 to 3701.5073701.509 of the Revised Code,	243
including establishment of newborn infant hearing-impairment risk	244
criteria and development of the high-risk questionnaire under	245
division (A) ofall of the following:	246

(a) Establishment under section 3701.504 of the Revised Code	247
of the statewide hearing screening, tracking, and early	248
intervention program to identify newborn and infant hearing	249
impairment; identification	250

(b)Identification of locations where assessment of infants	251
hearing evaluations may be conducted; recommendations	252

(c)Recommendations for methods and techniques of risk	253
hearing screening and hearing assessmentevaluation; referral	254

(d)Referral, data recording and compilation, and procedures	255
to encourage follow-up hearing assessmentscare; maintenance	256

(e)Maintenance of a register of newborns and infants	257
determined to be at high risk for hearing impairmentwho do not	258
pass the hearing screening; and preparation	259

(f) Preparation of the information required by section	260
3701.506 of the Revised Code and any other information the public	261
health council requires the department of health to provide.	262

(4) Ensure that the infant hearing screening and assessment	263
program established under sections 3701.503 to 3701.507 of the	264
Revised Code is incorporated into early intervention activities of	265
the department of health in compliance with the "Education of the	266
Handicapped Act Amendments of 1986," 100 Stat. 1145, 20 U.S.C.A.	267
1400.	268

Sec. 3701.508. (A) The public health council shall adopt	269
rules governing the statewide hearing screening, tracking, and	270
early intervention program established under section 3701.504 of	271
the Revised Code, including rules that do all of the following:	272

(1) Specify how hospitals and freestanding birthing centers	273
are to comply with the requirements of section 3701.505 of the	274
Revised Code, including methods to be used for hearing screening,	275
except that with regard to the physiologic equipment to be used	276
for hearing screening, the rules may require only that the	277
equipment be capable of giving reliable results and may not	278
specify particular equipment or a particular type of equipment;	279

(2) Provide that no newborn or infant shall be required to	280
undergo a hearing screening if the parent, guardian, or custodian	281
of the newborn or infant objects on the grounds that the screening	282
conflicts with the parent's, guardian's, or custodian's religious	283
tenets and practices;	284

(3) Provide for situations in which the parent, guardian,	285
or custodian of a newborn or infant objects to a hearing screening	286
for reasons other than religious tenets and practices;	287

(4) Specify how the department of health will determine	288
whether a person is financially unable to pay for a hearing	289
screening and define "third-party payer" for the purpose of	290
reimbursement of hearing screening by the department under section	291
3701.505 of the Revised Code;	292

(5) Specify an inexpensive and efficient format and	293
procedures for the submission of hearing screening information	294
from hospitals and freestanding birthing centers to the department	295
of health;	296

(6) Specify a procedure whereby the department may conduct	297
timely reviews of hearing screening information submissions for	298
purposes of quality assurance, training, and disease prevention	299
and control;	300

(7) Specify any additional information that hospitals and	301
freestanding birthing centers are to provide to the medically	302
handicapped children's medical advisory council's infant hearing	303
screening subcommittee under section 3701.509 of the Revised Code.	304

(B) In addition to the rules adopted under division (A) of	305
this section, the council shall adopt rules that specify the	306
training that must be completed by persons who will conduct	307
hearing screenings. In adopting these rules, the council shall	308
consider incorporating cost-saving training methods, including	309
computer-assisted learning and on-site training. Neither the rules	310
nor the director of health may establish a minimum educational	311
level for persons conducting hearing screenings.	312

(C) All rules adopted under this section shall be adopted in	313
accordance with Chapter 119. of the Revised Code and shall be	314
adopted so as to take effect not later than six months after the	315
effective date of this section.	316

Sec. 3701.509.  (A) The department of health shall develop a	317
mechanism to analyze and interpret the hearing screening	318
information to be reported under division (B) of this section.	319
The department shall notify all hospitals and freestanding	320
birthing centers subject to the reporting requirements of the date	321
the department anticipates that the mechanism will be complete.	322
After the mechanism is complete, the department shall notify each	323
hospital and freestanding birthing center subject to the reporting	324
requirement of the date by which the hospital or center must	325
submit its first report.	326

(B) Subject to division (A) of this section and in accordance	327
with rules adopted by the public health council under section	328
3701.508 of the Revised Code, each hospital and freestanding	329
birthing center that has conducted a hearing screening required by	330
section 3701.505 of the Revised Code shall provide to the	331
department of health for use by the medically handicapped	332
children's medical advisory council's infant hearing screening	333
subcommittee information specifying all of the following:	334

(1) The number of newborns born in the hospital or	335
freestanding birthing center and the number of newborns and	336
infants not screened because they were transferred to another	337
hospital;	338

(2) The number of newborns and infants referred to the	339
hospital or freestanding birthing center for a hearing screening	340
and the number of those newborns and infants who received a	341
hearing screening;	342

(3) The number of newborns and infants who did not pass the	343
hearing screenings conducted by the hospital or freestanding	344
birthing center;	345

(4) Any other information concerning the program established	346
under section 3701.504 of the Revised Code.	347

(C) The department of health shall conduct a timely review of	348
the information submitted by hospitals and freestanding birthing	349
centers in accordance with rules adopted by the public health	350
council under section 3701.508 of the Revised Code.	351

(D) The infant hearing screening subcommittee, with the	352
support of the department of health, shall compile and summarize	353
the information submitted to the department by hospitals and	354
freestanding birthing centers under division (B) of this section.	355
Beginning with the first year after the mechanism developed under	356
division (A) of this section is complete, the subcommittee shall	357
annually prepare and transmit a report to the director of health,	358
the speaker of the house of representatives, and the president of	359
the senate. The council shall make the report available to the	360
public.	361

(E) The department and all members of the subcommittee shall	362
maintain the confidentiality of patient-identifying information	363
submitted under division (B) of this section and section 3701.505	364
of the Revised Code. The information is not a public record under	365
section 149.43 of the Revised Code, except to the extent that the	366
information is used in preparing reports under this section.	367

Nothing in this division prohibits the department from	368
providing patient-identifying information to other entities as it	369
considers necessary to implement the statewide tracking and early	370
intervention components of the program established under section	371
3701.504 of the Revised Code. Any entity that receives	372
patient-identifying information from the department shall maintain	373
the confidentiality of the information.	374

Sec. 3923.55.  (A) As used in this section and section	376
3923.56 of the Revised Code:	377

(1) "Child health supervision services" means periodic	378
review of a child's physical and emotional status performed by a	379
physician or, by a health care professional under the supervision	380
of a physician, or, in the case of hearing screening, by an	381
individual acting in accordance with section 3701.505 of the	382
Revised Code.	383

(2) "Periodic review" means a review performed in accordance	384
with the recommendations of the American academy of pediatrics and	385
includes a history, complete physical examination, developmental	386
assessment, anticipatory guidance, appropriate immunizations, and	387
laboratory tests.	388

(3) "Physician" means a person authorized under Chapter	389
4731. of the Revised Code to practice medicine and surgery or	390
osteopathic medicine and surgery.	391

(B) Notwithstanding section 3901.71 of the Revised Code,	392
each policy of individual or group sickness and accident insurance	393
delivered, issued for delivery, or renewed in this state on or	394
after the effective date of this amendment, that provides coverage	395
for family members of the insured shall provide, with respect to	396
that coverage, that any benefits applicable for children shall	397
include benefits for child health supervision services from the	398
moment of birth until age nine.	399

(C) A policy that provides the benefits described in	400
division (B) of this section may limit the benefits to cover only	401
the expenses of child health supervision services that are	402
performed by one physician or by a health care professional under	403
the supervision of one physician during the course of any one	404
visit.	405

(D) Copayments and deductibles shall be reasonable and shall	406
not be a barrier to the necessary utilization of child health	407
supervision services by covered persons.	408

(E) Benefits for child health supervision services that are	409
provided to a child during the period from birth to age one shall	410
not exceed a maximum limit of five hundred dollars, including	411
benefits for the hearing screening required by the program	412
established under section 3701.504 of the Revised Code. The	413
benefits for the hearing screening shall not exceed a maximum	414
limit of seventy-five dollars. Benefits for child health	415
supervision services that are provided to a child during any year	416
thereafter shall not exceed a maximum limit of one hundred fifty	417
dollars per year.	418

(F) This section does not apply to any policy that provides	419
coverage for specific diseases or accidents only, or to any	420
hospital indemnity, medicare supplement, or other policy that	421
offers only supplemental benefits.	422

Sec. 3923.56.  (A) Notwithstanding section 3901.71 of the	423
Revised Code, each employee benefit plan established or maintained	424
in this state on or after the effective date of this amendment	425
that provides coverage for family members of the employee shall	426
provide, with respect to that coverage, that any benefits	427
applicable for children shall include benefits for child health	428
supervision services from the moment of birth until age nine.	429

(B) A plan that provides the benefits described in division	430
(A) of this section may limit the benefits to cover only the	431
expenses of child health supervision services that are performed	432
by one physician or by a health care professional under the	433
supervision of one physician during the course of any one visit.	434

(C) Copayments and deductibles shall be reasonable and shall	435
not be a barrier to the necessary utilization of child health	436
supervision services by covered persons.	437

(D) Benefits for child health supervision services that are	438
provided to a child during the period from birth to age one shall	439
not exceed a maximum limit of five hundred dollars, including	440
benefits for the hearing screening required by the program	441
established under section 3701.504 of the Revised Code. The	442
benefits for the hearing screening shall not exceed a maximum	443
limit of seventy-five dollars. Benefits for child health	444
supervision services that are provided to a child during any year	445
thereafter shall not exceed a maximum limit of one hundred fifty	446
dollars per year.	447

Section 2.  That existing sections 3701.503, 3701.504,	448
3701.505, 3701.506, 3701.507, 3923.55, and 3923.56 of the Revised	449
Code are hereby repealed.	450

Section 3. A hospital shall continue to comply with the risk	451
screening requirements of section 3701.505 of the Revised Code in	452
effect prior to the effective date of this act until the hospital	453
complies or is required to comply with the rules adopted under	454
section 3701.508 of the Revised Code. A hospital or freestanding	455
birthing center is not required to comply with the risk screening	456
requirements in effect prior to the effective date of this act	457
after the hospital or center commences compliance with the rules.	458