II

106TH CONGRESS

1ST SESSION S. 956

To establish programs regarding early detection, diagnosis, and interventions

for newborns and infants with hearing loss.

IN THE SENATE OF THE UNITED STATES

MAY 4, 1999

Ms. SNOWE (for herself, Mr. HARKIN, and Mr. FRIST) introduced the following bill; which was read twice and referred to the Committee on

Health, Education, Labor, and Pensions

A BILL

To establish programs regarding early detection, diagnosis,

and interventions for newborns and infants with hearing

loss.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Newborn and Infant

5 Hearing Screening and Intervention Act of 1999’’.

6 SEC. 2. EARLY DETECTION, DIAGNOSIS, AND INTERVEN7 TIONS FOR NEWBORNS AND INFANTS WITH

8 HEARING LOSS.

9 (a) DEFINITIONS.—In this Act:
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1 (1) AUDIOLOGIC EVALUATION.—The term

2 ‘‘audiologic evaluation’’ means procedures to assess

3 the status of the auditory system; to establish the

4 site of the auditory disorder, the type and degree of

5 hearing loss, and the potential effects of hearing loss

6 on communication; and to identify appropriate treat7 ment and referral options. Referral options should

8 include linkages to State coordinating agencies for

9 purposes of part C of the Individuals with Disabil10 ities Education Act (20 U.S.C. 1431 et seq.) or

11 other appropriate agencies, medical evaluation, hear12 ing aid/sensory aid assessment, audiologic rehabilita13 tion treatment, national and local consumer, self14 help, parent, and education organizations, and other

15 family-centered services.

16 (2) AUDIOLOGIC REHABILITATION.—The term

17 ‘‘audiologic rehabilitation’’ means procedures, tech18 niques, and technologies to facilitate the receptive

19 and expressive communication abilities of a child

20 with hearing loss.

21 (3) EARLY INTERVENTION.—The term ‘‘early

22 intervention’’ means providing appropriate services

23 for a child with hearing loss and ensuring that the

24 family of the child is provided with comprehensive,

25 consumer-oriented information about the full range
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1 of family support, training, information services,

2 communication options and are given the oppor3 tunity to consider the full range of educational and

4 program placements and options for their child.

5 (4) HEARING SCREENING.—The term ‘‘hearing

6 screening’’ with respect to newborns and infants

7 means objective physiologic procedures to detect pos8 sible hearing loss and to identify newborns and in9 fants who, after rescreening, require further

10 audiologic and medical evaluations.

11 (5) MEDICAL EVALUATION.—The term ‘‘med12 ical evaluation’’ means evaluation by a physician

13 consisting of key components including history, ex14 amination, and medical decision making focused on

15 symptomatic and related body systems for the pur16 pose of diagnosing the etiology of hearing loss and

17 related physical conditions, and for identifying ap18 propriate treatment and referral options.

19 (6) MEDICAL INTERVENTION.—The term ‘‘med20 ical intervention’’ means the process by which a phy21 sician provides medical diagnosis and direction for

22 medical or surgical treatment options of hearing loss

23 or related medical disorder associated with hearing

24 loss.
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1 (7) SECRETARY.—The term ‘‘Secretary’’ means

2 the Secretary of Health and Human Services.

3 (b) PURPOSES.—The purposes of this Act are to clar4 ify the authority within the Public Health Service Act to

5 authorize statewide newborn and infant hearing screening,

6 evaluation and intervention programs and systems, tech7 nical assistance, a national applied research program, and

8 interagency and private sector collaboration for policy de9 velopment, in order to assist the States in making

10 progress toward the following goals:

11 (1) All babies born in hospitals in the United

12 States and its territories should have a hearing

13 screening before leaving the birthing facility. Babies

14 born in other countries and residing in the United

15 States via immigration or adoption should have a

16 hearing screening as early as possible.

17 (2) All babies who are not born in hospitals in

18 the United States and its territories should have a

19 hearing screening within the first 3 months of life.

20 (3) Appropriate audiologic and medical evalua21 tions should be conducted by 3 months for all

22 newborns and infants suspected of having hearing

23 loss to allow appropriate referral and provisions for

24 audiologic rehabilitation, medical and early interven25 tion before the age of 6 months.
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1 (4) All newborn and infant hearing screening

2 programs and systems should include a component

3 for audiologic rehabilitation, medical and early inter4 vention options that ensures linkage to any new and

5 existing state-wide systems of intervention and reha6 bilitative services for newborns and infants with

7 hearing loss.

8 (5) Public policy in regard to newborn and in9 fant hearing screening and intervention should be

10 based on applied research and the recognition that

11 newborns, infants, toddlers, and children who are

12 deaf or hard-of-hearing have unique language, learn13 ing, and communication needs, and should be the re14 sult of consultation with pertinent public and private

15 sectors.

16 (c) STATEWIDE NEWBORN AND INFANT HEARING

17 SCREENING, EVALUATION AND INTERVENTION PRO18 GRAMS AND SYSTEMS.—Under the existing authority of

19 the Public Health Service Act, the Secretary, acting

20 through the Administrator of the Health Resources and

21 Services Administration, shall make awards of grants or

22 cooperative agreements to develop statewide newborn and

23 infant hearing screening, evaluation and intervention pro24 grams and systems for the following purposes:
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1 (1) To develop and monitor the efficacy of

2 statewide newborn and infant hearing screening,

3 evaluation and intervention programs and systems.

4 Early intervention includes referral to schools and

5 agencies, including community, consumer, and par6 ent-based agencies and organizations and other pro7 grams mandated by Part C of the Individuals with

8 Disabilities Education Act (20 U.S.C. 1431 et seq.),

9 which offer programs specifically designed to meet

10 the unique language and communication needs of

11 deaf and hard of hearing newborns, infants, tod12 dlers, and children.

13 (2) To collect data on statewide newborn and

14 infant hearing screening, evaluation and intervention

15 programs and systems that can be used for applied

16 research, program evaluation and policy develop17 ment.

18 (d) TECHNICAL ASSISTANCE, DATA MANAGEMENT,

19 AND APPLIED RESEARCH.—

20 (1) CENTERS FOR DISEASE CONTROL AND PRE21 VENTION.—Under the existing authority of the Pub22 lic Health Service Act, the Secretary, acting through

23 the Director of the Centers for Disease Control and

24 Prevention, shall make awards of grants or coopera25 tive agreements to provide technical assistance to
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1 State agencies to complement an intramural pro2 gram and to conduct applied research related to

3 newborn and infant hearing screening, evaluation

4 and intervention programs and systems. The pro5 gram shall develop standardized procedures for data

6 management and program effectiveness and costs,

7 such as—

8 (A) to ensure quality monitoring of new9 born and infant hearing loss screening, evalua10 tion, and intervention programs and systems;

11 (B) to provide technical assistance on data

12 collection and management;

13 (C) to study the costs and effectiveness of

14 newborn and infant hearing screening, evalua15 tion and intervention programs and systems

16 conducted by State-based programs in order to

17 answer issues of importance to State and na18 tional policymakers;

19 (D) to identify the causes and risk factors

20 for congenital hearing loss;

21 (E) to study the effectiveness of newborn

22 and infant hearing screening, audiologic and

23 medical evaluations and intervention programs

24 and systems by assessing the health, intellectual

25 and social developmental, cognitive, and lan-
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1 guage status of these children at school age;

2 and

3 (F) to promote the sharing of data regard4 ing early hearing loss with state-based birth de5 fects and developmental disabilities monitoring

6 programs for the purpose of identifying pre7 viously unknown causes of hearing loss.

8 (2) NATIONAL INSTITUTES OF HEALTH.—

9 Under the existing authority of the Public Health

10 Service Act, the Director of the National Institutes

11 of Health, acting through the Director of the Na12 tional Institute on Deafness and Other Communica13 tion Disorders, shall for purposes of this section,

14 continue a program of research and development on

15 the efficacy of new screening techniques and tech16 nology, including clinical studies of screening meth17 ods, studies on efficacy of intervention, and related

18 research.

19 (e) COORDINATION AND COLLABORATION.—

20 (1) IN GENERAL.—Under the existing authority

21 of the Public Health Service Act, in carrying out

22 programs under this section, the Administrator of

23 the Health Resources and Services Administration,

24 the Director of the Centers for Disease Control and

25 Prevention, and the Director of the National Insti-
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1 tutes of Health shall collaborate and consult with

2 other Federal agencies, State and local agencies (in3 cluding those responsible for early intervention serv4 ices pursuant to title XIX of the Social Security Act

5 (42 U.S.C. 1396 et seq.) (particularly early and

6 periodic screening, and diagnosis services described

7 in section 1905(r) of such title (42 U.S.C.

8 1396f(r))), title XXI of the Social Security Act (42

9 U.S.C. 1397aa et seq.) (the State Children’s Health

10 Insurance Program), title V of the Social Security

11 Act (42 U.S.C. 701 et seq.) (the Maternal and Child

12 Health Block Grant Program), Part C of the Indi13 viduals with Disabilities Education Act (20 U.S.C.

14 1431 et seq.), consumer groups of and that serve in15 dividuals who are deaf and hard-of-hearing and their

16 families, appropriate national medical and other

17 health and education specialty organizations, persons

18 who are deaf and hard-of-hearing and their families,

19 other qualified professional personnel who are pro20 ficient in deaf or hard-of-hearing children’s language

21 and who possess the specialized knowledge, skills,

22 and attributes needed to serve deaf and hard-of23 hearing newborns, infants, toddlers, children and

24 their families, third-party payers and managed care

25 organizations, and related commercial industries.
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1 (2) POLICY DEVELOPMENT.—Under the exist2 ing authority of the Public Health Service Act, the

3 Administrator of the Health Resources and Services

4 Administration, the Director of the Centers for Dis5 ease Control and Prevention, and the Director of the

6 National Institutes of Health shall coordinate and

7 collaborate on recommendations for policy develop8 ment at the Federal and State levels and with the

9 private sector, including consumer, medical and

10 other health and education professional-based orga11 nizations, with respect to newborn and infant hear12 ing screening, evaluation and intervention programs

13 and systems.

14 (3) STATE EARLY DETECTION, DIAGNOSIS, AND

15 INTERVENTION PROGRAMS AND SYSTEMS; DATA COL16 LECTION.—Under the existing authority of the Pub17 lic Health Service Act, the Administrator of the

18 Health Resources and Services Administration and

19 the Director of the Centers for Disease Control and

20 Prevention shall coordinate and collaborate in assist21 ing States to establish newborn and infant hearing

22 screening, evaluation and intervention programs and

23 systems under subsection (c) and to develop a data

24 collection system under subsection (d).
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1 (f) RULE OF CONSTRUCTION.—Nothing in this Act

2 shall be construed to preempt any State law.

3 (g) AUTHORIZATION OF APPROPRIATIONS.—

4 (1) STATEWIDE NEWBORN AND INFANT HEAR5 ING SCREENING, EVALUATION AND INTERVENTION

6 PROGRAMS AND SYSTEMS.—For the purpose of car7 rying out subsection (c) under the existing authority

8 of the Public Health Service Act, there are author9 ized to be appropriated to the Health Resources and

10 Services Administration, $5,000,000 for fiscal year

11 2000, $8,000,000 for fiscal year 2001, and such

12 sums as may be necessary for fiscal year 2002.

13 (2) TECHNICAL ASSISTANCE, DATA MANAGE14 MENT, AND APPLIED RESEARCH; CENTERS FOR DIS15 EASE CONTROL AND PREVENTION.—For the purpose

16 of carrying out subsection (d)(1) under the existing

17 authority of the Public Health Service Act, there are

18 authorized to be appropriated to the Centers for

19 Disease Control and Prevention, $5,000,000 for fis20 cal year 2000, $7,000,000 for fiscal year 2001, and

21 such sums as may be necessary for fiscal year 2002.

22 (3) TECHNICAL ASSISTANCE, DATA MANAGE23 MENT, AND APPLIED RESEARCH; NATIONAL INSTI24 TUTE ON DEAFNESS AND OTHER COMMUNICATION

25 DISORDERS.—For the purpose of carrying out sub-
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1 section (d)(2) under the existing authority of the

2 Public Health Service Act, there are authorized to

3 be appropriated to the National Institute on Deaf4 ness and Other Communication Disorders such sums

5 as may be necessary for each of the fiscal years

6 2000 through 2002.

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