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Newborn Screening and Health Insurance Laws

posted on Fri, Apr 1 2011 12:00 am by Mid-States and Western Regions

The Network for Public Health Law recently received several requests for information about an Arizona bill, introduced in the Arizona Senate on February 1, 2011, that would impact health insurance coverage in the state. S.B. 1593 would amend the state’s Insurance Code to allow insurance carriers registered in another state to sell health and disability insurance in Arizona as long as they comply with the laws in the state where they are registered. These companies would not have to comply with many of Arizona’s requirements, including laws that mandate coverage for minimum services. The Network was contacted over concern that the bill, if enacted, would affect screening of newborns under the state newborn screening law for congenital metabolic disorders and hearing loss, and the diagnosis and treatment of these children. The bill had been passed by Arizona’s legislature and was waiting signature or veto by the governor.

Within twelve hours of the initial request, the Network’s Mid-States and Western Regions coordinated to provide a detailed analysis of the bill’s impact on newborn screening. The Network clarified that the legislation would mean that an insurer’s coverage of newborn screening, diagnosis and treatment would depend on the laws of the state where the plan originated. For newborn hearing screening, the Network provided a table from the National Conference of State Legislatures that summarized the legislation of each state. Thirty-six states, including Arizona, require hearing screening by law. Seventeen require coverage by an insurer of the costs of such a screening, but Arizona does not. Nor does Arizona require insurers to cover screening for metabolic disorders. The Network also provided links to Arizona’s laws regarding mandatory insurance coverage. Although not specific to newborn screening disorders, Arizona does mandate certain coverage that might benefit these children. In this regard, all health plans’ contracts for family coverage must cover treatment for medically diagnosed congenital defects and birth abnormalities for newborns to the same extent as coverage applies to other family members. Further, any health plan contract that contains a prescription drug benefit must cover medical foods for inherited metabolic disorders identified through the newborn screening program. The Network provided a link to information from the National PKU Alliance regarding the variation in state laws regarding coverage of medical foods for patients with phenylketonuria (PKU), one of the metabolic disorders diagnosed through newborn screening. Twelve states have no requirements for medical food coverage.


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