A: State Directors of Speech and Hearing Programs continue to rate "difficulty in getting reimbursement" as the most serious obstacle in implementing universal newborn hearing screening programs. Because Medicaid pays for 30-50% of all new births depending on the state, Medicaid's reimbursement policies with regard to newborn hearing screening are an important consideration in whether hospitals implement newborn hearing screening programs.
Data collected recently from 46 states revealed inconsistencies, lack of coverage, and disincentives in Medicaid reimbursement policies for newborn hearing screening.
- In 34% of the states, hospital-based newborn hearing screening is never covered by Medicaid.
- In an additional 40% of the states, newborn hearing screening is theoretically covered by Medicaid, but only as part of a lump-sum payment for delivery of the baby. Thus, the hospital receives no additional money for doing screening.
- In 21% of the states, Medicaid only pays for screening done on an outpatient basis--this reduces coverage, increases cost, delays identification, and inconveniences families.
- The amount paid by Medicaid for newborn hearing screening ranges from $8 to $100.
- Only 31% of the states include hospital-based newborn hearing screening as a specific part of their EPSDT plan.
Making Medicaid reimbursement policies more consistent, equitable, and favorable toward newborn hearing screening would have a significant impact on the expansion of newborn hearing screening programs. Specific issues that need to be resolved include:
- Enable hospitals to obtain a modest additional amount of money ($25-$35) for each baby who receives a newborn hearing screen prior to discharge. Eliminate policies which pay only for outpatient screens, screening at-risk babies, or which include screening as a part of a capitated payment for delivery.
- Encourage states to include hospital-based newborn hearing screening as a specific part of their EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) plan. Because newborn hearing screening is so consistent with the purpose of EPSDT, this is easily done (see example from Utah).
Does Medicaid pay for newborn hearing screening in your state?
| a |
Yes, the hospital would receive additional money (over and above that paid for the delivery) for each baby screened. |
7 States (15%) |
| b |
Yes, but only as a "lump sum" payment for delivery of baby (often referred to as the DRG-Diagnosis-Related Group). The hospital would not receive any additional money for doing screening. |
19 States (40%) |
| c |
Yes, but only in those hospitals where Medicaid is still "fee for service" instead of managed care. |
3 States (6%) |
| d |
Yes, but only for "at risk" babies. |
2 States (4%) |
| e |
Yes, but only if the screening were done when the baby is an outpatient. Screening done prior to discharge would not be paid, or would be paid as part of a fixed "lump sum." |
10 States (21%) |
| f |
Medicaid does not pay for newborn hearing screening. |
6 States (13%) |
When Medicaid does pay for newborn hearing screening, what is the typical amount paid:
Mean = $43.77 Range: $8 to $100
In a 1998 survey, states were asked: Has hospital-based newborn hearing screening been specifically included in the state's EPSDT (Early and Periodic Screening, Diagnosis and Treatment) Program? Based on 25 responses:
| Yes |
8 States (31%) |
| Yes, but only for "at-risk" babies |
1 State (4%) |
| No |
16 States and 1 Territory (65%) |
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