Newborn Metabolic, Endocrine and Hemoglobinopathy and the Newborn Hearing Loss Screening Programs Mandate
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This policy documents Rhode Island state-mandated coverage requirements for newborn metabolic, endocrine, hemoglobinopathy, and newborn hearing loss screening programs and explains payer responsibilities and laboratory billing procedures for commercial products; it applies to insurers and providers operating in Rhode Island.
No material clinical or coverage changes in this revision.
Mandated Newborn Screening Coverage
Mandated coverage and program requirements
Covered when ALL of the following are met:
See chunk 16.A-B
See chunks 9 and 15
See chunks 10-14
See chunk 14
See chunk 16.C-D
Hearing Screening Coverage
Covered when:
See 'Preventive Services for Commercial Members' policy for additional billing/authorization details.
The Rhode Island Newborn Screening Program is a state-mandated benefit; however, mandated benefits do not apply to BlueCHiP for Medicare plans. Additionally, self-funded groups may choose not to follow state mandates, and benefits may therefore vary by contract. Providers should confirm applicable coverage in the member's Benefit Booklet, Evidence of Coverage, Subscriber Agreement, or employer agreement prior to billing.
Services determined to be not medically necessary or services that are non-covered benefits under a member's contract may be excluded from payment. Providers must verify member-specific benefits and eligibility; if a service is determined to be not medically necessary (or is a non-covered benefit) the member cannot be charged for the service unless the member was informed in advance and provided written agreement to pay out-of-pocket.
Per Rhode Island law (R.I. Gen. Laws § 23-13-14 and related provisions), newborn screening and hearing tests shall not be performed if the parents object on religious grounds. When parents assert such an objection, the tests must not be carried out.
If services are determined to be not medically necessary or are non-covered under the member's plan, the policy states that the provider may not bill the member unless the member was informed in advance and has agreed in writing to accept financial responsibility. Providers should confirm contractual obligations in their participation agreements and verify member benefits with the provider call center before seeking payment from a member.
Billing and Code Guidance
| 84999-32 | Unlisted code representing all tests performed by the Department of Health laboratory |
| No codes listed |
Provider Responsibilities and Billing Actions
Prior authorization not applicable
No prior authorization is required for the newborn screening programs.
Hearing screening coverage
Newborn hearing screenings are covered services; follow the 'Preventive Services for Commercial Members' policy for billing and authorization details.
Laboratory approval and reporting requirement
Ensure laboratories performing newborn screening are approved by the Director and submit all laboratory reports to the attending physician and the Department including actual values and reference ranges.
- Confirm the laboratory is Director‑approved before submitting specimens.
- Include actual test values and reference ranges on all lab reports sent to the attending physician and the Department.
Report confirmed cases to the Department within 90 days
Submit confirmed newborn screening diagnoses, diagnostic test type, treatment type and required surveillance data to the Department within 90 days of confirmation.
- Report confirmed cases and associated diagnostic/treatment information to the Department's Newborn Screening Program within ninety (90) days of confirmation.
- Provide any additional information the Director may require for surveillance or grant purposes.
Reporting and results documentation
All reports of newborn screening tests performed by a laboratory must be submitted to the attending physician and the Department and must include actual values and reference ranges used for each disorder; confirmed diagnoses and related information must be reported to the Department within 90 days.
- Send laboratory reports to both the attending physician and the Department.
- Include actual values and reference ranges for each disorder.
- Submit confirmed-case data within 90 days of confirmation.
Verify member benefits and eligibility
Verify member‑specific benefits and eligibility by calling the provider call center; subscriber agreements and employer agreements will supersede this policy.
- Contact the provider call center for member-specific coverage and eligibility questions.
- Recognize that the member's subscriber agreement or employer agreement governs benefits.
Benefit applicability may affect payment
Be aware that Rhode Island‑mandated benefits do not apply to BlueCHiP for Medicare plans and self‑funded groups may choose not to follow state mandates; lack of applicable benefit may result in claim denial.
- Check the member's product (e.g., BlueCHiP for Medicare or self‑funded plan) to determine if the state mandate applies before billing.
Member financial responsibility if service non‑covered or not medically necessary
If services are determined to be not medically necessary or are non‑covered benefits, the provider may not charge the member unless the member was informed and provided written agreement to pay in advance.
- Obtain written advance agreement from the member before providing services that are not medically necessary or are non‑covered if you intend to bill the member.
- Refer to your participation/subscriber agreements for applicable provisions.
Background on Newborn Screening
Newborn screening tests identify metabolic, endocrine, hemoglobinopathy and other disorders not apparent at birth; early detection and treatment can prevent death or disability. The state program requires screening of all newborns in Rhode Island for the enumerated disorders and for hearing impairment, typically performed within the first days of life. Laboratories performing screening must be approved and reports, including actual values and reference ranges, must be provided to the attending physician and the Department; confirmed diagnoses and associated diagnostic and treatment information must be reported to the Department within 90 days. When no third‑party payor information is available, hospitals or attending facilities are responsible for program costs unless other billing arrangements apply.
Program Definitions
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