In February the DSHS Council voted to approve rule changes that would increase the newborn screening specimen collection kits from $33.60 per kit to $55.24 per kit. The effective date has recently been pushed back to October 1, 2016.
Newborn screening is required by statute for all newborns in Texas. Ideally these screens are conducted by the newborn’s primary care provider to ensure that appropriate services and supports are coordinated when abnormal screens are detected.
Currently, the Department of State Health Services DSHS Newborn Screening Program is unable to recover the cost of testing for 53 disorders and follow-up on abnormal screens because the cost to perform these activities is more than is represented by the current charge of $33.60, the 10th lowest newborn screening fee in the United States. In order to recover costs for the current testing and follow-up, an increase of the newborn screening fee to $55.24 is needed. This would make Texas’ fee the 13th lowest in the nation (national range: $0.00 to $157.54).
About 60% of all births in Texas are Medicaid births, and the newborn screening costs are covered under Medicaid at no cost to physicians. Another 5% of births are charity tests that are covered by the Newborn Screening Program. The remaining 35% of births are covered by private health insurance. The fee increase will directly affect practices for those 35% of births that are privately insured.
Maintaining the Newborn Screening Program is essential to the health of children in Texas and we recognize the need to keep it viable. The TPS Pediatric Council is notifying major payers of the change, but we have not received any commitments yet to reimburse the full cost at $55.24.
Practices can prepare by:
- Contacting health plan representatives and medical directors to encourage payment increase, and
- Determining the number of kits to order through September 30 at the current kit cost of $33.50. Note that kits expire after approximately 18 months.
Proposed DSHS rules pertaining to this change can be found beginning on page 4 in the June 3, 2016 edition of the Texas Register on the Secretary of State's website: http://www.sos.state.tx.us/texreg/pdf/backview/0603/0603prop.pdf. Rules were posted for public comment for 30 days. Click here to view TPS comments submitted jointly with TMA. The public comment period has now ended. Adopted rules can be found here: http://www.sos.state.tx.us/texreg/pdf/backview/0909/0909is.pdf (25 TAC §73.54, §73.55). The Updated fee schedule can be found here: http://www.dshs.texas.gov/lab/fees.shtm
For questions, contact Kellie Dees, Public Health Education Manager at firstname.lastname@example.org
or (512) 370-1509.