Newborn Screening Benefits

1. Newborn Screening Benefits

2. Table of Contents

3. Origins • Legislative changes and funding mandated by the Texas Legislator in 2006 and in 2008 increased screened disorders from 7 to 28. • This greatly increased the numberof presumptive positive screens

4. Genetic Disorders Included in NBS • Amino acids • Organic acids • Fatty acid oxidation • Biotinidase deficiency • Congenital adrenal hyperplasia • Congenital hyperthyroidism • Galactosemia • Hemoglobinopathies • Cystic Fibrosis

5. What Is the NBS Benefits Program? • A program implemented in March 2007 to respond to the need for follow up services. • Program targets families without Medicaid or private insurance.

6. What are the NBS Benefits for Clients? • Confirmaratory Testing • Dietary SupplementsMetabolic Foods Low-protein foods • Medications • Vitamins • Follow-up Care

7. What are the NBS Benefits for Providers? • Reimbursement for:Specified/allowable services Confirmatory testing Evaluation Follow-up care Laboratory testing • Providers must apply through the open enrollment process

8. Service Provider Categories • Medical providers • Laboratories • Pharmacies • Providers of low- protein diet foods

9. Medical Providers • Board Certified/Eligible physicians in: Medical Biochemical Genetics Adult/Pediatric Endocrinologists Adult/Pediatric Hematologists Adult/Pediatric Pulmonologists • Providers currently enrolled as Medicaid providers

10. Laboratories • Must be CLIA certified. • Must have capacity to conduct confirmatory and follow- up testing.

11. Pharmacy Providers • Must have ability to provide prescribed Medications Vitamins Dietary supplements • Must be class A, B, C, D, or E.

12. Providers of Low Protein Diet Foods • Those manufacturers or retailers of low-protein diet foods.

13. Who is Eligibile? • Those with a presumed positive screen or a confirmed diagnosis of a disorder screened for in the Texas Newborn Screening Program. • Have an income at or below 350% of the federal poverty income level (FPL) • Make financial participation payments in a timely manner (if required)

14. Who is Eligible? (continued) • Provide updated information and/or documentation upon requestMedical Financial Residency • Not be eligible for other funding that would pay for all or part of the services Medicaid Children with Special Health Care Insurance (CHIP) CHIP Perinatal Title V Genetic Services Private insurance

15. Who is Eligible? (continued) • Have a parent, managing conservator or guardian agree to abide by these eligibility requirements if the individual is a minor.

16. Eligibility Processes • Presumptive EligibilityImmediate medical needs • Screening and EligibilityVerify documentation • Annual RecertificationRequired for continuation of services • Request for Waiver of Ineligibility

17. Limitations • Dependent of available funding • Program benefits will be available to the following populations, in this order: 1. Children 0 – 2 years of age 2. Children 3 – 5 years of age 3. Children 6 – 21 years of age 4. Pregnant women 5. Women of child-bearing age 6. Adults (male or female)

18. Enrollment Information, Application and Manual • Newborn Screening Benefits Program Fact SheetFor providers or clients needing services • Notice of Open Enrollment for Newborn Screening Benefits For provider enrollment as contractors in the Benefits Program Click on the above links for more information

19. Your Feedback Is Appreciated If you have any questions or concerns about the Newborn Screening Benefits Program Call 1-800-252-8023or email us atbenefits@dshs.state.tx.us Sharon Newcomb-Kase Ombudsman - Newborn Screening Support Group (512) 458-7111 ext. 3237 Etta Jimenez Newborn Screening Support (512) 458-7111 ext. 7724