Revision: Jan. 22, 2024, 1:16 p.m.
SB 355-FN - AS INTRODUCED
2024 SESSION
24-2852
05/06
SENATE BILL 355-FN
AN ACT relative to newborn screening for cytomegalovirus.
SPONSORS: Sen. Innis, Dist 7; Sen. Birdsell, Dist 19; Sen. Ward, Dist 8; Sen. Carson, Dist 14
COMMITTEE: Health and Human Services
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ANALYSIS
This bill requires newborn screening for cytomegalovirus (CMV). The bill also directs the pregnant woman's health care provider to perform an amniocentesis to confirm a congenital CMV infection under certain circumstances.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
24-2852
05/06
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to newborn screening for cytomegalovirus.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Newborn Screening for Cytomegalovirus. Amend RSA 132:10-a, I and II to read as follows:
I. The physician, hospital, nurse midwife, midwife, or other health care provider attending a newborn child shall test a newborn child for metabolic disorders. Such tests shall include, but not be limited to, phenylketonuria, galactosemia, homocystinuria, maple syrup urine disease, [and] hypothyroidism, and cytomegalovirus (CMV). Additional disorders shall be added to the newborn screening panel based upon, but not limited to, the following considerations:
(a) The disorder is well-defined with a known incidence.
(b) The disorder is associated with significant morbidity and/or mortality.
(c) The disorder can be detected with a screening test that is ethical, safe, accurate, and cost-effective.
(d) Effective treatment exists for the disorder, and that early treatment, meaning before the onset of symptoms, is more effective in improving health outcomes than later treatment.
I-a. If one or more of the following signs are identified during an ultrasound, an amniocentesis shall be done to confirm a congenital CMV infection:
(a) Placental thickening.
(b) Organomegaly - abnormal enlargement of organs.
(c) Hepatomegaly – abnormal enlargement of the liver.
(d) Splenomegaly – abnormal enlargement of the spleen.
(e) Pyelectasis - dilation of the renal pelvis, the funnel-like dilated proximal part of the ureter (muscular tubes that propel urine from the kidneys to the urinary bladder) in the kidney (also a marker for Down Syndrome).
(f) Megaloureter – abnormal dilation of the ureter.
(g) Ascites - gastroenterological term for an accumulation of fluid in the peritoneal cavity (is a potential space between the parietal peritoneum and visceral peritoneum; that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall).
(h) Fetal hydrops - accumulation of fluid in the fetal compartments.
(i) Abnormality of amniotic fluid.
(j) Microcephaly – small head circumference, more than two standard deviations smaller than average.
(k) Cerebral ventriculomegaly – dilation of the lateral ventricles of the brain.
(l) Intracranial calcifications - the build-up of calcium salts in the soft tissue of the brain.
(m) Hyperdense image in thalamic arteries.
(n) Periventricular echodensities.
(o) Hepatic echodensities.
(p) Intestinal echodensities.
(q) Cystic structures in the germinal zone.
I-b. If a pregnant woman is diagnosed with CMV during pregnancy, her doctor shall perform an amniocentesis to determine whether congenital CMV has passed to the unborn baby.
II. Notwithstanding any provision of law to the contrary, the commissioner of the department of health and human services shall establish fees, pursuant to RSA 541-A, to be paid directly by hospitals in their entirety, acknowledging that fees may be offset by reimbursement from commercial insurance, Medicaid, or other payors, paid to hospitals for the tests required under [paragraph] paragraphs I, I-a, and I-b. Nothing in this section is intended to prescribe the reimbursement method or the reimbursement level from a payor. The commissioner shall structure these fees to be reimbursable without out of pocket cost to the patient pursuant to 45 C.F.R. 147.130. All such fees shall be paid into the newborn screening fund, hereby established in the state treasury. Moneys from the newborn screening fund established under this section shall be nonlapsing and shall be continually appropriated for use by the department to cover laboratory analysis and related newborn screening program costs.
2 Effective Date. This act shall take effect July 1, 2025.
24-2852
Revised 1/22/24
SB 355-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to newborn screening for cytomegalovirus.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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Estimated State Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
Revenue | $0 | $0 | $537,500+ | $537,500+ | ||
Revenue Fund(s) | Fees deposited into the newborn screening fund; insurance premium tax revenue | |||||
Expenditures | $0 | $0 | $537,500 | $537,500 | ||
Funding Source(s) | Newborn screening fund | |||||
Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
• Does this bill provide sufficient funding to cover estimated expenditures? [X] Yes • Does this bill authorize new positions to implement this bill? [X] No | ||||||
METHODOLOGY:
This bill requires newborn screenings for cytomegalovirus (CMV), and requires the Department of Health and Human Services to establish fees to be paid by hospitals to cover costs associated with an ultrasound or amniocentesis if certain clinical symptoms are present. As with certain existing fees, the fees will be deposited into the newborn screening fund, which is used to cover laboratory analysis and other related costs. The Department notes that the newborn screening program currently screens for 37 heritable diseases at a cost of $146 per infant paid directly by birth hospitals. Based on data from Minnesota, the first state to implement universal CMV screening using blood spot, the Department estimates an additional cost of $43 per infant will be needed to implement the bill. Assuming 12,500 screenings annually, this will result in $537,500 in fees collected each year.
In addition, the Department states that, as with any newborn screen added to the existing panel, it will need to: collect and present information on CMV to the newborn screening advisory committee; work with the contracted laboratory to establish testing capabilities, protocols, and policies; develop metrics for tracking, screening, and confirmation of CMS; and produce and distribute educational materials. The Department assumes it will need a 0.5 full-time equivalent Program Specialist IV position at a cost of $58,000 (including equipment costs) in FY26 and $53,000 in FY27.
Although the Department does not explictly make this assumption, this fiscal note assumes that all revenues collected will be paid out by the Department to cover testing costs and the newly-established position, and hence expenditures will equal revenue collected.
The Department of Insurance states that, to the extent there is an increase in insurance claims for amniocentesis procedures, the bill may result in upward pressure on premium costs, potentially increasing insurance premium tax revenues.
As the bill has an effective date of July 1, 2025, it is assumed there will be no fiscal impact until FY26.
AGENCIES CONTACTED:
Departments of Insurance and Health and Human Services