FY 2009 Budget Justification

HRSA - U.S Department of Health and Human Services, Health Resources and Service Administration

U.S. Department of Health & Human Services

FY 2009 Budget Justification

Universal Newborn Hearing Screening

	FY 2007 Actual	FY 2008 Enacted	FY 2009 Request	FY 2009 +/- FY 2008
BA	$9,804,000	$11,790,000	---	-$11,790,000
FTE	3	4	---	-4

Authorizing Legislation - Section 399M of the Public Health Service Act.

FY 2009 Authorization	Expired
Allocation Method	Competitive grant/co-operative agreement

Program Description and Accomplishments
The Universal Newborn Hearing Screening program began in FY 2000 and supports: (1) physiologic testing of newborn infants prior to their hospital discharge; (2) audiologic evaluation by three months of age; and (3) entry into a program of early intervention by six months of age with linkages to a medical home and family-to-family support.

In FY 2007, the Maternal and Child Health Bureau awarded competitive grants to states to implement the program and to one technical assistance center that served those involved in the field. Collaboration with the Centers for Disease Control (CDC) and National Institutes of Health (NIH) National Institute on Deafness and Other Communication Disorders (NIDCD) occurred in an effort to stimulate the interest of the states and their commitment to implement the program.

The Universal Newborn Hearing Screening program was successful in increasing the percentage of newborns screened for hearing loss prior to hospital discharge. In 2005, the most recent year that data is available, 95% of newborns were screened for hearing loss prior to hospital discharge, exceeding the target of 94%. States will likely continue to improve their screening rates albeit at a slower rate than the rapid rises of the early years of the program. California, with the largest birth rate in the U.S., has revised legislation mandating screening of all babies as of January 2008, up from 75% previously mandated. In addition States are working with midwives to screen the infants born out of hospital, about 5% nationally).

The Universal Newborn Hearing Screening and Early Intervention program received a PART review rating in 2005 of Moderately Effective. The review cited that the program had completed its primary goal of helping States to implement universal newborn hearing screening. . The program is working toward a new goal: to improve the health outcomes of infants found to have hearing loss by helping them become enrolled in early intervention programs. An independent evaluation of the program has been completed and disseminated. A quality improvement initiative is also in progress. This initiative focuses on implementation of evaluation recommendations for programmatic changes which have proven to be effective in reducing loss to follow up, such as use of fax back forms to speed communication between and among service providers.

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

FY 2004	$ 9,873,000
FY 2005	$ 9,792,000
FY 2006	$ 9,794,000
FY 2007	$ 9,804,000
FY 2008	$11,790,000

Budget Request
The FY 2009 request continues the President's FY 2008 Budget request and provides no funding for this program. Activities previously funded under this authority may be addressed by the more flexible MCH Block Grant.

#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	FY 2006		FY 2007		FY 2008 Target	FY 2009 Target	Out-Year Target
#	Key Outcomes	FY 2004 Actual	FY 2005 Actual	Target/ Est.	Actual	Target/ Est.	Actual	FY 2008 Target	FY 2009 Target	Out-Year Target
Long-Term Objective : Promote effectiveness of health care services
13.1	Increase the percentage of children with non-syndromic hearing loss entering school with developmentally appropriate language skills (Baselline-2004)	20%(Est.)								2012: 85%

#	Key Outputs	FY 2004 Actual	FY 2005 Actual	FY 2006		FY 2007		FY 2008 Target/ Est.	FY 2009 Target/ Est.	Out-Year Target/ Est.
#	Key Outputs	FY 2004 Actual	FY 2005 Actual	Target/ Est.	Actual	Target/ Est.	Actual	FY 2008 Target/ Est.	FY 2009 Target/ Est.	Out-Year Target/ Est.
Long-Term Objective : Promote effectiveness of health care services
13.2	Increase the percentage of infants with hearing loss enrolled in early intervention before 6months of age(Baseline-2004)	57%								2012: 85%
13III.A.1	Percentage of infants suspected of having a hearing loss with a confirmed diagnosis by 3 months of age	50%	55%	60%	Jul-08	62%a	Jul-09	63%	NA	NA
13. III.A.2	Percentage of infants with a suspected or confirmed hearing loss referred to an ongoing source of comprehensive health care (i.e. medical home)	77%	80%	85%	Jul-08	87% a	Jul-09	88% a	NA	NA
13III.A.3	Percentage of infants screened for hearing loss prior to hospital discharge	93.20%	95%	96%	Jul-08	97% a	Jul-09	98% a	NA	NA
Efficiency Measure
13.E	Increase the percentage of infants suspected of having hearing loss (based on the results of their newborn hearing screen) who receive a confirmed diagnosis by 3 months of age while maintaining a constant Federal expenditure	50%	55%	60%	Jul-08	62% a	Jul-09	63% a	NA	NA

#	Key Outputs	FY 2004 Actual	FY 2005 Actual	FY 2006		FY 2007		FY 2008 Target/ Est.	FY 2009 Target/ Est.	Out-Year Target/ Est.
#	Key Outputs	FY 2004 Actual	FY 2005 Actual	Target/ Est.	Actual	Target/ Est.	Actual	FY 2008 Target/ Est.	FY 2009 Target/ Est.	Out-Year Target/ Est.
Other Outputs
	Grants to States	54	54		53		55	57	NA	NA
	Technical Assistance Center	1	1		1		1	1	NA	NA
	Appropriated Amount ($ Million)	9.873	9.792		9.794		9.804	11.79

Notes:
a The FY 2007 and FY2008 targets were changed from that shown in the FY 2008 Congressional Justification to reflect full-year CR funding for FY 2007 and the FY 2008 Appropriation. NA = Not applicable. FY 2009 targets are not included because no budget is proposed.