AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 502
(I-00)
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Introduced by:
Medical Student Section
Subject:
State Variations in Newborn screening
Referred to:
Reference Committee E
(C. Alvin Head, MD, Chair)
Whereas, There is no federal policy on newborn screening, leading to significant disparities
between states regarding newborn screening policies with some states screening for as few as
3 to as many as 21 hereditary genetic and metabolic disorders; and
Whereas, Variations in newborn screening: (1) limit access to screening tests with established
benefits due to discrepancies in financing, (2) lead to increased error in screening paradigms
(especially false positives), and (3) adversely affect follow up care for affected families; and
Whereas, Development of interstate and regional cooperation could provide states with
increased efficiency in quality of laboratory testing and newborn screening policy; and
Whereas, The U.S. Department of Health and Human Services, in conjunction with the
American Academy of Pediatrics (AAP) sponsored a task force which advocates reducing the
screening gap for newborns between states; and
Whereas, Current American Medical Association Policies H-320.953, H425.996, and H-425.997
define screening and medical necessity and provide minimal guidelines for health screening and
prevention services that could serve as a starting point for the development of standard
newborn screening recommendations and guidelines; therefore be it
RESOLVED, That our American Medical Association work in conjunction with the American
Academy of Pediatrics and other concerned organizations to study the issue of newborn
screening of hereditary metabolic disorders and genetic disorders, and develop
recommendations (including component laboratory tests, costs, interstate and regional
cooperation, and follow-up care protocols) for continuous improvement of newborn screening
programs; and be it further
RESOLVED, That our AMA work with the AAP and other concerned organizations, especially
state and county medical societies, to promote the continuous improvement of newborn
screening programs based on recommendations from studies by the AMA, AAP and other
concerned organizations on newborn screening.
Fiscal Note: $10,000
Received: 10/10/00
Resolution: 502 (I-00)
Page 2
RELEVANT AMA POLICY
H-320.953 Definitions of "Screening" and "Medical Necessity"
1. Our AMA defines screening as: Health care services or products provided to an individual
without apparent signs or symptoms of an illness, injury or disease for the purpose of
identifying or excluding an undiagnosed illness, disease, or condition.
2. Our AMA recognizes that federal law (EMTALA) includes the distinct use of the word
screening in the term "medical screening examination"; "The process required to reach, with
reasonable clinical confidence, the point at which it can be determined whether a medical
emergency does or does not exist."
3. Our AMA defines medical necessity as: Health care services or products that a prudent
physician would provide to a patient for the purpose of preventing, diagnosing or treating an
illness, injury, disease or its symptoms in a manner that is: (a) in accordance with generally
accepted standards of medical practice; (b) Clinically appropriate in terms of type,
frequency, extent, site, and duration; and (c) not primarily for the convenience of the patient,
physician, or other health care provider.
4. Our AMA incorporates its definition of "medical necessity" in relevant AMA advocacy
documents, including its "Model Managed Care Services Agreement." Usage of the term
"medical necessity" must be consistent between the medical profession and the insurance
industry. Carrier denials for non-covered services should state so explicitly and not
confound this with a determination of lack of "medical necessity".
5. Our AMA encourages physicians to carefully review their health plan medical services
agreements to ensure that they do not contain definitions of medical necessity that
emphasize cost and resource utilization above quality and clinical effectiveness.
6. Our AMA urges private sector health care accreditation organizations to develop and
incorporate standards that prohibit the use of definitions of medical necessity that
emphasize cost and resource utilization above quality and clinical effectiveness.
7. Our AMA advocates that determinations of medical necessity shall be based only on
information that is available at the time that health care products or services are provided.
8. Our AMA continues to advocate its policies on medical necessity determinations to
government agencies, managed care organizations, third-party payers, and private sector
health care accreditation organizations. (CMS Rep. 13, I-98)
H-425.996 Health Screening Programs
It is the position of the AMA that organizations, agencies or other entities that operate or
sponsor multiphasic health screening programs should be urged to include in their promotional
and explanatory materials on the availability of the program a definitive statement that reports
on the screening test results will be furnished to the individual participants only and that each
participant is responsible for obtaining any needed medical evaluation or follow-up should the
results of the tests deviate from the normal range. Those operating or sponsoring multiphasic
health screening programs also should be urged to utilize report forms that state in bold-face
type that the report does not constitute a medical diagnosis or evaluation and that the
participant should consult a physician of his or her choice if the screening test results are not
within the normal limits indicated on the report. (BOT Rep. L, A-80; Reaffirmed: CLRPD Rep. B,
I-90; Reaffirmed: Res. 806, I-98)
H-425.997 Preventive Services
The AMA encourages the development of policies and mechanisms to assure the continuity,
coordination and continuous availability of patient care, including professional preventive care
and early-detection screening services, provided the services are cost effective. (BOT Rep. A,
NCCMC Rec. 31, A-78; Reaffirmed: CLRPD Rep. C, A-89)