II

106TH CONGRESS

1ST SESSION S. 1120

To ensure that children enrolled in medicaid and other Federal means-tested

programs at highest risk for lead poisoning are identified and treated,

and for other purposes.

IN THE SENATE OF THE UNITED STATES

MAY 25, 1999

Mr. TORRICELLI (for himself, Mr. REED, Mr. LAUTENBERG, Mr. BRYAN, Mrs.

BOXER, Mrs. FEINSTEIN, Mr. DODD, Mr. ROCKEFELLER, Mr. BIDEN,

Mr. SCHUMER, Mrs. MURRAY, Mr. DURBIN, and Mr. KERRY) introduced

the following bill; which was read twice and referred to the Committee

on Finance

A BILL

To ensure that children enrolled in medicaid and other Federal means-tested programs at highest risk for lead poisoning are identified and treated, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Children’s Lead

5 Screening Accountability For Early-Intervention Act of

6 1999’’ or the ‘‘Children’s Lead SAFE Act’’.

7 SEC. 2. FINDINGS AND PURPOSES.

8 (a) FINDINGS.—Congress finds that—
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1 (1) lead poisoning remains a serious environ2 mental risk, especially to the health of young chil3 dren;

4 (2) childhood lead poisoning can cause reduc5 tions in IQ, attention span, reading, and learning

6 disabilities, and other growth and behavior problems;

7 (3) children under the age of 6 are at the great8 est risk of suffering the effects of lead poisoning be9 cause of the sensitivity of their developing brains

10 and nervous systems, while children under the age of

11 3 are especially at risk due to their stage of develop12 ment and hand-to-mouth activities;

13 (4) poor children and minority children are at

14 substantially higher risk of lead poisoning;

15 (5) three-fourths of all children ages 1 through

16 5 found to have an elevated blood lead level in a

17 Centers for Disease Control and Prevention nation18 ally representative sample were in enrolled in or tar19 geted by Federal health care programs, specifically

20 the medicaid program, the women, infants, and chil21 dren (WIC) program, and the community health

22 centers programs under section 330 of the Public

23 Health Service Act, equating to an estimated

24 688,000 children nationwide;
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1 (6) the General Accounting Office estimates

that 2 2 ⁄3 of the 688,000 children who have elevated

3 blood lead levels and are enrolled in or targeted by

4 Federal health care programs have never been

5 screened for lead;

6 (7) although the Health Care Financing Admin7 istration has required mandatory blood lead

8 screenings for children enrolled in the medicaid pro9 gram who are not less that 1 nor more than 5 years

10 of age, less than 20 percent of these children have

11 received such screenings;

12 (8) the Health Care Financing Administration

13 mandatory screening policy has not been effective, or

14 sufficient, to properly identify and screen children

15 enrolled in the medicaid program who are at risk;

(9) only about 1 16 ⁄2 of State programs have

17 screening policies consistent with Federal policy; and

18 (10) adequate treatment services are not uni19 formly available for children with elevated blood lead

20 levels.

21 (b) PURPOSE.—The purpose of this Act is to create

22 a lead screening safety net that will, through the medicaid,

23 women, infants, and children (WIC), head start and early

24 head start programs that include infants and toddlers, and

25 the maternal and child health block grant programs, en-
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1 sure that children covered by those programs receive blood

2 lead screenings and appropriate followup care.

3 SEC. 3. INCREASED LEAD POISONING SCREENINGS AND

4 TREATMENTS UNDER THE MEDICAID PRO5 GRAM.

6 (a) REPORTING REQUIREMENT.—Section

7 1902(a)(43)(D) of the Social Security Act (42 U.S.C.

8 1396a(a)(43)(D)) is amended—

9 (1) in clause (iii), by striking ‘‘and’’ at the end;

10 (2) in clause (iv), by striking the semicolon and

11 inserting ‘‘, and’’; and

12 (3) by adding at the end the following:

13 ‘‘(v) the number of children who are

14 under the age of 3 and enrolled in the

15 State plan and the number of those chil16 dren who have received a blood lead

17 screening test;’’.

18 (b) MANDATORY SCREENING REQUIREMENTS.—Sec19 tion 1902(a) of the Social Security Act (42 U.S.C.

20 1396a(a)) is amended—

21 (1) in paragraph (65), by striking the period

22 and inserting ‘‘; and’’; and

23 (2) by adding at the end the following:

24 ‘‘(66) provide that each contract entered into

25 between the State and an entity (including a health
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1 insuring organization and a medicaid managed care

2 organization) that is responsible for the provision

3 (directly or through arrangements with providers of

4 services) of medical assistance under the State plan

5 shall provide for—

6 ‘‘(A) compliance with mandatory blood

7 lead screening requirements that are consistent

8 with prevailing guidelines of the Centers for

9 Disease Control and Prevention for such screen10 ing; and

11 ‘‘(B) coverage of qualified lead treatment

12 services described in section 1905(v) including

13 diagnosis, treatment, and follow-up furnished

14 for children with elevated blood lead levels in

15 accordance with prevailing guidelines of the

16 Centers for Disease Control and Prevention.’’.

17 (c) REIMBURSEMENT FOR TREATMENT OF CHIL18 DREN WITH ELEVATED BLOOD LEAD LEVELS.—Section

19 1905 of the Social Security Act (42 U.S.C. 1396d) is

20 amended—

21 (1) in subsection (a)—

22 (A) in paragraph (26), by striking ‘‘and’’

23 at the end;

24 (B) by redesignating paragraph (27) as

25 paragraph (28); and
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1 (C) by inserting after paragraph (26) the

2 following:

3 ‘‘(27) qualified lead treatment services (as de4 fined in subsection (v)); and’’; and

5 (2) by adding at the end the following:

6 ‘‘(v)(1) In this subsection:

7 ‘‘(A) The term ‘qualified lead treatment serv8 ices’ means the following:

9 ‘‘(i) Lead-related medical management, as

10 defined in subparagraph (B).

11 ‘‘(ii) Lead-related case management, as de12 fined in subparagraph (C), for a child described

13 in paragraph (2).

14 ‘‘(iii) Lead-related anticipatory guidance,

15 as defined in subparagraph (D), provided as

16 part of—

17 ‘‘(I) prenatal services;

18 ‘‘(II) early and periodic screening, di19 agnostic, and treatment services (EPSDT)

20 services described in subsection (r) and

21 available under subsection (a)(4)(B) (in22 cluding as described and available under

23 implementing regulations and guidelines)

24 to individuals enrolled in the State plan
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1 under this title who have not attained age

2 21; and

3 ‘‘(III) routine pediatric preventive

4 services.

5 ‘‘(B) The term ‘lead-related medical manage6 ment’ means the provision and coordination of the

7 diagnostic, treatment, and follow-up services pro8 vided for a child diagnosed with an elevated blood

9 lead level (EBLL) that includes—

10 ‘‘(i) a clinical assessment, including a

11 physical examination and medically indicated

12 tests (in addition to diagnostic blood lead level

13 tests) and other diagnostic procedures to deter14 mine the child’s developmental, neurological,

15 nutritional, and hearing status, and the extent,

16 duration, and possible source of the child’s ex17 posure to lead;

18 ‘‘(ii) repeat blood lead level tests furnished

19 when medically indicated for purposes of moni20 toring the blood lead concentrations in the

21 child;

22 ‘‘(iii) pharmaceutical services, including

23 chelation agents and other drugs, vitamins, and

24 minerals prescribed for treatment of an EBLL;
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1 ‘‘(iv) medically indicated inpatient services

2 including pediatric intensive care and emer3 gency services;

4 ‘‘(v) medical nutrition therapy when medi5 cally indicated by a nutritional assessment, that

6 shall be furnished by a dietitian or other nutri7 tion specialist who is authorized to provide such

8 services under State law;

9 ‘‘(vi) referral—

10 ‘‘(I) when indicated by a nutritional

11 assessment, to the State agency or con12 tractor administering the program of as13 sistance under the special supplemental

14 food program for women, infants and chil15 dren (WIC) under section 17 of the Child

16 Nutrition Act of 1966 (42 U.S.C. 1786)

17 and coordination of clinical management

18 with that program; and

19 ‘‘(II) when indicated by a clinical or

20 developmental assessment, to the State

21 agency responsible for early intervention

22 and special education programs under the

23 Individuals with Disabilities Education Act

24 (20 U.S.C. 1400 et seq.); and
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1 ‘‘(vii) environmental investigation, as de2 fined in subparagraph (E).

3 ‘‘(C) The term ‘lead-related case management’

4 means the coordination, provision, and oversight of

5 the nonmedical services for a child with an EBLL

6 necessary to achieve reductions in the child’s blood

7 lead levels, improve the child’s nutrition, and secure

8 needed resources and services to protect the child by

9 a case manager trained to develop and oversee a

10 multi-disciplinary plan for a child with an EBLL or

11 by a childhood lead poisoning prevention program,

12 as defined by the Secretary. Such services include—

13 ‘‘(i) assessing the child’s environmental,

14 nutritional, housing, family, and insurance sta15 tus and identifying the family’s immediate

16 needs to reduce lead exposure through an initial

17 home visit;

18 ‘‘(ii) developing a multidisciplinary case

19 management plan of action that addresses the

20 provision and coordination of each of the fol21 lowing classes of services as appropriate—

22 ‘‘(I) whether or not such services are

23 covered under the State plan under this

24 title;
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1 ‘‘(II) lead-related medical manage2 ment of an EBLL (including environ3 mental investigation);

4 ‘‘(III) nutrition services;

5 ‘‘(IV) family lead education;

6 ‘‘(V) housing;

7 ‘‘(VI) early intervention services;

8 ‘‘(VII) social services; and

9 ‘‘(VIII) other services or programs

10 that are indicated by the child’s clinical

11 status and environmental, social, edu12 cational, housing, and other needs;

13 ‘‘(iii) assisting the child (and the child’s

14 family) in gaining access to covered and non15 covered services in the case management plan

16 developed under clause (ii);

17 ‘‘(iv) providing technical assistance to the

18 provider that is furnishing lead-related medical

19 management for the child; and

20 ‘‘(v) implementation and coordination of

21 the case management plan developed under

22 clause (ii) through home visits, family lead edu23 cation, and referrals.

24 ‘‘(D) The term ‘lead-related anticipatory guid25 ance’ means education and information for families
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1 of children and pregnant women enrolled in the

2 State plan under this title about prevention of child3 hood lead poisoning that addresses the following top4 ics:

5 ‘‘(i) The importance of lead screening tests

6 and where and how to obtain such tests.

7 ‘‘(ii) Identifying lead hazards in the home.

8 ‘‘(iii) Specialized cleaning, home mainte9 nance, nutritional, and other measures to mini10 mize the risk of childhood lead poisoning.

11 ‘‘(iv) The rights of families under the Resi12 dential Lead-Based Paint Hazard Reduction

13 Act of 1992 (42 U.S.C. 4851 et seq.).

14 ‘‘(E) The term ‘environmental investigation’

15 means the process of determining the source of a

16 child’s exposure to lead by an individual that is cer17 tified or registered to perform such investigations

18 under State or local law, including the collection and

19 analysis of information and environmental samples

20 from a child’s living environment. For purposes of

21 this subparagraph, a child’s living environment in22 cludes the child’s residence or residences, residences

23 of frequently visited caretakers, relatives, and play24 mates, and the child’s day care site. Such investiga25 tions shall be conducted in accordance with the
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1 standards of the Department of Housing and Urban

2 Development for the evaluation and control of lead3 based paint hazards in housing and in compliance

4 with State and local health agency standards for en5 vironmental investigation and reporting.

6 ‘‘(2) For purposes of paragraph (1)(A)(ii), a child de7 scribed in this paragraph is a child who—

8 ‘‘(A) has attained 6 months but has not at9 tained 6 years of age; and

10 ‘‘(B) has been identified as having a blood lead

11 level that equals or exceeds 20 micrograms per deci12 liter (or after 2 consecutive tests, equals or exceeds

13 15 micrograms per deciliter, or the applicable num14 ber of micrograms designated for such tests under

15 prevailing guidelines of the Centers for Disease Con16 trol and Prevention).’’.

17 (d) ENHANCED MATCH FOR DATA COMMUNICATIONS

18 SYSTEM.—Section 1903(a)(3) of the Social Security Act

19 (42 U.S.C. 1396b(a)(3)) is amended—

20 (1) in subparagraph (D), by striking ‘‘plus’’ at

21 the end and inserting ‘‘and’’; and

22 (2) by inserting after subparagraph (D), the

23 following:

24 ‘‘(E)(i) 90 percent of so much of the sums

25 expended during such quarter as are attrib-
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1 utable to the design, development, or installa2 tion of an information retrieval system that

3 may be easily accessed and used by other feder4 ally-funded means-tested public benefit pro5 grams to determine whether a child is enrolled

6 in the State plan under this title and whether

7 an enrolled child has received mandatory early

8 and periodic screening, diagnostic, and treat9 ment services, as described in section 1905(r);

10 and

11 ‘‘(ii) 75 percent of so much of the sums ex12 pended during such quarter as are attributable

13 to the operation of a system (whether such sys14 tem is operated directly by the State or by an15 other person under a contract with the State)

16 of the type described in clause (i); plus’’.

17 (e) REPORT.—The Secretary of Health and Human

18 Services, acting through the Administrator of the Health

19 Care Financing Administration, annually shall report to

20 Congress on the number of children enrolled in the med21 icaid program under title XIX of the Social Security Act

22 (42 U.S.C. 1396 et seq.) who have received a blood lead

23 screening test during the prior fiscal year, noting the per24 centage that such children represent as compared to all

25 children enrolled in that program.
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1 (f) RULE OF CONSTRUCTION.—Nothing in this Act

2 or in any amendment made by this Act shall be construed

3 as prohibiting the Secretary of Health and Human Serv4 ices or the State agency administering the State plan

5 under title XIX of the Social Security Act (42 U.S.C.

6 1396 et seq.) from using funds provided under title XIX

7 of that Act to reimburse a State or entity for expenditures

8 for medically necessary activities in the home of a lead9 poisoned child to prevent additional exposure to lead, in10 cluding specialized cleaning of lead-contaminated dust,

11 emergency relocation, safe repair of peeling paint, dust

12 control, and other activities that reduce lead exposure.

13 SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUP14 PLEMENTAL FOOD PROGRAM FOR WOMEN,

15 INFANTS, AND CHILDREN.

16 Section 17(d) of the Child Nutrition Act of 1966 (42

17 U.S.C. 1786(d)) is amended by adding at the end the fol18 lowing:

19 ‘‘(4) LEAD POISONING SCREENING.—

20 ‘‘(A) IN GENERAL.—A State agency

21 shall—

22 ‘‘(i) determine whether an infant or

23 child eligible to participate in the program

24 under this section has received a blood lead

25 screening test using a test that is appro-
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1 priate for age and risk factors upon the

2 enrollment of the infant or child in the

3 program; and

4 ‘‘(ii) in the case of an infant or child

5 who has not received a blood lead screen6 ing test—

7 ‘‘(I) refer the infant or child for

8 receipt of the test; and

9 ‘‘(II) determine whether the in10 fant or child receives the test during

11 a routine visit with a health care pro12 vider.

13 ‘‘(B) SCREENINGS BY STATE AGENCIES.—

14 ‘‘(i) IN GENERAL.—A State agency

15 may (under contract or otherwise) perform

16 a blood lead screening test that is appro17 priate for age and risk factors on an infant

18 or child who seeks to participate in the

19 program.

20 ‘‘(ii) REIMBURSEMENT.—

21 ‘‘(I) CHILDREN ENROLLED IN OR

22 ELIGIBLE FOR MEDICAID.—On the re23 quest of a State agency that performs

24 or arranges for the provision of a

25 blood lead screening test under clause
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1 (i) of an infant or child that is eligible

2 for or receiving medical assistance

3 under a State plan under title XIX of

4 the Social Security Act (42 U.S.C.

5 1396 et seq.), the Secretary of Health

6 and Human Services, notwithstanding

7 any other provision of, or limitation

8 under, title XIX of the Social Security

9 Act, shall reimburse the State agency,

10 from funds that are made available

11 under that title, for the Federal med12 ical assistance percentage (as defined

13 in section 1905(b) of the Social Secu14 rity Act (42 U.S.C. 1396d(b)) of the

15 cost of the test and data reporting.

16 Such costs shall include, if determined

17 to be desirable by the State agency,

18 the costs of providing screening

19 through clinical laboratories certified

20 under section 353 of the Public

21 Health Service Act (42 U.S.C. 263a),

22 or purchasing, for use at sites pro23 viding services under this section,

24 blood lead testing instruments and as25 sociated supplies approved for sale by
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1 the Food and Drug Administration

2 and used in compliance with such sec3 tion 353.

4 ‘‘(II) CHILDREN ENROLLED IN

5 OR ELIGIBLE FOR SCHIP.—In the case

6 of a blood lead screening test per7 formed under clause (i) (by the State

8 agency or under contract with the

9 State agency) on an infant or child

10 who is eligible for or receiving medical

11 assistance under a State plan under

12 title XXI of the Social Security Act,

13 the Secretary of Health and Human

14 Services, notwithstanding any other

15 provision of, or limitation under, such

16 title XXI, shall reimburse the State

17 agency, from funds that are made

18 available under that title, for the en19 hanced FMAP (as defined in section

20 2105(b) of the Social Security Act (42

21 U.S.C. 1397ee(b)) of the cost of the

22 test and data reporting. Such costs

23 shall include the costs described in the

24 second sentence of subclause (I).
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1 ‘‘(C) AUTHORIZATION FOR WIC.—There is

2 authorized to be appropriated such sums as

3 may be necessary to carry out this paragraph

4 with respect to blood lead screening tests per5 formed under this paragraph on an infant or

6 child, and any data reporting with respect to

7 such infant or child, who is not eligible for cov8 erage under title XIX or XXI of the Social Se9 curity Act, or is not otherwise covered under a

10 health insurance plan.’’.

11 SEC. 5. LEAD POISONING SCREENING FOR EARLY HEAD

12 START AND HEAD START PROGRAMS.

13 Section 645A of the Head Start Act (42 U.S.C

14 9840a) is amended—

15 (1) in the first sentence of subsection (d), by in16 serting before the period the following: ‘‘and shall

17 comply with subsection (h)’’; and

18 (2) by adding at the end the following:

19 ‘‘(h) LEAD POISONING SCREENING.—

20 ‘‘(1) IN GENERAL.—An entity shall—

21 ‘‘(A) determine whether a child eligible to

22 participate in the program described in sub23 section (a)(1) has received a blood lead screen24 ing test using a test that is appropriate for age
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1 and risk factors upon the enrollment of the

2 child in the program; and

3 ‘‘(B) in the case of a child who has not re4 ceived a blood lead screening test, ensure that

5 each enrolled child receives such a test either by

6 referral or by performing the test (under con7 tract or otherwise).

8 ‘‘(2) SCREENINGS BY ENTITIES.—

9 ‘‘(A) IN GENERAL.—An entity may (under

10 contract or otherwise) perform a blood lead

11 screening test that is appropriate for age and

12 risk factors on a child who seeks to participate

13 in the program.

14 ‘‘(B) REIMBURSEMENT.—

15 ‘‘(i) CHILDREN ENROLLED IN OR ELI16 GIBLE FOR MEDICAID.—On the request of

17 an entity that performs or arranges for the

18 provision of a blood lead screening test

19 under subparagraph (A) of a child that is

20 eligible for or receiving medical assistance

21 under a State plan under title XIX of the

22 Social Security Act (42 U.S.C. 1396 et

23 seq.), the Secretary of Health and Human

24 Services, notwithstanding any other provi25 sion of, or limitation under, title XIX of
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1 the Social Security Act, shall reimburse

2 the entity, from funds that are made avail3 able under that title, for the Federal med4 ical assistance percentage (as defined in

5 section 1905(b) of the Social Security Act

6 (42 U.S.C. 1396d(b)) of the cost of the

7 test and data reporting. Such costs shall

8 include, if determined to be desirable by

9 the State agency, the costs of providing

10 screening through clinical laboratories cer11 tified under section 353 of the Public

12 Health Service Act (42 U.S.C. 263a), or

13 purchasing, for use at sites providing serv14 ices under this section, blood lead testing

15 instruments and associated supplies ap16 proved for sale by the Food and Drug Ad17 ministration and used in compliance with

18 such section 353.

19 ‘‘(ii) CHILDREN ENROLLED IN OR EL20 IGIBLE FOR SCHIP.—In the case of a blood

21 lead screening test performed under sub22 paragraph (A) (by the entity or under con23 tract with the entity) on a child who is eli24 gible for or receiving medical assistance

25 under a State plan under title XXI of the
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1 Social Security Act, the Secretary of

2 Health and Human Services, notwith3 standing any other provision of, or limita4 tion under, such title XXI, shall reimburse

5 the entity, from funds that are made avail6 able under that title, for the enhanced

7 FMAP (as defined in section 2105(b) of

8 the Social Security Act (42 U.S.C.

9 1397ee(b)) of the cost of the test and data

10 reporting. Such costs shall include the

11 costs described in the second sentence of

12 clause (i).

13 ‘‘(3) AUTHORIZATION FOR EARLY HEAD

14 START.—There is authorized to be appropriated

15 such sums as may be necessary to carry out this

16 subsection with respect to blood lead screening tests

17 performed under this subsection on an infant or

18 child, and any data reporting with respect to such

19 infant or child, who is not eligible for coverage under

20 title XIX or XXI of the Social Security Act, or is

21 not otherwise covered under a health insurance plan.

22 ‘‘(4) HEAD START.—The provisions of this sub23 section shall apply to head start programs that in24 clude coverage, directly or indirectly, for infants and

25 toddlers under the age of 3 years.’’.
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1 SEC. 6. SCHIP COVERAGE FOR SCREENING OF CHILDREN.

2 (a) IN GENERAL.—Title XXI of the Social Security

3 Act is amended by adding at the end the following new

4 section:

5 ‘‘SEC. 2111. COVERAGE FOR LEAD POISONING SCREENING

6 OF CHILDREN.

7 ‘‘(a) COVERAGE.—Notwithstanding any other provi8 sion of this title, a State child health plan shall provide

9 for coverage of the costs (including data reporting) of a

10 blood lead screening test performed by—

11 ‘‘(1) a State agency administering the special

12 supplemental food program for women, infants and

13 children (WIC) under section 17 of the Child Nutri14 tion Act of 1966 (42 U.S.C. 1786) in accordance

15 with section 17(d)(4)(B) of that Act; or

16 ‘‘(2) an entity in accordance with section

17 645A(h)(2) of the Head Start Act (42 U.S.C

18 9840a(h)(2)).

19 ‘‘(b) REFERENCES TO TERMS AND SPECIAL

20 RULES.—With respect to the coverage described in sub21 section (a), the following special rules apply:

22 ‘‘(1) Any reference in this title to a targeted

23 low-income child is deemed to include a reference to

24 a child who receives a blood lead screening test per25 formed by a State agency or entity described in sub26 section (a).
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1 ‘‘(2) Any such reference to child health assist2 ance with respect to such a child is deemed a ref3 erence to the costs (including data reporting) of

4 such a test.

5 ‘‘(3) Subsection (a) of section 2103 (relating to

6 required scope of health insurance coverage) shall

7 not apply insofar to such coverage and the reference

8 to such section in section 2105(a)(1) is deemed not

9 to require, in such case, compliance with the require10 ments of section 2103(a).

11 ‘‘(4) There shall be no exclusion of benefits for

12 such coverage based on any pre-existing condition

13 and no waiting period (including a waiting period to

14 carry out section 2102(b)(3)(C)) shall apply.

15 ‘‘(c) NO IMPACT ON ALLOTMENTS.—Nothing in this

16 section shall be construed as affecting the amount of any

17 initial allotment provided to a State under section

18 2104(b).

19 ‘‘(d) APPLICATION OF FUNDING RESTRICTIONS.—

20 The coverage under this section (and the funding of such

21 coverage) is subject to the restrictions of section

22 2105(c).’’.

23 (b) CONFORMING AMENDMENT.—Section

24 2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B))

25 is amended—
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1 (1) by striking ‘‘and’’ at the end of clause (i);

2 (2) by striking the period at the end of clause

3 (ii) and inserting ‘‘; and’’; and

4 (3) by adding at the end the following new

5 clause:

6 ‘‘(iii) may not apply a waiting period

7 (including a waiting period to carry out

8 paragraph (3)(C)) in the case of a child

9 described in section 2111 who is deemed a

10 targeted low-income child under that sec11 tion.’’.

12 (c) EFFECTIVE DATE.—The amendments made by

13 this section take effect on the date described in section

14 11(a) and apply to allotments for all fiscal years.

15 SEC. 7. CENTERS FOR DISEASE CONTROL AND PREVEN16 TION EFFORTS TO COMBAT CHILDHOOD

17 LEAD POISONING.

18 (a) REQUIREMENTS FOR LEAD POISONING PREVEN19 TION GRANTEES.—Section 317A of the Public Health

20 Service Act (42 U.S.C. 247b–1) is amended—

21 (1) in subsection (d)—

22 (A) by redesignating paragraph (7) as

23 paragraph (8); and

24 (B) by inserting after paragraph (6) the

25 following:
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1 ‘‘(7) Assurances satisfactory to the Secretary

2 that the applicant will ensure complete and con3 sistent reporting of all blood lead test results from

4 laboratories and health care providers to State and

5 local health departments in accordance with guide6 lines of the Centers for Disease Control and Preven7 tion for standardized reporting as described in sub8 section (l).’’; and

9 (2) in subsection (j)(2)—

10 (A) in subparagraph (F) by striking ‘‘(E)’’

11 and inserting ‘‘(F)’’;

12 (B) by redesignating subparagraph (F) as

13 subparagraph (G); and

14 (C) by inserting after subparagraph (E)

15 the following:

16 ‘‘(F) The number of grantees that have es17 tablished systems to ensure mandatory report18 ing of all blood lead tests from laboratories and

19 health care providers to State and local health

20 departments.’’.

21 (b) GUIDELINES FOR STANDARDIZED REPORTING.—

22 Section 317A of the Public Health Service Act (42 U.S.C.

23 247b–1) is amended by adding at the end the following:

24 ‘‘(l) GUIDELINES FOR STANDARDIZED REPORT25 ING.—The Secretary, acting through the Director of the
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1 Centers for Disease Control and Prevention, shall develop

2 national guidelines for the uniform and complete reporting

3 of all blood test results to State and local health depart4 ments.’’.

5 (c) EARMARK OF OTHER GRANT FUNDS.—Section

6 317A of the Public Health Service Act (42 U.S.C. 247b–

7 1), as amended by subsection (b), is amended by adding

8 at the end the following:

9 ‘‘(m) REQUIREMENT FOR USE OF FUNDS.—Notwith10 standing any other provision of law, any individual or enti11 ty that receives from the Secretary, acting through the

12 Director of the Centers for Disease Control and Preven13 tion, a grant under this section or any other section of

14 this Act to carry out activities relating to childhood lead

15 poisoning prevention shall use 10 percent of the grant

16 funds awarded for the purpose of funding screening as17 sessments and referrals at State and local sites of oper18 ation of the program of assistance under the special sup19 plemental food program for women, infants and children

20 (WIC) under section 17 of the Child Nutrition Act of 1966

21 (42 U.S.C. 1786) or the early head start program under

22 section 645A of the Head Start Act (42 U.S.C 9840a).’’.

23 (d) DEVELOPMENT AND IMPLEMENTATION OF EF24 FECTIVE DATA MANAGEMENT BY THE CENTERS FOR DIS25 EASE CONTROL AND PREVENTION.—
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1 (1) IN GENERAL.—The Director of the Centers

2 for Disease Control and Prevention shall—

3 (A) assist with the improvement of data

4 linkages between State and local health depart5 ments and between State health departments

6 and the Centers for Disease Control and Pre7 vention;

8 (B) assist States with the development of

9 flexible, comprehensive State-based data man10 agement systems for the surveillance of children

11 with lead poisoning that has the capacity to

12 contribute to a national data set;

13 (C) assist with the improvement of the

14 ability of State-based data management systems

15 and federally-funded means-tested public ben16 efit programs (including the special supple17 mental food program for women, infants and

18 children (WIC) under section 17 of the Child

19 Nutrition Act of 1966 (42 U.S.C. 1786) and

20 the early head start program under section

21 645A of the Head Start Act (42 U.S.C

22 9840a(h)) to respond to ad hoc inquiries and

23 generate progress reports regarding the lead

24 blood level screening of children enrolled in

25 those programs that may be used in training
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1 and education programs conducted by the Cen2 ters for health care providers;

3 (D) assist with the establishment of a

4 State capacity for assessing how many children

5 enrolled in the medicaid, WIC, early head start,

6 and other federally-funded means-tested public

7 benefit programs are being screened for lead

8 poisoning at age-appropriate intervals;

9 (E) use data obtained as result of activities

10 under this section to formulate or revise exist11 ing lead blood screening and case management

12 policies; and

13 (F) establish performance measures for

14 evaluating State and local implementation of

15 the requirements and improvements described

16 in subparagraphs (A) through (E).

17 (2) AUTHORIZATION OF APPROPRIATIONS.—

18 There is authorized to be appropriated to carry out

19 this subsection, $10,000,000 for each of fiscal years

20 2000 and 2001.

21 (3) EFFECTIVE DATE.—This subsection takes

22 effect on the date of enactment of this Act.
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1 SEC. 8. GRANTS FOR LEAD POISONING RELATED ACTIVI2 TIES.

3 Title V of the Social Security Act (42 U.S.C. 701

4 et seq.) is amended by adding at the end the following:

5 ‘‘SEC. 511. GRANTS FOR LEAD POISONING RELATED ACTIVI6 TIES.

7 ‘‘(a) AUTHORITY TO MAKE GRANTS.—

8 ‘‘(1) IN GENERAL.—In addition to any other

9 payments made under this title to a State or any

10 other entity, the Secretary shall award grants to

11 States to support public health activities in States

12 and localities where data suggest that more than 5

13 percent of preschool-age children have had lead ex14 posure greater than 10 micrograms per deciliter

15 through—

16 ‘‘(A) effective, ongoing outreach and com17 munity education targeted to families most like18 ly to be at risk for lead poisoning;

19 ‘‘(B) individual family education activities

20 that are designed to reduce ongoing exposures

21 to lead for children with elevated blood lead lev22 els, including through home visits and coordina23 tion with other programs designed to identify

24 and treat children at risk for lead poisoning;

25 and
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1 ‘‘(C) the development, coordination and

2 implementation of community-based approaches

3 for comprehensive lead poisoning prevention

4 from surveillance to lead hazard control.

5 ‘‘(2) STATE MATCH.—A State is not eligible for

6 a grant under this section unless the State agrees to

7 expend (through State or local funds) $3 for every

8 $4 provided under the grant to carry out the activi9 ties described in paragraph (1).

10 ‘‘(3) APPLICATION.—A State shall submit an

11 application to the Secretary for a grant under this

12 section in such form and manner and containing

13 such information as the Secretary may require.

14 ‘‘(b) PERFORMANCE MEASURES.—The Secretary

15 shall establish needs indicators and performance measures

16 to evaluate the activities carried out under grants awarded

17 under this section. Such indicators shall be commensurate

18 with the national measures of the program under this title

19 and shall be developed in consultation with the Director

20 of the Centers for Disease Control and Prevention.

21 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

22 is authorized to be appropriated to carry out this section,

23 $20,000,000 for each of fiscal years 2000 through 2004.

24 ‘‘(d) APPLICATION OF OTHER PROVISIONS OF

25 TITLE.—
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1 ‘‘(1) IN GENERAL.—Except as provided in para2 graph (2), the other provisions of this title shall not

3 apply to a grant made, or activities of the Secretary,

4 under this section.

5 ‘‘(2) EXCEPTIONS.—The following provisions of

6 this title shall apply to a grant made under sub7 section (a) to the same extent and in the same man8 ner as such provisions apply to allotments made

9 under section 502(c):

10 ‘‘(A) Section 504(b)(1) (relating to ex11 penditures for inpatient services).

12 ‘‘(B) Section 504(b)(4) (relating to ex13 penditures of funds as a condition of receipt of

14 Federal funds).

15 ‘‘(C) Section 504(b)(5) (relating to limita16 tions on funds for research).

17 ‘‘(D) Section 504(b)(6) (relating to prohi18 bition on payments to excluded individuals and

19 entities).

20 ‘‘(E) Section 506 (relating to reports and

21 audits), but only to the extent determined by

22 the Secretary to be appropriate for grants made

23 under this section.

24 ‘‘(F) Section 507 (relating to penalties for

25 false statements).
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1 ‘‘(G) Section 508 (relating to non2 discrimination).’’.

3 SEC. 9. TRAINING AND REPORTS BY THE HEALTH RE4 SOURCES AND SERVICES ADMINISTRATION.

5 (a) TRAINING.—The Secretary of Health and Human

6 Services, acting through the Administrator of the Health

7 Resources and Services Administration and in collabora8 tion with the Administrator of the Health Care Financing

9 Administration and the Director of the Centers for Dis10 ease Control and Prevention, shall conduct education and

11 training programs for physicians and other health care

12 providers regarding childhood lead poisoning, current

13 screening and treatment recommendations and require14 ments, and the scientific, medical, and public health basis

15 for those policies.

16 (b) REPORT.—The Secretary of Health and Human

17 Services, acting through the Administrator of the Health

18 Resources and Services Administration, annually shall re19 port to Congress on the number of children who received

20 services through community health centers established

21 under section 330 of the Public Health Service Act (42

22 U.S.C. 254b) and received a blood lead screening test dur23 ing the prior fiscal year, noting the percentage that such

24 children represent as compared to all children who re25 ceived services through such community health centers.
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1 SEC. 10. CDC BONUS PROGRAM FOR IMPROVEMENT OF

2 CHILDHOOD LEAD SCREENING RATES.

3 (a) IN GENERAL.—The Director of the Centers for

4 Disease Control and Prevention shall establish a program

5 to improve the blood lead screening rates of States for

6 children under the age of 3 enrolled in the medicaid pro7 gram.

8 (b) PAYMENTS.—Under the program established

9 under subsection (a), the Director, using State-specific

10 blood lead screening data, shall, subject to the availability

11 of appropriations, annually pay a State an amount deter12 mined as follows:

13 (1) $25 per each 2 year-old child enrolled in the

14 medicaid program in the State who has received the

15 minimum required (for that age) screening blood

16 lead level tests (capillary or venous samples) to de17 termine the presence of elevated blood lead levels, as

18 established by the Centers for Disease Control and

19 Prevention, if the State rate for such screenings ex20 ceeds 65 but does not exceed 75 percent of all 2

21 year-old children in the State.

22 (2) $50 per each such child who has received

23 such minimum required tests if the State rate for

24 such screenings exceeds 75 but does not exceed 85

25 percent of all 2 year-old children in the State.
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1 (3) $75 per each such child who has received

2 such minimum required tests if the State rate for

3 such screenings exceeds 85 percent of all 2 year-old

4 children in the State.

5 (c) USE OF BONUS FUNDS.—Funds awarded to a

6 State under subsection (b) shall only be used—

7 (1) by the State department of health in the

8 case of a child with an elevated blood lead level who

9 is enrolled in medicaid or another Federal means10 tested program designed to reduce the source of the

11 child’s exposure to lead; or

12 (2) in accordance with guidelines for the use of

13 such funds developed by the Director of the Centers

14 for Disease Control and Prevention in collaboration

15 with the Secretary of Housing and Urban Develop16 ment.

17 (d) AUTHORIZATION OF APPROPRIATIONS.—There is

18 authorized to be appropriated to carry out this section,

19 $30,000,000 for each of fiscal years 2000 through 2004.

20 SEC. 11. GENERAL EFFECTIVE DATE.

21 (a) IN GENERAL.—Except as provided in section

22 7(d)(3) and subsection (b), the amendments made by this

23 Act take effect on the date that is 18 months after the

24 date of enactment of this Act.

25 (b) WIC AND EARLY HEAD START WAIVERS.—
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1 (1) IN GENERAL.—A State agency or contractor

2 administering the program of assistance under the

3 special supplemental food program for women, in4 fants and children (WIC) under section 17 of the

5 Child Nutrition Act of 1966 (42 U.S.C. 1786), or an

6 entity carrying out activities under section 645A of

7 the Head Start Act (42 U.S.C 9840a) may be

8 awarded a waiver from the amendments made by

9 sections 4 and 5 (as applicable) if the State where

10 the agency, contractor, or entity is located estab11 lishes to the satisfaction of the Secretary of Health

12 and Human Services, in accordance with require13 ments and procedures recommended in accordance

14 with paragraph (2) to the Secretary by the Director

15 of the Centers for Disease Control and Prevention,

16 in consultation with the Centers for Disease Control

17 and Prevention Advisory Committee on Childhood

18 Lead Poisoning Prevention, a plan for increasing the

19 number of blood lead screening tests of children en20 rolled in the WIC and the Early Head Start pro21 grams in the State.

22 (2) DEVELOPMENT OF WAIVER PROCEDURES

23 AND REQUIREMENTS.—Not later than 12 months

24 after the date of enactment of this Act, the Director

25 of the Centers for Disease Control and Prevention,
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1 in consultation with the Centers for Disease Control

2 and Prevention Advisory Committee on Childhood

3 Lead Poisoning Prevention, shall develop and rec4 ommend to the Secretary of Health and Human

5 Services criteria and procedures (including a time6 table for the submission of the State plan described

7 in paragraph (1)) for the award of waivers under

8 that paragraph.

Æ