```

[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1471 Introduced in Senate (IS)]

107th CONGRESS
  1st Session
                                S. 1471

 To amend titles XIX and XXI of the Social Security Act to ensure that 
children enrolled in the medicaid and State children's health insurance 
         program are identified and treated for lead poisoning.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 26, 2001

Mr. Torricelli (for himself, Mr. Reed, Mrs. Clinton, Mr. Wellstone, Mr. 
  Durbin, Mrs. Carnahan, and Mr. Lieberman) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
 To amend titles XIX and XXI of the Social Security Act to ensure that 
children enrolled in the medicaid and State children's health insurance 
         program are identified and treated for lead poisoning.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Lead Screening 
Accountability For Early-Intervention Act of 2001'' or the ``Children's 
Lead SAFE Act''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress finds that--
            (1) lead poisoning remains a serious environmental risk, 
        especially to the health of young children;
            (2) childhood lead poisoning can cause reductions in IQ, 
        attention span, reading, and learning disabilities, and other 
        growth and behavior problems;
            (3) children under the age of 6 are at the greatest risk of 
        suffering the effects of lead poisoning because of the 
        sensitivity of their developing brains and nervous systems, 
        while children under the age of 3 are especially at risk due to 
        their stage of development and hand-to-mouth activities;
            (4) poor children and minority children are at 
        substantially higher risk of lead poisoning;
            (5) three-fourths of all children ages 1 through 5 found to 
        have an elevated blood lead level in a Centers for Disease 
        Control and Prevention nationally representative sample were 
        enrolled in or targeted by Federal health care programs, 
        specifically the medicaid program, the special supplemental 
        nutrition program for women, infants, and children (WIC), and 
        the community health centers programs under section 330 of the 
        Public Health Service Act, equating to an estimated 688,000 
        children nationwide;
            (6) the General Accounting Office estimates that \2/3\ of 
        the 688,000 children who have elevated blood lead levels and 
        are enrolled in or targeted by Federal health care programs 
        have never been screened for lead;
            (7) although the Health Care Financing Administration has 
        required mandatory blood lead screenings for children enrolled 
        in the medicaid program who are not less than 1 nor more than 5 
        years of age, less than 20 percent of these children have 
        received such screenings;
            (8) the Health Care Financing Administration mandatory 
        screening policy has not been effective, or sufficient, to 
        properly identify and screen children enrolled in the medicaid 
        program who are at risk;
            (9) only about \1/2\ of State programs have screening 
        policies consistent with Federal policy; and
            (10) adequate treatment services are not uniformly 
        available for children with elevated blood lead levels.
    (b) Purpose.--The purpose of this Act is to create a lead screening 
safety net that will, through the medicaid and State children's health 
insurance program, ensure that children enrolled in those programs 
receive blood lead screenings and appropriate followup care.

SEC. 3. INCREASED LEAD POISONING SCREENINGS AND TREATMENTS UNDER THE 
              MEDICAID PROGRAM.

    (a) Reporting Requirement.--Section 1902(a)(43)(D) of the Social 
Security Act (42 U.S.C. 1396a(a)(43)(D)) is amended--
            (1) in clause (iii), by striking ``and'' at the end;
            (2) in clause (iv), by striking the semicolon and inserting 
        ``, and''; and
            (3) by adding at the end the following new clause:
                            ``(v) the number of children who are under 
                        the age of 3 and enrolled in the State plan 
                        under this title and the number of those 
                        children who have received a blood lead 
                        screening test;''.
    (b) Mandatory Screening Requirements.--Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)) is amended--
            (1) in paragraph (64), by striking ``and'' at the end;
            (2) in paragraph (65), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (65) the following new 
        paragraph:
            ``(66) provide that each contract entered into between the 
        State and an entity (including a health insuring organization 
        and a medicaid managed care organization) that is responsible 
        for the provision (directly or through arrangements with 
        providers of services) of medical assistance under the State 
        plan shall provide for--
                    ``(A) compliance with mandatory blood lead 
                screening requirements that are consistent with 
                prevailing guidelines of the Centers for Disease 
                Control and Prevention for such screening; and
                    ``(B) coverage of qualified lead treatment services 
                described in section 1905(x) including diagnosis, 
                treatment, and follow-up furnished for children with 
                elevated blood lead levels in accordance with 
                prevailing guidelines of the Centers for Disease 
                Control and Prevention.''.
    (c) Reimbursement for Treatment of Children With Elevated Blood 
Lead Levels.--Section 1905 of the Social Security Act (42 U.S.C. 1396d) 
is amended--
            (1) in subsection (a)--
                    (A) in paragraph (26), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (27) as paragraph 
                (28); and
                    (C) by inserting after paragraph (26) the following 
                new paragraph:
            ``(27) qualified lead treatment services (as defined in 
        subsection (x)); and''; and
            (2) by adding at the end the following new subsection:
    ``(x)(1) In this subsection:
            ``(A) The term `qualified lead treatment services' means 
        the following:
                    ``(i) Lead-related medical management, as defined 
                in subparagraph (B).
                    ``(ii) Lead-related case management, as defined in 
                subparagraph (C), for a child described in paragraph 
                (2).
                    ``(iii) Lead-related anticipatory guidance, as 
                defined in subparagraph (D), provided as part of--
                            ``(I) prenatal services;
                            ``(II) early and periodic screening, 
                        diagnostic, and treatment services (EPSDT) 
                        described in subsection (r) and available under 
                        subsection (a)(4)(B) (including as described 
                        and available under implementing regulations 
                        and guidelines) to individuals enrolled in the 
                        State plan under this title who have not 
                        attained age 21; and
                            ``(III) routine pediatric preventive 
                        services.
            ``(B) The term `lead-related medical management' means the 
        provision and coordination of the diagnostic, treatment, and 
        follow-up services provided for a child diagnosed with an 
        elevated blood lead level (EBLL) that includes--
                    ``(i) a clinical assessment, including a physical 
                examination and medically indicated tests (in addition 
                to diagnostic blood lead level tests) and other 
                diagnostic procedures to determine the child's 
                developmental, neurological, nutritional, and hearing 
                status, and the extent, duration, and possible source 
                of the child's exposure to lead;
                    ``(ii) repeat blood lead level tests furnished when 
                medically indicated for purposes of monitoring the 
                blood lead concentrations in the child;
                    ``(iii) pharmaceutical services, including 
                chelation agents and other drugs, vitamins, and 
                minerals prescribed for treatment of an EBLL;
                    ``(iv) medically indicated inpatient services 
                including pediatric intensive care and emergency 
                services;
                    ``(v) medical nutrition therapy when medically 
                indicated by a nutritional assessment, that shall be 
                furnished by a dietitian or other nutrition specialist 
                who is authorized to provide such services under State 
                law;
                    ``(vi) referral--
                            ``(I) when indicated by a nutritional 
                        assessment, to the State agency or contractor 
                        administering the program of assistance under 
                        the special supplemental nutrition program for 
                        women, infants and children (WIC) under section 
                        17 of the Child Nutrition Act of 1966 (42 
                        U.S.C. 1786) and coordination of clinical 
                        management with that program; and
                            ``(II) when indicated by a clinical or 
                        developmental assessment, to the State agency 
                        responsible for early intervention and special 
                        education programs under the Individuals with 
                        Disabilities Education Act (20 U.S.C. 1400 et 
                        seq.); and
                    ``(vii) environmental investigation, as defined in 
                subparagraph (E).
            ``(C) The term `lead-related case management' means the 
        coordination, provision, and oversight of the nonmedical 
        services for a child with an EBLL necessary to achieve 
        reductions in the child's blood lead levels, improve the 
        child's nutrition, and secure needed resources and services to 
        protect the child by a case manager trained to develop and 
        oversee a multi-disciplinary plan for a child with an EBLL or 
        by a childhood lead poisoning prevention program, as defined by 
        the Secretary. Such services include--
                    ``(i) assessing the child's environmental, 
                nutritional, housing, family, and insurance status and 
                identifying the family's immediate needs to reduce lead 
                exposure through an initial home visit;
                    ``(ii) developing a multidisciplinary case 
                management plan of action that addresses the provision 
                and coordination of each of the following items as 
                appropriate--
                            ``(I) determination of whether or not such 
                        services are covered under the State plan under 
                        this title;
                            ``(II) lead-related medical management of 
                        an EBLL (including environmental 
                        investigation);
                            ``(III) nutrition services;
                            ``(IV) family lead education;
                            ``(V) housing;
                            ``(VI) early intervention services;
                            ``(VII) social services; and
                            ``(VIII) other services or programs that 
                        are indicated by the child's clinical status 
                        and environmental, social, educational, 
                        housing, and other needs;
                    ``(iii) assisting the child (and the child's 
                family) in gaining access to covered and non-covered 
                services in the case management plan developed under 
                clause (ii);
                    ``(iv) providing technical assistance to the 
                provider that is furnishing lead-related medical 
                management for the child; and
                    ``(v) implementation and coordination of the case 
                management plan developed under clause (ii) through 
home visits, family lead education, and referrals.
            ``(D) The term `lead-related anticipatory guidance' means 
        education and information for families of children and pregnant 
        women enrolled in the State plan under this title about 
        prevention of childhood lead poisoning that addresses the 
        following topics:
                    ``(i) The importance of lead screening tests and 
                where and how to obtain such tests.
                    ``(ii) Identifying lead hazards in the home.
                    ``(iii) Specialized cleaning, home maintenance, 
                nutritional, and other measures to minimize the risk of 
                childhood lead poisoning.
                    ``(iv) The rights of families under the Residential 
                Lead-Based Paint Hazard Reduction Act of 1992 (42 
                U.S.C. 4851 et seq.).
            ``(E) The term `environmental investigation' means the 
        process of determining the source of a child's exposure to lead 
        by an individual that is certified or registered to perform 
        such investigations under State or local law, including the 
        collection and analysis of information and environmental 
        samples from a child's living environment. For purposes of this 
        subparagraph, a child's living environment includes the child's 
        residence or residences, residences of frequently visited 
        caretakers, relatives, and playmates, and the child's day care 
        site. Such investigations shall be conducted in accordance with 
        the standards of the Department of Housing and Urban 
        Development for the evaluation and control of lead-based paint 
        hazards in housing and in compliance with State and local 
        health agency standards for environmental investigation and 
        reporting.
    ``(2) For purposes of paragraph (1)(A)(ii), a child described in 
this paragraph is a child who--
            ``(A) has attained 6 months but has not attained 6 years of 
        age; and
            ``(B) has been identified as having a blood lead level that 
        equals or exceeds 20 micrograms per deciliter (or after 2 
        consecutive tests, equals or exceeds 15 micrograms per 
        deciliter, or the applicable number of micrograms designated 
        for such tests under prevailing guidelines of the Centers for 
        Disease Control and Prevention).''.
    (d) Enhanced Match for Data Communications System.--Section 
1903(a)(3) of the Social Security Act (42 U.S.C. 1396b(a)(3)) is 
amended--
            (1) in subparagraph (D), by striking ``plus'' at the end 
        and inserting ``and''; and
            (2) by inserting after subparagraph (D), the following new 
        subparagraph:
                    ``(E)(i) 90 percent of so much of the sums expended 
                during such quarter as are attributable to the design, 
                development, or installation of an information 
                retrieval system that may be easily accessed and used 
                by other federally-funded means-tested public benefit 
                programs to determine whether a child is enrolled in 
                the State plan under this title and whether an enrolled 
                child has received mandatory early and periodic 
                screening, diagnostic, and treatment services, as 
                described in section 1905(r); and
                    ``(ii) 75 percent of so much of the sums expended 
                during such quarter as are attributable to the 
                operation of a system (whether such system is operated 
                directly by the State or by another person under a 
                contract with the State) of the type described in 
                clause (i); plus''.
    (e) Report.--The Secretary of Health and Human Services, acting 
through the Administrator of the Health Care Financing Administration, 
annually shall report to Congress on the number of children enrolled in 
the medicaid program under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) who have received a blood lead screening test 
during the prior fiscal year, noting the percentage that such children 
represent as compared to all children enrolled in that program.
    (f) Emergency Measures.--
            (1) In general.--Subject to paragraph (2), the Secretary of 
        Health and Human Services or the State agency administering the 
        State plan under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) shall use funds provided under title XIX 
        of that Act to reimburse a State or entity for expenditures for 
        medically necessary activities in the home of a lead-poisoned 
        child with an EBLL of at least 20, or a pregnant woman with an 
        EBLL of at least 20, to prevent additional exposure to lead, 
        including specialized cleaning of lead-contaminated dust, 
        emergency relocation, safe repair of peeling paint, dust 
        control, and other activities that reduce lead exposure. Such 
        reimbursement, when provided by the State agency administering 
        the State plan under title XIX of the Social Security Act, 
        shall be considered medical assistance for purposes of section 
        1903(a) of such Act.
            (2) Limitation.--Not more than $1,000 in expenditures for 
        the emergency measures described in paragraph (1) may be 
        incurred on behalf of a child or pregnant woman to which that 
        paragraph applies.
    (g) Rule of Construction.--Nothing in this Act or any amendment 
made by this Act shall be construed as requiring a child enrolled in 
the State medicaid program under title XIX of the Social Security Act 
to undergo a lead blood screening test if the child's parent or 
guardian objects to the test on the ground that the test is 
inconsistent with the parent's or guardian's religious beliefs.

SEC. 4. BONUS PROGRAM FOR IMPROVEMENT OF CHILDHOOD LEAD SCREENING 
              RATES.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') may establish a program 
to improve the blood lead screening rates of States for children under 
the age of 3 enrolled in the medicaid program.
    (b) Payments.--If the Secretary establishes a program under 
subsection (a), the Secretary, using State-specific blood lead 
screening data, shall, subject to the availability of appropriations, 
annually pay a State an amount determined as follows:
            (1) $25 per each 2 year-old child enrolled in the medicaid 
        program in the State who has received the minimum required (for 
        that age) screening blood lead level tests (capillary or venous 
samples) to determine the presence of elevated blood lead levels, as 
established by the Centers for Disease Control and Prevention, if the 
State rate for such screenings exceeds 65 but does not exceed 75 
percent of all 2 year-old children in the State.
            (2) $50 per each such child who has received such minimum 
        required tests if the State rate for such screenings exceeds 75 
        but does not exceed 85 percent of all 2 year-old children in 
        the State.
            (3) $75 per each such child who has received such minimum 
        required tests if the State rate for such screenings exceeds 85 
        percent of all 2 year-old children in the State.
    (c) Use of Bonus Funds.--Funds awarded to a State under subsection 
(b) shall only be used--
            (1) by the State department of health in the case of a 
        child with an elevated blood lead level who is enrolled in 
        medicaid or another Federal means-tested program designed to 
        reduce the source of the child's exposure to lead; or
            (2) in accordance with guidelines for the use of such funds 
        developed by the Secretary in collaboration with the Secretary 
        of Housing and Urban Development.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $30,000,000 for each of fiscal 
years 2002 through 2006.

SEC. 5. AUTHORIZATION TO USE SCHIP FUNDS FOR BLOOD LEAD SCREENING.

    (a) Optional Application to SCHIP.--
            (1) In general.--Section 2107(e)(1) of the Social Security 
        Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end 
        the following new subparagraph:
                    ``(E) At State option, section 1902(a)(66) 
                (relating to blood lead screening and coverage of 
                qualified lead treatment services defined in section 
                1905(x)).''.
            (2) Conforming amendment.--Section 2110(a) of the Social 
        Security Act (42 U.S.C. 1397jj(a)) is amended--
                    (A) by redesignating paragraph (28) as paragraph 
                (29); and
                    (B) by inserting after paragraph (27) the following 
                new paragraph:
            ``(28) qualified lead treatment services (as defined in 
        section 1905(x)), but only if the State has elected under 
        section 2107(e)(1)(E) to apply section 1902(a)(66) to the State 
        child health plan under this title.''.
    (b) Inclusion in Medicaid Reporting Requirement.--
            (1) In general.--Section 1902(a)(43)(D)(v) of the Social 
        Security Act (42 U.S.C. 1396a(a)(43)(D)(v)), as added by 
        section 3(a)(3), is amended by inserting ``or, if the State has 
        elected under section 2107(e)(1)(E) to apply paragraph (66) to 
        the State child health plan under title XXI, in the State plan 
        under title XXI,'' after ``this title''.
            (2) Report to congress.--Section 3(e) of this Act is 
        amended--
                    (A) by inserting ``or in the State children's 
                health insurance program under title XXI of that Act 
                (42 U.S.C 1397aa et seq.)'' after ``(42 U.S.C. 1396 et 
                seq.)''; and
                    (B) by striking ``that program'' and inserting 
                ``those programs''.

SEC. 6. EFFECTIVE DATE.

    This Act and the amendments made by this Act take effect on the 
date that is 18 months after the date of enactment of this Act.
                                 <all>
```