I

105TH CONGRESS

2D SESSION H. R. 4825

To require proof of screening for lead poisoning and to ensure that children

at highest risk are identified and treated.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 13, 1998

Mr. MENENDEZ introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committee on Education and

the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To require proof of screening for lead poisoning and to

ensure that children at highest risk are identified and

treated.

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 ‘‘Childhood Lead Poi5 soning Protection Act of 1998’’.

6 SEC. 2. FINDINGS AND PURPOSES.

7 (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 because of the sensitivity of their developing

9 brains and nervous systems;

10 (4) poor children and minority children are at

11 substantially higher risk of lead poisoning;

12 (5) it is estimated that more than 500,000 chil13 dren enrolled in Medicaid have harmful levels of lead

14 in their blood;

15 (6) children enrolled in Medicaid represent 60

16 percent of the 890,000 children in the United States

17 with elevated blood lead levels;

18 (7) although the Health Care Financing Admin19 istration has required mandatory blood lead

20 screenings for children enrolled in Medicaid who are

21 not less than 1 nor more than 5 years of age, ap22 proximately two-thirds of children enrolled in Medic23 aid have not been screened or treated;

24 (8) the Health Care Financing Administration

25 mandatory screening policy has not been effective, or
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1 sufficient, to properly identify and screen children

2 enrolled in Medicaid who are at risk;

3 (9) uniform lead screening requirements do not

4 exist for children not enrolled in Medicaid; and

5 (10) adequate treatment services are not uni6 formly available for children with elevated blood lead

7 levels.

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

9 a lead screening safety net that will, through Medicaid and

10 other entitlement programs, ensure that low-income chil11 dren at the highest risk of lead poisoning receive blood

12 lead screenings and appropriate followup care.

13 SEC. 3. INCREASED LEAD POISONING SCREENINGS AND

14 TREATMENTS UNDER THE MEDICAID PRO15 GRAM.

16 (a) PENALTY FOR INSUFFICIENT INCREASES IN

17 LEAD POISONING SCREENINGS.—

18 (1) PERFORMANCE IMPROVEMENT.—Section

19 1903 of the Social Security Act (42 U.S.C. 1396b)

20 is amended by adding at the end the following:

21 ‘‘(x) PERFORMANCE IMPROVEMENT.—

22 ‘‘(1) IN GENERAL.—Notwithstanding section

23 1905(b), beginning with fiscal year 2000 and for

24 each fiscal year thereafter, with respect to any State

25 that fails to meet minimum blood lead screening
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1 rates stated in paragraph (2), the Federal medical

2 assistance percentage determined under section

3 1905(b) for the State for the fiscal year shall be re4 duced by 1 percentage point, but only with respect

5 to—

6 ‘‘(A) items and services furnished under a

7 State plan under this title during that fiscal

8 year;

9 ‘‘(B) payments made on a capitation or

10 other risk-basis under a State plan under this

11 title for coverage occurring during that fiscal

12 year; and

13 ‘‘(C) payments under a State plan under

14 this title that are attributable to DSH allot15 ments for the State determined under section

16 1923(f) for that fiscal year.

17 ‘‘(2) MINIMUM BLOOD LEAD SCREENING

18 RATES.—The minimum acceptable percentages of 2-

19 year-old Medicaid-enrolled children who have re20 ceived at least 1 blood lead screening test are—

21 ‘‘(A) 50 percent in fiscal year 2000;

22 ‘‘(B) 60 percent in fiscal year 2001;

23 ‘‘(C) 70 percent in fiscal year 2002;

24 ‘‘(D) 80 percent in fiscal year 2003; and
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1 ‘‘(E) 90 percent in each fiscal year after

2 fiscal year 2003.

3 ‘‘(3) MODIFICATION OR WAIVER.—The Sec4 retary may modify or waive the application of para5 graph (1) in the case of a State that the Secretary

6 determines has performed during a fiscal year such

7 a significant number of lead blood level assessments

8 that the State reasonably cannot be expected to

9 achieve the minimum blood lead screening rates es10 tablished by paragraph (2).’’.

11 (2) REPORTING REQUIREMENT.—Section

12 1902(a)(43)(D) of the Social Security Act (42

13 U.S.C. 1396a(a)(43)(D)) is amended—

14 (A) in clause (iii), by striking ‘‘and’’ at the

15 end;

16 (B) in clause (iv), by striking the semi17 colon and inserting ‘‘, and’’; and

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

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

20 not more than 2 years of age and enrolled

21 in the Medicaid Program and the number

22 and results of lead blood level assessments

23 performed by the State, along with demo24 graphic and identifying information that is

25 consistent with the recommendations of the
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1 Centers for Disease Control and Preven2 tion with respect to lead surveillance;’’.

3 (b) MANDATORY SCREENING REQUIREMENTS.—Sec4 tion 1902(a) of the Social Security Act (42 U.S.C.

5 1396a(a)) is amended—

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

7 and inserting ‘‘; and’’; and

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

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

10 between the State and an entity (including a health

11 insuring organization and a Medicaid managed care

12 organization) that is responsible for the provision

13 (directly or through arrangements with providers of

14 services) of medical assistance under the State plan

15 shall provide for—

16 ‘‘(A) compliance with mandatory screening

17 requirements for lead blood level assessments

18 (as appropriate for age and risk factors) that

19 are commensurate with guidelines and man20 dates issued by the Secretary through the Ad21 ministrator of the Health Care Financing Ad22 ministration; and

23 ‘‘(B) coverage of appropriate qualified lead

24 treatment services, as prescribed by the Centers

25 for Disease Control and Prevention guidelines,
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1 for children with elevated levels of lead in their

2 blood.’’.

3 (c) REIMBURSEMENT FOR TREATMENT OF CHIL4 DREN WITH ELEVATED BLOOD LEAD LEVELS.—Section

5 1905 of the Social Security Act (42 U.S.C. 1396d) is

6 amended—

7 (1) in subsection (a)—

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

9 at the end;

10 (B) by redesignating paragraph (27) as

11 paragraph (28); and

12 (C) by inserting after paragraph (26) the

13 following:

14 ‘‘(27) qualified lead treatment services (as de15 fined in subsection (v);’’; and

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

17 ‘‘(v)(1) The term ‘qualified lead treatment services’

18 means all appropriate and medically necessary services

19 that are provided by a qualified provider, as determined

20 by the State, to treat a child described in paragraph (2),

21 including—

22 ‘‘(A) environmental investigations to determine

23 the source of a child’s lead exposure, including the

24 costs of qualified and trained professionals (includ25 ing health professionals and lead professionals cer-
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1 tified by the State or the Environmental Protection

2 Agency) to conduct such investigations and the costs

3 of laboratory testing of substances suspected of

4 being significant pathways for lead exposure (such

5 as lead dust, paint chips, bare soil, and water);

6 ‘‘(B) professional case management services to

7 coordinate access to such services; and

8 ‘‘(C) emergency measures to reduce or elimi9 nate lead hazards to a child, if required (as rec10 ommended by the Centers for Disease Control and

11 Prevention).

12 ‘‘(2) For purposes of paragraph (1), a child described

13 in this paragraph is a child who—

14 ‘‘(A) has attained 6 months of age but has not

15 attained 73 months of age; and

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

17 level that equals or exceeds 20 micrograms per deci18 liter (or persistently equals or exceeds 15

19 micrograms per deciliter).’’.

20 (d) EFFECTIVE DATE.—

21 (1) IN GENERAL.—The amendments made by

22 this section apply on and after October 1, 1998.

23 (2) EXTENSION OF EFFECTIVE DATE FOR

24 STATE LAW AMENDMENT.—In the case of a State

25 plan under title XIX of the Social Security Act
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1 which the Secretary of Health and Human Services

2 determines requires State legislation in order for the

3 plan to meet the additional requirements imposed by

4 the amendments made by this section, the State

5 plan shall not be regarded as failing to comply with

6 the requirements of this section solely on the basis

7 of its failure to meet these additional requirements

8 before the first day of the first calendar quarter be9 ginning after the close of the first regular session of

10 the State legislature that begins after the date of the

11 enactment of this Act. For purposes of the previous

12 sentence, in the case of a State that has a 2-year

13 legislative session, each year of the session is consid14 ered to be a separate regular session of the State

15 legislature.

16 SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUP17 PLEMENTAL NUTRITION PROGRAM FOR

18 WOMEN, INFANTS, AND CHILDREN.

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

20 U.S.C. 1786(d)) is amended by adding at the end the fol21 lowing:

22 ‘‘(4) LEAD POISONING SCREENING.—

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B), for an infant or child to be eligible

25 to participate in the program under this sec-
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1 tion, a member of the family of the infant or

2 child shall provide proof to the State agency,

3 not later than 180 days after enrollment of the

4 infant or child in the program and periodically

5 thereafter (as determined by the State agency),

6 that the infant or child has received a blood

7 lead test for lead poisoning using an assessment

8 that is appropriate for age and risk factors.

9 ‘‘(B) WAIVERS.—A State agency or local

10 agency may waive the requirement of subpara11 graph (A) with respect to an infant or child if

12 the State agency or local agency determines

13 that—

14 ‘‘(i) the area in which the infant or

15 child resides does not pose a risk of lead

16 poisoning; or

17 ‘‘(ii) the requirement would be con18 trary to the religious beliefs or moral con19 victions of the family of the infant or child.

20 ‘‘(C) SCREENINGS BY STATE AGENCIES.—

21 ‘‘(i) IN GENERAL.—On the request of

22 a member of a family of an infant or child

23 who has not been screened for lead poison24 ing and who seeks to participate in the

25 program, at no charge to the family, a
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1 State agency shall perform a blood lead

2 test on the infant or child that is appro3 priate for age and risk factors.

4 ‘‘(ii) REIMBURSEMENT.—On the re5 quest of a State agency that screens for

6 lead poisoning under clause (i) an infant or

7 child that is receiving medical assistance

8 under a State plan under title XIX of the

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

10 seq.), the Secretary of Health and Human

11 Services shall reimburse the State agency,

12 from funds that are made available under

13 that title, for the cost of the screening (in14 cluding the cost of purchasing portable

15 blood lead analyzer instruments approved

16 for sale by the Food and Drug Administra17 tion and providing screening with the use

18 of such instruments through laboratories

19 certified under section 353 of the Public

20 Health Service Act (42 U.S.C. 263a)).’’.

21 SEC. 5. LEAD POISONING SCREENING FOR EARLY HEAD

22 START PROGRAMS.

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

24 9840a) is amended—
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1 (1) in subsection (c)(2), by inserting before the

2 semicolon the following: ‘‘, if the families comply

3 with subsection (i)’’; and

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

5 ‘‘(i) LEAD POISONING SCREENING.—

6 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

7 for a child to be eligible to participate in a program

8 described in subsection (a)(1), a member of the fam9 ily of the child shall provide proof to the entity car10 rying out the program, not later than 180 days after

11 enrollment of the child in the program and periodi12 cally thereafter (as determined by the entity), that

13 the child has received a blood lead test for lead poi14 soning using an assessment that is appropriate for

15 age and risk factors.

16 ‘‘(2) WAIVERS.—The entity may waive the re17 quirement of paragraph (1) with respect to a child

18 if the entity determines that—

19 ‘‘(A) the area in which the child resides

20 does not pose a risk of lead poisoning; or

21 ‘‘(B) the requirement would be contrary to

22 the religious beliefs or moral convictions of the

23 family of the child.

24 ‘‘(3) SCREENINGS BY ENTITIES.—
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1 ‘‘(A) IN GENERAL.—On the request of a

2 member of a family of a child who has not been

3 screened for lead poisoning and who seeks to

4 participate in the program, at no charge to the

5 family, the entity shall perform a blood lead

6 test on the child that is appropriate for age and

7 risk factors.

8 ‘‘(B) REIMBURSEMENT.—On the request

9 of an entity that screens for lead poisoning

10 under subparagraph (A) a child that is receiv11 ing medical assistance under a State plan under

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

13 1396 et seq.), the Secretary shall reimburse the

14 entity, from funds that are made available

15 under that title, for the cost of the screening

16 (including the cost of purchasing portable blood

17 lead analyzer instruments approved for sale by

18 the Food and Drug Administration and provid19 ing screening with the use of such instruments

20 through laboratories certified under section 353

21 of the Public Health Service Act (42 U.S.C.

22 263a)).’’.

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