I
106TH CONGRESS
1ST SESSION
H. R. 1996
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 HOUSE OF REPRESENTATIVES
MAY 27, 1999
Mr. MENENDEZ
(for himself, Mr. RUSH, Mr. HILLIARD, and Ms.
SCHAKOWSKY) 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 ensure that children enrolled in Medicaid and other Fed-
eral means-tested programs at highest risk for lead poi-
soning are identified and treated, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives 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
1999’’ or the ‘‘Children’s Lead SAFE Act’’.
SEC. 2. FINDINGS AND PURPOSES.
(a) FINDINGS.—Congress finds that—
(1) lead poisoning remains a serious environ-
mental risk, especially to the health of young chil-
dren;
(2) childhood lead poisoning can cause reduc-
tions in IQ, attention span, reading, and learning
disabilities, and other growth and behavior problems;
(3) children under the age of 6 are at the great-
est risk of suffering the effects of lead poisoning be-
cause 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 develop-
ment 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 nation-
ally representative sample were enrolled in or tar-
geted by Federal health care programs, specifically
the medicaid program, the women, infants, and chil-
dren (WIC) program, 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 by Federal health care pro-
grams have never been screened for lead;
(7) although the Health Care Financing Admin-
istration 
has 
required 
mandatory 
blood 
lead
screenings for children enrolled in the medicaid pro-
gram who are not less that 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 uni-
formly 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,
women, infants, and children (WIC), head start and early
head start programs that include infants and toddlers, and
the maternal and child health block grant programs, en-
sure that children covered by those programs receive blood
lead screenings and appropriate followup care.
SEC. 3. INCREASED LEAD POISONING SCREENINGS AND
TREATMENTS UNDER THE MEDICAID PRO-
GRAM.
(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:
‘‘(v) the number of children who are
under the age of 3 and enrolled in the
State plan and the number of those chil-
dren who have received a blood lead
screening test;’’.
(b) MANDATORY SCREENING REQUIREMENTS.—Sec-
tion 1902(a) of the Social Security Act (42 U.S.C.
1396a(a)) is amended—
(1) in paragraph (65), by striking the period
and inserting ‘‘; and’’; and
(2) by adding at the end the following:
‘‘(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 screen-
ing; and
‘‘(B) coverage of qualified lead treatment
services described in section 1905(v) 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 CHIL-
DREN 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:
‘‘(27) qualified lead treatment services (as de-
fined in subsection (v)); and’’; and
(2) by adding at the end the following:
‘‘(v)(1) In this subsection:
‘‘(A) The term ‘qualified lead treatment serv-
ices’ means the following:
‘‘(i) Lead-related medical management, as
defined in subparagraph (B).
‘‘(ii) Lead-related case management, as de-
fined 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, di-
agnostic, and treatment services (EPSDT)
services described in subsection (r) and
available under subsection (a)(4)(B) (in-
cluding 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 manage-
ment’ means the provision and coordination of the
diagnostic, treatment, and follow-up services pro-
vided 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 deter-
mine the child’s developmental, neurological,
nutritional, and hearing status, and the extent,
duration, and possible source of the child’s ex-
posure to lead;
‘‘(ii) repeat blood lead level tests furnished
when medically indicated for purposes of moni-
toring 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 emer-
gency services;
‘‘(v) medical nutrition therapy when medi-
cally indicated by a nutritional assessment, that
shall be furnished by a dietitian or other nutri-
tion 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 con-
tractor administering the program of as-
sistance under the special supplemental
food program for women, infants and chil-
dren (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 de-
fined 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 sta-
tus 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 fol-
lowing classes of services as appropriate—
‘‘(I) whether or not such services are
covered under the State plan under this
title;
‘‘(II) lead-related medical manage-
ment of an EBLL (including environ-
mental 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, edu-
cational, 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 edu-
cation, and referrals.
‘‘(D) The term ‘lead-related anticipatory guid-
ance’ means education and information for families
of children and pregnant women enrolled in the
State plan under this title about prevention of child-
hood lead poisoning that addresses the following top-
ics:
‘‘(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 mainte-
nance, nutritional, and other measures to mini-
mize the risk of childhood lead poisoning.
‘‘(iv) The rights of families under the Resi-
dential 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 cer-
tified 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 in-
cludes the child’s residence or residences, residences
of frequently visited caretakers, relatives, and play-
mates, and the child’s day care site. Such investiga-
tions 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 en-
vironmental investigation and reporting.
‘‘(2) For purposes of paragraph (1)(A)(ii), a child de-
scribed in this paragraph is a child who—
‘‘(A) has attained 6 months but has not at-
tained 6 years of age; and
‘‘(B) has been identified as having a blood lead
level that equals or exceeds 20 micrograms per deci-
liter (or after 2 consecutive tests, equals or exceeds
15 micrograms per deciliter, or the applicable num-
ber of micrograms designated for such tests under
prevailing guidelines of the Centers for Disease Con-
trol 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:
‘‘(E)(i) 90 percent of so much of the sums
expended during such quarter as are attrib-