utable to the design, development, or installa-
tion of an information retrieval system that
may be easily accessed and used by other feder-
ally-funded means-tested public benefit pro-
grams 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 treat-
ment services, as described in section 1905(r);
and
‘‘(ii) 75 percent of so much of the sums ex-
pended during such quarter as are attributable
to the operation of a system (whether such sys-
tem is operated directly by the State or by an-
other 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 med-
icaid 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 per-
centage that such children represent as compared to all
children enrolled in that program.
(f) RULE OF CONSTRUCTION.—Nothing in this Act
or in any amendment made by this Act shall be construed
as prohibiting the Secretary of Health and Human Serv-
ices or the State agency administering the State plan
under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) from using 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 to prevent additional exposure to lead, in-
cluding specialized cleaning of lead-contaminated dust,
emergency relocation, safe repair of peeling paint, dust
control, and other activities that reduce lead exposure.
SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUP-
PLEMENTAL FOOD PROGRAM FOR WOMEN,
INFANTS, AND CHILDREN.
Section 17(d) of the Child Nutrition Act of 1966 (42
U.S.C. 1786(d)) is amended by adding at the end the fol-
lowing:
‘‘(4) LEAD POISONING SCREENING.—
‘‘(A) 
IN
GENERAL.—A 
State 
agency
shall—
‘‘(i) determine whether an infant or
child eligible to participate in the program
under this section has received a blood lead
screening test using a test that is appro-
priate for age and risk factors upon the
enrollment of the infant or child in the
program; and
‘‘(ii) in the case of an infant or child
who has not received a blood lead screen-
ing test—
‘‘(I) refer the infant or child for
receipt of the test; and
‘‘(II) determine whether the in-
fant or child receives the test during
a routine visit with a health care pro-
vider.
‘‘(B) SCREENINGS BY STATE AGENCIES.—
‘‘(i) IN
GENERAL.—A State agency
may (under contract or otherwise) perform
a blood lead screening test that is appro-
priate for age and risk factors on an infant
or child who seeks to participate in the
program.
‘‘(ii) REIMBURSEMENT.—
‘‘(I) CHILDREN ENROLLED IN OR
ELIGIBLE FOR MEDICAID.—On the re-
quest of a State agency that performs
or arranges for the provision of a
blood lead screening test under clause
(i) of an infant or child that is eligible
for or receiving medical assistance
under a State plan under title XIX of
the Social Security Act (42 U.S.C.
1396 et seq.), the Secretary of Health
and Human Services, notwithstanding
any other provision of, or limitation
under, title XIX of the Social Security
Act, shall reimburse the State agency,
from funds that are made available
under that title, for the Federal med-
ical assistance percentage (as defined
in section 1905(b) of the Social Secu-
rity Act (42 U.S.C. 1396d(b)) of the
cost of the test and data reporting.
Such costs shall include, if determined
to be desirable by the State agency,
the 
costs 
of 
providing 
screening
through clinical laboratories certified
under section 353 of the Public
Health Service Act (42 U.S.C. 263a),
or purchasing, for use at sites pro-
viding services under this section,
blood lead testing instruments and as-
sociated supplies approved for sale by
the Food and Drug Administration
and used in compliance with such sec-
tion 353.
‘‘(II) CHILDREN
ENROLLED
IN
OR ELIGIBLE FOR SCHIP.—In the case
of a blood lead screening test per-
formed under clause (i) (by the State
agency or under contract with the
State agency) on an infant or child
who is eligible for or receiving medical
assistance under a State plan under
title XXI of the Social Security Act,
the Secretary of Health and Human
Services, notwithstanding any other
provision of, or limitation under, such
title XXI, shall reimburse the State
agency, from funds that are made
available under that title, for the en-
hanced FMAP (as defined in section
2105(b) of the Social Security Act (42
U.S.C. 1397ee(b)) of the cost of the
test and data reporting. Such costs
shall include the costs described in the
second sentence of subclause (I).
‘‘(C) AUTHORIZATION FOR WIC.—There is
authorized to be appropriated such sums as
may be necessary to carry out this paragraph
with respect to blood lead screening tests per-
formed under this paragraph on an infant or
child, and any data reporting with respect to
such infant or child, who is not eligible for cov-
erage under title XIX or XXI of the Social Se-
curity Act, or is not otherwise covered under a
health insurance plan.’’.
SEC. 5. LEAD POISONING SCREENING FOR EARLY HEAD
START AND HEAD START PROGRAMS.
Section 645A of the Head Start Act (42 U.S.C
9840a) is amended—
(1) in the first sentence of subsection (d), by in-
serting before the period the following: ‘‘and shall
comply with subsection (h)’’; and
(2) by adding at the end the following:
‘‘(h) LEAD POISONING SCREENING.—
‘‘(1) IN GENERAL.—An entity shall—
‘‘(A) determine whether a child eligible to
participate in the program described in sub-
section (a)(1) has received a blood lead screen-
ing test using a test that is appropriate for age
and risk factors upon the enrollment of the
child in the program; and
‘‘(B) in the case of a child who has not re-
ceived a blood lead screening test, ensure that
each enrolled child receives such a test either by
referral or by performing the test (under con-
tract or otherwise).
‘‘(2) SCREENINGS BY ENTITIES.—
‘‘(A) IN GENERAL.—An entity may (under
contract or otherwise) perform a blood lead
screening test that is appropriate for age and
risk factors on a child who seeks to participate
in the program.
‘‘(B) REIMBURSEMENT.—
‘‘(i) CHILDREN ENROLLED IN OR ELI-
GIBLE FOR MEDICAID.—On the request of
an entity that performs or arranges for the
provision of a blood lead screening test
under subparagraph (A) of a child that is
eligible for or receiving medical assistance
under a State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et
seq.), the Secretary of Health and Human
Services, notwithstanding any other provi-
sion of, or limitation under, title XIX of
the Social Security Act, shall reimburse
the entity, from funds that are made avail-
able under that title, for the Federal med-
ical assistance percentage (as defined in
section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)) of the cost of the
test and data reporting. Such costs shall
include, if determined to be desirable by
the State agency, the costs of providing
screening through clinical laboratories cer-
tified under section 353 of the Public
Health Service Act (42 U.S.C. 263a), or
purchasing, for use at sites providing serv-
ices under this section, blood lead testing
instruments and associated supplies ap-
proved for sale by the Food and Drug Ad-
ministration and used in compliance with
such section 353.
‘‘(ii) CHILDREN ENROLLED IN OR EL-
IGIBLE FOR SCHIP.—In the case of a blood
lead screening test performed under sub-
paragraph (A) (by the entity or under con-
tract with the entity) on a child who is eli-
gible for or receiving medical assistance
under a State plan under title XXI of the
Social Security Act, the Secretary of
Health and Human Services, notwith-
standing any other provision of, or limita-
tion under, such title XXI, shall reimburse
the entity, from funds that are made avail-
able under that title, for the enhanced
FMAP (as defined in section 2105(b) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1397ee(b)) of the cost of the test and data
reporting. Such costs shall include the
costs described in the second sentence of
clause (i).
‘‘(3) 
AUTHORIZATION
FOR
EARLY
HEAD
START.—There is authorized to be appropriated
such sums as may be necessary to carry out this
subsection with respect to blood lead screening tests
performed under this subsection on an infant or
child, and any data reporting with respect to such
infant or child, who is not eligible for coverage under
title XIX or XXI of the Social Security Act, or is
not otherwise covered under a health insurance plan.
‘‘(4) HEAD START.—The provisions of this sub-
section shall apply to head start programs that in-
clude coverage, directly or indirectly, for infants and
toddlers under the age of 3 years.’’.
SEC. 6. SCHIP COVERAGE FOR SCREENING OF CHILDREN.
(a) IN GENERAL.—Title XXI of the Social Security
Act is amended by adding at the end the following new
section:
‘‘SEC. 2111. COVERAGE FOR LEAD POISONING SCREENING
OF CHILDREN.
‘‘(a) COVERAGE.—Notwithstanding any other provi-
sion of this title, a State child health plan shall provide
for coverage of the costs (including data reporting) of a
blood lead screening test performed by—
‘‘(1) a State agency administering the special
supplemental food program for women, infants and
children (WIC) under section 17 of the Child Nutri-
tion Act of 1966 (42 U.S.C. 1786) in accordance
with section 17(d)(4)(B) of that Act; or
‘‘(2) an entity in accordance with section
645A(h)(2) of the Head Start Act (42 U.S.C
9840a(h)(2)).
‘‘(b) 
REFERENCES
TO
TERMS
AND
SPECIAL
RULES.—With respect to the coverage described in sub-
section (a), the following special rules apply:
‘‘(1) Any reference in this title to a targeted
low-income child is deemed to include a reference to
a child who receives a blood lead screening test per-
formed by a State agency or entity described in sub-
section (a).
‘‘(2) Any such reference to child health assist-
ance with respect to such a child is deemed a ref-
erence to the costs (including data reporting) of
such a test.
‘‘(3) Subsection (a) of section 2103 (relating to
required scope of health insurance coverage) shall
not apply insofar to such coverage and the reference
to such section in section 2105(a)(1) is deemed not
to require, in such case, compliance with the require-
ments of section 2103(a).
‘‘(4) There shall be no exclusion of benefits for
such coverage based on any pre-existing condition
and no waiting period (including a waiting period to
carry out section 2102(b)(3)(C)) shall apply.
‘‘(c) NO IMPACT ON ALLOTMENTS.—Nothing in this
section shall be construed as affecting the amount of any
initial allotment provided to a State under section
2104(b).
‘‘(d) APPLICATION OF FUNDING RESTRICTIONS.—
The coverage under this section (and the funding of such
coverage) is subject to the restrictions of section
2105(c).’’.
(b) 
CONFORMING
AMENDMENT.—Section
2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B))
is amended—
(1) by striking ‘‘and’’ at the end of clause (i);
(2) by striking the period at the end of clause
(ii) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
clause:
‘‘(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a child
described in section 2111 who is deemed a
targeted low-income child under that sec-
tion.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section take effect on the date described in section
11(a) and apply to allotments for all fiscal years.
SEC. 7. CENTERS FOR DISEASE CONTROL AND PREVEN-
TION 
EFFORTS 
TO 
COMBAT 
CHILDHOOD
LEAD POISONING.
(a) REQUIREMENTS FOR LEAD POISONING PREVEN-
TION GRANTEES.—Section 317A of the Public Health
Service Act (42 U.S.C. 247b–1) is amended—
(1) in subsection (d)—
(A) by redesignating paragraph (7) as
paragraph (8); and
(B) by inserting after paragraph (6) the
following:
‘‘(7) Assurances satisfactory to the Secretary
that the applicant will ensure complete and con-
sistent reporting of all blood lead test results from
laboratories and health care providers to State and
local health departments in accordance with guide-
lines of the Centers for Disease Control and Preven-
tion for standardized reporting as described in sub-
section (l).’’; and
(2) in subsection (j)(2)—
(A) in subparagraph (F) by striking ‘‘(E)’’
and inserting ‘‘(F)’’;
(B) by redesignating subparagraph (F) as
subparagraph (G); and
(C) by inserting after subparagraph (E)
the following:
‘‘(F) The number of grantees that have es-
tablished systems to ensure mandatory report-
ing of all blood lead tests from laboratories and
health care providers to State and local health
departments.’’.
(b) GUIDELINES FOR STANDARDIZED REPORTING.—
Section 317A of the Public Health Service Act (42 U.S.C.
247b–1) is amended by adding at the end the following:
‘‘(l) GUIDELINES
FOR
STANDARDIZED
REPORT-
ING.—The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall develop
national guidelines for the uniform and complete reporting
of all blood test results to State and local health depart-
ments.’’.
(c) EARMARK OF OTHER GRANT FUNDS.—Section
317A of the Public Health Service Act (42 U.S.C. 247b–
1), as amended by subsection (b), is amended by adding
at the end the following:
‘‘(m) REQUIREMENT FOR USE OF FUNDS.—Notwith-
standing any other provision of law, any individual or enti-
ty that receives from the Secretary, acting through the
Director of the Centers for Disease Control and Preven-
tion, a grant under this section or any other section of
this Act to carry out activities relating to childhood lead
poisoning prevention shall use 10 percent of the grant
funds awarded for the purpose of funding screening as-
sessments and referrals at State and local sites of oper-
ation of the program of assistance under the special sup-
plemental food program for women, infants and children
(WIC) under section 17 of the Child Nutrition Act of 1966
(42 U.S.C. 1786) or the early head start program under
section 645A of the Head Start Act (42 U.S.C 9840a).’’.
(d) DEVELOPMENT AND IMPLEMENTATION OF EF-
FECTIVE DATA MANAGEMENT BY THE CENTERS FOR DIS-
EASE CONTROL AND PREVENTION.—
(1) IN GENERAL.—The Director of the Centers
for Disease Control and Prevention shall—
(A) assist with the improvement of data
linkages between State and local health depart-
ments and between State health departments
and the Centers for Disease Control and Pre-
vention;
(B) assist States with the development of
flexible, comprehensive State-based data man-
agement systems for the surveillance of children
with lead poisoning that has the capacity to
contribute to a national data set;
(C) assist with the improvement of the
ability of State-based data management systems
and federally-funded means-tested public ben-
efit programs (including the special supple-
mental food program for women, infants and
children (WIC) under section 17 of the Child
Nutrition Act of 1966 (42 U.S.C. 1786) and
the early head start program under section
645A of the Head Start Act (42 U.S.C
9840a(h)) to respond to ad hoc inquiries and
generate progress reports regarding the lead
blood level screening of children enrolled in
those programs that may be used in training
and education programs conducted by the Cen-
ters for health care providers;
(D) assist with the establishment of a
State capacity for assessing how many children
enrolled in the medicaid, WIC, early head start,
and other federally-funded means-tested public
benefit programs are being screened for lead
poisoning at age-appropriate intervals;
(E) use data obtained as result of activities
under this section to formulate or revise exist-
ing lead blood screening and case management
policies; and
(F) establish performance measures for
evaluating State and local implementation of
the requirements and improvements described
in subparagraphs (A) through (E).
(2) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to carry out
this subsection, $10,000,000 for each of fiscal years
2000 and 2001.
(3) EFFECTIVE DATE.—This subsection takes
effect on the date of enactment of this Act.
SEC. 8. GRANTS FOR LEAD POISONING RELATED ACTIVI-
TIES.
Title V of the Social Security Act (42 U.S.C. 701
et seq.) is amended by adding at the end the following:
‘‘SEC. 511. GRANTS FOR LEAD POISONING RELATED ACTIVI-
TIES.
‘‘(a) AUTHORITY TO MAKE GRANTS.—
‘‘(1) IN GENERAL.—In addition to any other
payments made under this title to a State or any
other entity, the Secretary shall award grants to
States to support public health activities in States
and localities where data suggest that more than 5
percent of preschool-age children have had lead ex-
posure greater than 10 micrograms per deciliter
through—
‘‘(A) effective, ongoing outreach and com-
munity education targeted to families most like-
ly to be at risk for lead poisoning;
‘‘(B) individual family education activities
that are designed to reduce ongoing exposures
to lead for children with elevated blood lead lev-
els, including through home visits and coordina-
tion with other programs designed to identify
and treat children at risk for lead poisoning;
and
‘‘(C) the development, coordination and
implementation of community-based approaches
for comprehensive lead poisoning prevention
from surveillance to lead hazard control.
‘‘(2) STATE MATCH.—A State is not eligible for
a grant under this section unless the State agrees to
expend (through State or local funds) $3 for every
$4 provided under the grant to carry out the activi-
ties described in paragraph (1).
‘‘(3) APPLICATION.—A State shall submit an
application to the Secretary for a grant under this
section in such form and manner and containing
such information as the Secretary may require.
‘‘(b) PERFORMANCE
MEASURES.—The Secretary
shall establish needs indicators and performance measures
to evaluate the activities carried out under grants awarded
under this section. Such indicators shall be commensurate
with the national measures of the program under this title
and shall be developed in consultation with the Director
of the Centers for Disease Control and Prevention.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
is authorized to be appropriated to carry out this section,
$20,000,000 for each of fiscal years 2000 through 2004.
‘‘(d) APPLICATION
OF
OTHER
PROVISIONS
OF
TITLE.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the other provisions of this title shall not
apply to a grant made, or activities of the Secretary,
under this section.
‘‘(2) EXCEPTIONS.—The following provisions of
this title shall apply to a grant made under sub-
section (a) to the same extent and in the same man-
ner as such provisions apply to allotments made
under section 502(c):
‘‘(A) Section 504(b)(1) (relating to ex-
penditures for inpatient services).
‘‘(B) Section 504(b)(4) (relating to ex-
penditures of funds as a condition of receipt of
Federal funds).
‘‘(C) Section 504(b)(5) (relating to limita-
tions on funds for research).
‘‘(D) Section 504(b)(6) (relating to prohi-
bition on payments to excluded individuals and
entities).
‘‘(E) Section 506 (relating to reports and
audits), but only to the extent determined by
the Secretary to be appropriate for grants made
under this section.
‘‘(F) Section 507 (relating to penalties for
false statements).
‘‘(G) 
Section 
508 
(relating 
to 
non-
discrimination).’’.
SEC. 9. TRAINING AND REPORTS BY THE HEALTH RE-
SOURCES AND SERVICES ADMINISTRATION.
(a) TRAINING.—The Secretary of Health and Human
Services, acting through the Administrator of the Health
Resources and Services Administration and in collabora-
tion with the Administrator of the Health Care Financing
Administration and the Director of the Centers for Dis-
ease Control and Prevention, shall conduct education and
training programs for physicians and other health care
providers regarding childhood lead poisoning, current
screening and treatment recommendations and require-
ments, and the scientific, medical, and public health basis
for those policies.
(b) REPORT.—The Secretary of Health and Human
Services, acting through the Administrator of the Health
Resources and Services Administration, annually shall re-
port to Congress on the number of children who received
services through community health centers established
under section 330 of the Public Health Service Act (42
U.S.C. 254b) and received a blood lead screening test dur-
ing the prior fiscal year, noting the percentage that such
children represent as compared to all children who re-
ceived services through such community health centers.
SEC. 10. CDC BONUS PROGRAM FOR IMPROVEMENT OF
CHILDHOOD LEAD SCREENING RATES.
(a) IN GENERAL.—The Director of the Centers for
Disease Control and Prevention shall establish a program
to improve the blood lead screening rates of States for
children under the age of 3 enrolled in the medicaid pro-
gram.
(b) PAYMENTS.—Under the program established
under subsection (a), the Director, using State-specific
blood lead screening data, shall, subject to the availability
of appropriations, annually pay a State an amount deter-
mined 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 de-
termine the presence of elevated blood lead levels, as
established by the Centers for Disease Control and
Prevention, if the State rate for such screenings ex-
ceeds 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 Director of the Centers
for Disease Control and Prevention in collaboration
with the Secretary of Housing and Urban Develop-
ment.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated to carry out this section,
$30,000,000 for each of fiscal years 2000 through 2004.
SEC. 11. GENERAL EFFECTIVE DATE.
(a) IN GENERAL.—Except as provided in section
7(d)(3) and subsection (b), the amendments made by this
Act take effect on the date that is 18 months after the
date of enactment of this Act.
(b) WIC AND EARLY HEAD START WAIVERS.—
(1) IN GENERAL.—A State agency or contractor
administering the program of assistance under the
special supplemental food program for women, in-
fants and children (WIC) under section 17 of the
Child Nutrition Act of 1966 (42 U.S.C. 1786), or an
entity carrying out activities under section 645A of
the Head Start Act (42 U.S.C 9840a) may be
awarded a waiver from the amendments made by
sections 4 and 5 (as applicable) if the State where
the agency, contractor, or entity is located estab-
lishes to the satisfaction of the Secretary of Health
and Human Services, in accordance with require-
ments and procedures recommended in accordance
with paragraph (2) to the Secretary by the Director
of the Centers for Disease Control and Prevention,
in consultation with the Centers for Disease Control
and Prevention Advisory Committee on Childhood
Lead Poisoning Prevention, a plan for increasing the
number of blood lead screening tests of children en-
rolled in the WIC and the Early Head Start pro-
grams in the State.
(2) DEVELOPMENT
OF
WAIVER
PROCEDURES
AND
REQUIREMENTS.—Not later than 12 months
after the date of enactment of this Act, the Director
of the Centers for Disease Control and Prevention,
in consultation with the Centers for Disease Control
and Prevention Advisory Committee on Childhood
Lead Poisoning Prevention, shall develop and rec-
ommend to the Secretary of Health and Human
Services criteria and procedures (including a time-
table for the submission of the State plan described
in paragraph (1)) for the award of waivers under
that paragraph.
Æ