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 Com-
mittee on Commerce, and in addition to the Committee on Education and
the Workforce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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.
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 ‘‘Childhood Lead Poi-
soning Protection Act of 1998’’.
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 because of the sensitivity of their developing
brains and nervous systems;
(4) poor children and minority children are at
substantially higher risk of lead poisoning;
(5) it is estimated that more than 500,000 chil-
dren enrolled in Medicaid have harmful levels of lead
in their blood;
(6) children enrolled in Medicaid represent 60
percent of the 890,000 children in the United States
with elevated blood lead levels;
(7) although the Health Care Financing Admin-
istration 
has 
required 
mandatory 
blood 
lead
screenings for children enrolled in Medicaid who are
not less than 1 nor more than 5 years of age, ap-
proximately two-thirds of children enrolled in Medic-
aid have not been screened or treated;
(8) the Health Care Financing Administration
mandatory screening policy has not been effective, or
sufficient, to properly identify and screen children
enrolled in Medicaid who are at risk;
(9) uniform lead screening requirements do not
exist for children not enrolled in Medicaid; 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 Medicaid and
other entitlement programs, ensure that low-income chil-
dren at the highest risk of lead poisoning receive blood
lead screenings and appropriate followup care.
SEC. 3. INCREASED LEAD POISONING SCREENINGS AND
TREATMENTS UNDER THE MEDICAID PRO-
GRAM.
(a) PENALTY
FOR INSUFFICIENT INCREASES
IN
LEAD POISONING SCREENINGS.—
(1) 
PERFORMANCE
IMPROVEMENT.—Section
1903 of the Social Security Act (42 U.S.C. 1396b)
is amended by adding at the end the following:
‘‘(x) PERFORMANCE IMPROVEMENT.—
‘‘(1) IN
GENERAL.—Notwithstanding section
1905(b), beginning with fiscal year 2000 and for
each fiscal year thereafter, with respect to any State
that fails to meet minimum blood lead screening
rates stated in paragraph (2), the Federal medical
assistance percentage determined under section
1905(b) for the State for the fiscal year shall be re-
duced by 1 percentage point, but only with respect
to—
‘‘(A) items and services furnished under a
State plan under this title during that fiscal
year;
‘‘(B) payments made on a capitation or
other risk-basis under a State plan under this
title for coverage occurring during that fiscal
year; and
‘‘(C) payments under a State plan under
this title that are attributable to DSH allot-
ments for the State determined under section
1923(f) for that fiscal year.
‘‘(2) 
MINIMUM
BLOOD
LEAD
SCREENING
RATES.—The minimum acceptable percentages of 2-
year-old Medicaid-enrolled children who have re-
ceived at least 1 blood lead screening test are—
‘‘(A) 50 percent in fiscal year 2000;
‘‘(B) 60 percent in fiscal year 2001;
‘‘(C) 70 percent in fiscal year 2002;
‘‘(D) 80 percent in fiscal year 2003; and
‘‘(E) 90 percent in each fiscal year after
fiscal year 2003.
‘‘(3) MODIFICATION
OR
WAIVER.—The Sec-
retary may modify or waive the application of para-
graph (1) in the case of a State that the Secretary
determines has performed during a fiscal year such
a significant number of lead blood level assessments
that the State reasonably cannot be expected to
achieve the minimum blood lead screening rates es-
tablished by paragraph (2).’’.
(2) 
REPORTING
REQUIREMENT.—Section
1902(a)(43)(D) of the Social Security Act (42
U.S.C. 1396a(a)(43)(D)) is amended—
(A) in clause (iii), by striking ‘‘and’’ at the
end;
(B) in clause (iv), by striking the semi-
colon and inserting ‘‘, and’’; and
(C) by adding at the end the following:
‘‘(v) the number of children who are
not more than 2 years of age and enrolled
in the Medicaid Program and the number
and results of lead blood level assessments
performed by the State, along with demo-
graphic and identifying information that is
consistent with the recommendations of the
Centers for Disease Control and Preven-
tion with respect to lead surveillance;’’.
(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 screening
requirements for lead blood level assessments
(as appropriate for age and risk factors) that
are commensurate with guidelines and man-
dates issued by the Secretary through the Ad-
ministrator of the Health Care Financing Ad-
ministration; and
‘‘(B) coverage of appropriate qualified lead
treatment services, as prescribed by the Centers
for Disease Control and Prevention guidelines,
for children with elevated levels of lead in their
blood.’’.
(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
(2) by adding at the end the following:
‘‘(v)(1) The term ‘qualified lead treatment services’
means all appropriate and medically necessary services
that are provided by a qualified provider, as determined
by the State, to treat a child described in paragraph (2),
including—
‘‘(A) environmental investigations to determine
the source of a child’s lead exposure, including the
costs of qualified and trained professionals (includ-
ing health professionals and lead professionals cer-
tified by the State or the Environmental Protection
Agency) to conduct such investigations and the costs
of laboratory testing of substances suspected of
being significant pathways for lead exposure (such
as lead dust, paint chips, bare soil, and water);
‘‘(B) professional case management services to
coordinate access to such services; and
‘‘(C) emergency measures to reduce or elimi-
nate lead hazards to a child, if required (as rec-
ommended by the Centers for Disease Control and
Prevention).
‘‘(2) For purposes of paragraph (1), a child described
in this paragraph is a child who—
‘‘(A) has attained 6 months of age but has not
attained 73 months of age; and
‘‘(B) has been identified as having a blood lead
level that equals or exceeds 20 micrograms per deci-
liter 
(or 
persistently 
equals 
or 
exceeds 
micrograms per deciliter).’’.
(d) EFFECTIVE DATE.—
(1) IN GENERAL.—The amendments made by
this section apply on and after October 1, 1998.
(2) EXTENSION
OF
EFFECTIVE
DATE
FOR
STATE LAW AMENDMENT.—In the case of a State
plan under title XIX of the Social Security Act
which the Secretary of Health and Human Services
determines requires State legislation in order for the
plan to meet the additional requirements imposed by
the amendments made by this section, the State
plan shall not be regarded as failing to comply with
the requirements of this section solely on the basis
of its failure to meet these additional requirements
before the first day of the first calendar quarter be-
ginning after the close of the first regular session of
the State legislature that begins after the date of the
enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of the session is consid-
ered to be a separate regular session of the State
legislature.
SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUP-
PLEMENTAL 
NUTRITION 
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.—Subject to subpara-
graph (B), for an infant or child to be eligible
to participate in the program under this sec-
tion, a member of the family of the infant or
child shall provide proof to the State agency,
not later than 180 days after enrollment of the
infant or child in the program and periodically
thereafter (as determined by the State agency),
that the infant or child has received a blood
lead test for lead poisoning using an assessment
that is appropriate for age and risk factors.
‘‘(B) WAIVERS.—A State agency or local
agency may waive the requirement of subpara-
graph (A) with respect to an infant or child if
the State agency or local agency determines
that—
‘‘(i) the area in which the infant or
child resides does not pose a risk of lead
poisoning; or
‘‘(ii) the requirement would be con-
trary to the religious beliefs or moral con-
victions of the family of the infant or child.
‘‘(C) SCREENINGS BY STATE AGENCIES.—
‘‘(i) IN GENERAL.—On the request of
a member of a family of an infant or child
who has not been screened for lead poison-
ing and who seeks to participate in the
program, at no charge to the family, a