Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1241 - EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT PROGRAM › ADMINISTRATIVE SANCTIONS › Appendix E - GUIDELINES ON CHILDHOOD LEAD POISONING PREVENTION

Current through Register Vol. 54, No. 28, July 13, 2024
Childhood Lead Poisoning Prevention
					 Questionnaire
Does your child live in or regularly visit a house, a
					 day-care center or a nursery school that was built before 1960 and has peeling
					 or chipping paint?
Does your child live in a home built before 1960 that is
					 being remodeled or renovated?
Does your child live near a heavily traveled major highway
					 where soil and dust may be contaminated with lead?
Have any of your children or their playmates had lead
					 poisoning?
Do you give your child any home or folk remedies which may
					 contain lead?
Does your child often come in contact with an adult who
					 works with lead-in construction, welding, plumbing, pottery or other
					 trades?
Does your child live near a lead smelter, a
					 battery-recycling plant or other industrial sites likely to release
					 lead?
Does your home plumbing have lead pipes or copper with lead
					 solder joints?
Under recent Federal clarification, a child, whose parent
					 has answered "yes" to one or more of the risk assessment questions, is
					 determined to be at high risk. A child, whose parent has answered "no" to all
					 questions, is determined to be at low risk. We believe that most MA eligible
					 children will be at high risk for lead poisoning. The EP test is not effective
					 and is no longer acceptable as a screening test for lead poisoning. The use of
					 the blood lead test is now required when screening Medicaid-eligible children
					 for lead toxicity, whether they are determined high risk or low risk.
Screening Schedule
I. For children 6 to 36 months of age who are at LOW risk
					 for HIGH dose lead exposure by questionnaire: an initial blood lead (PbB) test
					 at 12 months of age and as follows:
A. If PbB test result: <10 ug/dL, retest at 24
					 months.
B. If PbB test result: 10-14 ug/dL, retest every 3 to 4
					 months. After 2 consecutive measurements are <10 ug/dL or three are [LESS
					 THAN EQUAL TO]15 ug/dL, retest child in 1 year.
C. If PbB test result >=15 ug/dL, case manage and retest
					 every 3 to 4 months.
II. For children 6 to 36 months of age who are at HIGH risk
					 for HIGH dose exposure by questionnaire an initial PbB test at 6 months of age
					 and as follows:
A. If PbB test result is <10 ug/dL, rescreen every 6
					 months. After 2 subsequent consecutive measurements are <10 ug/dL or three
					 are [LESS THAN EQUAL TO]15 ug/dL, testing frequency can be decreased to once a
					 year.
B. If PbB test result 10-14 ug/dL, rescreen child every 3
					 to 4 months. After 2 subsequent consecutive measurements <10 ug/dL or three
					 are [LESS THAN EQUAL TO]15 ug/dL, testing frequency can be decreased to once a
					 year.
III. For children 36 to 72 months of age:
As for younger children, a questionnaire should be used at
					 each routine office visit of children from 36 to 72 months of age. Any child at
					 HIGH risk by questionnaire who has not been previously tested should be tested.
					 All children who have had venous blood lead tests >=15 ug/dL or who are at
					 risk by questionnaire should be screened at least once a year until their sixth
					 birthday (age 72 months) or later, if indicated (e.g. developmentally delayed
					 with pica). Children should also be screened any time history suggests exposure
					 has increased.
Follow up for all Children 6 to 72
					 months
at PbB Levels >15 ug/dL
A. If PbB 10-14 rescreen in 3-4 months or more often is
					 indicated, provide family with education and nutritional counseling, and take a
					 detailed environmental history to identify any obvious sources or pathways of
					 lead exposure. It is unlikely that there is a single predominant source of lead
					 exposure for most of these children, thus, a full home inspection is not
					 recommended. It is prudent, however, to try to decrease exposure to lead with
					 some simple interventions.
B. If PbB 15-19 ug/dL: same as preceding, plus discuss
					 interventions to reduce PbB levels. If the PbB persists at this level,
					 environmental investigation and abatement.
C. If PbB 20-44 ug/dL: same as for all of the preceding,
					 plus venous confirmation, medical evaluation and follow-up.
D. If 45-69 ug/dL: same as for all of the preceding, plus
					 URGENT medical and environmental follow-up.
Elevated PbB results obtained on capillary screening
					 specimens are presumptive and must be confirmed using venous PbB as follows:
					 less than 10 ug/dL not applicable; 10-14 ug/dL not applicable; 15-19 ug/dL
					 within 1 month; 20-44 ug/dL within 1 week; 45-69 ug/dL within 48 hours; greater
					 than or equal to 70 ug/dL immediately.
The Department currently reimburses for blood lead testing
					 through distinct procedure codes listed on the MA Fee Schedule and as a
					 component of the Early and Periodic Screening, Diagnosis and Treatment
					 Program.
NOTE: For a free copy of the October 1991 CDC Statement
					 contact the Pennsylvania Department of Health, Childhood Lead Poisoning
					 Prevention Program at (717) 783-8451.