[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 2598 Introduced in Senate (IS)]

  2d Session
                                S. 2598

  To require proof of screening for lead poisoning and to ensure that 
          children at highest risk are identified and treated.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

              October 9 (legislative day, October 2), 1998

    Mr. Torricelli (for himself and Mr. Lautenberg) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Lead Prevention and 
Inclusive Treatment Act of 1998'' or the ``Children's Lead PAInT Act''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress finds that--
            (1) lead poisoning remains a serious environmental risk, 
        especially to the health of young children;
            (2) childhood lead poisoning can cause reductions in IQ, 
        attention span, reading, and learning disabilities, and other 
        growth and behavior problems;
            (3) children under the age of 6 are at the greatest 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 children 
        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 Administration has 
        required mandatory blood lead screenings for children enrolled 
        in medicaid who are not less than 1 nor more than 5 years of 
        age, approximately two-thirds of children enrolled in medicaid 
        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 uniformly 
        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 children 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 PROGRAM.

    (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 reduced 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 allotments 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 received 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 Secretary may modify or 
        waive the application of paragraph (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 established 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 semicolon 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 demographic and identifying 
                        information that is consistent with the 
                        recommendations of the Centers for Disease 
                        Control and Prevention with respect to lead 
                        surveillance;''.
    (b) Mandatory Screening Requirements.--Section 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 mandates issued by the 
                Secretary through the Administrator of the Health Care 
                Financing Administration; 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 Children 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 defined 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 (including health professionals and 
        lead professionals certified 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 eliminate lead 
        hazards to a child, if required (as recommended 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 deciliter (or persistently 
        equals or exceeds 15 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 beginning 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 
considered to be a separate regular session of the State legislature.

SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUPPLEMENTAL 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 following:
            ``(4) Lead poisoning screening.--
                    ``(A) In general.--Subject to subparagraph (B), for 
                an infant or child to be eligible to participate in the 
                program under this section, 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 subparagraph (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 contrary to 
                        the religious beliefs or moral convictions 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 poisoning and 
                        who seeks to participate in the program, at no 
                        charge to the family, a State agency shall 
                        perform a blood lead test on the infant or 
                        child that is appropriate for age and risk 
                        factors.
                            ``(ii) Reimbursement.--On the request of a 
                        State agency that screens for lead poisoning 
                        under clause (i) an infant or child that is 
                        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 shall reimburse the State 
                        agency, from funds that are made available 
                        under that title, for the cost of the screening 
                        (including the cost of purchasing portable 
                        blood lead analyzer instruments approved for 
                        sale by the Food and Drug Administration and 
                        providing screening with the use of such 
                        instruments through laboratories certified 
                        under section 353 of the Public Health Service 
                        Act (42 U.S.C. 263a)).''.

SEC. 5. LEAD POISONING SCREENING FOR EARLY HEAD START PROGRAMS.

    Section 645A of the Head Start Act (42 U.S.C 9840a) is amended--
            (1) in subsection (c)(2), by inserting before the semicolon 
        the following: ``, if the families comply with subsection 
        (i)''; and
            (2) by adding at the end the following:
    ``(i) Lead Poisoning Screening.--
            ``(1) In general.--Subject to paragraph (2), for a child to 
        be eligible to participate in a program described in subsection 
        (a)(1), a member of the family of the child shall provide proof 
        to the entity carrying out the program, not later than 180 days 
        after enrollment of the child in the program and periodically 
        thereafter (as determined by the entity), that the child has 
        received a blood lead test for lead poisoning using an 
        assessment that is appropriate for age and risk factors.
            ``(2) Waivers.--The entity may waive the requirement of 
        paragraph (1) with respect to a child if the entity determines 
        that--
                    ``(A) the area in which the child resides does not 
                pose a risk of lead poisoning; or
                    ``(B) the requirement would be contrary to the 
                religious beliefs or moral convictions of the family of 
                the child.
            ``(3) Screenings by entities.--
                    ``(A) In general.--On the request of a member of a 
                family of a child who has not been screened for lead 
                poisoning and who seeks to participate in the program, 
                at no charge to the family, the entity shall perform a 
                blood lead test on the child that is appropriate for 
                age and risk factors.
                    ``(B) Reimbursement.--On the request of an entity 
                that screens for lead poisoning under subparagraph (A) 
                a child that is receiving medical assistance under a 
                State plan under title XIX of the Social Security Act 
                (42 U.S.C. 1396 et seq.), the Secretary shall reimburse 
                the entity, from funds that are made available under 
                that title, for the cost of the screening (including 
                the cost of purchasing portable blood lead analyzer 
                instruments approved for sale by the Food and Drug 
                Administration and providing screening with the use of 
                such instruments through laboratories certified under 
                section 353 of the Public Health Service Act (42 U.S.C. 
                263a)).''.
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