[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1120 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1120

 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 SENATE OF THE UNITED STATES

                              May 25, 1999

Mr. Torricelli (for himself, Mr. Reed, Mr. Lautenberg, Mr. Bryan, Mrs. 
   Boxer, Mrs. Feinstein, Mr. Dodd, Mr. Rockefeller, Mr. Biden, Mr. 
    Schumer, Mrs. Murray, Mr. Durbin, and Mr. Kerry) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
 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.

    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 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 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 of 
        suffering the effects of lead poisoning because 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 development 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 nationally representative sample were in 
        enrolled in or targeted by Federal health care programs, 
        specifically the medicaid program, the women, infants, and 
        children (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 enrolled in or targeted by Federal health care programs 
        have never been screened for lead;
            (7) although the Health Care Financing Administration has 
        required mandatory blood lead screenings for children enrolled 
        in the medicaid program 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 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 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, ensure 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 PROGRAM.

    (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 children who have received 
                        a blood lead screening test;''.
    (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 blood lead 
                screening requirements that are consistent with 
                prevailing guidelines of the Centers for Disease 
                Control and Prevention for such screening; 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 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''; and
            (2) by adding at the end the following:
    ``(v)(1) In this subsection:
            ``(A) The term `qualified lead treatment services' means 
        the following:
                    ``(i) Lead-related medical management, as defined 
                in subparagraph (B).
                    ``(ii) Lead-related case management, as defined 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, 
                        diagnostic, and treatment services (EPSDT) 
                        services described in subsection (r) and 
                        available under subsection (a)(4)(B) (including 
                        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 management' means the 
        provision and coordination of the diagnostic, treatment, and 
        follow-up services provided 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 determine the child's 
                developmental, neurological, nutritional, and hearing 
                status, and the extent, duration, and possible source 
                of the child's exposure to lead;
                    ``(ii) repeat blood lead level tests furnished when 
                medically indicated for purposes of monitoring 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 emergency 
                services;
                    ``(v) medical nutrition therapy when medically 
                indicated by a nutritional assessment, that shall be 
                furnished by a dietitian or other nutrition 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 contractor 
                        administering the program of assistance under 
                        the special supplemental food program for 
                        women, infants and children (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 defined 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 status 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 following classes of 
                services as appropriate--
                            ``(I) whether or not such services are 
                        covered under the State plan under this title;
                            ``(II) lead-related medical management of 
                        an EBLL (including environmental 
                        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, educational, 
                        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 education, and referrals.
            ``(D) The term `lead-related anticipatory guidance' means 
        education and information for families of children and pregnant 
        women enrolled in the State plan under this title about 
        prevention of childhood lead poisoning that addresses the 
        following topics:
                    ``(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 maintenance, 
                nutritional, and other measures to minimize the risk of 
                childhood lead poisoning.
                    ``(iv) The rights of families under the Residential 
                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 certified 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 includes the child's 
        residence or residences, residences of frequently visited 
        caretakers, relatives, and playmates, and the child's day care 
        site. Such investigations 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 environmental investigation and reporting.
    ``(2) For purposes of paragraph (1)(A)(ii), a child described in 
this paragraph is a child who--
            ``(A) has attained 6 months but has not attained 6 years of 
        age; and
            ``(B) has been identified as having a blood lead level that 
        equals or exceeds 20 micrograms per deciliter (or after 2 
        consecutive tests, equals or exceeds 15 micrograms per 
        deciliter, or the applicable number of micrograms designated 
        for such tests under prevailing guidelines of the Centers for 
        Disease Control 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 attributable to the design, 
                development, or installation of an information 
                retrieval system that may be easily accessed and used 
                by other federally-funded means-tested public benefit 
                programs 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 treatment services, as 
                described in section 1905(r); and
                    ``(ii) 75 percent of so much of the sums expended 
                during such quarter as are attributable to the 
                operation of a system (whether such system is operated 
                directly by the State or by another 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 medicaid 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 percentage 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 Services 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, including 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 SUPPLEMENTAL 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 following:
            ``(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 appropriate 
                        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 screening 
                        test--
                                    ``(I) refer the infant or child for 
                                receipt of the test; and
                                    ``(II) determine whether the infant 
                                or child receives the test during a 
                                routine visit with a health care 
                                provider.
                    ``(B) Screenings by state agencies.--
                            ``(i) In general.--A State agency may 
                        (under contract or otherwise) perform a blood 
                        lead screening test that is appropriate 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 request 
                                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 medical 
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 certified under section 353 of the Public Health Service 
Act (42 U.S.C. 263a), or purchasing, for use at sites providing 
services under this section, blood lead testing instruments and 
associated supplies approved for sale by the Food and Drug 
Administration and used in compliance with such section 353.
                                    ``(II) Children enrolled in or 
                                eligible for schip.--In the case of a 
                                blood lead screening test performed 
                                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 
                                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 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 performed under this paragraph 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.''.

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 inserting 
        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 subsection 
                (a)(1) has received a blood lead screening 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 received a 
                blood lead screening test, ensure that each enrolled 
                child receives such a test either by referral or by 
                performing the test (under contract 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 eligible 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 
                        provision of, or limitation under, title XIX 
of the Social Security Act, shall reimburse the entity, from funds that 
are made available under that title, for the Federal medical 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 
certified under section 353 of the Public Health Service Act (42 U.S.C. 
263a), or purchasing, for use at sites providing services under this 
section, blood lead testing instruments and associated supplies 
approved for sale by the Food and Drug Administration and used in 
compliance with such section 353.
                            ``(ii) Children enrolled in or eligible for 
                        schip.--In the case of a blood lead screening 
                        test performed under subparagraph (A) (by the 
                        entity or under contract with the entity) on a 
                        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 entity, from 
                        funds that are made available 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 subsection shall 
        apply to head start programs that include 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 provision 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 Nutrition 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 subsection (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 performed by a State agency or 
        entity described in subsection (a).
            ``(2) Any such reference to child health assistance with 
        respect to such a child is deemed a reference 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 requirements 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 
                        section.''.
    (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 PREVENTION EFFORTS TO COMBAT 
              CHILDHOOD LEAD POISONING.

    (a) Requirements for Lead Poisoning Prevention 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 consistent reporting of all 
        blood lead test results from laboratories and health care 
        providers to State and local health departments in accordance 
        with guidelines of the Centers for Disease Control and 
        Prevention for standardized reporting as described in 
        subsection (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 established 
                systems to ensure mandatory reporting 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 Reporting.--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 
departments.''.
    (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.--Notwithstanding any other 
provision of law, any individual or entity that receives from the 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, 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 assessments and referrals at State 
and local sites of operation of the program of assistance under the 
special supplemental 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 Effective Data Management by 
the Centers for Disease 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 departments and between 
                State health departments and the Centers for Disease 
                Control and Prevention;
                    (B) assist States with the development of flexible, 
                comprehensive State-based data management 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 benefit programs (including 
                the special supplemental 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 Centers 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 existing 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 ACTIVITIES.

    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 ACTIVITIES.

    ``(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 
        exposure greater than 10 micrograms per deciliter through--
                    ``(A) effective, ongoing outreach and community 
                education targeted to families most likely 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 levels, including 
                through home visits and coordination 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 activities 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 paragraph (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 subsection (a) to the same 
        extent and in the same manner as such provisions apply to 
        allotments made under section 502(c):
                    ``(A) Section 504(b)(1) (relating to expenditures 
                for inpatient services).
                    ``(B) Section 504(b)(4) (relating to expenditures 
                of funds as a condition of receipt of Federal funds).
                    ``(C) Section 504(b)(5) (relating to limitations on 
                funds for research).
                    ``(D) Section 504(b)(6) (relating to prohibition 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 
                nondiscrimination).''.

SEC. 9. TRAINING AND REPORTS BY THE HEALTH RESOURCES 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 collaboration with the Administrator of the 
Health Care Financing Administration and the Director of the Centers 
for Disease 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 requirements, 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 report 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 during the prior 
fiscal year, noting the percentage that such children represent as 
compared to all children who received 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 program.
    (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 determined 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 determine the presence of elevated blood lead 
        levels, as established by the Centers for Disease Control and 
        Prevention, if the State rate for such screenings exceeds 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 Development.
    (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, infants 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 
        establishes to the satisfaction of the Secretary of Health and 
        Human Services, in accordance with requirements 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 enrolled in the WIC and the 
        Early Head Start programs 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 recommend to the Secretary of 
        Health and Human Services criteria and procedures (including a 
        timetable for the submission of the State plan described in 
        paragraph (1)) for the award of waivers under that paragraph.
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