[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2788 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 2788
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 HOUSE OF REPRESENTATIVES
August 2, 2001
Mr. Menendez (for himself, Mr. Capuano, Mr. Rush, Mr. Baldacci, Ms.
Schakowsky, Mr. Frost, Mr. Bonior, Mrs. Jones of Ohio, Mr. Borski, Mr.
McDermott, Mr. Wexler, Ms. Sanchez, Mr. Engel, Mr. Gutierrez, Mr. Clay,
Mr. Cummings, and Mr. Green of Texas) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Education and the Workforce, for a period
to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Children's Lead
Screening Accountability For Early-Intervention Act of 2001'' or the
``Children's Lead SAFE Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Increased lead poisoning screenings and treatments under the
medicaid program.
Sec. 4. Bonus program for improvement of childhood lead screening
rates.
Sec. 5. Authorization to use SCHIP funds for blood lead screening.
Sec. 6. Lead poisoning screening for the Head Start and Early Head
Start programs.
Sec. 7. Lead poisoning screening for special supplemental nutrition
program for Women, Infants, and Children
(WIC).
Sec. 8. Effective date.
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
enrolled in or targeted by Federal health care programs,
specifically the medicaid program, the special supplemental
nutrition program for women, infants, and children (WIC), 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 than 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 new clause:
``(v) the number of children who are under
the age of 3 and enrolled in the State plan
under this title 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 (64), by striking ``and'' at the end;
(2) in paragraph (65), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (65) the following new
paragraph:
``(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(x) 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
new paragraph:
``(27) qualified lead treatment services (as defined in
subsection (x)); and''; and
(2) by adding at the end the following new subsection:
``(x)(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)
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 nutrition 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 items as
appropriate--
``(I) determination of 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 new
subparagraph:
``(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) Emergency Measures.--
(1) In general.--Subject to paragraph (2), 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.) shall use 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 with an EBLL of at least 20, or a pregnant woman with an EBLL of
at least 20, 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. Such reimbursement, when provided by the State
agency administering the State plan under title XIX of the Social
Security Act, shall be considered medical assistance for purposes of
section 1903(a) of such Act.
(2) Limitation.--Not more than $1,000 in expenditures for
the emergency measures described in paragraph (1) may be
incurred on behalf of a child or pregnant woman to which that
paragraph applies.
(g) Rule of Construction.--Nothing in this Act or any amendment
made by this Act shall be construed as requiring a child enrolled in
the State medicaid program under title XIX of the Social Security Act
to undergo a lead blood screening test if the child's parent or
guardian objects to the test on the ground that the test is
inconsistent with the parent's or guardian's religious beliefs.
SEC. 4. BONUS PROGRAM FOR IMPROVEMENT OF CHILDHOOD LEAD SCREENING
RATES.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') may 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.--If the Secretary establishes a program under
subsection (a), the Secretary, 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 Secretary 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 2002 through 2006.
SEC. 5. AUTHORIZATION TO USE SCHIP FUNDS FOR BLOOD LEAD SCREENING.
(a) Optional Application to SCHIP.--
(1) In general.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended by adding at the end
the following new subparagraph:
``(E) At State option, section 1902(a)(66)
(relating to blood lead screening and coverage of
qualified lead treatment services defined in section
1905(x)).''.
(2) Conforming amendment.--Section 2110(a) of the Social
Security Act (42 U.S.C. 1397jj(a)) is amended--
(A) by redesignating paragraph (28) as paragraph
(29); and
(B) by inserting after paragraph (27) the following
new paragraph:
``(28) qualified lead treatment services (as defined in
section 1905(x)), but only if the State has elected under
section 2107(e)(1)(E) to apply section 1902(a)(66) to the State
child health plan under this title.''.
(b) Inclusion in Medicaid Reporting Requirement.--
(1) In general.--Section 1902(a)(43)(D)(v) of the Social
Security Act (42 U.S.C. 1396a(a)(43)(D)(v)), as added by
section 3(a)(3), is amended by inserting ``or, if the State has
elected under section 2107(e)(1)(E) to apply paragraph (66) to
the State child health plan under title XXI, in the State plan
under title XXI,'' after ``this title''.
(2) Report to congress.--Section 3(e) of this Act is
amended--
(A) by inserting ``or in the State children's
health insurance program under title XXI of that Act
(42 U.S.C 1397aa et seq.)'' after ``(42 U.S.C. 1396 et
seq.)''; and
(B) by striking ``that program'' and inserting
``those programs''.
SEC. 6. LEAD POISONING SCREENING FOR THE HEAD START AND EARLY 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. 7. LEAD POISONING SCREENING FOR SPECIAL SUPPLEMENTAL NUTRITION
PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC).
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. 8. EFFECTIVE DATE.
(a) In General.--Except as provided in 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
nutrition 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 6 and 7 (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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