[Congressional Record Volume 147, Number 127 (Wednesday, September 26, 2001)]
[Senate]
[Pages S9879-S9881]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. TORRICELLI (for himself, Mr. Reed, Mrs. Clinton, Mr. 
        Wellstone, Mr. Durbin, Mrs. Carnahan, and Mr. Lieberman):
  S. 1471. A bill to amend titles XIX and XXI of the Social Security 
Act to ensure that Children enrolled in the Medicaid and State 
children's health insurance program are identified and treated for lead 
poisoning; to the committee on Finance.
  Mr. TORRICELLI. Mr. President, I rise today along with my colleague, 
Senator Reed of Rhode Island, to introduce the Children's Lead 
Screening Accountability for Early-Intervention Act of 2001 and the 
Early Childhood Lead Poisoning Prevention Act of 2001.
  Lead poisoning is one of the dangerous environmental health hazards 
for young children. It is estimated that 890,000 children nationally 
suffer from elevated blood lead levels. Lead poisoning causes damage to 
the brain and nervous system, loss in IQ, impaired physical development 
and behavioral problems. High levels of exposure to lead can result in 
comas, convulsions and death. Poor and minority children are most at-
risk of lead poisoning because of inadequate diets and exposure to 
environmental hazards such as old housing.
  In an effort to alleviate this problem, in 1992, Congress instructed 
the Health Care Financing Administration to require States to lead 
screen Medicaid children under the age of two. The screening would have 
enabled the highest-risk children to be tested and treated before lead 
poisoning impaired their development. Despite the Federal law, however, 
a study from the General Accounting Office indicates that currently 
two-thirds of all Medicaid children remain unscreened and that only 
half the States have screening policies consistent with the law. In New 
Jersey, only 30% of children covered by Medicaid are tested.
  The Children's Lead Screening Accountability for Early-Intervention 
Act or Children's Lead SAFE Act will create a lead screening safety net 
that will, though the Medicaid and State Children's Health Insurance, 
SCHIP, programs, ensure that children enrolled in these programs 
receive blood lead screenings and appropriate follow-up care. 
Specifically, this legislation will require state Medicaid contracts to 
explicitly require health management organizations to comply with 
federal rules related to lead screening and treatment. The bill will 
expand Medicaid coverage to include lead treatment services and 
environmental investigations to determine the source of the poisoning.
  The Early Childhood Lead Poisoning Prevention Act of 2001 requires 
the Head Start, Early Head Start and Women, Infants and Children, WIC, 
programs to determine if enrolled children under age three have 
received a blood lead screening test appropriate for their age and risk 
factors. This legislation also requires that these programs provide and 
track referrals for any child who has not been screened for lead 
poisoning. Importantly, this legislation authorizes WIC, Head Start and 
Early Head Start programs to seek reimbursement through Medicaid or the 
SCHIP program for eligible children who have received a lead screening 
test.
  The health and safety of our children would be greatly enhanced with 
the passage of these important measures. Childhood lead poisoning is 
easily preventable and I hope my colleagues will join us in support of 
this legislation.
  At this time, I ask that the text of the Children's Lead Screening 
Accountability for Early-Intervention Act of 2001 be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1471

       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 2001'' 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 
     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 and 
     State children's health insurance program, ensure that 
     children enrolled in 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

[[Page S9880]]

     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

[[Page S9881]]

     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. EFFECTIVE DATE.

       This Act and the amendments made by this Act take effect on 
     the date that is 18 months after the date of enactment of 
     this Act.
                                 ______