Requires each contract between the State and an entity responsible for provision of medical assistance under the State plan to provide for: (1) compliance with mandatory blood lead screening requirements consistent with prevailing guidelines of the Centers for Disease Control and Prevention (CDC) for such screening; and (2) coverage of qualified lead treatment services. Allows reimbursement for qualified lead treatment services for children with elevated blood lead levels. Provides for: (1) enhanced Federal matching contributions for an information retrieval system that determines whether a child is enrolled under a State plan and whether an enrolled child has received mandatory early and periodic screening, diagnostic, and treatment services; and (2) emergency measures.
Authorizes the Secretary to establish a program of bonus payments to States to improve the blood lead screening rates of States for children under age three enrolled in Medicaid.
Amends SSA title XXI (State Children's Health Insurance Program) (SCHIP) to grant States the option of using SCHIP funds for applying the blood lead screening and coverage of qualified lead treatment services under Medicaid to the State's SCHIP plan.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1471 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1471
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 26, 2001
Mr. Torricelli (for himself, Mr. Reed, Mrs. Clinton, Mr. Wellstone, Mr.
Durbin, Mrs. Carnahan, and Mr. Lieberman) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
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.
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
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. 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.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S9879)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S9879-9881)
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