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PRINTER'S NO. 3038
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1917
Session of
2015
INTRODUCED BY CRUZ, SCHLOSSBERG, ROZZI, McCARTER, SCHREIBER,
DAVIS, W. KELLER, YOUNGBLOOD, COHEN, V. BROWN, THOMAS,
O'BRIEN, ACOSTA, DAVIDSON, KIM, BULLOCK, KAUFER, CALTAGIRONE,
SIMS, SANTARSIERO, GOODMAN, BURNS, D. COSTA, MAHER, ROEBUCK,
McNEILL AND KINSEY, APRIL 1, 2016
REFERRED TO COMMITTEE ON HEALTH, APRIL 1, 2016
AN ACT
Providing for lead screening and related services, for health
insurance coverage for lead screening and related diagnostic
services and supplies and for duties of the Department of
Health.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Lead Testing
and Protection Act.
Section 2. Declaration of policy.
The General Assembly hereby finds and declares as follows:
(1) According to the Centers for Disease Control and
Prevention, at least four million households have children
living in them who are being exposed to high levels of lead.
(2) There are approximately 500,000 children in the
United States between one and five years of age with blood
lead levels above five micrograms per deciliter (µg/dL), the
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reference level at which the Centers for Disease Control and
Prevention recommends public health actions be initiated.
(3) Lead poisoning is most detrimental to children under
72 months of age and expectant mothers.
(4) The effects of lead poisoning are not reversible.
(5) According to the department's 2014 Childhood Lead
Surveillance Annual Report, of the 1,028,282 children in this
Commonwealth under seven years of age, only 140,524 children
were screened for blood lead levels. Of the 140,524 children
tested, 13,171 children had elevated blood lead levels.
(6) Complications from lead poisoning include the
following:
(i) Developmental delays.
(ii) Brain damage.
(iii) Nervous system damage.
(iv) Memory loss.
(v) Abdominal pain.
(vi) Aggressive behavior.
(vii) Constipation.
(viii) Sleep problems.
(ix) Headaches.
(x) Irritability.
(xi) Loss of developmental skills in children.
(xii) Loss of appetite.
(xiii) Fatigue.
(xiv) High blood pressure.
(xv) Numbness or tingling in the extremities.
(xvi) Anemia.
(xvii) Kidney dysfunction.
(7) No safe blood lead level in children has been
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identified.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Birthing facility." An inpatient or ambulatory health care
facility licensed by the department that provides birthing and
newborn care services.
"Blood lead level." A measure of lead in the blood, measured
in micrograms of lead per deciliter of whole blood (µg/dL).
"Child." A child under 72 months of age who is a resident of
this Commonwealth.
"Department." The Department of Health of the Commonwealth.
"Diagnostic blood lead level testing." Analysis of a blood
sample to determine quantitative blood lead levels for a sample:
(1) Obtained by venipuncture for the purpose of any of
the following:
(i) Confirming lead poisoning as a follow-up blood
lead level test.
(ii) Diagnosing a child or expectant mother showing
signs or symptoms of lead poisoning.
(iii) Diagnosing a child or expectant mother
suspected of having sustained a significant lead
exposure.
(2) Analyzed in a laboratory licensed by the department
to perform the testing or in a laboratory of the department.
"Diagnostic evaluation." Obtaining and evaluating medical
history information, conducting a physical examination and
diagnostic blood lead level testing, identifying potential
sources of lead exposure and evaluating iron status.
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"Government program." Any of the following:
(1) The children's health care program under Article
XXIII-A of the act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921.
(2) The Commonwealth's medical assistance program
established under the act of June 13, 1967 (P.L.31, No.21),
known as the Human Services Code.
"Health care practitioner." As defined in section 103 of the
act of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
"Insurance policy." An individual or group health insurance
policy, contract or plan issued by or through an insurer or a
government program that provides medical or health care coverage
by a health care facility or licensed health care provider. The
term does not include accident only, fixed indemnity, limited
benefit, credit, dental, specified disease, Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS) supplement,
long-term care or disability income, workers' compensation or
automobile medical payment insurance.
"Insurer." An entity or affiliate entity that issues an
insurance policy that is offered or governed under any of the
following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) The act of May 18, 1976 (P.L.123, No.54), known as
the Individual Accident and Sickness Insurance Minimum
Standards Act.
(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
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corporations).
(5) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Lead poisoning." A blood lead level that meets one of the
following criteria:
(1) A confirmed blood lead level greater than or equal
to 20 µg/dL in a child or expectant mother.
(2) Two blood lead level samples of a child or expectant
mother, separated by at least 90 days, but not more than 365
days, which indicate a blood lead level greater or equal to
15 µg/dL.
"Lead screening-related services." Include:
(1) Materials and supplies used to obtain blood
specimens for quantitative blood lead level or erythrocyte
protoporphyrin (EP) analysis.
(2) Laboratory analysis of submitted samples for
quantitative blood lead level or EP.
(3) Evaluation of results obtained from laboratory
analysis of samples submitted for quantitative blood lead
level or EP analysis, as well as related consultation,
referral and follow-up of potentially lead-poisoned children
and expectant mothers.
"Screening test." A blood sample obtained either by
venipuncture or finger stick capillary blood collection from an
asymptomatic child or expectant mother not known to be lead
poisoned in order to identify the child or expectant mother's
risk of lead poisoning.
Section 4. Screening.
(a) General rule.--Screening tests shall be performed in
accordance with the following:
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(1) Children shall receive a screening test in
accordance with the following schedule:
(i) Each child shall be screened at 12 months of age
and 24 months of age.
(ii) All children designated as high risk through a
risk assessment evaluation promulgated by the department
shall be screened annually from 12 months of age to 72
months of age.
(iii) More frequent screening tests for asymptomatic
children under 72 months of age may be completed upon
recommendation of a health care practitioner.
(2) All expectant mothers shall receive a screening test
as part of their prenatal care.
(b) Testing methods.--Health care practitioners shall ensure
that screening tests are conducted either by venipuncture or by
capillary blood sampling in accordance with department
regulation.
(c) Exception.--If the parent or guardian of a child objects
on the ground that a screening test conflicts with a religious
belief or practice, the screening test under subsection (a) may
not be performed.
Section 5. Health insurance coverage.
(a) General rule.--An insurance policy shall provide
coverage for all of the following:
(1) Screening tests and lead screening-related services
for children under 72 months of age and expectant mothers.
(2) Diagnostic evaluations.
(b) Department duties.--The department shall provide the
following services for children under 72 months of age and
expectant mothers who are not covered by a health insurance
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policy:
(1) Screening tests and lead screening-related services.
(2) Diagnostic evaluations.
(c) Reimbursement.--The department shall not be required to
reimburse third parties for services under subsection (b) that
are not provided by the department.
(d) Applicability.--This section shall apply to insurance
policies issued or entered into on or after the effective date
of this section.
Section 6. Materials.
(a) Educational and instructional materials.--The department
shall distribute readily understandable information and
educational and instructional materials regarding lead
poisoning. The materials shall explain the risk factors
associated with lead exposure and emphasize lead screening and
testing procedures. The materials shall be provided to parents
of newborns prior to discharge from a hospital or birthing
facility. If the birth takes place in a setting other than a
hospital or birthing facility, the materials shall be provided
by a health care practitioner who assists at the birth.
(b) Acknowledgment statement.--An acknowledgment statement
shall be signed by a parent of a newborn prior to discharge from
a hospital or birthing facility or after a birth that takes
place in a setting other than a hospital or birthing facility.
One copy of the acknowledgment statement shall be given to a
parent and one copy shall remain on file in the hospital or
birthing facility. Copies of acknowledgment statements signed by
parents of newborns in settings other than a hospital or
birthing facility shall be kept on file by the health care
practitioner who assists at the birth. The acknowledgment
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statement shall be in a form as prescribed by the department.
(c) Distribution of materials.--The information and
educational and instructional materials described in subsection
(a) shall be provided without cost by each hospital, birthing
facility or health care practitioner to a parent of each newborn
upon discharge from a hospital or birthing facility or after
births that take place in settings other than a hospital or
birthing facility.
(d) Liability.--A hospital, birthing facility or health care
practitioner shall not be civilly or criminally liable for the
action or inaction of a parent with regard to lead exposure
pursuant to materials given to the parent relating to lead
exposure.
Section 7. Regulations.
The department shall promulgate regulations as necessary to
implement the provisions of this act.
Section 8. Effective date.
This act shall take effect in 90 days.
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