Trial Engrossment of Amendment A05860 to Senate Bill 0522 P.N. 1935, Regular Session 2021-2022

HOUSE AMENDED

A05860

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

522

Session of

2021

INTRODUCED BY BAKER, YUDICHAK, FONTANA, KANE, YAW, HUGHES,

SANTARSIERO, SCAVELLO, TARTAGLIONE, SCHWANK, COSTA, HAYWOOD

AND COMITTA, APRIL 9, 2021

AS REPORTED FROM COMMITTEE ON CHILDREN AND YOUTH, HOUSE OF

REPRESENTATIVES, AS AMENDED, SEPTEMBER 21, 2022

AN ACT

Providing for blood lead assessment and testing of certain

children and pregnant women by health care providers;

imposing duties on the Department of Health; and requiring

certain health insurance policies to cover blood lead tests.

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 Childhood

Blood Lead Test Act.

Section 2. Legislative findings.

The General Assembly finds that:

(1) Lead is a naturally occurring element that is toxic

to humans when ingested or inhaled.

(2) Severe lead poisoning causes convulsions,

intellectual disabilities, seizures and sometimes death.

(3) Low-level exposure to lead reduces intelligence,

delays cognitive growth and impairs physical development.

(4) Children who are in utero or less than seven years

of age are most sensitive to lead poisoning because their

brains and nervous systems are still developing.

(5) The only way to diagnose a child with an elevated

blood lead level is through a blood test.

(6) The health and development of children is endangered

by chipping or peeling lead-based paint or lead-contaminated

dust or soil in homes and neighborhoods throughout this

Commonwealth.

(7) Other sources of lead exposure can be through lead

service lines for drinking water and lead solder used in

drinking water lines, and lead in consumer products such as

toys, foods, cosmetics and ceramics are also of concern.

Section 3. Legislative purpose.

The purposes of this act are:

(1) To substantially reduce, and eventually eliminate,

the incidence of childhood lead poisoning in this

Commonwealth.

(2) To improve public awareness of lead safety issues in

housing and educate both property owners and tenants about

practices that can reduce the incidence INCIDENCES of lead

poisoning.

(3) To require encourage the testing of all children in

this Commonwealth by two years of age so that prompt

diagnosis and treatment, as well as the prevention of harm,

are possible.

Section 4. 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:

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"Blood lead test." A blood lead draw, whether by capillary,

venous or unknown sample type, on a child that produces a

quantifiable result and is analyzed by a Clinical-Laboratory-

Improvement-Amendments-certified facility or an approved

portable device.

"Department." The Department of Health of the Commonwealth.

"Elevated blood lead level." A single blood lead test,

whether capillary or venous, at or above the Centers for Disease

Control and Prevention's reference range value, currently

established at three and one-half micrograms per deciliter.

"GOVERNMENT PROGRAM." ANY OF THE FOLLOWING:

(1) 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.

(2) THE CHILDREN'S HEALTH INSURANCE 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.

"HEALTH INSURANCE POLICY." A POLICY, SUBSCRIBER CONTRACT,

CERTIFICATE OR PLAN ISSUED BY AN INSURER THAT PROVIDES HOSPITAL

OR MEDICAL/SURGICAL HEALTH CARE COVERAGE. THE TERM DOES NOT

INCLUDE ANY OF THE FOLLOWING:

(1) AN ACCIDENT-ONLY POLICY.

(2) A CREDIT-ONLY POLICY.

(3) A LONG-TERM CARE OR DISABILITY INCOME POLICY.

(4) A SPECIFIED DISEASE POLICY.

(5) A MEDICARE SUPPLEMENT POLICY.

(6) A FIXED INDEMNITY POLICY.

(7) A DENTAL-ONLY POLICY.

(8) A VISION-ONLY POLICY

(9) A WORKERS' COMPENSATION POLICY.

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(10) AN AUTOMOBILE MEDICAL PAYMENT POLICY.

(11) A POLICY UNDER WHICH BENEFITS ARE PROVIDED BY THE

FEDERAL GOVERNMENT TO ACTIVE OR FORMER MILITARY PERSONNEL AND

THEIR DEPENDENTS.

(12) A HOSPITAL INDEMNITY POLICY.

(13) ANY OTHER SIMILAR POLICY PROVIDING FOR LIMITED

BENEFITS.

"INSURER." AN ENTITY THAT OFFERS, ISSUES OR RENEWS AN

INDIVIDUAL OR GROUP HEALTH, ACCIDENT OR SICKNESS INSURANCE

POLICY, CONTRACT OR PLAN AND THAT IS SUBJECT TO ANY OF THE

FOLLOWING:

(1) 40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN

CORPORATIONS) OR 63 (RELATING TO PROFESSIONAL HEALTH SERVICES

PLAN CORPORATIONS).

(2) THE INSURANCE COMPANY LAW OF 1921, INCLUDING SECTION

630 AND ARTICLE XXIV.

(3) THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364),

KNOWN AS THE HEALTH MAINTENANCE ORGANIZATION ACT.

Section 5. Lead poisoning prevention, assessment and testing.

(a) Lead testing requirements for children.--

(1) A health care provider shall make reasonable efforts

to ensure that a patient under the health care provider's

care receives a AT LEAST ONE blood lead test by 24 months of

age or the age of 24 through 72 months if they have THE

PATIENT HAS never been tested in accordance with

recommendations from the Centers for Disease Control and

Prevention and the American Academy of Pediatrics.

(1) The following:

(i) A health care provider shall consider possible

lead exposure in an individual patient by evaluating risk

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factors for lead exposure and perform blood lead testing

in accordance with recommendations from the Centers for

Disease Control and Prevention and the American Academy

of Pediatrics by 24 months of age.

(ii) If a patient has never been tested in

accordance with recommendations from the Centers for

Disease Control and Prevention and the American Academy

of Pediatrics by 24 months of age, a health care provider

shall consider possible lead exposure and perform blood

lead testing in an individual patient between 24 months

and 72 months of age.

(iii) A health care provider shall make reasonable

efforts to ensure that a patient's parent or legal

guardian understands the risks and benefits of blood lead

testing prior to obtaining consent.

(2) If a patient's parent or legal guardian consents to

blood lead testing for the patient under paragraph (1) and

the results of a capillary blood lead test indicate an

elevated blood lead level, the health care provider shall

perform a confirmatory blood lead test by venipuncture within

12 weeks of the first blood lead test after obtaining the

consent of the patient's parent or legal guardian.

(b) Lead exposure risk assessment and testing requirements

for pregnant women.--A health care provider shall consider

possible lead exposure in individual pregnant women by

evaluating risk factors for lead exposure and perform blood lead

testing if a single risk factor is identified in accordance with

recommendations from the Centers for Disease Control and

Prevention and the American College of Obstetricians and

Gynecologists.

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comply with reporting regulations as specified in 28 Pa. Code §

27.34 (relating to reporting cases of lead poisoning).

(d) Nonapplicability.--The requirements under this section

shall not apply if a child's parent or legal guardian or a

patient under prenatal care objects in writing to the blood lead

test on religious grounds or on the basis of a strong moral or

ethical conviction similar to a religious belief.

Section 6. Duties of department.

(a) Comprehensive educational program.--The department shall

conduct a public information campaign to inform parents of young

children, physicians, nurses and other health care providers of

the lead assessment and testing requirements of this act.

(b) Distribution of literature about childhood lead

poisoning.--

(1) The department shall provide culturally and

linguistically appropriate educational materials regarding

childhood lead poisoning, the importance of assessments and

testing for elevated lead levels, prevention of childhood

lead poisoning, treatment of childhood lead poisoning,

remediation and, when appropriate, the requirements of this

act.

(2) Educational materials shall be available at no cost

and shall be developed for specific audiences, including

health care providers, homeowners, landlords and parents or

caregivers.

Section 7. Blood lead assessment and testing coverage.

(a) General rule.--A health insurance policy or government

program covered under this section shall provide to covered

individuals or recipients blood lead tests as follows:

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(1) In the case of individuals or recipients who are

pregnant, one blood lead test per pregnancy if a single risk

factor is identified in accordance with recommendations from

the Centers for Disease Control and Prevention and the

American College of Obstetricians and Gynecologists.

(2) In the case of individuals or recipients who are

under two years of age, AT LEAST one blood lead test by 24

months of age in accordance with recommendations from the

Centers for Disease Control and Prevention and the American

Academy of Pediatrics, and, if the result of the blood level

test indicates an elevated blood lead level, another blood

lead test by venipuncture within 12 weeks of the blood level

test in which the elevated blood lead level was indicated.

(b) Copayments, deductibles and coinsurance.--Coverage under

this section shall be subject to copayment, deductible and

coinsurance provisions and any other general exclusions or

limitations of a health insurance policy or government program

to the same extent as other medical services covered by the

policy or program are subject to these provisions.

limiting benefits which are otherwise available to an individual

under a health insurance policy or government program.

(d) Applicability.--

(1) This section shall apply to all group and individual

major medical health insurance policies offered, issued or

renewed in this Commonwealth in accordance with section 8.

This section shall not include the following policies:

(i) An accident-only policy.

(ii) A credit-only policy.

(iii) A long-term care or disability income policy.

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(iv) A specified disease policy.

(v) A Medicare supplement policy.

(vi) A TRICARE policy, including a Civilian Health

and Medical Program of the Uniformed Services (CHAMPUS)

supplement policy.

(vii) A fixed indemnity policy.

(viii) A dental-only policy.

(ix) A vision-only policy.

(x) A workers' compensation policy.

(xi) An automobile medical payment policy.

(xii) Hospital indemnity policy.

(xiii) Another similar policy providing for limited

benefits.

(2) (Reserved).

Section 8. Implementation.

Section 7 shall apply as follows:

(1) For health insurance policies for which either rates

or forms are required to be filed with the Insurance

Department or the Federal Government, this act SECTION 7

shall apply to any policy for which a form or rate is first

filed on or after the effective date of this section.

(2) For health insurance policies for which neither

rates nor forms are required to be filed with the Insurance

Department or the Federal Government, this act SECTION 7

shall apply to any policy issued or renewed on or after 180

days after the effective date of this section.

Section 9. Effective date.

This act shall take effect in 60 days.

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