PRIOR PRINTER'S NO. 82
PRINTER'S NO. 2935
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
79
Session of
2019
INTRODUCED BY ISAACSON, HOHENSTEIN, A. DAVIS, KENYATTA, OTTEN,
HILL-EVANS, SAMUELSON, SCHLOSSBERG, SIMS, INNAMORATO,
McCLINTON, DiGIROLAMO, MULLINS, RAVENSTAHL, KORTZ, DALEY,
VITALI, WARREN, ROEBUCK, GAINEY, CEPHAS, BULLOCK, CIRESI,
D. MILLER, ROZZI, READSHAW, FRANKEL, WHEATLEY, McCARTER,
O'MARA, LEE AND BOBACK, JANUARY 28, 2019
AS REPORTED FROM COMMITTEE ON CHILDREN AND YOUTH, HOUSE OF
REPRESENTATIVES, AS AMENDED, NOVEMBER 20, 2019
AN ACT
Providing for blood lead testing of certain children by health
care providers, for health insurance coverage for blood lead
testing PRACTITIONERS; and imposing duties on 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 Childhood
Blood Lead Test Act.
Section 2. Legislative findings.
The General Assembly finds and declares as follows:
(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,
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delays cognitive growth and impairs physical development.
(4) Children who are in utero or less than six 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, lead solder used in
drinking water lines and lead in consumer products such as
toys, foods, cosmetics and ceramics.
Section 3. Legislative purpose.
The purposes of this act are:
(1) To promote the elimination of childhood lead
poisoning in this Commonwealth with the purpose of
establishing a system predicated on cost-effective, health-
protective measures to evaluate and control lead-based paint
hazards in housing built prior to 1978.
(2) To substantially reduce, and eventually eliminate,
the incidence of childhood lead poisoning in this
Commonwealth.
(3) To substantially reduce the risk of childhood lead
poisoning in this Commonwealth by increasing the supply of
lead-safe housing.
(4) To improve public awareness of lead safety issues
and educate both property owners and tenants about practices
that can reduce the incidence of lead poisoning.
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(5) To require the testing of all children in this
Commonwealth at one and two years of age so that prompt
diagnosis and treatment, as well as the prevention of harm,
are possible.
Section 4 2. 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:
"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.
"HEALTH CARE FACILITY." A HOSPITAL OR HEALTH CARE FACILITY
THAT IS LICENSED, CERTIFIED OR OTHERWISE REGULATED TO PROVIDE
HEALTH CARE SERVICES UNDER THE LAWS OF THIS COMMONWEALTH.
"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.
Section 5 3. Lead poisoning prevention.
(a) Lead testing requirements.--
(1) A health care provider shall make reasonable efforts
to ensure that patients under the health care provider's care
receive a blood lead test between nine and twelve months of
age and again at approximately 24 months of age.
(2) If the results of the blood lead test indicate an
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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.
(3) Health care providers and laboratories shall comply
with reporting regulations as specified in 28 Pa. Code §
27.34 (relating to reporting cases of lead poisoning).
(b) Nonapplicability.--The testing requirements in this
section shall not apply if a child's parent or legal guardian
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.
(A) LEAD TESTING REQUIREMENTS.--A CHILD SHALL RECEIVE A
BLOOD LEAD TEST BETWEEN NINE AND 12 MONTHS OF AGE AND AGAIN AT
APPROXIMATELY 24 MONTHS OF AGE. THE FOLLOWING APPLY:
(1) A HEALTH CARE PRACTITIONER PROVIDING HEALTH CARE
SERVICES TO CHILDREN UNDER TWO YEARS OF AGE SHALL PERFORM
LEAD TESTING ON THOSE CHILDREN, UNLESS THE HEALTH CARE
PRACTITIONER, AFTER QUERYING THE STATEWIDE REGISTRY PROVIDED
FOR UNDER SECTION 4(C), DETERMINES THAT THE CHILD HAS ALREADY
UNDERGONE LEAD TESTING.
(2) A CHILD WHO HAS NOT HAD HIS BLOOD LEAD LEVEL TESTED
BETWEEN APPROXIMATELY NINE AND 12 MONTHS OF AGE AND AGAIN AT
APPROXIMATELY 24 MONTHS OF AGE SHALL HAVE HIS BLOOD LEAD
LEVEL TESTED AS SOON AS POSSIBLE AFTER 24 MONTHS OF AGE BUT
BEFORE 72 MONTHS OF AGE.
(B) ADDITIONAL TESTING.--IF THE RESULTS OF A BLOOD LEAD TEST
INDICATE A BLOOD LEAD LEVEL AT OR ABOVE THE REFERENCE VALUE FOR
EXPOSURE IDENTIFIED BY THE CENTERS FOR DISEASE CONTROL AND
PREVENTION, THE HEALTH CARE PRACTITIONER SHALL PERFORM A
CONFIRMATORY BLOOD LEAD TEST BY VENIPUNCTURE WITHIN 12 WEEKS OF
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THE FIRST BLOOD LEAD TEST AND WITHIN THE TIME FRAME RECOMMENDED
BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION.
(C) REPORTING.--HEALTH CARE PRACTITIONERS, HEALTH CARE
FACILITIES AND LABORATORIES SHALL COMPLY WITH 28 PA. CODE §
27.34 (RELATING TO REPORTING CASES OF LEAD POISONING).
Section 6 4. Duties of department.
(a) Comprehensive educational program.--The department shall
conduct a public information campaign to inform parents of young
children, physicians, nurses HEALTH CARE PRACTITIONERS, HEALTH
CARE FACILITIES and other health care providers of the lead
testing requirements under 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 testing for
elevated lead levels, INSURANCE COVERAGE FOR TESTING,
INCLUDING INFORMATION REGARDING THE MEDICAL ASSISTANCE (MA)
EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT
(EPSDT) PROGRAM AND HOW TO ENROLL, 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, PRACTITIONERS, HEALTH CARE FACILITIES,
homeowners, landlords and parents or caregivers.
(c) Statewide registry.--The department shall develop an
electronic system to provide for the confidential storage and
management of blood lead testing information that enables a
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health care provider PRACTITIONER to review a patient's history
to determine the status of blood lead testing required under
this act.
Section 7. Blood lead testing coverage.
(a) General rule.--A health insurance policy or government
program covered under this section shall provide to covered
individuals or recipients who are under two years of age
coverage for one blood lead test during the time period between
nine and twelve months of age, one blood lead test at
approximately 24 months of age and, if the results of either of
the blood level tests indicate an elevated blood lead level, an
additional 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
health insurance policy or government program are subject to
such provisions.
(c) Construction.--This section shall not be construed as
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 a health insurance
policy offered, issued or renewed on or after July 1, 2019,
in this Commonwealth to groups of 51 or more employees. This
section shall not include the following policies:
(i) An accident only policy.
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(ii) A credit only policy.
(iii) A long-term care or disability income policy.
(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 worker's compensation policy.
(xi) An automobile medical payment policy.
(xii) Another similar policy providing for limited
benefits.
(2) This section shall apply to a contract executed on
or after July 1, 2019, under Article XXIII-A of the act of
May 17, 1921 (P.L.682, No.284), known as The Insurance
Company Law of 1921, or by any successor program.
(e) Report.--An insurer shall issue a report to the
Insurance Department, in a form and manner as determined by the
Insurance Department, to evaluate the implementation of this
section by January 1, 2021.
Section 8. Applicability.
This act 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 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
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rates nor forms are required to be filed with the Insurance
Department or the Federal Government, this act shall apply to
any policy issued or renewed on or after 180 days after the
effective date of this section.
Section 9 5. Regulations.
The department shall MAY promulgate rules and regulations
necessary to administer this act.
Section 10 6. Effective Date DATE.
This act shall take effect in 60 days.
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