A05546
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 AMENDED ON THIRD CONSIDERATION, JUNE 13, 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
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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 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) (1) 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) (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.
(5) (3) To require the testing of all children in this
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Commonwealth at one and 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:
"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.
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(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.
(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 between 9 and 12
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months of age and again at approximately 24 months of age. 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.
(2) If the results of the 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.
(b) Lead testing requirements for pregnant women.--A health
care provider shall ensure that a patient under the health care
provider's care receives a blood lead test as part of the
patient's prenatal care. 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.
(c) Reporting.--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).
(d) Nonapplicability.--The testing 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
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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.
(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
health care provider to review a patient's history to determine
the status of blood lead testing required by this act.
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 who are pregnant or under two years of
age coverage for INDIVIDUALS OR RECIPIENTS blood lead tests as
follows:
(1) In the case of individuals or recipients who are
pregnant, one blood lead test as part of prenatal care. PER
PREGNANCY IF A SINGLE RISK FACTOR IS IDENTIFIED IN ACCORDANCE
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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, one blood lead test during the time
period between 9 and 12 months of age, one blood lead test at
approximately 24 months of age and, if the results of either
of 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 tests 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.
(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 any health insurance
policy offered, issued or renewed on or after July 1, 2022,
in this Commonwealth to groups of 51 or more employees 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
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policies:
(i) An accident-only policy.
(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 workers' compensation policy.
(xi) An automobile medical payment policy.
(xii) Hospital indemnity policy.
(xiii) Another similar policy providing for limited
benefits.
(2) This section shall apply to any contract executed on
or after July 1, 2022, by the adult basic coverage insurance
program established under Chapter 13 of the act of June 26,
2001 (P.L.755, No.77), known as the Tobacco Settlement Act,
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.
(3) On January 1, 2024, insurers shall make a report to
the Insurance Department, in a form and manner as determined
by the department, to evaluate the implementation of this
section.
(2) (RESERVED).
Section 8. Implementation.
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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. Regulations.
The department shall promulgate rules and regulations to
administer and enforce this act.
Section 10 9. Effective date.
This act shall take effect in 60 days.
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