Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1241 - EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT PROGRAM
ADMINISTRATIVE SANCTIONS
Appendix E - GUIDELINES ON CHILDHOOD LEAD POISONING PREVENTION
Childhood Lead Poisoning Prevention Questionnaire
Does your child live in or regularly visit a house, a day-care center or a nursery school that was built before 1960 and has peeling or chipping paint?
Does your child live in a home built before 1960 that is being remodeled or renovated?
Does your child live near a heavily traveled major highway where soil and dust may be contaminated with lead?
Have any of your children or their playmates had lead poisoning?
Do you give your child any home or folk remedies which may contain lead?
Does your child often come in contact with an adult who works with lead-in construction, welding, plumbing, pottery or other trades?
Does your child live near a lead smelter, a battery-recycling plant or other industrial sites likely to release lead?
Does your home plumbing have lead pipes or copper with lead solder joints?
Under recent Federal clarification, a child, whose parent has answered "yes" to one or more of the risk assessment questions, is determined to be at high risk. A child, whose parent has answered "no" to all questions, is determined to be at low risk. We believe that most MA eligible children will be at high risk for lead poisoning. The EP test is not effective and is no longer acceptable as a screening test for lead poisoning. The use of the blood lead test is now required when screening Medicaid-eligible children for lead toxicity, whether they are determined high risk or low risk.
Screening Schedule
I. For children 6 to 36 months of age who are at LOW risk for HIGH dose lead exposure by questionnaire: an initial blood lead (PbB) test at 12 months of age and as follows:
A. If PbB test result: <10 ug/dL, retest at 24 months.
B. If PbB test result: 10-14 ug/dL, retest every 3 to 4 months. After 2 consecutive measurements are <10 ug/dL or three are [LESS THAN EQUAL TO]15 ug/dL, retest child in 1 year.
C. If PbB test result >=15 ug/dL, case manage and retest every 3 to 4 months.
II. For children 6 to 36 months of age who are at HIGH risk for HIGH dose exposure by questionnaire an initial PbB test at 6 months of age and as follows:
A. If PbB test result is <10 ug/dL, rescreen every 6 months. After 2 subsequent consecutive measurements are <10 ug/dL or three are [LESS THAN EQUAL TO]15 ug/dL, testing frequency can be decreased to once a year.
B. If PbB test result 10-14 ug/dL, rescreen child every 3 to 4 months. After 2 subsequent consecutive measurements <10 ug/dL or three are [LESS THAN EQUAL TO]15 ug/dL, testing frequency can be decreased to once a year.
III. For children 36 to 72 months of age:
As for younger children, a questionnaire should be used at each routine office visit of children from 36 to 72 months of age. Any child at HIGH risk by questionnaire who has not been previously tested should be tested. All children who have had venous blood lead tests >=15 ug/dL or who are at risk by questionnaire should be screened at least once a year until their sixth birthday (age 72 months) or later, if indicated (e.g. developmentally delayed with pica). Children should also be screened any time history suggests exposure has increased.
Follow up for all Children 6 to 72 months
at PbB Levels >15 ug/dL
A. If PbB 10-14 rescreen in 3-4 months or more often is indicated, provide family with education and nutritional counseling, and take a detailed environmental history to identify any obvious sources or pathways of lead exposure. It is unlikely that there is a single predominant source of lead exposure for most of these children, thus, a full home inspection is not recommended. It is prudent, however, to try to decrease exposure to lead with some simple interventions.
B. If PbB 15-19 ug/dL: same as preceding, plus discuss interventions to reduce PbB levels. If the PbB persists at this level, environmental investigation and abatement.
C. If PbB 20-44 ug/dL: same as for all of the preceding, plus venous confirmation, medical evaluation and follow-up.
D. If 45-69 ug/dL: same as for all of the preceding, plus URGENT medical and environmental follow-up.
Elevated PbB results obtained on capillary screening specimens are presumptive and must be confirmed using venous PbB as follows: less than 10 ug/dL not applicable; 10-14 ug/dL not applicable; 15-19 ug/dL within 1 month; 20-44 ug/dL within 1 week; 45-69 ug/dL within 48 hours; greater than or equal to 70 ug/dL immediately.
The Department currently reimburses for blood lead testing through distinct procedure codes listed on the MA Fee Schedule and as a component of the Early and Periodic Screening, Diagnosis and Treatment Program.
NOTE: For a free copy of the October 1991 CDC Statement contact the Pennsylvania Department of Health, Childhood Lead Poisoning Prevention Program at (717) 783-8451.
