A3411

An Act concerning childhood lead poisoning, and amending P.L.1985, c.84, P.L.1995, c.316, and P.L.1995, c.328.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 2 of P.L.1985, c.84 (C.26:2-131) is amended to read as follows:

2. As used in this act:

[a.] "Child" means a person one through five years of age [;] .

[b.] "Commissioner" means the Commissioner of Health [;] .

[c.] "Department" means the Department of Health [;] .

[d.] "Lead poisoning" means [a concentration of lead as defined in Chapter XIII of the State Sanitary Code established pursuant to section 7 of P.L. 1947, c. 177 (C. 26:1A-7)] the poisoning of the bloodstream that results from prolonged exposure to lead or lead-based substances in water, paint, building materials, or the environment, and which causes uncorrectable developmental delay and decreased mental functioning capacity in children, and in severe cases, can lead to a child’s premature death.

(cf: P.L.1985, c.84, s.2)

2. Section 7 of P.L.1995, c.316 (C.26:2-137.1) is amended to read as follows:

7. The Department of Health shall specify by regulation, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.):

a. The lead screening requirements provided for under P.L.1995, c.316 (C.17:48E-35.10 et al.), including the age of the child when initial screening should be conducted, the time intervals between screening, when follow-up testing is required, the methods that shall be used to conduct the lead screening, and , in accordance with the latest recommendations of the federal Centers for Disease Control and Prevention and the provisions of P.L.1995, c.328 (C.26:2-137.2 et seq.), the level of lead in the bloodstream that shall [be considered to be "lead poisoning"] necessitate the undertaking of responsive action; and

b. The childhood immunizations recommended by the Advisory Committee on Immunization Practices of the United States Public Health Service and the Department of Health.

(cf: P.L.1995, c.316, s.7)

3. Section 1 of P.L.1995, c.328 (C.26:2-137.2) is amended to read as follows:

1. The Legislature finds and declares that:

a. According to the New Jersey Department of Health, 630,000 children under the age of six are at risk of lead poisoning in New Jersey and should be screened for elevated blood lead levels. Of this number, the Department of Health estimates that 177,000 pre-school children are at particularly high risk of lead poisoning;

b. Approximately 70,000 pre-school children, or almost 10[%] percent of the population of children under age six, are currently screened for lead poisoning;

c. Screening is an essential element [of] in the fight to reduce and eventually eliminate childhood lead poisoning, and identification of children in the early stages of lead exposure can prevent children from suffering severe cases of lead poisoning;

d. There is no safe level of lead exposure in children, and even low levels of lead in the bloodstream have been shown to affect IQ, attention span, and academic achievement, in a manner that cannot be corrected;

e. Although lead can be found in many sources, lead exposure is entirely preventable, and the federal Centers for Disease Control and Prevention recognizes that the best way to address the problem of lead poisoning is to take action to prevent children from coming into contact with lead, while providing appropriate treatment and case management to those children who are found to have elevated blood lead levels;

f. A universal lead screening program will identify which children require medical evaluation and treatment , and will alert parents about the need to identify and abate lead hazards in their [home] homes;

[e. A universal lead screening program that is integrated with education] g. The integration of educational and community outreach programs , as part of a universal lead screening program, will raise public consciousness about the insidious dangers of childhood lead poisoning, [and] encourage parents to take preventive steps to make their homes lead-safe , and encourage communities to strengthen lead exposure prevention programs; and

[f.] h. Universal lead screening and [the] universal reporting of lead test results will [provide] allow the Department of Health and local boards of health [with] to obtain information on [high risk] neighborhoods and communities that are at a high risk for lead exposure, and [can result in] thereby allow for the implementation of targeted lead hazard reduction programs in the areas of greatest need.

(cf: P.L.1995, c.328, s.1)

4. Section 2 of P.L.1995, c.328 (C.26:2-137.3) is amended to read as follows:

2. As used in this act:

"Commissioner" means the Commissioner of Health [;] .

"Department" means the Department of Health [;] .

“Elevated blood lead level” means a level of lead in the bloodstream that equals or exceeds five micrograms per deciliter or other such amount as may be identified in the most recent recommendations from the federal Centers for Disease Control and Prevention, and that necessitates the undertaking of responsive action.

"Lead poisoning" means [an elevated level of lead in the bloodstream, as established by regulation of the department pursuant to this act;] the poisoning of the bloodstream that results from prolonged exposure to lead or lead-based substances in water, paint, building materials, or the environment, and which causes uncorrectable developmental delay and decreased mental functioning capacity in children, and in severe cases, can lead to a child’s premature death.

"Lead screening" means the application of a detection technique to measure a child's blood lead level and determine the extent of a child's recent exposure to lead.

(cf: P.L.1995, c.328, s.2)

5. Section 3 of P.L.1995, c.328 (C.26:2-137.4) is amended to read as follows:

3. a. A physician or registered professional nurse, as appropriate, shall perform lead screening on each [of his patients] patient under six years of age to whom [he] the physician or registered professional nurse provides health care services , unless the physician or registered professional nurse has knowledge that the child has already undergone lead screening in accordance with the requirements of this act. If the physician [or] , registered professional nurse , or [his] an authorized staff member cannot perform the required lead screening, the physician or registered professional nurse may refer the patient, in writing, to another physician [or] , registered professional nurse, health care facility , or designated agency or program which is able to perform the lead screening.

b. A health care facility that serves children and is licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) [which serves children] , and any other agency or program that serves children and [that] is designated by the commissioner to perform lead screening, shall perform lead screening on each child under six years of age that the facility, agency , or program serves, unless the facility, agency , or program has knowledge that the child has already undergone lead screening in accordance with the requirements of this act. If the health care facility , agency, or program cannot perform the required lead screening, the [health care] facility , agency, or program may refer the patient, in writing, to another health care facility, physician, registered professional nurse, or other designated agency or program which is able to perform the lead screening.

c. If a physician, registered professional nurse, or health care facility, agency , or program receives laboratory test results [that indicate] indicating that a child has [lead poisoning] an elevated blood lead level, the physician, registered professional nurse, or health care facility, agency , or program shall notify [, in writing,] the parent or guardian of the child , in writing, about the test results , and shall additionally provide the parent or guardian with an explanation , in plain language , of the significance of lead poisoning. The physician, registered professional nurse, or health care facility, agency , or program [also] shall also take appropriate measures to ensure that any of the child’s siblings or other members of the household who are under the age of six either are , or have been , screened for lead exposure.

d. A physician, registered professional nurse, or health care facility, agency , or program shall not be required to conduct lead screening under this act if the parent or guardian of the child objects to the testing in writing.

e. (1) The department shall specify, by regulation, the parameters for lead screening required under this act, including the age of the child when initial screening shall be conducted, the time intervals between screening, when follow-up testing is required, and the methods that shall be used to conduct the lead screening.

(2) (a) The department shall additionally specify, by regulation, in accordance with the most recent recommendations of the federal Centers for Disease Control and Prevention, the elevated blood lead levels that require responsive action under this act, and the types of responsive action, including environmental follow-up, notice to the family, additional screening of family members, the provision of case management services, and the provision of medical treatment such as chelation therapy, that shall be undertaken when a screening test reveals an elevated blood lead level. The levels of responsive action required by the department pursuant to this paragraph may vary, consistent with the latest recommendations of the federal Centers for Disease Control and Prevention, based on the severity of the elevated blood lead level.

(b) Within 30 days after the enactment of P.L. , c. (pending before the Legislature as this bill), and on a biennial basis thereafter, the department shall review and appropriately revise its rules and regulations pertaining to elevated blood lead levels, in order to ensure that they appropriately reflect, and are consistent with, the latest guidance from the federal Centers for Disease Control and Prevention.

f. The department shall develop a mechanism, such as distribution of lead screening record cards or other appropriate means, by which children who have undergone lead screening can be identified by physicians, registered professional nurses , and health care facilities, agencies , and programs that perform lead screening , so as to avoid duplicate lead screening of children.

g. The department shall [conduct] continuously engage in a public information campaign to inform the parents of young children, as well as physicians, registered professional nurses , and other health care providers , of the lead screening requirements of this act. At a minimum, the public information campaign shall: (1) highlight the importance of lead screening, and encourage parents, especially those who have not yet complied with the lead screening provisions of this act, to have their children screened for lead poisoning at regular intervals, in accordance with the age-based timeframes established by department regulation; and (2) provide for the widespread dissemination of information to parents and health care providers on the dangers of lead poisoning, the factors that contribute to lead poisoning, the recommended ages at which children should be tested for lead poisoning, and the elevated blood lead levels that require responsive action under this act. If the department changes the elevated blood lead levels that require responsive action under this act, as may be necessary to conform its regulations to federal guidance, the information disseminated through the public information campaign shall be appropriately revised to reflect the new action levels, and shall be reissued to parents and health care providers, within 30 days after the change is implemented.

h. The department, to the greatest extent possible, shall coordinate payment for lead screening required pursuant to this act with the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and other federal children's health programs , so as to ensure that the State receives the maximum amount of federal financial participation available for the lead screening services provided pursuant to this act.

(cf: P.L.1995, c.328, s.3)

6. This act shall take effect immediately.

STATEMENT

This bill would amend the State statutes related to childhood lead poisoning, in order to clarify that the Department of Health (DOH) regulations regarding elevated blood lead levels and the appropriate responses thereto, are to be consistent with the most recent recommendations of the federal Centers for Disease Control and Prevention (CDC).

The CDC previously recommended that responsive action be taken to address childhood lead poisoning in those cases where a lead screening test showed an elevated blood lead level of 10 micrograms per deciliter or more – designated as a blood lead “level of concern.” In late 2010, however, the CDC’s Advisory Committee for Childhood Lead Poisoning Prevention (ACCLPP) formed a working group to evaluate new approaches and strategies for defining elevated blood lead levels among children, and to recommend how best to replace the term “level of concern” in response to the accumulation of scientific evidence showing the adverse effects of blood lead levels that are less than 10 micrograms per deciliter.

In its final report, issued in 2012, the working group concluded, based on existing scientific evidence, that the term “level of concern” should be eliminated from all future CDC policies, guidance documents, and other publications, and that the recommendations as to elevated blood lead levels, which were based on that “level of concern,” should be updated to reflect current data showing that there is no safe blood lead level in children. In particular, the working group recommended that the CDC adopt a lower benchmark for responsive action – an elevated blood lead level of only five micrograms per deciliter – which is based on the 97.5th percentile of children. The working group also recommended that the CDC take action, every four years, to update this recommended action level, as appropriate, based on the most recent data available.

Although the CDC has concurred with the conclusions of the working group, in this regard, and has updated its own agency recommendations on children’s blood lead levels to incorporate the recommendations of the working group, the DOH has not similarly revised its regulations to this effect, and it continues to determine the necessity for responsive action based on the outdated blood lead “level of concern” of 10 micrograms per deciliter.

This bill, therefore, would revise the current law pertaining to childhood lead poisoning, in order to reflect the current position of the CDC on elevated blood lead levels and require the DOH to make its regulations consistent with that position. The bill would define the term “elevated blood lead level” to mean a level of lead in the bloodstream that equals or exceeds five micrograms per deciliter or other such amount as may be identified in the most recent CDC recommendations, and that necessitates the undertaking of responsive action.

The bill would expressly require the DOH’s rules and regulations regarding elevated blood lead levels to be consistent with the CDC’s recommendations, and it would further require the DOH, within 30 days after the bill’s date of enactment, and on at least a biennial basis thereafter, to review and revise these rules and regulations, in order to ensure that they comport with the latest CDC guidance on this issue.

The bill would further specify that the department’s public information campaign on lead screening is to: (1) highlight the importance of lead screening, and encourage parents, especially those who have not yet complied with the screening provisions of this act, to have their children screened for lead poisoning at regular intervals, in accordance with the age-based timeframes established by department regulation; and (2) provide for the widespread dissemination of information to parents and health care providers on the dangers of lead poisoning, the factors that contribute to lead poisoning, the recommended ages at which children should be tested for lead poisoning, and the elevated blood lead levels that will necessitate responsive action under this act. If the DOH changes the elevated blood lead levels that are required for responsive action, as may be necessary to conform its regulations to federal guidance, the information disseminated through the public information campaign would need to be revised and reissued within 30 days thereafter.