SCREENING FOR LEAD POISONING; MINORS S.B. 31 (S-1):
SUMMARY OF SUBSTITUTE BILL
IN COMMITTEE
Senate Bill 31 (Substitute S-1)
CONTENT
The bill would amend the Public Health Code to require a physician treating a minor to test or order a test for lead poisoning at early ages and require the Michigan Department of Health and Human Services (DHHS) to promulgate specified rules related to the testing of lead poisoning. The bill specifies that its provisions would not apply to a minor whose parent, guardian, or person in loco parentis objected to testing.
Beginning January 1, 2024, a physician treating a minor would have to test or order a test for the minor for lead poisoning with the rules promulgated by the DHHS as described below. The physician also would have to make an entry of the testing on the minor's certificate of immunization.
The DHHS would have to promulgate rules to implement the bill. The rules would have to require that a minor residing in the State was tested at the following ages:
-- Once at one year old.
-- Once at two years old.
-- Once at four years old, if the minor were in a geographic area of the State identified to pose a high risk for childhood lead poisoning as determined by the DHHS.
-- At least once between two and six years old, if the minor had no prior experience with testing.
In addition, the rules would have to include the following:
-- Factors to identify a minor who was at high risk for lead poisoning, including residing in a home where other minors had been diagnosed with lead poisoning and residing in a home built before 1978.
-- A requirement that a minor was tested at intervals determined by the DHHS if a physician determined the minor was at high risk for lead poisoning by applying the factors above, through a parent's attestation, or through the physician's own independent medical judgement.
-- Procedures for entering the testing information onto the certificate of immunization, including procedures for entering the information if the testing were performed by a person other than a physician.
If, after five years of data collection on lead poisoning, the DHHS determined that testing minors was no longer appropriate to maintain the health and safety of minors in Michigan, the DHHS would be allowed to alter these rules.
Under the Code, a health care provider administering an immunizing agent to a child must present the person accompanying the child with a written certificate of immunization or make
an entry on a certificate in the person's possession. Certificates must indicate certain immunization information. Under the bill, beginning January 1, 2024, the certificate also would have to have a space indicating whether the minor had been tested for lead poisoning.
MCL 333.9206 et al.
PREVIOUS LEGISLATION
(Please note: This section does not provide a comprehensive account of all previous legislative efforts on the relevant subject matter.)
The bill is similar to House Bill 5365 from the 2019-2020 Legislative Session.
BACKGROUND
Under Federal law, all children who receive Medicaid coverage are required to test for lead poisoning at the ages of one and two years old.[1] Additionally, if a child is enrolled into Medicaid coverage before they are six years old and did not test at either one or two years old, they are required to take a test before their sixth birthday. The provisions of the bill would replicate this model. The Centers for Disease Control and Prevention (CDC) recommend action to be taken if blood lead levels register at 3.5 micrograms per deciliter or higher.[2] Lead poisoning in children can cause damage to the brain and nervous system, slowed growth and development, learning and behavioral problems, and hearing and speech problems.[3] Adults can help reduce children's lead exposure by frequently washing children's hands and children's toys that may have come into contact with contaminated paint or soil, and by covering up cracks in paint in houses built before 1978 to reduce contact with lead dust.3 In addition, other common sources of lead exposure include certain water pipes, candies or traditional home remedies, and aviation gas from piston engine aircrafts.[4] According to the DHHS, 96,462 Michigan children under six years old underwent a blood lead test in 2021, and 3.5% of those children had elevated blood levels at or above 3.5 micrograms per deciliter.[5]
Legislative Analyst: Alex Krabill
FISCAL IMPACT
The bill would have a minor negative fiscal impact on the DHHS and no impact on local units of government. The DHHS would incur costs as a result of increased administrative activities from promulgating rules to implement the required testing for lead poisoning and then reviewing the rules after five years. The costs would be borne by existing DHHS resources.
Fiscal Analyst: Ellyn Ackerman
This analysis was prepared by nonpartisan Senate staff for use by the Senate in its deliberations and does not constitute an official statement of legislative intent.
[1] Centers for Medicare & Medicaid Services, Lead Screening, 2023.
[2] Centers for Disease Control and Prevention, Recommended Actions Based on Blood Lead Level, 2022.
[3] Centers for Disease Control and Prevention, Prevent Children's Exposure to Lead, October 2022.
[4] Centers for Disease Control and Prevention, Sources of Lead Exposure, January 2023.
[5] Michigan Department of Health and Human Services, MiTracking – Michigan Environmental Public Health Tracking, 2021.
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This analysis was prepared by nonpartisan Senate staff for use by the Senate in its deliberations and does not constitute an official statement of legislative intent.