SB2637

SECTION 1. The legislature finds that it is well-established that lead poisoning can cause permanent health damage, including intellectual disabilities, learning and behavior problems, high blood pressure, damage to the brain, nervous system, kidneys, and red blood cells, as well as coma and death in severe cases. Even at low levels, lead exposure can result in adverse health effects, especially in young children. According to the Centers for Disease Control and Prevention, the effects of childhood lead poisoning are most effectively treated through early intervention programs before the age of three. Under federal law, all medicaid-insured children are to be screened for lead at one and two years of age, but no mandate currently exists at the state level, even though the federal Individuals with Disabilities Education Act requires all states to offer early intervention services for children at risk for developmental delays or disability before they are three years of age.

Though the reported number of children in Hawaii with elevated blood lead levels has decreased over time, elevated blood lead levels among children continue to be a concern. At this time, only twenty-five per cent of children under the age of three are tested for lead, which means that the blood lead levels of the unscreened children are unknown and untreated.

The purpose of this Act is to keep Hawaii's children safe from lead hazards, and the effects of lead poisoning, by requiring lead tests for well-child checks at ages one, two, and three for all children residing in the State, and to provide early-intervention services to children who have elevated blood lead levels of ten micrograms per deciliter or higher.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . mandatory screening for lead poisoning

§321-A Definitions. As used in this part, unless the context clearly indicates otherwise:

"Delayed development" has the same meaning as provided for in section 321-351.

"Department" means the department of health.

"Director" means the director of health.

"Early intervention services" has the same meaning as provided for in section 321-351.

"Infant" means a child from birth to thirty-six months of age.

"Infants and toddlers with special needs" means infants and toddlers from birth to age three having delayed development.

"Lead poisoning" means a medical condition present in a child younger than six years of age in which the child has a concentration of lead in whole venous blood of ten micrograms per deciliter or higher.

§321-B Duties. It shall be the duty and responsibility of the department to establish, implement, and evaluate a statewide program for early identification of, and intervention for, lead poisoning in infants.

§321-C Regular screening of children for lead poisoning. (a) All children shall be screened once between nine and twelve months of age, and again at two and three years of age.

(b) In addition, children who live in neighborhoods with a high risk for childhood lead poisoning, as determined by the department, shall be screened at four years of age.

§321-D Screening of children at high risk for lead poisoning. (a) A child shall be screened for lead poisoning more than once a year whenever, in the sound medical judgment of the child's health care provider, the child is at high risk of lead poisoning or meets one of the following high-risk criteria:

(1) The child lives in a home where siblings or other children in the same household are lead poisoned;

(2) The child lives in a home constructed before 1978 that is undergoing renovations, unless the home has been inspected by a lead inspector and the surfaces to be disturbed are found not to contain dangerous levels of lead; or

(3) The child lives in a home constructed prior to 1978 with deteriorated paint or plaster, unless the home has been inspected by a lead inspector and is found not to contain a dangerous level of lead.

(b) A child who meets any of the high-risk criteria set forth under subsection (a) shall be screened at least every six months between six months and three years of age, and again at four and five years old.

(c) If a child between one and six years of age has never been screened for lead poisoning, the child shall be screened upon the child's entry into day care, including group or family day care, or kindergarten or pre-kindergarten, and the child's parent or guardian shall present evidence of the screening. If the child has previously been screened for lead poisoning, the child shall not be required to be screened again to fulfill daycare, pre-kindergarten, or kindergarten entry requirements, but the child's parent or guardian shall present evidence of previous screening.

§321-E Health care provider applicability. (a) Each physician duly licensed under chapter 453 shall screen patients for lead poisoning at the intervals specified under section 321‑D, using the methods specified in this part.

(b) Each licensed, registered, or approved health care facility serving children younger than six years of age, including hospitals and clinics issued a certificate of need under section 323D-43 shall take appropriate steps to screen patients for lead poisoning.

(c) Each health maintenance organization issued a certificate of authority under section 432D-2 shall take appropriate steps to screen patients for lead poisoning.

§321-F Recommended screening protocol. (a) If a capillary sample is used, screening shall conform to the capillary blood sample protocol approved by the director. If a capillary sample shows that the child has a concentration of five micrograms of lead per deciliter of blood or higher, a confirmatory venous blood sample shall be required in accordance with guidance issued by the director.

(b) A child who meets the high-risk criteria under section 321-D(a)(2) shall be screened within four weeks of the start of the home renovation and once a month thereafter during the duration of the renovation, and once after the completion of the renovation.

§321-G Early intervention services. Children younger than four years of age who are identified as having a blood lead level of ten micrograms of lead per deciliter of blood or higher shall be provided with early intervention services and receive repeat screenings in accordance with the current standards developed by the American Academy of Pediatrics or any other qualified medical authority as determined by the director.

§321-H Reimbursement for mandatory lead screening services. The following blood lead screening services shall constitute mandatory blood lead screening and shall be covered under individual or group policies of insurance as provided under chapter 431, article 10A, parts I and II; individual or group hospital or medical service plan contracts as provided under chapter 432, article 1; and health maintenance contracts as provided by chapter 432D:

(1) Assessment of the child for regular screening at age four, in accordance with section 321-C and assessment for high-risk screening in accordance with section 321-D;

(2) Completion of the laboratory form known as a bloodslip;

(3) Drawing of the blood specimen pursuant to section 321‑F;

(4) Packaging and handling of the blood specimen including postage costs for mailing the specimen to the laboratory; and

(5) Analysis of the blood specimen for lead level by atomic absorption spectrophotometry or any other method approved by the Clinical Laboratory Improvement Amendments of 1988, Public Law 100-578, and 42 U.S.C. 263a, and for erythrocyte protoporphyrin by fluorometry, either through the measurement of zinc protoporphyrin or by extraction."

SECTION 3. This Act shall take effect on July 1, 2020.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2637
THIRTIETH LEGISLATURE, 2020
STATE OF HAWAII