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AB-1316 Public health: childhood lead poisoning: prevention.(2017-2018)

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Date Published: 05/02/2017 09:00 PM
AB1316:v97#DOCUMENT

Revised  May 26, 2017
Amended  IN  Assembly  May 02, 2017
Amended  IN  Assembly  April 18, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 1316


Introduced by Assembly Members Quirk and Cristina Garcia
(Principal coauthor: Senator Skinner)
(Coauthor: Assembly Member Gonzalez Fletcher)

February 17, 2017


An act to amend Sections 1367.3, 105280, 105285, 105290, 105310, and 124150 of the Health and Safety Code, relating to childhood lead poisoning.


LEGISLATIVE COUNSEL'S DIGEST


AB 1316, as amended, Quirk. Public health: childhood lead poisoning: prevention.
Existing law, the Childhood Lead Poisoning Prevention Act of 1991, required the State Department of Public Health (formerly the State Department of Health Services) between July 1, 1992, and July 1, 1993, to adopt regulations establishing a standard of care at least as stringent as the most recent United States Centers for Disease Control and Prevention screening guidelines, whereby all children are evaluated for risk of lead poisoning by health care providers during each child’s periodic health assessment. The standard of care, among others, is required to be that, upon evaluation, those children determined to be at risk for lead poisoning, according to the regulations, are required to be screened. Existing law creates the Childhood Lead Poisoning Prevention Fund consisting of fees imposed on manufacturers and other persons formerly, presently, or both formerly and presently engaged in the stream of commerce of lead or products containing lead, or who are otherwise responsible for identifiable sources of lead that have significantly contributed historically, currently contribute, or both have significantly contributed historically and contribute currently to environmental lead contamination. The moneys in the fund are required to be expended, upon appropriation by the Legislature, for the purposes of the act.
This bill would instead require the standard of care to be that all children be screened for blood lead levels, as specified, require that the regulations establishing a standard of care include a risk assessment for determining whether a child is at risk for lead poisoning that considers the most significant environmental risk factors, as specified, and would clarify that the lead screening would not be paid for by funds from the Childhood Lead Poisoning Prevention Fund. The bill would also make conforming changes, technical changes, and delete obsolete provisions.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1367.3 of the Health and Safety Code is amended to read:

1367.3.
 (a) Every health care service plan that covers hospital, medical, or surgical expenses on a group basis shall offer benefits for the comprehensive preventive care of children. This section shall apply to children 17 and 18 years of age, except as provided in subparagraph (D) of paragraph (2) of subdivision (b). Every plan shall communicate the availability of these benefits to all group contractholders and to all prospective group contractholders with whom they are negotiating. This section shall apply to a plan that, by rule or order of the director, has been exempted from subdivision (i) of Section 1367, insofar as that section and the rules thereunder relate to the provision of the preventive health care services described herein.
(b) For purposes of this section, benefits for the comprehensive preventive care of children shall comply with both of the following:
(1) Be consistent with both of the following:
(A) The Recommendations for Preventive Pediatric Health Care, as adopted by the American Academy of Pediatrics in September of 1987.
(B) The most current version of the Recommended Childhood Immunization Schedule/United States, jointly adopted by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians, unless the State Department of Public Health determines, within 45 days of the published date of the schedule, that the schedule is not consistent with the purposes of this section.
(2) Provide for the following:
(A) Periodic health evaluations.
(B) Immunizations.
(C) Laboratory services in connection with periodic health evaluations.

(D)Screening for blood lead levels in all children if the screening is prescribed by a physician and surgeon affiliated with the plan.

(D) Screening for blood lead levels in children of any age who are at risk for lead poisoning, as determined by a physician and surgeon affiliated with the plan, if the screening is prescribed by a physician and surgeon affiliated with the plan.

SEC. 2.

 Section 105280 of the Health and Safety Code is amended to read:

105280.
 For purposes of this chapter, the following definitions apply:
(a) “Appropriate case management” means health care referrals, environmental assessments, and educational activities, performed by the appropriate person, professional, or entity, necessary to reduce a child’s exposure to lead and the consequences of the exposure, as determined by the United States Centers for Disease Control and Prevention, or as determined by the department pursuant to Section 105300.
(b) “Lead poisoning” means the disease present when the concentration of lead in whole venous blood reaches or exceeds levels constituting a health risk, as specified in the most recent United States Centers for Disease Control and Prevention guidelines for lead poisoning as determined by the department, or when the concentration of lead in whole venous blood reaches or exceeds levels constituting a health risk as determined by the department pursuant to Section 105300.
(c) “Department” means the State Department of Public Health.
(d) “Health assessment” has the same meaning as prescribed in Section 6800 of Title 17 of the California Code of Regulations.
(e) “Screen” means the medical procedure by which the concentration of lead in whole venous blood is measured.
(f) “Health care” means the identification, through evaluation and screening, if indicated, of lead poisoning, as well as any followup medical treatment necessary to reduce the elevated blood lead levels.
(g) “Environmental lead contamination” means the persistent presence of lead in the environment, in quantifiable amounts, that results in ongoing and chronic exposure to children.

SEC. 3.

 Section 105285 of the Health and Safety Code is amended to read:

105285.
 (a) The department shall adopt regulations establishing a standard of care, at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines, whereby all children are evaluated for risk of lead poisoning by health care providers during each child’s periodic health assessment. The regulations shall include a risk assessment for determining whether a child is “at risk” that considers the most significant environmental risk factors, including, but not limited to, a child’s time spent in a home, school, or building built before 1978, a child’s proximity to a former lead or steel smelter, a child’s proximity to a freeway, a child’s consumption of imported foods and spices, and other known risk factors for lead exposure. The regulations shall be developed in consultation with medical experts, environmental experts, appropriate professional organizations, and the public, as determined by the department.

(b)The standard of care shall require that all children be screened in accordance with the timeframes for screening established in Section 37100 of Title 17 of the California Code of Regulations.

(b) The standard of care shall require a child who is determined to be “at risk” for lead poisoning, according to the regulations adopted pursuant to subdivision (a), to be screened.
(c) The standard of care shall provide that a child shall not be screened pursuant to this chapter if the parent or guardian of the child refuses to consent to the screening.

(d)The standard of care shall provide that health care providers are responsible for evaluation of all children and for medically necessary followup services.

(d) The standard of care shall provide that health care providers are responsible only for evaluation of all children, for screening of children determined to be at risk, and for medically necessary followup services.

SEC. 4.

 Section 105290 of the Health and Safety Code is amended to read:

105290.
 When a child is identified with lead poisoning, the department shall ensure appropriate case management. The department may contract with any public or private entity, including local agencies, to conduct the case management.

SEC. 5.

 Section 105310 of the Health and Safety Code is amended to read:

105310.
 (a) There is hereby imposed a fee on manufacturers and other persons formerly, presently, or both formerly and presently engaged in the stream of commerce of lead or products containing lead, or who are otherwise responsible for identifiable sources of lead that have significantly contributed historically, currently contribute, or both have significantly contributed historically and contribute currently to environmental lead contamination.
(b) The department shall, by regulation, establish specific fees to be assessed on manufacturers and other parties formerly, presently, or both formerly and presently engaged in the stream of commerce of lead or products containing lead, or who are otherwise responsible for identifiable sources of lead that, as determined by the department, have significantly contributed historically, currently contribute, or both have significantly contributed historically and contribute currently to environmental lead contamination.
To the maximum extent practicable, the fees shall be assessed on the basis of the following criteria:
(1) A person’s past and present responsibility for environmental lead contamination.
(2) A person’s “market share” responsibility for environmental lead contamination.
This section shall not apply to, and no fee shall be assessed upon, any retailer of lead or products containing lead.
(c) The fee shall be assessed and collected annually by the State Board of Equalization. The annual fee assessment in subdivision (a) shall be adjusted by the department to reflect both of the following:
(1) The increase in the annual average of the California Consumer Price Index, as recorded by the California Department of Industrial Relations, for the most recent year available.
(2) The increase or decrease in the number of children in California who are receiving services, excluding screening for blood lead levels as described in Section 105285, pursuant to this chapter.
This adjustment of fees shall not be subject to the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d) (1) A fee shall not be assessed upon a person if that person can demonstrate, as determined by the department, that his or her industry did not contribute in any manner, as described in this section, to environmental lead contamination.
(2) A fee shall not be assessed upon a party if that party demonstrates, as determined by the department, that the lead, or the product containing lead, with which it is currently, or was historically, associated does not currently, or did not historically, result in quantifiably persistent environmental lead contamination.
(e) The fee imposed pursuant to this section shall be administered and collected by the State Board of Equalization in accordance with Part 22 (commencing with Section 43001) of Division 2 of the Revenue and Taxation Code. The fees shall be deposited in the Childhood Lead Poisoning Prevention Fund, which is hereby created in the State Treasury. Moneys in the fund shall be expended for the purposes of this chapter, including the State Board of Equalization’s costs of collection and administration of fees, upon appropriation by the Legislature. All interest earned on the moneys that have been deposited into the Childhood Lead Poisoning Prevention Fund shall be retained in that fund.
(f) The fees collected pursuant to this section and the earnings therefrom shall be used solely for the purposes of implementing this chapter. The department shall not collect fees pursuant to this section in excess of the amount reasonably anticipated by the department to fully implement this chapter. The department shall not spend more than it collects from the fees and the earnings in implementing this chapter. In no fiscal year shall the department collect more than sixteen million dollars ($16,000,000) in fees, as adjusted for inflation pursuant to subdivision (b).
(g) It is the intent of the Legislature, in subsequent legislation, to appropriate and deposit into the Childhood Lead Poisoning Prevention Fund the sum of one hundred twenty-eight thousand dollars ($128,000) from the General Fund on July 1, 1992, to the Controller for allocation as loans as follows:
(1) Seventy-eight thousand dollars ($78,000) to the department, for the purposes of adopting regulations to establish the fee schedule authorized by this section. The State Board of Equalization shall repay the amount of this appropriation, on or before June 30, 1993, with interest at the pooled money investment rate, from fees collected pursuant to this section.
(2) Fifty thousand dollars ($50,000) to the State Board of Equalization, for the purposes of implementing this section. The State Board of Equalization shall repay the amount of this appropriation on or before June 30, 1993, with interest at the pooled money investment rate, from fees collected pursuant to this section.
(h) Regulations adopted for fee assessment and collection pursuant to this section shall be exempt from review by the Office of Administrative Law.

SEC. 6.

 Section 124150 of the Health and Safety Code is amended to read:

124150.
 The Legislature hereby finds and declares that the activities conducted by the department pursuant to Section 124130 have confirmed and supported the findings specified in Section 124125 and, in addition, have resulted in the following findings:
(a) Very few children are currently tested for elevated blood lead levels in California. The lead registry established pursuant to Section 124130 has been effective at identifying incidents of occupational lead poisoning; however, because childhood lead screening is not now required in California, the registry is unable to serve as the exclusive mechanism to identify children with elevated blood lead levels. Additional blood lead screening needs to be done to identify children at high risk of lead poisoning.
(b) Based on emerging information about the severe deleterious effects of low levels of lead on children’s health, the lead danger level is expected to continue to be lowered.
(c) Lead poisoning poses a serious health threat for significant numbers of California children. Based on lead registry reports and targeted screening results, the department has estimated that tens of thousands of California children may be suffering from blood lead levels greater than the danger level.
(d) The implications of lead exposure to children and pregnant women from lead brought home on the clothing of workers is unknown, but may be significant.
(e) Levels of lead found in soil and paint around and on housing constitute a health hazard to children living in the housing. No regulations currently exist to limit allowable levels of lead in paint surfaces in California housing.

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REVISIONS:
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