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SB-1041 Childhood lead poisoning prevention.(2017-2018)

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Date Published: 09/24/2018 09:00 PM
SB1041:v94#DOCUMENT

Senate Bill No. 1041
CHAPTER 690

An act to amend Sections 105285, 105295, 105300, and 124125 of, and to add Section 105286 to, the Health and Safety Code, relating to public health.

[ Approved by Governor  September 22, 2018. Filed with Secretary of State  September 22, 2018. ]

LEGISLATIVE COUNSEL'S DIGEST


SB 1041, Leyva. Childhood lead poisoning prevention.
Existing law, the Childhood Lead Poisoning Prevention Act of 1991, establishes the Childhood Lead Poisoning Prevention Program (Program), which is administered by the State Department of Public Health. Existing law requires the department 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. Existing law provides that the standard of care shall require a child who is determined to be at risk for lead poisoning to be screened. Existing regulations require every health care provider who performs a periodic health assessment of a child to order a child who receives services from a publicly funded program for low-income children to be screened for lead poisoning. Existing law requires the department to collect and analyze all information necessary to effectively monitor appropriate case management efforts, prepare a biennial report on this material, and disseminate the report to local health departments and the general public.
This bill would make it a goal of the state that all children at risk of lead exposure receive blood lead screening tests, and would require the department to take action, and to require local agencies to take action, necessary to ensure these goals are met. By requiring local agencies to take action to meet these goals, this bill would impose a state-mandated local program.
The bill would require the department to notify health care providers who perform periodic health assessments for children about, and would require those health care providers to inform parents and guardians about, the childhood lead exposure and blood lead screening tests, as specified.
The bill would require the department to report on additional content, including the total number of children enrolled in Medi-Cal and who have secured blood lead screening tests. The bill would specify that any material in the report comply with state and federal privacy laws. The bill would require the department to prominently post the biennial report on the Internet Web site. The bill would require the department to collaborate with the State Department of Health Care Services to collect and analyze information related to children enrolled in Medi-Cal.
Existing law requires the department to, by March 1, 2019, and by March 1 of each year thereafter, prepare and prominently post on its Internet Web site information that evaluates the department’s progress in meeting the program goals.
This bill would require the information to include the biennial report.
This bill would incorporate additional changes to Section 105295 of the Health and Safety Code proposed by SB 1097 to be operative only if this bill and SB 1097 are enacted and this bill is enacted last.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

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

105285.
 (a) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.
(b) 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 meet the goals of subdivision (a) and shall include the determination of risk factors for whether a child is “at risk.” When determining the risk factors, the department shall consider 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 or an industrial facility that historically emitted or currently emits lead, a child’s proximity to a freeway or heavily traveled roadway, other potential risk factors for lead exposure, and known sources of lead contamination. By July 1, 2019, the regulations shall be developed in consultation with medical experts, environmental experts, appropriate professional organizations, the public, and others as determined by the department.
(c) 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 (b), to be screened.
(d) 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.
(e) 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.
(f) The fee imposed by Section 105310 shall not be used to fund blood lead screening under this section.

SEC. 2.

 Section 105286 is added to the Health and Safety Code, to read:

105286.
 (a) The department shall notify health care providers who perform periodic health assessments for children about, and those health care providers shall inform parents and guardians about, all of the following:
(1) The risks and effects of childhood lead exposure.
(2) The requirement that children enrolled in Medi-Cal receive blood lead screening tests as set forth in the department’s standard of care policies, promulgated regulations, and published guidelines, in accordance with Section 105285.
(3) The requirement that children not enrolled in Medi-Cal who are at high risk of lead exposure receive blood lead screening tests as set forth in the department’s standard of care policies, promulgated regulations, and published guidelines, in accordance with Section 105285.
(b) To implement the requirements of subdivision (a), the department may use channels of communication, including, but not limited to, publications that serve the health care provider community, such as newsletters developed by either the Medical Board of California, other licensing organizations or associations, or local organizations and jurisdictions.

SEC. 3.

 Section 105295 of the Health and Safety Code is amended to read:

105295.
 (a) The department shall collect and analyze information necessary to effectively monitor appropriate case management efforts. The department shall prepare a biennial report describing the effectiveness of appropriate case management efforts. The report shall include, but not be limited to, all of the following:
(1) The number of enrolled children in Medi-Cal, identified by county and year of age, who received blood lead screening tests and who have not received these tests.
(2) The number of children not enrolled in Medi-Cal, identified by county and year of age, who have received blood lead screening tests.
(3) Publicly releasable data and information that the department compiles, identifies, and analyzes in accordance with subdivision (b) of Section 124125.
(b) This report shall be made available to local health departments and the general public. The department shall prominently post the report on the Internet Web site consistent with the requirements of subdivision (c) of Section 124125.
(c) The department shall collaborate with the State Department of Health Care Services to collect and analyze information identified under subdivision (a) that pertains to children enrolled in Medi-Cal.

SEC. 3.5.

 Section 105295 of the Health and Safety Code is amended to read:

105295.
 (a) (1) The department shall collect and analyze all information necessary to effectively monitor appropriate case management efforts. The department shall prepare a biennial report describing the effectiveness of appropriate case management efforts. This report shall be made available to local health departments and the general public.
(2) The department shall prominently post the report prepared pursuant to this subdivision on the department’s Internet Web site consistent with the requirements of subdivision (c) of Section 124125.
(b) The report prepared pursuant to subdivision (a) shall include all of the following information listed for each county:
(1) The total number of children tested for lead poisoning.
(2) The results of blood lead testing by ranges of lead levels.
(3) The number of children, by blood lead level range, who were referred for case management and environmental services and who received the following services:
(A) Home visit.
(B) Environmental investigation.
(C) Family education and provision of educational materials, nutrition assessment, and nutrition education.
(4) (A) The identified sources of lead exposure for those children having lead poisoning.
(B) The report shall indicate whether the sources of lead exposure identified in, on, or around a residence or location associated with a child with lead poisoning have been removed, remediated, or abated.
(c) The report shall also include, but not be limited to, all of the following:
(1) The number of enrolled children in Medi-Cal, identified by county and year of age, who received blood lead screening tests and who have not received these tests.
(2) The number of children not enrolled in Medi-Cal, identified by county, and year of age, who have received blood lead screening tests.
(3) Publicly releasable data and information that the department compiles, identifies, and analyzes in accordance with subdivision (b) of Section 124125.
(d) The department shall collaborate with the State Department of Health Care Services to collect and analyze information identified under subdivision (c) that pertains to children enrolled in Medi-Cal.
(e) When preparing the report required by subdivision (b), the department may use the information that the department receives through its existing case management efforts, including, but not limited to, the data in biennial reports provided to the department from local health departments.
(f) The department shall provide the data collected and the report prepared pursuant to this section to the Healthy Communities Data and Indicators Project (HCI) standardized set of statistical measures for use in any tools developed by HCI that are used for planning healthy communities and evaluating the impact of plans, projects, policies, and environmental changes on community health.
(g) All uses and disclosure of data made pursuant to this section shall comply with all applicable state and federal laws for the protection of the privacy and security of data, including, but not limited to, subdivision (g) of Section 124130 and the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code).

SEC. 4.

 Section 105300 of the Health and Safety Code is amended to read:

105300.
 Notwithstanding Section 124130, the department shall have broad regulatory authority to fully implement and effectuate the purposes of this chapter. The authority shall include, but is not limited to, the following:
(a) The development of protocols to be utilized in screening and the procedures for changing those protocols when more accurate or efficient technologies become available.
(b) The designation of laboratories which are qualified to analyze whole blood specimens for concentrations of lead and the monitoring of those laboratories for accuracy.
(c) The development of reporting procedures by laboratories.
(d) The reimbursement for state-sponsored services related to screening and appropriate case management.
(e) The establishment of lower concentrations of lead in whole blood than those specified by the United States Centerms in California; that it is well known that the environment is widely contaminated with lead; that excessive lead exposure causes acute and chronic damage to a child’s renal system, red blood cells, and developing brain and nervous system; that at least one in every 25 children in the nation has an elevated blood lead level; and that the cost to society of neglecting this problem may be enormous.
(b) The Legislature further finds and declares that knowledge about where and to what extent harmful childhood lead exposures are occurring in the state could lead to the prevention of these exposures, and to the betterment of the health of California’s future citizens. Therefore, the enactment of this article establishes a state Childhood Lead Poisoning Prevention Program. The department shall accomplish all of the following:
(1) Compile information concerning the prevalence, causes, and geographic occurrence of high childhood blood lead levels.
(2) Identify and target areas of the state where childhood lead exposures are especially significant.
(3) Analyze information collected pursuant to this article and, where indicated, design and implement a program of medical followup and environmental abatement and followup that will reduce the incidence of excessive childhood lead exposures in California.
(4) Work, as necessary, with the State Department of Health Care Services to advance lead testing of children enrolled in Medi-Cal.
(c) (1) By March 1, 2019, and by March 1 of each year thereafter, the department shall prepare and prominently post on its Internet Web site information that evaluates the department’s progress in meeting the goals of this section. The information shall also include all of the following:
(A) An annually updated analysis of the data and information identified and compiled relative to paragraphs (1) and (2) of subdivision (b).
(B) To the greatest extent possible, a list of the census tracts in which children test positive at a rate higher than the national average for blood lead in exceedance of the federal Centers for Disease Control and Prevention’s reference level for elevated blood lead based on the data and information received during the previous calendar year.
(C) The report developed pursuant to Section 105295.
(2) All uses and disclosures of data made pursuant to this section shall comply with all applicable state and federal laws for the protection of the privacy and security of data, including, but not limited to, the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code), Title 1.81 (commencing with Section 1798.80) of Part 4 of Division 3 of the Civil Code, the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), and the federal Health Information Technology for Economic and Clinical Health Act, Title XIII of the federal American Recovery and Reinvestment Act of 2009 (Public Law 111-5), and implementing regulations.

SEC. 6.

 Section 3.5 of this bill incorporates amendments to Section 105295 of the Health and Safety Code proposed by both this bill and Senate Bill 1097. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2019, (2) each bill amends Section 105295 of the Health and Safety Code, and (3) this bill is enacted after Senate Bill 1097, in which case Section 3 of this bill shall not become operative.

SEC. 7.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.