New Jersey-2024-A910-Introduced

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

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

1. (New section) a. Every physician, registered professional nurse, or health care facility, agency, or program that is subject to the provisions of section 3 of P.L.1995, c.328 (C.26:2-137.4) shall perform lead screening on each patient between six months and 26 months of age, in accordance with the schedule specified in this section.

b. A child shall be screened for elevated blood lead levels, during the regular course of a well visit:

(1) when the child is between nine and 18 months of age; preferably on the date of, or as close as possible to, the child's first birthday; and

(2) at least six months after the first lead screening test, when the child is between 18 and 26 months of age; preferably on the date of, or as close as possible to, the child's second birthday.

c. A physician, registered professional nurse, or health care facility, agency, or program performing lead screening in accordance with the provisions of this section and the provisions of P.L.1995, c.328 (C.26:2-137.2 et seq.) may perform the screening on-site, at the point of care, during the course of a well visit.

d. The physician, registered professional nurse, or health care facility, agency, or program performing lead screening in accordance with the provisions of this section and the provisions of P.L.1995, c.328 (C.26:2-137.2 et seq.) shall record, in the child's permanent health record, the date the test was administered and the results of the test.

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 necessitate the undertaking of responsive action . Any regulations adopted pursuant to this subsection shall be consistent with the provisions of P.L.1995, c.328 (C.26:2-137.2 et seq.) and section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill); 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.2017, c.7, s.2)

3. 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 patient under six years of age to whom the physician or registered professional nurse provides health care services, in accordance with the provisions of N.J.A.C.8:51A-2.2 and the timeframes established pursuant to section 1 of P.L. , c. (C. )(pending before the Legislature as this bill), 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] P.L.1995, c.328 (C.26:2-137.2 et seq.) and section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). If the physician, registered professional nurse, or 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, 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.), and any other agency or program that serves children and 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, in accordance with the provisions of N.J.A.C.8:51A-2.2 and the timeframes established pursuant to section 1 of P.L, c. (C. ) (pending before the Legislature as this bill), unless the facility, agency, or program has knowledge that the child has already undergone lead screening in accordance with the requirements of [this act] P.L.1995, c.328 (C.26:2-137.2 et seq.) and section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). If the health care facility, agency, or program cannot perform the required lead screening, the 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] lead screening test results [indicating] indicate that a child has an elevated blood lead level, the physician, registered professional nurse, or health care facility, agency, or program receiving the results of the screening test shall notify 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 elevated blood lead [poisoning] levels . The physician, registered professional nurse, or health care facility, agency, or program 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 by physicians, registered professional nurses, and health care facilities, agencies, or programs to conduct [the] lead [screening] screenings in accordance with the provisions of P.L.1995, c.328 (C.26:2-137.2 et seq.) and section 1 of P.L., c. (C. ) (pending before the Legislature as this bill), and the conditions and circumstances that will necessitate the use of follow-up testing.

(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.2017, c.7, 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 continuously engage in a public information and educational outreach campaign to inform the parents and guardians of young children, as well as physicians, registered professional nurses, and other health care providers, [of] about the lead screening requirements [of this act] established by P.L.1995, c.328 (C.26:2-137.2 et seq.), and about the lead screening schedule established by section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). Any information or documentation that is prepared for purposes of the public information and educational outreach campaign shall also be posted at a publicly accessible location on the department's Internet website.

At a minimum, the public information [campaign] and educational outreach campaigns 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 elevated blood lead [poisoning] levels 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 elevated blood lead [poisoning] levels, the factors that contribute to elevated blood lead [poisoning] levels, the recommended ages at which children should be tested for elevated blood lead [poisoning] levels, 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] and educational outreach campaigns 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] in order to ensure that the State receives the maximum amount of federal financial participation available for the lead screening services provided pursuant to [this act] P.L.1995, c.328 (C.26:2-137.2 et seq.) and section 1 of P.L.,
c. (C. ) (pending before the Legislature as this bill).

(cf: P.L.2017, c.7, s.5)

4. The Commissioners of Health and Education, in consultation with each other, shall each adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to implement the provisions of this act.

5. This act shall take effect immediately.

STATEMENT

This bill would strengthen the existing State requirements for childhood lead screening by: (1) codifying, in the statutory law, the existing schedule for childhood lead screening that appears in regulations adopted by the Department of Health (DOH); and (2) allowing health care professionals to perform lead screenings at the point-of-care, in the regular course of a well visit.

The bill would specify, in particular, that every physician, registered professional nurse, or health care facility, agency, or program that is subject to the State's childhood elevated blood lead level prevention laws will be required to perform a lead screening on each patient between six months and 26 months of age to whom services are provided, during the course of a well visit, in accordance with the following schedule:

1) when the child is between nine and 18 months of age; preferably on the date of, or as close as possible to, the child's first birthday; and

2) at least six months after the first lead screening test, when the child is between 18 and 26 months of age; preferably on the date of, or as close as possible to, the child's second birthday.

A physician, registered professional nurse, or health care facility, agency, or program performing a lead screening in accordance with this schedule will be authorized to perform the screening on-site, at the point of care, during the course of a well visit.

The physician, registered professional nurse, or health care facility, agency, or program performing lead screening will be required to record in the child's permanent health record the date on which the lead screening test was administered and the results of the test.

The bill requires the DOH to modify its existing lead screening public information campaign to inform the parents and guardians of small children, as well as physicians, registered professional nurses, and other health care providers, about the lead screening schedule and requirements, and the conditions for initial school enrollment, established by the bill. The bill additionally requires the DOH to establish an educational outreach campaign providing the same information to the same populations. Any information or documentation that is prepared for the public information and educational outreach campaigns is to be posted at a publicly accessible location on the DOH Internet website.

The bill clarifies that any DOH regulations adopted pursuant to P.L.1995, c.316 (C.17:48E-35.10 et al.), concerning the provision of insurance coverage for lead screenings, are to be consistent with the revisions to the State's lead screening laws adopted under the bill.