Guidance for blood lead level screening of young children

The California Department of Health Care Services (DHCS) issued All Plan Letter APL 20‑016 (Revised) to clarify blood lead screening, monitoring, and reporting requirements for members enrolled in Medi‑Cal Managed Care.

According to the Centers for Disease Control and Prevention (CDC), protecting children from lead exposure is important to lifelong good health. Even low levels of lead in the blood can affect IQ, the ability to pay attention, and academic achievement. Lead exposure can cause damage to the brain and nervous system, slowed growth and development, learning and behavioral problems, and hearing and speech problems. The most important step to take is to prevent lead exposure before it occurs.

All care providers must document in the medical record the delivery of anticipatory guidance to parents or guardians during every well‑child visit for children aged 6 to 72 months as well as blood lead tests that are ordered and completed at the required ages of 12 and 24 months.

Requirements for care providers:

• Providers must conduct oral or written anticipatory guidance, which must be documented in the medical record for the child, to the parent(s) or guardian(s) of a child. The anticipatory guidance should include at a minimum, sources of lead exposure and that children can be harmed by any exposure to lead. This anticipatory guidance must be performed at each periodic health assessment from 6 until 72 months of age:
• Regardless of risk assessment, care providers must order or perform and document in medical records blood lead level (BLL) screening tests (capillary or venous sample) on all children:
• At 12 months and at 24 months of age.
• Whenever the care provider is aware the child has not had a BLL test performed up to 72 months of age.
• Whenever an increased risk for lead exposure is identified (risk factors).
• When requested by the parent or guardian.
• Refugees:
• Who are ages birth to 16 years according to CDC guidelines.
• Who are older than age 16 who are at high risk.
• Who are pregnant or lactating.
• Elevated capillary BLL results above the CDC Blood Lead Reference Value should be followed up with a venous BLL to confirm the result:
• The healthcare provider is not required to perform BLL testing if:
• A parent or guardian of the child or other person with legal authority to withhold consent refuses to consent to the screening
• In the professional judgment of the provider, the risk of screening poses a greater risk to the child’s health than the risk of lead poisoning.
• Care providers must document the reasons for not screening in the child’s medical record and include a signed statement of voluntary refusal of the BLL test by the parent or guardian who refuses this service or documents the reason the signed statement was not obtained.
• Laboratories and care providers who perform point‑of-care (POC) BLL tests must report all results and patient demographic information to the California Childhood Lead Poisoning Prevention Branch (CLPPB).
• Care providers who perform POC BLL tests should use CPT^® code 83655 to indicate the BLL test was performed on data submitted to Anthem.
• DHCS requires all managed care plans to ensure that network providers are following all required components listed above and Anthem and the CLPPB guidelines for providing anticipatory guidance on sources.