SF 1015

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to children's environmental health; allowing filter paper testing for
blood lead levels; lowering the blood lead level threshold for reporting and risk
assessments; requiring medical assistance coverage to cover environmental
investigations for children with elevated blood lead levels; amending Minnesota
Statutes 2006, sections 144.9501, by adding a subdivision; 144.9502,
subdivisions 3, 4, 8; 144.9503, subdivision 2; 144.9504, subdivision 2; 144.9507,
by adding a subdivision; 256B.0625, subdivision 14, by adding a subdivision;
proposing coding for new law in Minnesota Statutes, chapter 144.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2006, section 144.9501, is amended by adding a
subdivision to read:

new text begin Subd. 11a. new text end

new text begin Filter paper test. new text end

new text begin A "filter paper test" means a test for preserving and
testing blood specimens for lead that involves preserving patient blood specimens in the
form of blood drops spotted on filter paper.
new text end

Sec. 2.

Minnesota Statutes 2006, section 144.9502, subdivision 3, is amended to read:

Subd. 3.

Reports of blood lead analysis required.

(a) Every hospital, medical
clinic, medical laboratory, other facility, or individual performing blood lead analysis shall
report the results after the analysis of each specimen analyzed, for both capillary new text begin , filter
paper test, new text end and venous specimens, and epidemiologic information required in this section
to the commissioner of health, within the time frames set forth in clauses (1) and (2):

(1) within two working days by telephone, fax, or electronic transmission, with
written or electronic confirmation within one month, for a venous new text begin or filter paper test new text end
blood lead level equal to or greater than deleted text begin 15 deleted text end new text begin five new text end micrograms of lead per deciliter of whole
blood; or

(2) within one month in writing or by electronic transmission, for any capillary new text begin , or
filter paper test, new text end result or for a venous blood lead level less than deleted text begin 15 deleted text end new text begin five new text end micrograms of
lead per deciliter of whole blood.

(b) If a blood lead analysis is performed outside of Minnesota and the facility
performing the analysis does not report the blood lead analysis results and epidemiological
information required in this section to the commissioner, the provider who collected the
blood specimen must satisfy the reporting requirements of this section. For purposes of
this section, "provider" has the meaning given in section 62D.02, subdivision 9.

(c) The commissioner shall coordinate with hospitals, medical clinics, medical
laboratories, and other facilities performing blood lead analysis to develop a universal
reporting form and mechanism.

Sec. 3.

Minnesota Statutes 2006, section 144.9502, subdivision 4, is amended to read:

Subd. 4.

Blood lead analyses and epidemiologic information.

The blood lead
analysis reports required in this section must specify:

(1) whether the specimen was collected as a capillary new text begin , filter paper test, new text end or venous
sample;

(2) the date the sample was collected;

(3) the results of the blood lead analysis;

(4) the date the sample was analyzed;

(5) the method of analysis used;

(6) the full name, address, and phone number of the laboratory performing the
analysis;

(7) the full name, address, and phone number of the physician or facility requesting
the analysis;

(8) the full name, address, and phone number of the person with the blood lead level,
and the person's birthdate, gender, and race.

Sec. 4.

Minnesota Statutes 2006, section 144.9502, subdivision 8, is amended to read:

Subd. 8.

Laboratory standards.

(a) A laboratory performing blood lead analysis
shall use methods that:

(1) meet or exceed the proficiency standards established in the federal Clinical
Laboratory Improvement Regulations, Code of Federal Regulations, title 42, section 493,
promulgated in accordance with the Clinical Laboratory Improvement Act amendments
of 1988, Public Law 100-578; deleted text begin or
deleted text end

(2) meet or exceed the Occupational Safety and Health Standards for Lead in
General Industries, Code of Federal Regulations, section 1910.1025, and Occupational
Safety and Health Standards for Lead in Construction, Code of Federal Regulations,
section 1926.62 new text begin ; or
new text end

new text begin (3) meet or exceed the standards established by the commissioner under paragraph
(c) for filter paper testing new text end .

(b) A laboratory performing lead analysis of paint, soil, or dust must be a laboratory
recognized by the United States Environmental Protection Agency under the Toxic
Substances Control Act, United States Code, title 15, section 2685, paragraph (b).
Analysis of samples of drinking water must be performed by a laboratory certified by
the commissioner to analyze lead in water.

new text begin (c) The commissioner shall establish minimum standards for the use of filter paper
tests in analyzing blood lead levels.
new text end

Sec. 5.

Minnesota Statutes 2006, section 144.9503, subdivision 2, is amended to read:

Subd. 2.

Priorities for primary prevention.

(a) The commissioner of health and
boards of health serving cities of the first class shall determine areas at high risk for toxic
lead exposure.

(b) A board of health serving a city of the first class shall rank order census tracts
by awarding points as specified in this paragraph. The priority for primary prevention in
census tracts at high risk for toxic lead exposure shall be based on the cumulative points
awarded to each census tract. A greater number of points means a higher priority.

(1) One point may be awarded to a census tract for each ten percent of children who
were under six years old at the time they were screened for lead in blood and whose blood
lead level exceeds ten micrograms of lead per deciliter of whole blood, provided the
commissioner has determined that the data used to award the points are comprehensive
and representative.

(2) One point may be awarded for every five percent of housing that is defined as
dilapidated or deteriorated by the planning department or similar agency of the city in
which the housing is located. Where data is available by neighborhood or section within a
city, the percent of dilapidated or deteriorated housing shall apply equally to each census
tract within the neighborhood or section.

(3) One point may be awarded for every 100 parts per million of lead in soil, based
on the median soil lead values of foundation soil samples, calculated on 100 parts per
million intervals, or fraction thereof. A board of health shall use data from its own soil
survey conducted according to rules adopted under section 144.9508, except that a board
of health serving Minneapolis or St. Paul that has not conducted its own soil survey
shall use the June 1988 census tract version of the houseside map titled "Distribution of
Houseside Lead Content of Soil-Dust in the Twin Cities," prepared by the Center for
Urban and Regional Affairs, Humphrey Institute, University of Minnesota, Publication
1989, Center for Urban and Regional Affairs 89-4. Where the map displays a census
tract that is crossed by two or more intervals, the board of health shall make a reasoned
determination of the median foundation soil lead value for that census tract.

(4) A board of health may award one point to each census tract for each of the
following factors based on cutoff criteria to be determined by the board of health:

(i) percent of minority population;

(ii) number of children less than six years of age;

(iii) percent of housing built before 1950; and

(iv) percent of population living in poverty.

(c) The commissioner may determine areas at high risk for toxic lead exposure at
the county level or within a county outside a city of the first class using one or more
of the following criteria:

(1) blood lead levels greater than deleted text begin ten deleted text end new text begin five new text end micrograms per deciliter of whole blood in
children under six years of age;

(2) percent of dilapidated or deteriorated housing;

(3) soil lead levels in excess of 100 parts per million;

(4) percent of minority population;

(5) percent of housing built before 1950;

(6) percent of children living in poverty; or

(7) other factors appropriate in preventing lead exposure, as determined by a federal
agency including the United States Centers for Disease Control and Prevention, the United
States Environmental Protection Agency, or the United States Department of Housing
and Urban Development.

Sec. 6.

Minnesota Statutes 2006, section 144.9504, subdivision 2, is amended to read:

Subd. 2.

Lead risk assessment.

(a) An assessing agency shall conduct a lead risk
assessment of a residence according to the deleted text begin venous deleted text end blood lead level new text begin , as determined by a
venous blood draw or second filter paper test, new text end and time frame set forth in clauses (1) to
(4) for purposes of secondary prevention:

(1) within 48 hours of a child or pregnant female in the residence being identified to
the agency as having a deleted text begin venous deleted text end blood lead level equal to or greater than deleted text begin 60 deleted text end new text begin 45 new text end micrograms
of lead per deciliter of whole blood new text begin , as confirmed by a venous blood draw or second
filter paper test new text end ;

(2) within five working days of a child or pregnant female in the residence being
identified to the agency as having a deleted text begin venous deleted text end blood lead level equal to or greater than deleted text begin 45 deleted text end new text begin 15 new text end
micrograms of lead per deciliter of whole blood new text begin , as confirmed by a venous blood draw or
second filter paper test new text end ;

(3) within ten working days of a child in the residence being identified to the agency
as having a deleted text begin venous deleted text end blood lead level equal to or greater than deleted text begin 15 deleted text end new text begin five new text end micrograms of lead per
deciliter of whole blood new text begin , as confirmed by a venous blood draw or second filter paper test new text end ; or

(4) within ten working days of a pregnant female in the residence being identified
to the agency as having a deleted text begin venous deleted text end blood lead level equal to or greater than deleted text begin ten deleted text end new text begin five new text end
micrograms of lead per deciliter of whole blood new text begin , as confirmed by a venous blood draw or
second filter paper test new text end .

(b) Within the limits of available local, state, and federal appropriations, an assessing
agency may also conduct a lead risk assessment for children with any elevated blood
lead level.

(c) In a building with two or more dwelling units, an assessing agency shall assess
the individual unit in which the conditions of this section are met and shall inspect all
common areas accessible to a child. If a child visits one or more other sites such as another
residence, or a residential or commercial child care facility, playground, or school, the
assessing agency shall also inspect the other sites. The assessing agency shall have one
additional day added to the time frame set forth in this subdivision to complete the lead
risk assessment for each additional site.

(d) Within the limits of appropriations, the assessing agency shall identify the
known addresses for the previous 12 months of the child or pregnant female with deleted text begin venous deleted text end
blood lead levels of at least deleted text begin 15 deleted text end new text begin five new text end micrograms per deciliter deleted text begin for the child or at least
ten micrograms per deciliter for the pregnant female deleted text end new text begin , as confirmed by a venous blood
draw or second filter paper test new text end ; notify the property owners, landlords, and tenants at
those addresses that an elevated blood lead level was found in a person who resided
at the property; and give them primary prevention information. Within the limits of
appropriations, the assessing agency may perform a risk assessment and issue corrective
orders in the properties, if it is likely that the previous address contributed to the child's
or pregnant female's blood lead level. The assessing agency shall provide the notice
required by this subdivision without identifying the child or pregnant female with the
elevated blood lead level. The assessing agency is not required to obtain the consent of
the child's parent or guardian or the consent of the pregnant female for purposes of this
subdivision. This information shall be classified as private data on individuals as defined
under section 13.02, subdivision 12.

(e) The assessing agency shall conduct the lead risk assessment according to rules
adopted by the commissioner under section 144.9508. An assessing agency shall have
lead risk assessments performed by lead risk assessors licensed by the commissioner
according to rules adopted under section 144.9508. If a property owner refuses to allow
a lead risk assessment, the assessing agency shall begin legal proceedings to gain entry
to the property and the time frame for conducting a lead risk assessment set forth in this
subdivision no longer applies. A lead risk assessor or assessing agency may observe the
performance of lead hazard reduction in progress and shall enforce the provisions of this
section under section 144.9509. Deteriorated painted surfaces, bare soil, and dust must be
tested with appropriate analytical equipment to determine the lead content, except that
deteriorated painted surfaces or bare soil need not be tested if the property owner agrees to
engage in lead hazard reduction on those surfaces. The lead content of drinking water
must be measured if another probable source of lead exposure is not identified. Within a
standard metropolitan statistical area, an assessing agency may order lead hazard reduction
of bare soil without measuring the lead content of the bare soil if the property is in a
census tract in which soil sampling has been performed according to rules established by
the commissioner and at least 25 percent of the soil samples contain lead concentrations
above the standard in section 144.9508.

(f) Each assessing agency shall establish an administrative appeal procedure which
allows a property owner to contest the nature and conditions of any lead order issued by
the assessing agency. Assessing agencies must consider appeals that propose lower cost
methods that make the residence lead safe. The commissioner shall use the authority and
appeal procedure granted under sections 144.989 to 144.993.

(g) Sections 144.9501 to 144.9509 neither authorize nor prohibit an assessing agency
from charging a property owner for the cost of a lead risk assessment.

Sec. 7.

Minnesota Statutes 2006, section 144.9507, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Medical assistance. new text end

new text begin Medical assistance reimbursement for lead risk
assessment services under section 256B.0625, subdivision 49, shall not be used to replace
or decrease existing state or local funding for lead services and lead-related activities.
new text end

Sec. 8.

new text begin [144.9513] WINDOW REPLACEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Account establishment. new text end

new text begin The commissioner of finance shall establish
and implement a revolving account in the state government special revenue fund to
provide loans to property owners to assist in the cost of replacing lead painted windows.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible for a loan under this program, an applicant
must own the property and the property must:
new text end

new text begin (1) have been built prior to 1960;
new text end

new text begin (2) contain wooden frame interior windows with lead-based paint; and
new text end

new text begin (3) have no more than four units.
new text end

new text begin (b) Loans obtained through the program must be used for window replacement,
including installation, cavity insulation, and frame repairs. Replacement windows must
have a U rating from the National Fenestration Rating Council no greater than 35 and
must be purchased from a Minnesota-based manufacturer.
new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin An applicant must submit a loan application to the
commissioner of health on forms prescribed by the commissioner. The application must
include, at the minimum:
new text end

new text begin (1) the amount of the loan requested with a description of the replacement project;
new text end

new text begin (2) a legal description of the property; and
new text end

new text begin (3) a signed contract with a certified contractor for window replacement.
new text end

new text begin Subd. 4. new text end

new text begin Duties of local agencies. new text end

new text begin The commissioner of health shall designate local
administrative agencies, including, but not limited to, community action partnership
agencies, tribal, city or county housing agencies, and nonprofit organizations to be
responsible for:
new text end

new text begin (1) qualifying properties as eligible for the program;
new text end

new text begin (2) filing a lien on each property receiving a loan through the program;
new text end

new text begin (3) certifying installation contractors; and
new text end

new text begin (4) conducting program outreach to eligible property owners, with priority given to
properties where young children reside.
new text end

new text begin Subd. 5. new text end

new text begin Loans. new text end

new text begin (a) The commissioner of health shall make a no-interest loan to
property owners who are eligible under subdivision 2. Priority shall be given to properties
where young children reside on a first-come basis provided that the property owner
complies with this section. The total accumulative loan principal must not exceed $.......
per loan.
new text end

new text begin (b) The commissioner may prescribe forms and establish an application process and
may impose an administrative fee not to exceed ten percent of the amount of the loan to
cover the cost of administering the loan program.
new text end

new text begin (c) The borrower must begin repaying the principal no later than two years from the
date of the loan. Loans must be amortized no later than 15 years from the date of the loan.
new text end

new text begin (d) The principal becomes due upon the sale of the property or upon the refinancing
of the current mortgage on the property.
new text end

new text begin (e) Repayments must be credited to the account.
new text end

Sec. 9.

Minnesota Statutes 2006, section 256B.0625, subdivision 14, is amended to
read:

Subd. 14.

Diagnostic, screening, and preventive services.

(a) Medical assistance
covers diagnostic, screening, and preventive services.

(b) "Preventive services" include services related to pregnancy, including:

(1) services for those conditions which may complicate a pregnancy and which may
be available to a pregnant woman determined to be at risk of poor pregnancy outcome;

(2) prenatal HIV risk assessment, education, counseling, and testing; and

(3) alcohol abuse assessment, education, and counseling on the effects of alcohol
usage while pregnant. Preventive services available to a woman at risk of poor pregnancy
outcome may differ in an amount, duration, or scope from those available to other
individuals eligible for medical assistance.

(c) "Screening services" include, but are not limited to, blood lead tests. new text begin Screening
services also include, for children with blood lead levels equal to or greater than five
micrograms of lead per deciliter of whole blood, environmental investigations to
determine the source of lead exposure. Reimbursement is limited to a health professional's
time and activities during an on-site investigation of a child's home or primary residence.
new text end

Sec. 10.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 49. new text end

new text begin Lead risk assessments. new text end

new text begin (a) Effective October 1, 2007, or six months after
federal approval, whichever is later, medical assistance covers lead risk assessments
provided by a lead risk assessor who is licensed by the commissioner of health under
section 144.9505 and employed by an assessing agency as defined in section 144.9501.
Medical assistance covers a onetime on-site investigation of a recipient's home or primary
residence to determine the existence of lead so long as the recipient is under the age
of 21 and has a venous blood lead level specified in section 144.9504, subdivision 2,
paragraph (a).
new text end

new text begin (b) Medical assistance reimbursement covers the lead risk assessor's time to
complete the following activities:
new text end

new text begin (1) gathering samples;
new text end

new text begin (2) interviewing family members;
new text end

new text begin (3) gathering data, including meter readings; and
new text end

new text begin (4) providing a report with the results of the investigation and options for reducing
lead-based paint hazards.
new text end

new text begin Medical assistance coverage of lead risk assessment does not include testing of
environmental substances such as water, paint, or soil or any other laboratory services.
Medical assistance coverage of lead risk assessments is not included in the capitated
services for children enrolled in health plans through the prepaid medical assistance
program and the MinnesotaCare program.
new text end

new text begin (c) Payment for lead risk assessment must be cost-based and must meet the criteria
for federal financial participation under the Medicaid program. The rate must be based
on allowable expenditures from cost information gathered. Under section 144.9507,
subdivision 5, federal medical assistance funds may not replace existing funding for
lead-related activities. The nonfederal share of costs for services provided under this
subdivision must be from state or local funds and is the responsibility of the agency
providing the risk assessment. Eligible expenditures for the nonfederal share of costs may
not be made from federal funds or funds used to match other federal funds. Any federal
disallowances are the responsibility of the agency providing risk assessment services.
new text end