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Lead Poisoning Prevention

CMFHP Care Manager Services	If blood lead level is elevated...
Lead - general information	Forms, links to recall information
State testing mandates and links	Continuing education
Lead test billing codes	State contact information

CMFHP Care Manager (CM) Services

The Children’s Mercy Family Health Partners Lead Poisoning Prevention Care Managers are available to help you with the following:

• Identifying CMFHP members with elevated blood lead levels.
• Identifying CMFHP members who need blood lead testing.
• Care Coordination or Case Management services as needed.
• Phone calls and education packets to members.
• Support and coordination of services with Kansas or Missouri Health Departments, State Lead Program Case Managers and Environmental staff.
• Community outreach events to raise public awareness about lead poisoning prevention and to encourage blood lead testing.
• Lead Poisoning Prevention presentation to your Provider office or community agency. This has been approved for_1 CE or CME contact hour through Children’s Mercy Hospitals and Clinics*.

CMFHP Contact information

Lead - general information

Lead is a naturally occurring metal in the earth’s soil, yet it has no purpose in the body. Severe and life-threatening effects can occur if the level of lead is allowed to build up in the body over time.

Children and pregnant women are the most vulnerable. Even low levels of lead poisoning can cause learning and behavior problems, lower IQ scores, and interfere with growth and hearing. The developing bodies of children under age six absorb more lead than adults or older children. Their brains and nervous systems are more sensitive to the damaging effects of lead. Hand-to-mouth behavior increases the chance of exposure. Lead poisoning is caused by either ingestion or inhalation of lead particles. Most often, there are no symptoms of lead poisoning.

Lead was added to many household products in order to enhance their appearance, durability or performance. Lead paint is the most common source. However, lead was also added to gasoline, glassware (lead crystal), and mini-blinds. It continues to be used in some manufacturing industries and home hobbies like welding car parts, making fishing tackle or producing stained glass pieces.

Lead paint was banned for domestic use in 1978 and phased out of gasoline in 1986. Homes built before 1978 need to be assessed for environmental hazards including the use of lead paint for interior and exterior surfaces and for any contamination of the soil around the foundation of these homes.

General recommendations to help families avoid or reduce exposure to lead include:

• Learn about recommended cleaning techniques to keep lead dust and chipping, pealing or flaking paint away from young children
• Understand the risks of and proper methods to use before remodeling
• Follow good handwashing practices
• Feed children foods high in calcium, iron, and vitamin C and avoid fats and oils
• Find grassy areas for children to play in (if soil is bare, cover it)
• Change clothes and shower before entering the home if working with lead; leave shoes outside or at the door to reduce dust exposure
• Eliminate household items that may contain lead or change their use (for example, use a ceramic pot for decoration instead of cooking)
• Continue to receive follow-up blood testing until the lead level is below 10
• Advocate! Request the blood test, get the results, write it down and keep the healthy child exams (the KBH/HCY or EPSDT exam)

State testing mandates

Both Kansas and Missouri have mandated that all Medicaid-eligible children be screened for lead poisoning.

Children should be tested for lead poisoning at 12 and 24 months of age. They should also receive the blood lead test if they are under 72 months (age 6) and have never been tested, if they have a sibling or playmate with an elevated blood lead level or if they continue to live in geographical areas identified as high risk for lead exposure: http://www.kshealthyhomes.org/maps.htm
http://www.dhss.mo.gov/ChildhoodLead/Maps.html

Pregnant women should also be screened for lead poisoning.

To learn more or for specific questions, please refer to the Provider General Benefits Manual for your state.
	Kansas HealthWave - KMAP: www.kmap-state-ks.us	Missouri - MO HealthNet: www.dss.mo.gov/mhd
For confirmed blood lead levels of ≥ 10 ug/dL, please refer to each state for retest recommendations.
	Kansas www.unleadedks.com Click on the icon for the Case Management Guidelines, page 7	Missouri www.dhss.mo.gov/ChildhoodLead Click on “Lead testing guidelines and risk assessment tools.” Look for Childhood Blood Lead testing and Follow-up Guidelines.
Reporting Results
	Kansas Any blood lead level result of ≥ 10 ug/dL is to be reported within 48 hours to the Division of Health and Environmental Laboratories (DHEL) c/o the Department of Health and Environment, (785) 296-1623, Fax (785) 296-1641. All other results should be reported to DHEL within 30 days.	Missouri All blood lead level results should be reported within twenty-four (24) hours to the Missouri Childhood Lead Poisoning Prevention Program c/o the Missouri Department of Health, 1 (866) 628-9891.
Lead analyzer – reporting requirements are the same as those stated under Reporting Results section.
High risk areas – to view the most recent maps of identified high risk areas for lead exposure, please visit:
	Kansas www.unleadedks.com/maps.htm	Missouri www.dhss.mo.gov/ChildhoodLead
Lead risk assessment verbal screening questionnaire – A blood lead poisoning verbal screen must be conducted at each EPSDT screening beginning at six months and continuing through 72 months of age. In addition, a pregnant woman may be advised to complete a verbal lead risk assessment screening on her first prenatal visit. Any time a child has a minimum of one positive response during the screening, a blood lead test is required. Results received from the verbal blood lead screen must be recorded and maintained in the child’s medical record.
For further information, please visit:
	KMAP Website www.kmap-state-ks.us	MO HCY lead assessment guide http://manuals.momed.com/forms/ HCY_Lead_Risk_Assessment_Guide.pdf
Please note: the blood lead level tests are required at 12 and 24 months regardless of the responses on this verbal screening questionnaire.

What to expect if the blood lead level is elevated An “elevated” result is ≥ 10ug/dl. Please note: An elevated capillary or filter paper result will need to be confirmed by a venous draw. Kansas also accepts as confirmatory a repeat capillary if completed within 12 weeks. Environmental Investigation The local Health Department or the State Environmental program conducts an Environmental Investigation (EI) for confirmed elevated blood lead levels. The EI helps to identify and offer guidance on reducing or avoiding possible exposure sources. To contact an Environmental Investigator in Misouri, call 1-866-628-9891, In Kansas, call 1-866-865-3233 (1-866-UnleadedKS). CM services A Lead Case Manager will be assigned from the area Health Department, State Lead Program or from CMFHP. The Case Manager assists the member and their family to coordinate resources, understand re-test recommendations, and monitor progress toward decreasing the lead level and exposure risks. To locate a Lead Case Manager in your area, please contact the CMFHP Lead Poisoning Prevention Care Manager for your state. Helpful forms, websites and recall information Downloadable forms: Blood Lead Testing Record Kansas Lead Billing Quick Reference Guide Kansas Lead Testing and Follow-up Guidelines Missouri Lead Billing Quick Reference Guide Missouri Lead Testing and Follow-up Guidelines Helpful websites: Toy Recalls Join the Consumer Product Safety Commission (CPSC) recall notification list at www.cpsc.gov. Candy To read more about candy potentially contaminated with lead, please visit www.unleadedks.com/lead_in_candy.html. Remodeling To read about the new Pre-Renovation guidelines, please visit http://www.unleadedks.com/Pre_Renovation.htm or contact the National Lead Information Center at 1-800-424-LEAD and ask for the brochure “Reducing Lead Hazards When Remodeling Your Home.” Continuing Education The Lead Poisoning Prevention presentation has been approved for 1 contact hour through Children’s Mercy Hospitals and Clinics. Children's Mercy Hospitals and Clinics is approved as a provider of continuing nursing education by the Missouri Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.* *Children’s Mercy Hospitals and Clinics is accredited by the Missouri State Medical Association to sponsor continuing education for physicians. Children’s Mercy Hospitals and Clinics designates this education activity as meeting the criteria for a maximum of _1_ AMA PRA Category 1 credit ™. State contact information Kansas Department of Health and Environment (KDHE) KS Healthy Homes and Lead Hazard Prevention Program (formerly the KS Childhood Lead Poisoning Prevention Program) 1-866-865-3233 www.kdheks.gov/lead/index.html Kansas HealthWave (Medical Assistance Program) Helpline 1-800-348-6627 Customer Service 1-800-792-4884 www.kansashealthwave.org or www.kmap-state-ks.us Missouri Department of Health and Senior Services 1-866-628-9891 www.dhss.mo.gov/ChildhoodLead MO HealthNet Division (MHD) (formerly Missouri Medicaid or the Department of Social Services, Division of Medical Services) Main number: 1-573-751-3425 Fax number: 1-573-751-6564 Provider line: 1-573-751-2896 or 1-573-635-8908 www.dss.mo.gov/mhd