QUEST Integration – Blood Lead Testing

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

The Centers for Medicare and Medicaid Services mandates verbal lead risk assessments and blood lead testing as required components of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for the early identification of members who have been exposed, or at risk of exposure, to lead.

It is expected that the member’s Primary Care Provider (PCP) will perform verbal assessments for lead exposure risk in accordance with EPSDT requirements. The PCP should order a blood lead level (BLL) for EPSDT-eligible members who meet one or more of the following criteria:

• 9-12 months of age, required even if not at risk.
• 24 months of age, required even if not at risk.
• 36-72 months of age, if not previously tested.
• At any age, whenever identified as having at least one risk factor through the verbal risk assessment.

The PCP should ensure that EPSDT members with an elevated BLL receive the appropriate medical evaluation and treatment. The PCP should also evaluate or refer for evaluation other individuals (e.g., family members) identified as at risk.

Upon request, the HMSA QUEST Integration Case Management/Care Coordination unit can assist the family and PCP in accessing specialty care and medical care for further testing, treatment, and surveillance as needed. If the PCP has difficulties identifying a source for chelation medication, HMSA will assist the PCP to locate one. HMSA QUEST Integration can also assist the PCP in locating a physician experienced in the treatment of elevated BLL.

Environmental assessments and other services provided in the home or potential exposure area are not HMSA covered benefits. These include:

• An environmental assessment of the home and other areas where a member may be exposed to lead products.
• Counseling of a parent or legal guardian in the home about a member's elevated BLL and its relation to neurological problems or delayed development.
• Developmental testing of a member in the home.
• Nutrition counseling in the home.
• Collection and analysis of paint, soil samples, dishes or other products for the presence of lead.

Revision History