Lead Information for Health Care Providers
- Medical Management Guidelines for Providers
- Childhood Blood Lead Medical Management Guidelines for Providers in Indiana UPDATED: October 1, 2022
The Childhood Blood Lead Medical Management Guidelines for Providers in Indiana provide guidance for the treatment, medical management and follow-up of children with elevated blood lead levels. These guidelines represent a set of best practices and recommendations for health care providers working with children exposed to lead. Health care providers may include physicians, physician assistants, nurse practitioners and other health professionals in a medical setting who serve and treat individuals who have received a blood lead test.
- Reporting Requirements
- Indiana statute (410 IAC 29-3-1) requires that ALL blood lead tests, REGARDLESS OF RESULTS are required to be reported to IDOH by the entity examining the specimen (i.e. Laboratory, Clinic, Physician, etc.) not later than one (1) week after completing the test.
- IDOH Lead and Healthy Homes Division can accept results electronically from blood lead level testing through HL7 messaging or direct entry into the Lead Data Flow (LDF) database.
- HL7 messaging: A Electronic Medical Record (EMR) system can be set up to automatically send HL7 messages to IDOH’s DREX system for all testing that is required to be reported to IDOH.
- Direct Entry: Blood lead level test results can be entered directly into LDF through the IDOH electronic gateway portal at https://gateway.isdh.in.gov/Gateway/SignIn.aspx.
- An account will be created for each person that reports test results. The user will then be able to enter each result manually into the LDF database.
Contact Hazarath Thanneeru: email@example.com with the information listed below to set up your account.
Information needed for each account:
- First and Last Name
- Business Email
- Office Address
- Office Phone
- CLIA ID
- IDOH can also accept test results through secure fax or secure email, but this method is not recommended as the best option for submitting blood lead level testing results and should be considered a temporary or short-term option for submitting results. Per 410 IAC 29-3-1(b) any provider or lab submitting more than 50 results per year will be required to report electronically.
- Laboratory Reporting Form - This form is only used for individual, single use reporting of blood lead test results sent via fax to IDOH.
- Questions about blood lead level reporting or signing up for electronic reporting, please contact Hazarath Thanneeru: firstname.lastname@example.org.
- Testing Requirements
Universal Screening (Testing)
On March 10, 2022, Governor Holcomb signed House Enrolled Act (HEA) 1313 into law requiring healthcare providers to confirm that children under 7 have been tested for lead, and if not, to offer this testing to the parent or guardian of that child. The bill is slated to take effect January 1, 2023.
Guidance and Standards for Health Care Providers
- To ensure uniformity between HEA 1313 and the Medicaid Early and Periodic, Screening, Diagnostics, and Treatment (EPDST) guidelines, IDOH is requiring all providers to follow the steps below:
- Children should receive a blood lead test between the ages of nine (9) and thirteen (13) months, or as close as reasonably possible to the patient’s appointment.
- Children should have another blood lead test between the ages of twenty-one (21) and twenty-seven (27) months, or as close as reasonable possible to the patient’s appointment.
- Any child between twenty-eight (28) and seventy-two (72) months that does not have a record of any prior blood lead test must have a blood lead test performed as soon as possible.
- If a provider can verify, via the Children’s Health and Immunization registry Program (CHIRP), or the records from another provider, that blood lead testing has occurred at the required interval(s), they are not obligated to repeat the procedure.
- If a parent or guardian refuses to allow their child to be tested, providers are encouraged to document the refusal in writing and have the parent or guardian sign an attestation of refusal.
- Testing Recommendations
- The CDC recommends that public health and clinical professionals focus screening efforts on neighborhoods and children at high risk, based on age of housing (built before 1950) and socioeconomic risk factors
- Public health and clinical professionals should collaborate to develop screening plans responsive to local conditions, using local data.
- In the absence of such plans, universal BLL testing is recommended.
- Jurisdictions should follow the Centers for Medicare & Medicaid Services requirement that all Medicaid-enrolled children be tested at ages 12 months and 24 months or at age 24–72 months if they have not previously been screened.
- Assess all children ages 6 months to 6 years at every well child visit for risk of lead exposure and obtain a blood lead test if the parent/guardian responds “Yes” or “I Don’t Know” to any of the questions listed below.
1. Does your child live in or regularly visit a building with potential lead exposure, such as peeling or chipping paint; recent or ongoing renovation or remodeling; or high levels of lead in the drinking water? Older dwellings (built before 1978) may have lead based paint. Consider day care, preschool, school, and homes of babysitters or relatives. Children with Medicaid, those entering foster care, and recently arrived refugees are at higher risk for lead toxicity.
2. Has your child spent any significant time outside the U.S. in the past year? All children born outside the U.S. and children visiting other countries for extended periods of time should be tested upon arrival or return to the U.S. due to higher lead risk in many countries.
3. Does your child currently have a sibling, housemate, or playmate with an elevated blood lead level, and your child has not been tested?
4. Does your child have developmental disabilities and/or exhibit behaviors that puts him/her at higher risk for lead exposure? Young children and children with developmental disabilities (autism spectrum disorder and Down syndrome) may have behaviors that place them at higher risk for lead exposure. These may include: pica; putting nonfood items (e.g., fingers, toys, jewelry, keys, or soil) in their mouth; mouthing painted surfaces; any behaviors that disturb painted surfaces.
5. Does your child have frequent contact with an adult whose job or hobby involves exposure to lead? An adult may bring home lead from a job or hobby, such as house painting; plumbing; construction; auto repair; welding; battery recycling; lead smelting; jewelry, stained glass or pottery making; fishing (lead in sinkers); making or shooting firearms; and collecting lead or pewter figurines.
6. Does your family use traditional medicine, health remedies, cosmetics, powders, spices, or food from other countries? Lead can be in items such as Ayurvedic medicines, alkohl, azarcon (Alarcon, luiga, rueda, coral), greta, litargirio, ghasard, pay-loo-ah, bala goli, Daw Tway, and Daw Kyin; cosmetics including kohl, surma, and sindoor; and some candies and products from other countries, particularly Mexico.
7. Does your family cook, store, or serve food in crystal, pewter, or pottery from other countries? Lead exposure risk from pottery is higher with old, cracked/chipped, and painted china and in pottery from other countries particularly from Latin America or Asia. Also, imported samovars, urns, and kettles could be soldered with lead.
- CDC Childhood Lead Poisoning Prevention: Healthcare Providers – Resources and information on lead screening, reporting, medical management, education and other lead health issues.
- American Academy of Pediatrics (AAP) information on lead exposure – information and resources for physicians on prevention and medical management
- “Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention” – Report of the CDC’s Advisory Committee on Childhood Lead Poisoning Prevention.
- Pediatric Environmental Health Specialty Unit (PEHSU) – Information about protecting children from environmental hazards.
- PEHSU Region 5 – Great Lakes Center for Children’s Environmental Health: Indiana member
- Guidelines For the Identification and Management of Lead Exposure in Pregnant and Lactating Women (2010) – These guidelines are based on scientific data and practical considerations regarding preventing lead exposure during pregnancy, assessment and blood lead testing during pregnancy, medical and environmental management to reduce fetal exposure, breastfeeding, and follow up of infants and children exposed to lead in utero. (CDC)