Memo from Perkins to Matthews File

    National Health Law Program, INC. 

  

  

  

   

    

    
   

  

MAIN OFFICE 

La Cienega Boulevard 
geles, California 90034 

(213) 204-6010 
Fax #: (213) 204-0891 

Memo BRANCH OFFICE 
TERT — . Street, N.W. Suite 705 

: : wed LEGAL DEFENSE Washington, D.C. 20006 

Fax #: (202) 785-6792 

From: Jpy¥ 

Date: March 12, 1991 

Re: Production of Documents [set 1] 

Document #1 (1 page): Letter from Ruth Range, CHDP Regional 
Operations Section Chief, to Arthur Lisbin, LA Co. Dept. of Health 
Services (July 26, 1989) 

states that "current medical guidelines," which require 
an FEP Test before doing a blood lead level 
determination, are under revision and that the 
requirement was dropped from the PM160 form. 

Dr. Lynn Goldman, Chief of the State Environmental 
Epidemiology and Toxicology Section states that if single 
test is to be done, it should be blood lead. "Ideally 
. . . one should obtain concurrent measures of both" 
because FEP is a better measure of past exposure. 

DHS has reimbursed blood lead test even though an FEP 
test was not recorded as being done. 

Document #2 (1 page): Letter from Arthur Lisbin to Ruth Range 
(July 11, 1989) 

Recommends that medical guidelines be revised and the 
FEP test removed as a test for lead peisoning. 

Document #3 (1 page): Letter from Gordon Cumming, CHDP Chief, to 
Barbara Allen, Director Alameda Co. CHDP Prog. (Feb. 15, 1990) 

States that FEP test "is no longer" required before blood 
level test will be reimbursed 

"The program has always promoted lead testing in children 
whose histories indicated they are at risk for lead 
poisoning." 

Reimbursement will be approved only when the blood test 
is part of a complete CHDP health assessment. 

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FUNDED BY THE LEGAL SERVICES CORPORATION 

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[We need to find out what this means. If it means that 
the provider must be able to render the complete CHDP 
screen, it is illegal.] 

Asks county to "inform us of the number of children you 
plan to test and other specific risk criteria to be used” 

Document #4 (3 pages): Letter from Barbara Allen to Gordon Cumming 
{Feb. 5, 1990) 

Seeks approval to screen high risk Alameda County 
residents including the City of Berkeley between 9 months 
to 6 years of age "routinely" using blood lead 
determinations directly, rather than first screening for 
FEP. 

Refers to 1986 Childhood Lead Poisoning Prevention 
Program (CLPPP) law (H & S Code 3097). 

Lead poisoning in Oakland children "is a public health 
crisis." 1.3% of children examined had blood lead levels 
greater than 25 ug/dl; 19.1% has levels greater than 15 
ug/dl. 

EP sensitivity in detecting blood lead is "extremely 
poor." If EP test had been used in Oakland, 20% of the 
children would have been missed. 

Notes that Kenneth Kizer made Lynn Goldman and Mary Haan, 
Program Director/Epidemiologist of the Childhood Lead 
Poisoning Prevention Project, available to Alameda Co. 
to assist in development of an effective lead screening, 
diagnosis, treatment, abatement and community education 
plan. "The screening component provides for blood-lead 
determination by venipuncture of all at-risk Oakland 
children, 9 months to 6 years of age." (p. 2) Campaign 
to begin March or April 1990. 

Document #5 (3 pages): CHDP Program Informaticn Notice #82-E (To: 
Community CHDP Directors and Deputy Directors, March 24, 1982) 

Re: Lead Poisoning in Hispanic Children due to folk 
remedy azarcon. 

Document #6 (15 pages): CHDP Fiscal Year 1984-85 Fact Book 

283 children received Lead:FEP test, and 2 received Lead: 
Blood test. 440,084 children received services through 
Medi-Cal. Minority children constituted 62% of those 
served. 2,878,765 people (10.9% of population) were 
eligible for Medi-Cal services. 

 



  

Fact Book also reports on Medi-Cal eligible children by 
age, ethnicity, gender, county of residence, and on 

provider type. 

Document #7 (57 pages) CHDP Regulations (July 1990) 

excerpted from Title 17 CCR. 

"Health assessment" includes as a required screening 
procedure "testing for . . . lead poisoning where 
appropriate." (sec. 6846). 

"Screening" not defined (sec. 6818). Cites to H&S Code 
208 and 121, 320 et seq. 

"Periodicity" defined at sec. 6847. 

Schedule of maximum allowance (sec. 6868) FEP: $7.50, 

Lead blood: $22.45. 

Informing duties at sec. 6824; outreach at sec. 6842. 

Document #8 (39 pages) CDC, Preventing Lead Poisoning in Young 

Children (1985). 
  

  

Chapter IV discusses screening [and is very good]. 

Document #9 (53 pages) DHS, CHDP Medical Guidelines (Dec. 31, 1982) 
  

Health assessment procedures form lists FEP -- "may be 
done only if health history warrants;" Blood Lead level 
-- "may be done only if FEP is above 35 ug/dl." 

Includes lead paint education as suggested health 
education topic. 

States that children with pica behavior are candidates 
for lead poisoning. "Strongly recommends" venous blood 
sample if lead poisoning is suspected. "If this is not 
possible," finger prick for FEP. Defines poisoning at 
25 ug /dl. Poisoned children "should be referred to" 
Public Health Nursing and an "environmental investigation 
should be initiated." 

Requires prior approval for "routine testing on 
all children screened." (page 26) 

Document #10 (61 pages) PM160 Instructions (May 1990) 

The form to be used by providers to request payment for 
health assessment services. The general instructions 
say that a "complete health assessment must be done" 

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according to the instructions contained in later sections 

of the PM160 form. The instructions explain in detail 

how to complete the billing form. The instructions 

include two separate lead tests as "other tests," as 

follows: "Code 14 Lead: FEP -- Should be done if health 

history warrants or prior approval received from State. 

Code 15 lead: blood lead." 

Page 50 lists health assessment procedures required for 

various age groups. FEP and blood lead level tests are 

listed under laboratory tests, and instructions state: 

"May be done if health history warrants." Includes 
schedule of maximum allowances ($7.50 for FEP and $22.45 
for venous blood test). According to the instructions, 
CHDP pays only for screening. If the recipient is 

covered by Medi-Cal, the Medi-Cal fiscal intermediary 
must be billed for covered diagnosis and treatment. 

Document #11 (6 pages): CHDP Billing Forms 

Copies of the confidential screening/billing report form 
for CHDP assessments by providers. Lead tests listed 
under "other test."