LEAD POISONING PREVENTION.

SEC. 303. LEAD POISONING PREVENTION. (a) In General.— Section 317A of the Public Health Service Act (42 U.S.C. 247b–1) is amended to read as follows: “screenings, referrals, and education regarding lead poisoning “Sec. 317A. (a) Authority for Grants.— “(1) In general.— Subject to paragraph (2), the Secretary, acting through the Director of the Centers for Disease Control and Prevention, may make grants to States and political subdivisions of States for the initiation and expansion of community programs designed— “(A) to provide, for infants and children— “(i) screening for elevated blood lead levels; “(ii) referral for treatment of such levels; and “(iii) referral for environmental intervention associated with such levels; and “(B) to provide education about childhood lead poisoning. ‘(2) Authority regarding certain entities.— With respect to a geographic area with a need for activities authorized in paragraph (1), in any case in which neither the State nor the political subdivision in which such area is located has applied for a grant under paragraph (1), the Secretary may make a grant under such paragraph to any grantee under section 329, 330, 340, or 340A for carrying out such activities in the area. “(3) Provision of all services and activities through each grantee.— In making grants under paragraph (1), the Secretary shall ensure that each of the activities described in such paragraph is provided through each grantee under106 STAT. 3485 such paragraph. The Secretary may authorize such a grantee to provide the services and activities directly, or through arrangements with other providers. “(b) Status as Medicaid Provider.— “(1) In general.— Subject to paragraph (2), the Secretary may not make a grant under subsection (a) unless, in the case of any service described in such subsection that is made available pursuant to the State plan approved under title XIX of the Social Security Act for the State involved— “(A) the applicant for the grant will provide the service directly, and the applicant has entered into a participation agreement under the State plan and is qualified to receive payments under such plan: or “(B) the applicant will enter into an agreement with a provider under which the provider will provide the service, and the provider has entered into such a participation agreement and is qualified to receive such payments. “(2) Waiver regarding certain secondary agreements.— “(A) In the case of a provider making an agreement pursuant to paragraph (1)(B) regarding the provision of services, the requirement established in such paragraph regarding a participation agreement shall be waived by the Secretary if the provider does not, in providing health care services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits plan. “(B) A determination by the Secretary of whether a provider referred to in subparagraph (A) meets the criteria or a waiver under such subparagraph shall be made without regard to whether the provider accepts voluntary donations regarding the provision of services to the public. “(c) Priority in Making Grants.— In making grants under subsection (a), the Secretary shall give priority to applications for programs that will serve areas with a nigh incidence of elevated blood lead levels in infants and children. “(d) Grant Application.— No grant may be made under subsection (a), unless an application therefor has been submitted to, and approved by, the Secretary. Such an application shall be in such form and shall be submitted in such manner as the Secretary shall prescribe and shall include each of the following: “(1) A complete description of the program which is to be provided by or through the applicant. “(2) Assurances satisfactory to the Secretary that the program to be provided under the grant applied for will include educational programs designed to— “(A) communicate to parents, educators, and local health officials the significance and prevalence of lead poisoning in infants and children (including the sources of lead exposure, the importance of screening young children for lead, and the preventive steps that parents can take in reducing the risk of lead poisoning) which the program is designed to detect and prevent; and “(B) communicate to health professionals and paraprofessionals updated knowledge concerning lead poisoning and research (including the health consequences, if any,106 STAT. 3486 of low-level lead burden; the prevalence of lead poisoning among all socioeconomic groupings; the benefits of expanded lead screening; and the therapeutic and other interventions available to prevent and combat lead poisoning in affected children and families). “(3) Assurances satisfactory to the Secretary that the applicant will report on a quarterly basis the number of infants and children screened for elevated blood lead levels, the number of infants and children who were found to have elevated blood lead levels, the number and type of medical referrals made for such infants and children, the outcome of such referrals, and other information to measure program effectiveness. “(4) Assurances satisfactory to the Secretary that the applicant will make such reports respecting the program involved as the Secretary may require. “(5) Assurances satisfactory to the Secretary that the applicant will coordinate the activities carried out pursuant to subsection (a) with related activities and services carried out in the State by grantees under title V or XIX of the Social Security Act. “(6) Assurances satisfactory to the Secretary that Federal funds made available under such a grant for any period will be so used as to supplement and, to the extent practical, increase the level of State, local, and other non-Federal funds that would, in the absence of such Federal funds, be made available for the program for which the grant is to be made and will in no event supplant such State, local, and other non-Federal funds. “(7) Such other information as the Secretary may prescribe. “(e) Relationship to Services and Activities Under Other Programs.— “(1) In general.— A recipient of a grant under subsection (a) may not make payments from the grant for any service or activity to the extent that payment has been made, or can reasonably be expected to be made, with respect to such service or activity— “(A) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or “(B) by an entity that provides health services on a prepaid basis. “(2) Applicability to certain secondary agreements for provision of services.— Paragraph (1) shall not apply in the case of a provider through which a grantee under subsection (a) provides services under such subsection if the Secretary has provided a waiver under subsection (b)(2) regarding the provider. “(f) method and Amount of Payment.— The Secretary shall determine the amount of a grant made under subsection (a). Payments under such grants may be made in advance on the basis of estimates or by way of reimbursement, with necessary adjustments on account of underpayments or overpayments, and in such installments and on such terms and conditions as the Secretary finds necessary to carry out the purposes of such grants. Not more than 10 percent of any grant may be obligated for administrative costs. 106 STAT. 3487 “(g) Supplies, Equipment, and Employee Detail.— The Secretary, at the request of a recipient of a grant under subsection (a), may reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee; when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient. “(h) Records.— Each recipient of a grant under subsection (a) shall keep such records as the Secretary shall prescribe, including records which fully disclose the amount and disposition by such recipient of the proceeds of such grant, the total cost of the under-taking in connection with which such grant was made, and the amount of that portion of the cost of the undertaking supplied by other sources, and such other records as will facilitate an effective audit. “(i) Audit and Examination of Records.— The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall have access for the purpose of audit and examination to any books, documents, papers, and records of the recipient of a grant under subsection (a), that are pertinent to such grant. “(j) Annual Report.— “(1) In general.— Not later than May 1 of each year, the Secretary shall submit to the Congress a report on the effectiveness during the preceding fiscal year of programs carried out with grants under subsection (a) and of any programs that are carried out by the Secretary pursuant to subsection (1)(2). “(2) Certain requirements.— Each report under paragraph (1) shall include, in addition to any other information that the Secretary may require, the following information: “(A) The number of infants and children screened. “(B) Demographic information on the population of infants and children screened, including the age and racial or ethnic status of such population. “(C) The number of screening sites. “(D) A description of the severity of the extent of the blood lead levels of the infants and children screened, expressed in categories of severity. “(E) The sources of payment for the screenings. “(F) A comparison of the data provided pursuant to subparagraphs (A) through (E) with the equivalent data, if any, provided in the report under paragraph (1) preceding the report involved. 106 STAT. 3488 “(k) Indian Tribes.— For purposes of this section, the term ‘political subdivision’ includes Indian tribes. “(l) Funding.— “(1) Authorization of appropriations.— For the purpose of carrying out this section, there are authorized to be appropriated $40,000,000 for fiscal year 1993, and such sums as may be necessary for each of the fiscal years 1994 through “(2) Allocation for other programs.— Of the amounts appropriated under paragraph (1) for any fiscal year, the Secretary may reserve not more than 20 percent for carrying out programs regarding the activities described in subsection (a) in addition to the program of grants established in such subsection.”. (b) Other Programs.— Part A of title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by inserting after section 317A the following section: “education, technology assessment, and epidemiology regarding lead poisoning “Sec. 317B. (a) Prevention.— “(1) Public education.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall carry out a program to educate health professionals and paraprofessionals and the general public on the prevention of lead poisoning in infants and children. In carrying out the program, the Secretary shall make available information concerning the health effects of low-level lead toxicity, the causes of lead poisoning, and the primary and secondary preventive measures that may be taken to prevent such poisoning. “(2) Interagency task force.— “(A) Not later than 6 months after the date of the enactment of the Preventive Health Amendments of 1992, the Secretary shall establish a council to be known as the Interagency Task Force on the Prevention of Lead Poisoning (in this paragraph referred to as the ‘Task Force’). The Task Force shall coordinate the efforts of Federal agencies to prevent lead poisoning. “(B) The Task Force shall be composed of— “(i) the Secretary, who shall serve as the chair of the Task Force; “(ii) the Secretary of Housing and Urban Development; “(iii) the Administrator of the Environmental Protection Agency; and “(iv) senior staff of each of the officials specified in clauses (i) through (iii), as selected by the officials respectively. “(C) The Task Force shall— “(i) review, evaluate, and coordinate current strategies and plans formulated by the officials serving as members of the Task Force, including— “(I) the plan of the Secretary of Health and Human Services entitled “Strategic Plan for the Elimination of Lead Poisoning”, dated February 21, 1991; 106 STAT. 3489 “(II) the plan of the Secretary of Housing and Urban Development entitled “Comprehensive and Workable Plan for the Abatement of Lead-Based Paint in Privately Owned Housing”, dated December 7, 1990; and “(III) the strategy of the Administrator of the Environmental Protection Agency entitled “Strategy for Reducing Lead Exposures”, dated February 21, 1991; “(ii) develop a unified implementation plan for programs that receive Federal financial assistance for activities related to the prevention of lead poisoning; “(iii) establish a mechanism for sharing and disseminating information among the agencies represented on the Task Force; “(iv) identify the most promising areas of research and education concerning lead poisoning; “(v) identify the practical and technological constraints to expanding lead poisoning prevention; “(vi) annually carry out a comprehensive review of Federal programs providing assistance to prevent lead poisoning, and not later than May 1 of each year, submit to the Committee on Labor and Human Resources of the Senate and the Committee on the Environment and Public Works of the Senate, and to the Committee on Energy and Commerce of the House of Representatives, a report that summarizes the findings made as a result of such review and that contains the recommendations of the Task Force on the programs and policies with respect to which the Task Force is established, including related budgetary recommendations; and “(vii) annually review and coordinate departmental and agency budgetary requests with respect to all lead poisoning prevention activities of the Federal Government. “(b) Technology Assessment and Epidemiology.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall, directly or through grants or contracts— “(1) provide for the development of improved, more cost-effective testing measures for detecting lead toxicity in children; “(2) provide for the development of improved methods of assessing the prevalence of lead poisoning, including such methods as may be necessary to conduct individual assessments for each State; “(3) provide for the collection of data on the incidence and prevalence of lead poisoning of infants and children, on the demographic characteristics of infants and children with such poisoning (including racial and ethnic status), and on the source of payment for treatment for such poisoning (including the extent to which insurance has paid for such treatment); and “(4) provide for any applied research necessary to improve the effectiveness of programs for the prevention of lead poisoning in infants and children.”.