Bill Summary – FastDemocracy

Legislative Analysis
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TESTING FOR CHILDHOOD LEAD POISONING
                                                                             http://www.house.mi.gov/hfa
Senate Bill 31 as enacted                                                    Analysis available at
Public Act 146 of 2023                                                       http://www.legislature.mi.gov
Sponsor: Sen. John Cherry
House Bill 4200 as enacted
Public Act 145 of 2023
Sponsor: Rep. Helena Scott
House Committee: Health Policy
Senate Committee (SB 31): Health Policy
Senate Committee (HB 4200): Committee of the Whole
Complete to 2-15-24
SUMMARY:
       Senate Bill 31 amends the Public Health Code to require that children be tested for lead
       poisoning at certain ages, that the testing be recorded on their certificate of immunization, and
       that the Department of Health and Human Services (DHHS) develop rules to implement the
       bill’s requirements. The bill also allows DHHS to adjust the testing requirements after
       collecting and reviewing testing and related data for five years. House Bill 4200 requires
       certificates of immunization to include a space for indicating whether a minor has been tested
       for lead poisoning. The bills took effect October 3, 2023.
       Testing
       Beginning January 1, 2024, a physician treating a patient who is a minor (under 18 years of
       age) must test the minor for lead poisoning (or order the test for the minor) at the intervals and
       using the methods specified by DHHS by rule.
       However, this requirement does not apply to a minor whose parent, guardian, or person in loco
       parentis objects to the testing.
       Certificate of immunization
       A physician who performs a lead poisoning test as described above must make an entry of the
       testing on the minor’s certificate of immunization. Beginning January 1, 2024, a certificate of
       immunization must include a space in which to indicate whether the minor has been tested for
       lead poisoning.
       (Under the code, a certificate of immunization is presented to a person accompanying a child
       by a health care provider that administers an immunizing agent to the child. The certificate is
       required to be in a form prescribed by DHHS and must indicate the diseases or infections for
       which the child has been immunized, the number of doses given, the dates when administered,
       and whether further immunizations are indicated.)
House Fiscal Agency                                                                           Page 1 of 3
       Rules
       DHHS must promulgate rules to implement SB 31 that include at least all of the following:
          • A requirement that a minor residing in Michigan be tested at 12 months of age and 24
             months of age, and a requirement that a minor residing in Michigan be tested between
             24 months of age and 72 months of age if they have no previous record of the test
             required by SB 31.
          • The identification of geographic areas in Michigan that pose a high risk for childhood
             lead poisoning, and a requirement that a minor who is 48 months of age be tested if
             they reside in one of those geographic areas.
          • Factors to identify a minor who is at high risk for lead poisoning. The factors must at
             a minimum include residing in a home where other minors have been diagnosed with
             lead poisoning and residing in a home built before 1978.
          • A requirement that a minor be tested at intervals determined by DHHS if a physician
             determines that the minor is at high risk for lead poisoning by applying the factors
             identified above, through a parent’s attestation, or through the physician’s own
             independent medical judgment.
          • Procedures for entering testing information on the minor’s certificate of immunization
             as required, including how to enter the information if the testing is performed by a
             person other than a physician.
       In addition, if after collecting and reviewing data on lead poisoning in Michigan for five years
       DHHS determines that the non–high-risk testing requirements described above (the first
       bulleted item) are no longer necessary or appropriate to maintain the health and safety of
       Michigan children, DHHS may adjust the ages in those requirements or eliminate them
       altogether. If it does so, it must submit a report to the legislature detailing its rationale.
       MCL 333.5474d (SB 31) and MCL 333.9206 (HB 4200)
BRIEF DISCUSSION:
       Lead is a neurotoxin that can damage organs and lead to cognitive and behavioral impacts that
       can affect a person throughout their life. Lead exposure knows no socioeconomic boundaries,
       and all children may be at risk simply because lead can accumulate to dangerous levels more
       quickly in the smaller bodies of children and because children, more than adults, tend to touch
       surfaces that may be contaminated with lead (e.g., window sills in older homes or dirt in yards)
       and then place their fingers in their mouths. But lead also can be carried in the air, so
       neighborhoods downwind of certain facilities or construction sites can also carry risk of lead
       exposure to residents of all ages.
       The federal Medicaid program requires all child beneficiaries to have their blood tested for
       lead at 12 and 24 months of age, with catch-up testing of any child between 24 and 72 months
       old not tested previously. However, children of those ages who are not enrolled in Medicaid
       are not required to be tested for dangerous levels of lead in their blood, even though they may
       have the same risk of exposure.
       Early detection and treatment can mitigate the dangerous effects of lead poisoning, and since
       young children are more impacted by early lead exposure, many believe it makes sense that all
       young children be tested for blood lead levels.
House Fiscal Agency                                           SB 31 and HB 4200 as enacted   Page 2 of 3
FISCAL IMPACT:
       The bills would have one-time modest fiscal implications for DHHS to carry out the process
       of promulgation of rules to implement the bills. These costs should be able to be absorbed by
       the current appropriations for administration and the relevant programs. The bills would have
       one-time minor fiscal implications for DHHS to modify the existing form of the certificate of
       immunization. Additionally, there may be minor fiscal implications for DHHS for data
       collection and review in order to modify or eliminate the testing requirement after five years.
                                                          Legislative Analyst: Rick Yuille
                                                               Fiscal Analyst: Sydney Brown
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations and does not constitute an official statement of legislative intent.
House Fiscal Agency                                           SB 31 and HB 4200 as enacted   Page 3 of 3
Statutes affected: 
Substitute (S-2): 333.9206, 333.1101, 333.25211
Substitute (H-1): 333.1101, 333.25211
Senate Introduced Bill: 333.9206, 333.1101, 333.25211
As Passed by the Senate: 333.9206, 333.1101, 333.25211
As Passed by the House: 333.1101, 333.25211
Senate Concurred Bill: 333.1101, 333.25211
Public Act: 333.1101, 333.25211
Senate Enrolled Bill: 333.1101, 333.25211