Sec. 10.11.04.04. Blood Tests for Lead Poisoning

A. Effective March 28, 2016, a primary care provider for a child who resides, or who is known to have previously resided, in an at-risk area shall administer a blood test for lead poisoning during the 12-month visit and again during the 24-month visit.

B. Effective March 28, 2016, a primary care provider for a child who is 24 months old or older and younger than 6 years old who resides, or who is known to have previously resided, in an at-risk area as defined in the 2004 Targeting Plan for Areas at Risk for Childhood Lead Poisoning, shall administer a blood test for lead poisoning if the:

(1) Child has not previously received a blood test for lead poisoning;

(2) Child’s parent or guardian fails to provide documentation that the child has previously received a blood test for lead poisoning; or

(3) Provider is unable to obtain the results of a previous blood lead analysis.

C. A primary care provider for a child shall administer a blood test for lead poisoning to a child if:

(1) An affirmative answer, or a response indicating that the parent or guardian does not know the answer, is given for any question on a lead exposure risk questionnaire that is completed for the child pursuant to Regulation .03 of this chapter; or

(2) The child's parent or guardian requests that the child receive a blood test for lead poisoning regardless of the child's age or area of residence.

D. If a child is insured under Maryland's Medicaid program, the child's primary care provider shall administer a blood test for lead poisoning to the child at the 12-month visit and again at the 24-month visit in accordance with EPSDT requirements regardless of the child's area of residence.

E. A primary care provider shall administer a blood test for lead poisoning, by venous methodology, if the results of a capillary blood test for lead poisoning indicate an elevated blood lead level.

F. For each blood test for lead poisoning administered by a health care provider, the provider shall provide on the lab order form the information for blood lead reporting that is required under Environment Article, §6-303, Annotated Code of Maryland, to the medical laboratory that:

(1) Draws the blood specimen; or

(2) Performs the blood lead analysis.

G. Physician offices and other point-of-care laboratories shall comply with the requirements under COMAR 10.10.03.02B(36) and C.

H. Bona Fide Religious Beliefs - At Risk.

(1) If the parent or guardian of a child who resides or has previously resided in an at-risk area that is not a high risk area refuses to consent to a blood test for lead poisoning due to the parent or guardian's stated bona fide religious beliefs and practices, a primary care provider shall:

(a) Counsel the parent or guardian that the blood test for lead poisoning is required by law due to the fact that their child is at risk for having an elevated blood lead level;

(b) Complete a lead exposure risk questionnaire for the child in the presence of the child and the child's parent or guardian.

(2) If an affirmative response to the questionnaire under §H(1)(b) of this regulation, or a response indicating that the parent or guardian does not know the answer, is entered for any question on the lead exposure risk questionnaire for the child, the provider shall:

(a) Further counsel the parent or guardian regarding the risks of lead poisoning, including the potential physical, behavioral, developmental, and intellectual effects, and again request the parent or guardian to consent to a blood test for lead poisoning;

(b) Document in the child's medical record any continued refusal by the parent or guardian to consent to a blood test for lead poisoning despite counseling, and the grounds for the parent or guardian's refusal;

(c) Write and sign an order for a blood test for lead poisoning on a medical laboratory order form; and

(d) Give the child's parent or guardian the completed order for the medical laboratory to draw a blood specimen for blood lead analysis.

(3) If all the responses to the lead exposure risk questionnaire are negative, the provider shall:

(a) Follow procedures set forth in §H(2)(b) of this regulation; and

(b) Complete a form issued by the Department indicating that the questionnaire was completed.

I. Bona Fide Religious Beliefs - High Risk.

(1) If the parent or guardian of a child at high risk refuses to consent to a blood test for lead poisoning due to the parent or guardian's stated bona fide religious beliefs and practices, a primary care provider shall:

(a) Follow the procedures set forth in §H(1) and (2) of this regulation; and

(b) If a provider determines that a child is at a substantial risk of harm from lead exposure, the provider shall follow applicable law if the child’s parent or guardian continues to refuse to have the child tested.

(2) If all the responses to the lead exposure risk questionnaire are negative, the provider shall complete the form issued by the Department indicating that the questionnaire was completed.

J. This regulation does not limit the duties of the child's health care provider, with respect to any child who resides or has previously resided in an at-risk area, under any other provision of the law.

K. A health care provider giving nonprimary care to a child may, but is not required to, administer a blood test for lead poisoning, even if a blood test for lead poisoning is not medically indicated.