(Flickr / thechunk)

Lead screening, be it universal or targeted, is the topic of a letter to Andy Slavitt, Acting Administrator for the Center for Medicare and Medicaid Services (CMS) from Rep. Frank Pallone, Ranking Member, House Energy and Commerce Committee and Senator Ron Wyden, Ranking Member, Senate Finance Committee. The letter asks Acting Director Slavitt to respond to several questions about lead screening for young children covered by Medicaid.

Historically, Medicaid required that all children be screened for lead exposure at 12 and 24 months of age, universal screening. In 2012, that requirement was changed to match the then-updated targeted approach to lead screening from the Centers for Disease Control and Prevention (CDC). The CDC’s recommendation didn’t completely end universal screening, but said that if there is sufficient data to support targeted screening to vulnerable populations, that should be allowed. Though just one state has taken up that option via the waiver process, the letter seeks to find out how decisions are made to grant such waivers.

Because states now have the option to move away from universal screening, the letter to CMS asks questions that may help clarify how the decision is made to grant such a waiver. What processes are used to evaluate state data? How can we be sure that a targeted screening approach will improve a state’s ability to identify children with a high-risk for exposure to lead? What about the states whose health officials say they don’t require blood level testing or who don’t recognize the federal mandate for testing? How are they handled and do they have a specific exemption? If so, how did they get that exemption, and if not, how can they be brought back into compliance?

The final question in the letter to CMS may be one of the most significant: it asks if CMS has plans to update their current elevated blood lead reference level. In 2012, the CDC updated its recommendation on what qualifies as an elevated blood lead reference level for children – 5 micrograms per deciliter, while level CMS recognizes is 10 micrograms per deciliter. (To that end, the Department of Housing and Urban Development (HUD) regulations do not call for action until after a child’s blood lead level is 20 micrograms per deciliter, or 15 to 19 micrograms per deciliter over three months.)

The questions in the letter are necessary, and the forthcoming information from CMS could provide critical information about how lead screening can best be accomplished. Universal screening, screening of all Medicaid children at 12 and 24 months, could provide critical data as to the actual number of children who are exposed to lead and where they reside, though sometimes exposure comes from other locations.Limited funding and low testing numbers in some states or areas were issues before targeted screening was recommended and provided incomplete data. However, without accurate and true universal testing and a solid database of those results, it’s hard to know for certain where targeted screening is appropriate. This is where the issues between universal or targeted screening leave many puzzled.

Once CMS provides their answers to the letter, we will begin to learn the actual difference between targeted and universal lead screening and how it works in the real world. Now, without these answers, it can be very difficult to know which approach is the best one.

.@RonWyden and @FrankPallone ask CMS: What’s the best way to screen for lead? http://bit.ly/2aNtIHx | via @First_Focus | @carriemf
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