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Lead Overview

Review of Lead Screening, including an overview of State guidelines vs. NCQA requirements with emphasis on age compliance ranges and best practices. Discuss testing requirements, risk assessment questionnaire, reporting, coding and reimbursement, and MedTox.

Lead Overview


Hello and welcome. Thank you for joining this webinar. I'll be talking about lead, state guidelines versus NCQA requirements.

The objectives that I will be going over is to help you understand the difference in State versus NCQA requirements, the age compliance ranges, the cause and effect of lead poisoning and how to apply suggested best practices.

Goal is to improve clinical outcomes and performance on Lead screening in children and promote the care received by our members.

You may of heard some myths regarding lead poisoning. So I will go over some of those myths and the reality of each. Myth: Only high levels of lead have lasting effects on children. Reality: Even low levels of exposure to lead can cause long term effects on child's learning and behavior. Myth: lead poisoning is a health problem that only doctors can solve. Reality: Lead poisoning is a housing problem and a health problem.

Medical treatment cannot protect a child from breathing in more lead.

Myth: Lead poisoned children always have severe symptoms, but in reality, children with low and moderate lead levels may show no symptoms when symptoms do appear lead may have already done permanent damage.

Symptoms are often confused with other causes.

Now, I will go over the different requirements for NCQA and State lead screening in children.

Lead screening in children NCQA requirements. Measure: the percentage of children 2 years of age during the measurement year who had one or more capillary or venous blood tests for lead poisoning by his or her 2nd birthday. Eligibility: children 2 years of age during the measurement year.

Line of business: Medicaid. Meets the measure by having at least 1 capillary or venous blood test on or before child's second birthday as documented through either administrative data or medical record review.

Possible exclusions: Members in hospice.

Lead screening in children State requirements.

State contract: providers will have a compliance rate of greater than 80% for two consecutive six month periods for lead level tests. Eligibility: children 9 months to 19 months of age during the measurement year.

Line of business: Medicaid. Meets measure: Required testing by the state of New Jersey at 12 and 24 months of age.

A capillary or venous blood tests documented through either administrative data or medical record review between 9 months and 18 months of age-target age 12 months and between 18 months, and 26 months of age, target age, 24 months.

A verbal risk assessment shall be performed for lead toxicity at every periodic visit between the ages and 6 and 72 months.

The Lead Risk Assessment Questionnaire is used to screen and capture early lead exposure before it can do irreversible harm.

Some example questions are: Does your child live in or regularly visit a house with peeling or chipping paint built before 1978? Does your child frequently come in contact with adults whose job or hobby involves exposure to lead? If the answers to any of the 10 questions are "yes" or "don't know" a child is considered a high risk for high doses of lead exposure and a blood level should be attained. If the answers to all the questions are "No." a child is considered at low risk for high doses of lead exposure. A child's risk category can change with each administration of the lead risk assessment questionnaire. The new reference value for what is considered high risk is more than 3.5 micrograms per dL. It used to be more than 5 micrograms per dL.

This form on the right is a lead risk assessment questionnaire that can be found on our horizon website or your practice may have a similar form.

This verbal risk assessment should be performed for lead toxicity at every periodic visit between the ages of 6 months to 6 years of age.

Here are some resources. Horizon Healthy journey is our outreach and intervention team. They send members semi-annual postcards on my screening, IVR call reminders about lead

And case management follows up with children with reported high lead levels. And this below is an example of a postcard sent to members that sent to members.

MedTox Testing Kits are in-office collection of blood sample by fingerstick, clinical laboratory improvement amendments CLIA certified, point of care testing reimbursable by Horizon NJ Health for 10 dollars, Free MedTox kits can be obtained from LabCorp.

If you have any questions regarding MedTox, please contact Joe Huffer at this number 1-877-725-7241.

If you already have an account set up with LabCorp, you can now also order MedTox kits online as alternative to venous blood draw. The convenience of using MedTox is, it's simple, cost effective, and accurate.

It's simple because screenings may be performed with 2 drops of blood during a routine office visit.

May be less invasive and traumatic for a child than a venous collection.

There's no spinning refrigeration or phlebotomist required, reports are available via fax, secure website or EMR.

Cost effective, because collection supplies and specimens shipments are included, LabCorp file claims with Medicaid and most major insurance companies, there's no equipment to purchase or maintain and it's accurate.

Using state of the art technology assuring timely and accurate results,

Samples are stable for up to 6 months and LabCorp meets State, reporting requirements for lead screening results.

Here are some useful reminders.

State requirements versus NCQA standards. State requirements 2 tests.

1 on or before members 1st birthday and 1 on or before member 2nd birthday.

NCQA standards, 1 test on or before member's 2nd birthdate.

MedTox, kits are free to offices through LabCorp, incentives of 10 dollars per test. Compliant versus Non-compliant.

Compliant providers receive incentives for gap closed after the NCQA benchmarks.

Non-compliant sites with less than 80% compliance for 2 consecutive 6 month period will be placed on a corrective action plan.

Again, the new reference value for what is considered high risk is more than 3.5 micrograms per dL.

Sources of lead and ways of exposure. Lead can be found in air, soil, water and pesticides. New Jersey, which is known as the Garden State has a lot of agricultural lands that may use some of these pesticides.

It may be also present in ceramics, welding, gasoline batteries and cosmetics more than 65% of the housing New Jersey was built before 1960's which means that some of the pipes plumbing materials and paint may contain lead. Before people knew how dangerous lead really was, it was used in such things as cookware, crayons, and toys.

Lead can still be found in products that come from other countries, such as pottery candy wrappers and cosmetics.

Lead can also be brought home from hobbies and remodeling projects.

Exposure to lead can seriously harm a child's health and cause well-documented adverse effects such as, damage to the brain and nervous system, slow growth and development learning and behavior problems

Hearing and speech problems. This can cause lower IQ, decrease ability to pay attention and under performance in school. There is also evidence by childhood exposure to lead can cause long term harm.

The good news is the childhood lead poisoning is 100% preventable.

Ways to prevent lead exposure through education. So far, we talked about the prevalence of lead in everyday things. And we also talked about the detrimental health effects of lead can have, especially in young children. But not to be alarmed, there are several ways we can prevent lead exposure. And these are simple, straightforward practices that you can encourage all guardians to do. The goal is to prevent childhood lead exposure before any harm occurs. Encourage guardians to have their child get a simple blood lead test. Make parents aware that they can go to their local health department about testing paint and dust in their home for lead if their home was built before 1978. The removal of Lead hazards from the environment before a child is exposed is the most effective way to ensure that children do not experience harmful long-term effects of lead exposure for example, reminding guardians to remove recalled toys and toy jewelry from their children and discard as appropriate

Encourage guardians to offer children these foods that are recommended to limit absorption of lead: calcium in milk, yogurt, green, leafy vegetables, like spinach.

Iron and lean red meats, beans, peanut butter and cereals.

Vitamin C in oranges, green and red peppers and juices.

Here are best practices that you can use for lead screening in children

Educate guardians on the importance of lead screening and the dangerous effects of lead poisoning.

Set EMR alerts and standard orders.

Order the test at the appropriate ages.

Follow up on open lab orders for lead screening.

Be sure chart documentation includes the date the test was performed, and the results or finding, utilize the HEDIS recommended codes to ensure gap closure.

Provide in-office testing. Note, if a member has not had a lead test by 24 to 72 months of age, testing should be done but will not be compliant.

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