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PRIOR PRINTER'S NO. 965 PRINTER'S NO. 3286
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 916
Session of
2025
INTRODUCED BY GIRAL, PIELLI, SANCHEZ, McNEILL, HILL-EVANS,
SCHLOSSBERG, HOHENSTEIN, CIRESI, OTTEN, WEBSTER, GREEN AND
RIVERA, MARCH 17, 2025
AS REPORTED FROM COMMITTEE ON HEALTH, HOUSE OF REPRESENTATIVES,
AS AMENDED, APRIL 28, 2026
AN ACT
Amending the act of November 3, 2022 (P.L.2135, No.150),
entitled "An act providing for blood lead assessment and
testing of certain children and pregnant women by health care
providers; imposing duties on the Department of Health; and
requiring certain health insurance policies to cover blood
lead tests," further providing for legislative findings and
for definitions; repealing provisions relating to lead
poisoning prevention, assessment and testing; providing for
lead poisoning prevention, assessment and testing; and
further providing for duties of department and for blood lead
assessment and testing coverage.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2 of the act of November 3, 2022
(P.L.2135, No.150), known as the Childhood Blood Lead Test Act,
is amended by adding paragraphs to read:
Section 2. Legislative findings.
The General Assembly finds that:
* * *
(8) No safe blood lead level in children has been
identified.
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(9) The effects of lead poisoning are not reversible.
Section 2. Section 4 of the act is amended by adding
definitions to read:
Section 4. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Birthing facility." An inpatient or ambulatory health care
facility licensed by the department that provides birthing and
newborn care services.
"Blood lead level." A measure of lead in the blood, measured
in micrograms of lead per deciliter of whole blood (µg/dL).
* * *
"Child." A child younger than 72 months of age who is a
resident of this Commonwealth.
* * *
"Diagnostic blood lead level testing." An analysis of a
blood sample to determine blood lead levels for the sample,
which is obtained by venipuncture or capillary blood sampling
for the purpose of any of the following:
(1) Confirming lead poisoning as a follow-up blood lead
level test.
(2) Diagnosing a child or pregnant woman showing signs
or symptoms of lead poisoning.
(3) Diagnosing a child or pregnant woman suspected of
having sustained a significant lead exposure.
"Diagnostic evaluation." Obtaining and evaluating medical
history information, conducting a physical examination and
diagnostic blood lead level testing, identifying potential
sources of lead exposure and evaluating iron status.
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* * *
"Lead poisoning." A blood lead level that meets one of the
following criteria:
(1) A confirmed blood lead level greater than or equal
to 20 µg/dL in a child or pregnant woman.
(2) Two blood lead level samples of a child or pregnant
woman, separated by at least 90 days, but not more than 365
days, which indicate a blood lead level greater than or equal
to 15 µg/dL.
"Lead-screening-related services." Any of the following:
(1) Materials and supplies used to obtain blood
specimens for quantitative blood lead level or erythrocyte
protoporphyrin analysis.
(2) Laboratory analysis of submitted samples for
quantitative blood lead level testing or erythrocyte
protoporphyrin analysis.
(3) Evaluation of results obtained from laboratory
analysis of samples submitted for quantitative blood lead
level or erythrocyte protoporphyrin analysis, as well as
related consultation, referral and follow-up of children and
pregnant women who potentially have lead poisoning.
"Screening test." A blood sample obtained by venipuncture or
capillary blood sampling from an asymptomatic child or pregnant
woman not known to have lead poisoning to identify risk of lead
poisoning for the child or pregnant woman.
Section 3. Section 5 of the act is repealed:
[Section 5. Lead poisoning prevention, assessment and testing.
(a) Lead testing for children.--
(1) The following apply:
(i) A health care provider shall consider possible
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lead exposure in an individual patient by evaluating risk
factors for lead exposure and perform blood lead testing
in accordance with recommendations from the Centers for
Disease Control and Prevention and the American Academy
of Pediatrics by 24 months of age.
(ii) If a patient has never been tested in
accordance with recommendations from the Centers for
Disease Control and Prevention and the American Academy
of Pediatrics by 24 months of age, a health care provider
shall consider possible lead exposure and perform blood
lead testing in an individual patient between 24 months
and 72 months of age.
(iii) A health care provider shall make reasonable
efforts to ensure that a patient's parent or legal
guardian understands the risks and benefits of blood lead
testing prior to obtaining consent.
(2) If a patient's parent or legal guardian consents to
blood lead testing for the patient under paragraph (1) and
the results of a capillary blood lead test indicate an
elevated blood lead level, the health care provider shall
perform a confirmatory blood lead test by venipuncture within
12 weeks of the first blood lead test after obtaining the
consent of the patient's parent or legal guardian.
(b) Lead exposure risk assessment and testing requirements
for pregnant women.--A health care provider shall consider
possible lead exposure in individual pregnant women by
evaluating risk factors for lead exposure and perform blood lead
testing if a single risk factor is identified in accordance with
recommendations from the Centers for Disease Control and
Prevention and the American College of Obstetricians and
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Gynecologists.
(c) Reporting.--Health care providers and laboratories shall
comply with reporting regulations as specified in 28 Pa. Code §
27.34 (relating to reporting cases of lead poisoning).]
Section 4. The act is amended by adding a section to read:
Section 5.1. Lead poisoning prevention, assessment and testing.
(a) Lead testing requirements for children.--
(1) A health care provider or certified assistant of a
health care provider shall make reasonable efforts to ensure
that a child under the health care provider's care receives
at least one blood lead test by 24 months of age or between
the ages of 24 through 72 months of age if the child has
never been tested in accordance with recommendations from the
Centers for Disease Control and Prevention and the American
Academy of Pediatrics.
(2) If the results of a blood lead test under paragraph
(1) indicate an elevated blood lead level, the health care
provider or certified assistant of the health care provider
shall perform a confirmatory blood lead test on the child
within 12 weeks of the first blood lead test.
(3) A health care provider or certified assistant of a
health care provider shall perform a screening test for a
child under the health care provider's care who is designated
as high risk through a risk assessment evaluation promulgated
by the department on an annual basis from 12 months of age to
72 months of age.
(4) Upon recommendation by a health care provider, a
health care provider or certified assistant of a health care
provider may perform frequent screening tests on an
asymptomatic child under the health care provider's care who
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is younger than 72 months of age.
(b) Lead testing requirements for pregnant women.--A health
care provider or certified assistant of a health care provider
shall make reasonable efforts to ensure that a pregnant woman
under the health care provider's care receives at least one
blood lead test as part of the pregnant woman's prenatal care.
(c) Testing methods.--Health care providers shall ensure
that screening tests are conducted by venipuncture or capillary
blood sampling in accordance with regulations promulgated by the
department.
(d) Reporting.--Health care providers and laboratories shall
comply with reporting regulations as specified in 28 Pa. Code §
27.34 (relating to reporting cases of lead poisoning).
(e) Nonapplicability.--If a child's parent or legal guardian
or a pregnant woman receiving prenatal care objects in writing
to a blood lead test on religious grounds or on the basis of a
strong moral or ethical conviction similar to a religious
belief, a health care provider or certified assistant of the
health care provider shall perform a diagnostic evaluation in
the least invasive manner practicable.
Section 5. Section 6(b)(1) of the act is amended, the
subsection is amended by adding paragraphs and the section is
amended by adding a subsection to read:
Section 6. Duties of department.
* * *
(b) Distribution of literature about childhood lead
poisoning.--
(1) The department shall provide culturally and
linguistically appropriate educational materials regarding
childhood lead poisoning, the risk factors associated with
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lead exposure, the importance of assessments and testing for
elevated lead levels, prevention of childhood lead poisoning,
treatment of childhood lead poisoning, remediation and, when
appropriate, the requirements of this act.
* * *
(3) A hospital, birthing facility or health care
provider shall provide the information under subsection (a)
and the educational materials under this subsection without
cost to a parent of a newborn prior to discharge from the
hospital or birthing facility or, if childbirth occurs in a
setting other than a hospital or birthing facility, by a
health care provider who assists the parent during
childbirth.
(4) A parent of a newborn prior to discharge from a
hospital or birthing facility, or after a childbirth that
takes place in a setting other than a hospital or birthing
facility, shall sign an acknowledgment statement in a form
determined by the department that the parent received the
information under subsection (a) and the educational
materials under this subsection. A hospital, birthing
facility or health care provider shall provide a copy of the
acknowledgment statement to the parent and keep another copy
of the acknowledgment statement on file at the hospital,
birthing facility or setting other than a hospital or
birthing facility, as applicable.
(c) Liability.--A hospital, birthing facility or health care
provider shall not be civilly or criminally liable for the
action or inaction of a parent with regard to lead exposure
based on the information under subsection (a) and the
educational materials under subsection (b).
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Section 6. Section 7(a) of the act is amended and the
section is amended by adding subsections to read:
Section 7. Blood lead assessment and testing coverage.
(a) [General rule] Coverage.--A health insurance policy or
government program covered under this section shall provide to
covered individuals or recipients [blood lead tests as follows:
(1) In the case of individuals or recipients who are
pregnant, one blood lead test per pregnancy if a single risk
factor is identified in accordance with recommendations from
the Centers for Disease Control and Prevention and the
American College of Obstetricians and Gynecologists.
(2) In the case of individuals or recipients who are
under two years of age, at least one blood lead test by 24
months of age in accordance with recommendations from the
Centers for Disease Control and Prevention and the American
Academy of Pediatrics and, if the result of the blood level
test indicates an elevated blood lead level, another blood
lead test by venipuncture within 12 weeks of the blood level
test in which the elevated blood lead level was indicated.]
coverage for all of the following:
(3) Screening tests and lead-screening-related services
for children younger than 72 months of age and pregnant
women.
(4) Diagnostic evaluations.
(a.1) Services.--The department shall provide the following
services for children younger than 72 months of age and pregnant
women who are not covered by a health insurance policy:
(1) Screening tests and lead-screening-related services.
(2) Diagnostic evaluations.
(a.2) Reimbursement.--The department shall not be required
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to reimburse a third party for services under subsection (b)
that are not provided by the department.
* * *
Section 7. This act shall take effect in 60 days.
AMENDING THE ACT OF NOVEMBER 3, 2022 (P.L.2135, NO.150),
ENTITLED "AN ACT PROVIDING FOR BLOOD LEAD ASSESSMENT AND
TESTING OF CERTAIN CHILDREN AND PREGNANT WOMEN BY HEALTH CARE
PROVIDERS; IMPOSING DUTIES ON THE DEPARTMENT OF HEALTH; AND
REQUIRING CERTAIN HEALTH INSURANCE POLICIES TO COVER BLOOD
LEAD TESTS," FURTHER PROVIDING FOR TITLE OF ACT, FOR
LEGISLATIVE PURPOSE, FOR DEFINITIONS, FOR LEAD POISONING
PREVENTION, ASSESSMENT AND TESTING, FOR DUTIES OF DEPARTMENT
AND FOR BLOOD LEAD ASSESSMENT AND TESTING COVERAGE.
THE GENERAL ASSEMBLY OF THE COMMONWEALTH OF PENNSYLVANIA
HEREBY ENACTS AS FOLLOWS:
SECTION 1. THE TITLE OF THE ACT OF NOVEMBER 3, 2022
(P.L.2135, NO.150), KNOWN AS THE CHILDHOOD BLOOD LEAD TEST ACT,
IS AMENDED TO READ:
AN ACT
PROVIDING FOR BLOOD LEAD ASSESSMENT AND TESTING OF CERTAIN
CHILDREN AND PREGNANT WOMEN BY HEALTH CARE [PROVIDERS]
PRACTITIONERS; IMPOSING DUTIES ON THE DEPARTMENT OF HEALTH;
AND REQUIRING CERTAIN HEALTH INSURANCE POLICIES TO COVER
BLOOD LEAD TESTS.
SECTION 2. SECTION 3(3) OF THE ACT IS AMENDED TO READ:
SECTION 3. LEGISLATIVE PURPOSE.
THE PURPOSES OF THIS ACT ARE:
* * *
(3) TO [ENCOURAGE] REQUIRE THE TESTING OF ALL CHILDREN
IN THIS COMMONWEALTH BY TWO YEARS OF AGE SO THAT PROMPT
DIAGNOSIS AND TREATMENT, AS WELL AS THE PREVENTION OF HARM,
ARE POSSIBLE.
SECTION 3. SECTION 4 OF THE ACT IS AMENDED BY ADDING A
DEFINITION TO READ:
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SECTION 4. DEFINITIONS.
THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ACT SHALL
HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
CONTEXT CLEARLY INDICATES OTHERWISE:
* * *
"HEALTH CARE PRACTITIONER." AS DEFINED IN SECTION 103 OF THE
ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN AS THE HEALTH CARE
FACILITIES ACT.
* * *
SECTION 4. SECTIONS 5, 6(A) AND (B)(2) AND 7(A) AND (B) OF
THE ACT ARE AMENDED TO READ:
SECTION 5. LEAD POISONING PREVENTION, ASSESSMENT AND TESTING
REQUIREMENTS.
[(A) LEAD TESTING FOR CHILDREN.--
(1) THE FOLLOWING APPLY:
(I) A HEALTH CARE PROVIDER SHALL CONSIDER POSSIBLE
LEAD EXPOSURE IN AN INDIVIDUAL PATIENT BY EVALUATING RISK
FACTORS FOR LEAD EXPOSURE AND PERFORM BLOOD LEAD TESTING
IN ACCORDANCE WITH RECOMMENDATIONS FROM THE CENTERS FOR
DISEASE CONTROL AND PREVENTION AND THE AMERICAN ACADEMY
OF PEDIATRICS BY 24 MONTHS OF AGE.
(II) IF A PATIENT HAS NEVER BEEN TESTED IN
ACCORDANCE WITH RECOMMENDATIONS FROM THE CENTERS FOR
DISEASE CONTROL AND PREVENTION AND THE AMERICAN ACADEMY
OF PEDIATRICS BY 24 MONTHS OF AGE, A HEALTH CARE PROVIDER
SHALL CONSIDER POSSIBLE LEAD EXPOSURE AND PERFORM BLOOD
LEAD TESTING IN AN INDIVIDUAL PATIENT BETWEEN 24 MONTHS
AND 72 MONTHS OF AGE.
(III) A HEALTH CARE PROVIDER SHALL MAKE REASONABLE
EFFORTS TO ENSURE THAT A PATIENT'S PARENT OR LEGAL
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GUARDIAN UNDERSTANDS THE RISKS AND BENEFITS OF BLOOD LEAD
TESTING PRIOR TO OBTAINING CONSENT.
(2) IF A PATIENT'S PARENT OR LEGAL GUARDIAN CONSENTS TO
BLOOD LEAD TESTING FOR THE PATIENT UNDER PARAGRAPH (1) AND
THE RESULTS OF A CAPILLARY BLOOD LEAD TEST INDICATE AN
ELEVATED BLOOD LEAD LEVEL, THE HEALTH CARE PROVIDER SHALL
PERFORM A CONFIRMATORY BLOOD LEAD TEST BY VENIPUNCTURE WITHIN
12 WEEKS OF THE FIRST BLOOD LEAD TEST AFTER OBTAINING THE
CONSENT OF THE PATIENT'S PARENT OR LEGAL GUARDIAN.]
(A.1) LEAD TESTING REQUIREMENTS FOR CHILDREN.--
(1) A HEALTH CARE PRACTITIONER SHALL MAKE REASONABLE
EFFORTS TO ENSURE THAT A PATIENT UNDER THE HEALTH CARE
PRACTITIONER'S CARE RECEIVES AT LEAST ONE BLOOD LEAD TEST BY
12 MONTHS OF AGE AND A SECOND BLOOD LEAD TEST BY 24 MONTHS OF
AGE.
(2) IF A PATIENT HAS NEVER BEEN TESTED BY 24 MONTHS OF
AGE, A HEALTH CARE PRACTITIONER SHALL ENSURE THAT THE PATIENT
RECEIVES AT LEAST ONE BLOOD LEAD TEST BETWEEN 24 MONTHS AND
72 MONTHS OF AGE.
(3) IF A CAPILLARY BLOOD LEAD TEST INDICATES AN ELEVATED
BLOOD LEAD LEVEL, A HEALTH CARE PRACTITIONER SHALL PERFORM A
CONFIRMATORY BLOOD LEAD TEST BY VENIPUNCTURE IN ACCORDANCE
WITH RECOMMENDATIONS FROM THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(B) LEAD EXPOSURE RISK ASSESSMENT AND TESTING REQUIREMENTS
FOR PREGNANT WOMEN.--A HEALTH CARE [PROVIDER] PRACTITIONER SHALL
CONSIDER POSSIBLE LEAD EXPOSURE IN INDIVIDUAL PREGNANT WOMEN BY
EVALUATING RISK FACTORS FOR LEAD EXPOSURE AND PERFORM BLOOD LEAD
TESTING IF A SINGLE RISK FACTOR IS IDENTIFIED IN ACCORDANCE WITH
RECOMMENDATIONS FROM THE CENTERS FOR DISEASE CONTROL AND
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PREVENTION AND THE AMERICAN COLLEGE OF OBSTETRICIANS AND
GYNECOLOGISTS.
(C) REPORTING.--HEALTH CARE [PROVIDERS] PRACTITIONERS AND
LABORATORIES SHALL COMPLY WITH REPORTING REGULATIONS AS
SPECIFIED IN 28 PA. CODE § 27.34 (RELATING TO REPORTING CASES OF
LEAD POISONING).
(D) COMMUNICATION OF RISKS AND BENEFITS.--NOTWITHSTANDING
SUBSECTION (E), A HEALTH CARE PRACTITIONER SHALL MAKE REASONABLE
EFFORTS TO ENSURE THAT A CHILD'S PARENT OR LEGAL GUARDIAN, OR A
WOMAN UNDER PRENATAL CARE, UNDERSTANDS THE BENEFITS AND RISKS OF
A BLOOD LEAD TEST.
(E) NONAPPLICABILITY.--THE REQUIREMENTS UNDER THIS SECTION
SHALL NOT APPLY IF A CHILD'S PARENT OR LEGAL GUARDIAN, OR A
WOMAN UNDER PRENATAL CARE, OBJECTS TO THE BLOOD LEAD TEST FOR
ANY REASON. A HEALTH CARE PRACTITIONER SHALL DOCUMENT THE
OBJECTION IN WRITING AND INCLUDE THE OBJECTION IN THE PATIENT'S
MEDICAL RECORD. BEFORE PERFORMING A BLOOD LEAD TEST UNDER THIS
SECTION, THE HEALTH CARE PRACTITIONER SHALL NOTIFY THE CHILD'S
PARENT OR LEGAL GUARDIAN, OR THE WOMAN UNDER PRENATAL CARE, OF
THE OPTION TO OBJECT TO A BLOOD LEAD TEST.
SECTION 6. DUTIES OF DEPARTMENT.
(A) COMPREHENSIVE EDUCATIONAL PROGRAM.--THE DEPARTMENT SHALL
CONDUCT A PUBLIC INFORMATION CAMPAIGN TO INFORM PARENTS OF YOUNG
CHILDREN, PHYSICIANS, NURSES AND OTHER HEALTH CARE [PROVIDERS]
PRACTITIONERS OF THE LEAD ASSESSMENT AND TESTING REQUIREMENTS OF
THIS ACT.
(B) DISTRIBUTION OF LITERATURE ABOUT CHILDHOOD LEAD
POISONING.--
* * *
(2) EDUCATIONAL MATERIALS SHALL BE AVAILABLE AT NO COST
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AND SHALL BE DEVELOPED FOR SPECIFIC AUDIENCES, INCLUDING
HEALTH CARE [PROVIDERS] PRACTITIONERS, HOMEOWNERS, LANDLORDS
AND PARENTS OR CAREGIVERS.
SECTION 7. BLOOD LEAD ASSESSMENT AND TESTING COVERAGE.
(A) GENERAL RULE.--A HEALTH INSURANCE POLICY OR GOVERNMENT
PROGRAM COVERED UNDER THIS SECTION SHALL PROVIDE TO COVERED
INDIVIDUALS OR RECIPIENTS BLOOD LEAD TESTS AS FOLLOWS:
(1) IN THE CASE OF INDIVIDUALS OR RECIPIENTS WHO ARE
PREGNANT, ONE BLOOD LEAD TEST PER PREGNANCY [IF A SINGLE RISK
FACTOR IS IDENTIFIED IN ACCORDANCE WITH RECOMMENDATIONS FROM
THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND THE
AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS].
(2) IN THE CASE OF INDIVIDUALS OR RECIPIENTS WHO ARE:
(I) UNDER TWO YEARS OF AGE, AT LEAST [ONE BLOOD LEAD
TEST] TWO BLOOD LEAD TESTS BY 24 MONTHS OF AGE IN
ACCORDANCE WITH RECOMMENDATIONS FROM THE CENTERS FOR
DISEASE CONTROL AND PREVENTION AND THE AMERICAN ACADEMY
OF PEDIATRICS [AND, IF]; AND
(II) BETWEEN 24 MONTHS OF AGE AND 72 MONTHS OF AGE,
AT LEAST ONE BLOOD LEAD TEST BY 72 MONTHS OF AGE IF THE
INDIVIDUAL OR RECIPIENT HAS NEVER BEEN TESTED BY 24
MONTHS OF AGE.
(3) IF THE RESULT OF THE BLOOD [LEVEL] LEAD TEST COVERED
UNDER PARAGRAPH (1) OR (2) INDICATES AN ELEVATED BLOOD LEAD
LEVEL, ANOTHER BLOOD LEAD TEST BY VENIPUNCTURE [WITHIN 12
WEEKS OF THE BLOOD LEVEL TEST IN WHICH THE ELEVATED BLOOD
LEAD LEVEL WAS INDICATED.] IN ACCORDANCE WITH RECOMMENDATIONS
FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION.
(B) COPAYMENTS, DEDUCTIBLES AND COINSURANCE.--COVERAGE UNDER
THIS SECTION SHALL BE SUBJECT TO [COPAYMENT, DEDUCTIBLE AND
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COINSURANCE PROVISIONS AND ANY OTHER GENERAL EXCLUSIONS OR
LIMITATIONS OF A HEALTH INSURANCE POLICY OR GOVERNMENT PROGRAM
TO THE SAME EXTENT AS OTHER MEDICAL SERVICES COVERED BY THE
POLICY OR PROGRAM ARE SUBJECT TO THESE PROVISIONS.] THE TERMS
AND CONDITIONS OF THE APPLICABLE HEALTH INSURANCE POLICY.
* * *
SECTION 5. THE AMENDMENT OF SECTION 7(A) AND (B) OF THE ACT
SHALL APPLY AS FOLLOWS:
(1) FOR HEALTH INSURANCE POLICIES FOR WHICH EITHER RATES
OR FORMS ARE REQUIRED TO BE FILED WITH THE INSURANCE
DEPARTMENT OR THE FEDERAL GOVERNMENT, THE AMENDMENT OF
SECTION 7 OF THE ACT SHALL APPLY TO ANY POLICY FOR WHICH A
FORM OR RATE IS FIRST FILED ON OR AFTER THE EFFECTIVE DATE OF
THIS SECTION.
(2) FOR HEALTH INSURANCE POLICIES FOR WHICH NEITHER
RATES NOR FORMS ARE REQUIRED TO BE FILED WITH THE INSURANCE
DEPARTMENT OR THE FEDERAL GOVERNMENT, THE AMENDMENT OF
SECTION 7 OF THE ACT SHALL APPLY TO ANY POLICY ISSUED OR
RENEWED ON OR AFTER 180 DAYS AFTER THE EFFECTIVE DATE OF THIS
SECTION.
SECTION 6. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
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