For Healthcare Providers

For Healthcare Providers

New requirements for blood lead testing of young children: The Governor of Michigan signed a bill package on October 3, 2023 that includes requirements for physicians to test, or order a blood lead test for, all children at age 12 months and 24 months and at other intervals based on exposure risk. This age-based approach to blood lead testing requirements for all children is commonly called “universal testing”.

The law updates the Public Health Code, adding MCL 333.5474d and amending MCL 333 9206(1). MDHHS is in the process of developing administrative rules that detail the testing requirements. Blood lead testing requirements go into effect when the rules are published in 2024.

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Questions and answers for physicians about universal blood lead testing

IMPORTANT UPDATES

BLOOD LEAD REFERENCE VALUE UPDATE

On October 28, 2021, The Centers for Disease Control and Prevention (CDC) updated the blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL (MMWR 2021). As of May 1, 2022, State of Michigan Medicaid policy will align with this update (MDHHS Health and Aging Services Administration Bulletin 22-11). The blood lead reference value is based on the 97.5th percentile of the blood lead distribution in U.S. children ages 1-5 years from the National Health and Nutrition Examination Survey.

No level of lead in the blood is safe, and MDHHS welcomes the update of the BLRV for clinical management and public health response for children with lead exposure. As outlined in updated guidance from the CDC, American Academy of Pediatrics, and the Pediatric Environmental Health Specialty Units, health care providers should begin providing follow-up testing and other recommended actions for children with BLL ≥ 3.5 µg/dL.

Blood Lead Reference Value Resources

MDHHS Pediatric Blood Lead Level Quick Reference for Primary Care Providers
MMWR Update of the Blood Lead Reference Value - United States, 2021 | MMWR (cdc.gov)
CDC Recommended Actions Based on Blood Lead Level CDC - Lead - Recommended Actions Based on Blood Lead Levels
PEHSU Factsheet Recommendation on Management of Lead Exposure Articles - PEHSU
AAP Press Release Lower blood lead reference level doesn't change clinical management | American Academy of Pediatrics (aappublications.org)
Update of Blood Lead Reference Value and Recommendations on the Medical Management of Childhood Lead Exposure MDHHS Health and Aging Services Administration Bulletin 22-11 | (Michigan.gov)
Definition of Elevated Blood Lead Test Result

Healthcare providers play an important role in preventing primary lead exposure, as well as identifying those at risk of blood lead poisoning.

WHO NEEDS A BLOOD LEAD TEST?

Children
Pregnant and Breastfeeding Persons
Adults

All children with a positive lead exposure questionnaire. The American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule recommends questionnaire screening for lead exposure at well-child exams conducted at 6 months through 6 years.
- The MDHHS lead exposure questions can be found on the Pediatric Blood Lead Level Quick Reference for Primary Care Providers. A “YES” or “I DON’T KNOW” response indicates a positive screen.
Children enrolled in Medicaid. Blood lead testing is required at:
- 12 and 24 months.
- Between 36 and 72 months, if not previously tested (Medicaid Provider Manual Early and Periodic Screening, Diagnosis and Treatment; Section 9.6).
Children enrolled in WIC. During child certification/recertification and mid-certification appointments, WIC staff shall assess the history of blood lead testing for every child. If a child has not had a blood lead test, they must be referred for blood lead testing. Per the U.S. Department of Agriculture (USDA), blood lead testing is not an allowable WIC Program cost. Some local WIC agencies have internal collaborations/mechanisms established to facilitate lead testing on-site (Social Welfare Act; Children Participants in WIC Program MCL § 400.111l, MI-WIC Lead Services (michigan.gov)).
Children who are refugees ages 6 months through 16 years. CDC recommends a blood lead test within 90 days of arrival in the U.S.
- Retest after 3-6 months for refugee children < 6 years (Immigrant, Refugee, and Migrant Health (CDC.gov)).

The American College of Obstetricians and Gynecologists (ACOG) recommends health care providers evaluate risk factors for lead exposure in pregnant and lactating patients and perform blood lead testing if any risk factors are identified (Lead Screening During Pregnancy and Lactation Committee Opinion (ACOG.org)).
- MDHHS has a Blood Lead Risk Assessment questionnaire for Pregnant & Breastfeeding Persons in the Pregnant and Nursing Persons Factsheet.

There is no public health recommendation for routine blood lead testing for nonpregnant or breastfeeding adults. Blood lead testing in adults should be based on clinical judgement and exposure history, including potential exposure associated with jobs and hobbies.
- Adult Exposure to Lead (michigan.gov)
- Lead in Jobs and Hobbies (michigan.gov)

The Michigan Occupational Safety and Health Administration (MIOSHA) has established lead standards for workers in general industrial and construction jobs. Both standards define minimum safety precautions, including regular testing, that employers must provide for employees exposed to lead on the job.
- General Industry Safety and Health Standard; Lead in general industry (Michigan.gov).
- Construction Safety and Health Standard; Lead Exposure in Construction (Michigan.gov).

Blood lead test tube laying on paperwork indicating lead present

Important notes on blood lead testing:

Blood lead tests via capillary sampling are for screening only, all elevated capillary samples require venous confirmatory testing.
At a blood lead level of 45 µg/dL or greater, any treatment should be performed in consultation with Michigan’s Poison Control Center. Hospitalization and/or chelation should be considered. Other children who may have also been exposed should be tested. The family should NOT return to the lead-contaminated home.

Michigan Care Improvement Registry (MCIR)

The Blood Lead Module is a component of a patient's MCIR record. If the patient has had a blood lead test, the results will be displayed in the record, as well as how to interpret the results with corresponding recommended actions.

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IMPORTANT UPDATES

BLOOD LEAD REFERENCE VALUE UPDATE

Provider Resources

Childhood Blood Lead Testing: Michigan Data Briefs for Health Care Providers

Patient Resources

Other Agency Resources for Health Care Providers

WHO NEEDS A BLOOD LEAD TEST?

Important notes on blood lead testing:

Michigan Care Improvement Registry (MCIR)