Section 22-B7302. TESTING AND CASE MANAGEMENT

 

7302.1This section establishes best practices for providing diagnostic testing, follow-up testing, and case management when a child under the age of six (6) has a BLL screening that indicates an elevated BLL.

 

7302.2Each health care provider or health care facility should provide:

 

(a)Diagnostic and follow-up testing, treatment, and care for a child with an elevated BLL; and

 

(b)Case management for a lead-poisoned child, according to generally accepted medical standards and the guidelines established in this section. The guidelines in this section should be applied in conjunction with pertinent information regarding the child's medical condition and risk of exposure to lead hazards.

 

7302.3Each health care provider or health care facility should give a child with an elevated blood level, based on the BLL in a screening test, a diagnostic test according to the following schedule:

 

(a)If the results of a BLL screening test are equal to ten (10) micrograms per deciliter (μ/dL), or between ten (10) and nineteen (19) micrograms per deciliter (μ/dL), the child should receive a diagnostic test within three (3) months after the screening test; and

 

(b)If the results of a BLL screening test are equal to or greater than twenty (20) micrograms per deciliter (μ/dL), the child should receive a diagnostic test according to the following schedule:

 

(1)Between one (1) week and one (1) month after the screening test when the BLL was between twenty (20) and forty-four (44) micrograms per deciliter (μ/dL);

 

(2)Not later than forty-eight (48) hours after the screening test when the BLL was between forty-five (45) and fifty-nine (59) micrograms per deciliter (μ/dL);

 

(3)Not later than twenty-four (24) hours after the screening test when the BLL was between sixty (60) and sixty-nine (69) micrograms per deciliter (μ/dL); or

 

(4)Immediately, as an emergency laboratory test, when the BLL was equal to or greater than seventy (70) micrograms per deciliter (μ/dL).

 

7302.4If a child twelve (12) months of age or younger has an elevated BLL on a screening test, or the health care provider has reason to believe that the child's BLL is increasing rapidly, the health care provider may provide the diagnostic test sooner than indicated in subsection 7302.3. Generally, there is a direct correlation between the elevation of the BLL and the urgency for performing a diagnostic test.

 

7302.5Each health care provider or health care facility should provide a child with an elevated BLL equal to or greater than ten (10) micrograms per deciliter (μ/dL), as indicated in a diagnostic test, with the following services:

 

(a)Case management; and

 

(b)Follow-up testing within two (2) months of the diagnostic test.

 

7302.6A child receiving case management pursuant to this section should receive follow-up testing at not sooner than thirty (30) days and not more than sixty (60) day intervals until all of the following conditions are met:

 

(a)The child's BLL is less than ten (10) micrograms of lead per deciliter (μ/dL) for at least two (2) follow-up tests;

 

(b)The lead hazards that caused, or that are likely to have caused, the child's elevated BLL have been removed; and

 

(c)There is no new exposure and no increased likelihood of exposure to lead hazards.

 

7302.7After all the conditions in § 7302.6 have been met, the child should be tested approximately once every three (3) months, until the child reaches thirty-six (36) months of age and typically no longer requires follow-up testing.

 

source

Final Rulemaking published at 52 DCR 9852 (November 4, 2005).