Lead Testing and Risk Assessment Tool

Missouri Facts

Specific Recommendations For Blood Lead Testing

  1. Universal blood lead testing of children who reside in High-Risk areas of Missouri. Risk assessments may indicate the need for blood lead testing at an earlier age (six months) and/or more frequently.

    2. In High-Risk areas the following activities shall occur:

    • Any child under the age of six years living in or visiting for 10 hours per week or more, the high-risk area, will be tested annually for lead.
    • Day care facilities are required to record a "proof of lead testing" signed by the Health Care Provider performing the test within thirty (30) days of the child's enrollment. If the parent/guardian does not provide it or a written statement stating why they do not want the child tested, the Day care facility is to offer the parent assistance in scheduling a test.
    • Any child found to be at High-Risk, is living in a residence that was built before 1978, and is undergoing renovation, may be tested every six months and once following completion of the work. (Also applies to children found to be at high-risk in non high-risk areas.)

    In Non-High Risk areas the following activities shall occur:

    • Any child under the age of six years visiting for 10 hours per week or more, a high-risk area, will be tested annually for lead.
    • All Medicaid eligible children will be blood tested for lead at age 12 and 24 months of age. It is recommended that all children (regardless of Medicaid eligibility) be tested for lead at 12 and 24 months of age. (This statement does not appear in the law, but applies as HCFA policy and DHSS recommendations.)
    • Beginning at age six months up to age six years every child will be screened annually by verbal risk assessment (DHSS/DSS questionnaire) to determine whether they are at high risk.
    • Every child, less than age six, found to be at high risk, will be tested for lead.

    The Centers for Medicare and Medicaid Services (CMS)/Missouri Department of Social Services, Division of Medical Services requires a blood lead test at 12 and 24 months for all Medicaid eligible children.

    The choice of a sample-collection method (venipuncture or capillary) should be determined by the availability of trained personnel, the frequency of false-positive capillary results, convenience, and cost. If children's fingers, heels or earlobes are cleaned carefully, capillary sampling can perform well as an initial testing tool.

    Confirm capillary results with a venous blood draw if results are:

    • 10 μg/dl or greater
    • questionable

  2. Immediate blood testing of any Medicaid child 12 to 72 months who does not have a documented blood lead test. Childhood Blood Lead testing and Follow-up Guidelines.
  3. Re-evaluation of all children less than six years of age, for risk of lead poisoning at health care visits (at least annually). For this purpose, a HCY Lead Risk Assessment Guide is recommended. Conduct a blood lead test for those found to be at risk.

Prenatal Assessment Questionnaire
Healthcare professionals that serve pregnant women, including but not limited to health departments, hospitals, clinics, healthcare facilities, and health maintenance organizations, should perform a lead risk assessment of pregnant woman as part of the first prenatal visit. A questionnaire for assessing risk of lead poisoning in pregnant women has been developed by DHSS. The questionnaire is designed to be self administered, with the responses being reviewed by the health care provider to clarify any unknown or incomplete responses. Any positive response to the questionnaire should be considered an indication of lead poisoning risk to both the fetus and pregnant woman. The completed questionnaire should become part of the woman’s medical record. Healthcare professionals identifying a pregnant woman with a risk factor(s) should take the appropriate steps to refer the pregnant woman to a licensed physician or health care provider for a blood lead test.