DEPARTMENT OF HEALTH AND HUMAN SERVICES 

 

BUREAU OF EPIDEMIOLOGY AND POPULATION HEALTH

 

DIVISION OF ENVIRONMENTAL HEALTH 

 

UNIVERSAL LEAD TESTING

 

Filed with the secretary of state on

 

These rules become effective immediately after filing with the secretary of state unless adopted under section 33, 44, or 45a(9) of the administrative procedures act of 1969, 1969 PA 306, MCL 24.233, 24.244, or 24.245a.  Rules adopted under these sections become effective 7 days after filing with the secretary of state.

 

(By authority conferred on the director of the department of health and human services by sections 2233, 5474d, and 9227 of the public health code, 1978 PA 368, MCL 333.2233, 333.5474d, and 333.9227) 

 

R 330.301, R 330.302, R 330.303, and R 330.304 are added to the Michigan Administrative Code, as follows: 

 

R 330.301  Definitions. 

  Rule 1. As used in these rules:

  (a) “Blood lead reference value” means a blood lead level of 3.5 micrograms per deciliter. 

  (b) “Certificate of immunization” means the official record of a child’s immunizations available from the department, either in print or digital format in a provider’s office from the Michigan electronic immunization information system, as required by section 9206 of the public health code, 1978 PA 368, MCL 333.9206.  

  (c) “Department” means the department of health and human services. 

  (d) “Lead poisoning” means the condition of having a blood lead level that is equal to or greater than the blood lead reference value.

  (e) “Jurisdiction” means a legally defined county subdivision, which in this state includes cities and townships, that is defined as “Minor Civil Division” by the United States Census Bureau.

  (f) “Michigan childhood lead poisoning surveillance system” means the web-based laboratory management application that houses the validated blood lead laboratory results of patients from clinical laboratories and portable analyzers.

  (g) “Minor” is an individual less than 18 years of age.  

  (h) “Physician” means an individual licensed to engage in the practice of medicine, as that term is defined in section 17001 of the public health code, 1978 PA 368, MCL 333.17001, or the practice of osteopathic medicine and surgery under section 17501 of the public health code, 1978 PA 368, MCL 333.17501. 

  (i) “Test” and “tested” means a venous or capillary blood test for the presence of lead.  

 

R 330.302  Blood lead testing of a minor. 

  Rule 2. (1) A physician treating a minor patient shall test, or order a test, for lead in blood at the following ages:  

   (a) 12 months.  

   (b) 24 months. 

   (c) If the minor has no previous record of the test required under this rule, between 24 months and 72 months of age. 

  (2) If a minor patient resides in 1 of the jurisdictions identified in R 330.303 as a geographic area where children are at high risk of lead poisoning, a physician treating the minor patient shall test, or order a test, for lead in blood of the minor between 48 months and 60 months of age.   

  (3) If a physician determines that a minor patient is at high risk for lead poisoning, the physician shall test, or order a test, for lead in blood of the minor as provided in subrules (4) and (5) of this rule.

  (4) If either of the following factors that identify a minor at high risk for lead poisoning are present, a physician treating the minor shall test, or order a test, for lead in blood of the minor at least once in between the date of the minor’s most recent test and 72 months of age:

   (a) The minor resides in a home where other minors have been tested and found to have lead poisoning.

   (b) The minor resides in a home built before 1978.  

  (5) If a physician treating a minor patient determines that the minor is at high risk for lead poisoning through a parent’s attestation or through the physician’s own independent medical judgment, the physician shall test, or order a test, for lead in blood of the minor at least once between the time of that determination and 3 months following that determination.

  (6) The department shall make available educational materials for physicians regarding health effects, risk factors, testing, and medical care for lead-exposed minors. The materials must include a written reference guide that summarizes risk factors for lead poisoning, for which additional blood lead testing may be indicated.

  (7) If capillary blood lead test results are equal to or greater than the blood lead reference value, the physician shall test, or order a test, for lead in blood with venous blood.  The venous blood lead test must be analyzed in a laboratory using a high complexity method, such as inductively coupled plasma mass spectrometry or graphite furnace atomic absorption spectroscopy. 

 

R 330.303  Geographic areas identified as high-risk of lead poisoning.

  Rule 3.  (1) As required under section 5474d of the public health code, 1978 PA 368, MCL 333.5474d, the following jurisdictions are identified as the geographic areas where there is a high risk of lead poisoning:

 

Jurisdiction (Minor Civil Division Type)

County

Adrian (City)

Lenawee

Albion (City)

Calhoun

Allegan (City)

Allegan

Bad Axe (City)

Huron

Battle Creek (City)

Calhoun

Bay City (City)

Bay

Belding (City)

Ionia

Benton Harbor (City)

Berrien

Benton Township

Berrien

Bridgeport Township

Saginaw

Bronson (City)

Branch

Buena Vita Township

Saginaw

Calumet Twp Township

Houghton

Cato Twp (City)

Montcalm

Coldwater (City)

Branch

Colon Township

Saint Joseph

Constantine Township

Saint Joseph

Croswell (City)

Sanilac

Curtis Township

Alcona

Detroit (City)

Wayne

Dowagiac (City)

Cass

Eastpointe (City)

Macomb

Ecorse (City)

Wayne

Escanaba (City)

Delta

Evart (City)

Osceola

Flint (City)

Genesee

Galien Township

Berrien

Gladstone (City)

Delta

Grand Rapids (City)

Kent

Greenville (City)

Montcalm

Hamtramck (City)

Wayne

Harper Woods (City)

Wayne

Hartford (City)

Van Buren

Highland Park (City)

Wayne

Hillsdale (City)

Hillsdale

Homer Twp (City)

Calhoun

Hudson (City)

Lenawee

Imlay City (City)

Lapeer

Inkster (City)

Wayne

Ionia (City)

Ionia

Ironwood (City)

Gogebic

Ishpeming (City)

Marquette

Ithaca (City)

Gratiot

Jackson (City)

Jackson

Kalamazoo (City)

Kalamazoo

Lagrange Township

Cass

Lansing (City)

Clinton, Eaton, Ingham

Lansing Township

Ingham

Lapeer (City)

Lapeer

Leoni Township

Jackson

Lincoln Park (City)

Wayne

Ludington (City)

Mason

Manistee (City)

Manistee

Maple Valley Township

Montcalm

Medina Township

Lenawee

Menominee (City)

Menominee

Monroe (City)

Monroe

Morenci (City)

Lenawee

Mount Clemens (City)

Macomb

Mount Morris (City)

Genesee

Muskegon (City)

Muskegon

Muskegon Heights (City)

Muskegon

Niles (City)

Berrien, Cass

Owosso (City)

Shiawassee

Paw Paw Township

Van Buren

Pokagon Township

Cass

Pontiac (City)

Oakland

Port Huron (City)

Saint Clair

Port Huron Township

Saint Clair

Reed City (City)

Osceola

River Rouge (City)

Wayne

Saginaw (City)

Saginaw

Saint Louis (City)

Gratiot

Scottville (City)

Mason

Springfield (City)

Calhoun

Stanton (City)

Montcalm

Sturgis (City)

Saint Joseph

Summit Township

Jackson

Three Rivers (City)

Saint Joseph

Union Township

Branch

Wayne (City)

Wayne

Wright Township

Hillsdale

 

  (2) The department shall make available on the department’s website a document that describes the data and analytical methods used to identify geographic areas that pose a high risk for childhood lead poisoning.

 

R 330.304  Blood lead testing records in the minor’s certificate of immunization. 

  Rule 4. (1) Blood lead test results must be included in the minor’s certificate of immunization. 

  (2) The department shall link all blood lead tests reported to the department, as required by section 5474 of the public health code, 1978 PA 368, MCL 333.5474 and R 325.9081 to R 325.9086, to the minor’s electronic immunization record in the Michigan electronic immunization information system. 

  (3) The physician shall be able to view the minor’s blood lead testing records when the minor’s electronic immunization record is accessed, and the minor’s most recent blood lead test results must be included in the printed copy of the minor’s certificate of immunization given to parents.  

  (4) If the blood lead test results are not otherwise reported to the department consistent with R 325.9081 to R 325.9086, the physician or individual other than the physician performing the test shall report those results to the department’s childhood lead poisoning prevention program for entry into the Michigan childhood lead poisoning surveillance system so that the results are linked to the minor’s record in the electronic immunization information system in this state.