Medicaid-enrolled children in five states missed out on recommended lead toxicity testing: OIG report

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In five U.S. states, most of the medical records for children with a diagnosis of lead toxicity lacked the information needed to confirm such a diagnosis, according to a report released Tuesday by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Many children for whom there was sufficient medical record documentation to confirm their diagnosis did not receive comprehensive follow-up testing and treatment services for their identified blood lead level, the report found.

The findings, part of a study conducted by HHS-OIG based on an analysis of Medicaid claims, may have implications for the oversight of the Early and Periodic Screening, Diagnostic, and Treatment Program, a Centers for Medicare & Medicaid Services initiative that enables comprehensive preventive medical screening services for millions of children annually. Treatment services correct issues such as lead toxicity that are identified by blood-lead testing.

“When young children with confirmed blood lead levels do not receive timely follow-up testing and treatment services, they could be left vulnerable to continuing lead exposure and permanent developmental effects,” HHS-OIG noted in a statement.

Though there is no safe level of lead exposure for young children, exposure is preventable and can be minimized through regular cleaning of the home, washing of hands and toys, and other preventive care -- actions that support early detection of lead toxicity and timely follow-up testing and treatment.

An OIG report issued in October 2021 had already found that more than one-third of Medicaid-enrolled children in five states -- California, New York, Ohio, Pennsylvania, and Texas -- did not receive required blood-lead screening tests from fiscal years 2015 through 2018.

The current study expands on that research. For the five states, HHS-OIG reviewed Medicaid claims data for fiscal years 2015 to 2018, selecting a sample of 625 children with a diagnosis indicating lead toxicity. The investigators reviewed the children's medical records from the date of diagnosis through the next six months, noting whether follow-up testing and treatment services were implemented based on identified blood lead levels and as recommended by CMS and the Centers for Disease Control and Prevention (CDC).

Medical reviewers could not identify adequate information to confirm a diagnosis in the records of 415 out of 581 children, HHS-OIG said, adding that it is unclear why the medical records lacked information to confirm the diagnosis of lead toxicity.

"The lack of documentation in the medical records to confirm children's lead toxicity diagnoses raises concerns regarding the accuracy of using Medicaid claims data, solely, to identify children being treated for lead toxicity,” the report said, adding, “It may also have implications for states' annual EPSDT reporting to CMS regarding treatment services.”

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