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KMAP BULLETIN: Lead Hazard Risk Assessments – Local Health Departments Enrollment and Coverage

Date: 09/19/24

KMAP GENERAL BULLETIN 24180 (PDF)

Effective on and after October 1, 2024, Kansas Medicaid will allow Local Health Departments (LHDs) to enroll and render lead hazard assessments (direct or contractor) under a new Provider Type/Provider Specialty (PT/PS) for children aged 0-20 years, if they are shown to have an Elevated Blood Lead (EBL) level equal to or greater than 10 mcg/dL.

LHDs can provide Lead Hazard Risk Assessments directly by becoming a licensed Lead Activity Firm and employing a Risk Assessor or EBL-level investigator, or they may contract with a licensed Lead Activity Firm that employs a Risk Assessor or EBL-level investigator.

Coverage Requirements:

  • A confirmatory blood lead level test with a result equal to or greater than 10 mcg/dL from a venous sample is needed.
  • Prior authorization is required.

The below activities are not billable as part of a Lead Hazard Risk Assessment.

  • Laboratory analysis.
  • Testing of substances that must be sent off-site for analysis.
  • Any non-medical activities such as removal or abatement of lead sources.
  • Relocation efforts.

Covered Services:

  • The following services are covered for Lead Hazard Risk Assessments and must be billed with primary diagnosis code R78.71.

Visit Type

Procedure Code

Frequency Limit

Rate*

Initial Comprehensive Visit

 

T1029

One per calendar year

 

$600

Follow-up Visit

T1029-U1

Two per calendar year

$150

*The rates noted in this bulletin may change in the future. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.

Note: With prior authorization, state plan limits may be exceeded based on a child’s medical necessity.

Lead Hazard Risk Assessment investigations of the child’s home involve identifying potential sources of exposure to lead and advising parents or guardians about identified and potential sources of lead and ways to reduce exposure. This service may include but is not limited to:

  • Collection of samples and/or use of an X-ray fluorescence analyzer to measure environmental lead (dust, paint, soil, or water).
  • Visual examination of the dwelling and property to determine the locations of deteriorated paint and lead paint hazards.
  • Identification and evaluation of any non-paint lead hazards.

Once homeowners or rental property owners are notified of the problem and have an opportunity to remedy the situation, a follow-up Lead Hazard Risk Assessment clearance investigation should be conducted to ensure that the problem is resolved. Lead abatement activities should be performed by a licensed Lead Activity Firm or Lead Renovation Firm that is certified through the Residential Lead Hazard Prevention Program.

Follow-up lead clearance investigation may include but is not limited to:

  • A visual assessment to determine that all identified lead hazards have been remediated, no visible dust or debris remains, and non-paint hazards have been removed.
  • For interior lead paint hazards, a collection of clearance dust- wipe samples to verify safe completion and clean-up of work.

Billing Guidelines:

If more than one child in the home has an EBL level, all services must be billed under one child’s Medicaid ID only. A Lead Hazard Risk Assessment should be done in the child’s primary residence. If there is a second home that a child resides in, a Lead Hazard Risk Assessment can be done on the secondary residence with prior authorization.

Enrollment Requirements for Lead Hazard Risk Assessments:

  • LHDs can submit enrollment applications with the enrollment type ‘Facility’ and attach a copy of their Kansas Department of Health and Environment (KDHE) Risk Assessor or EBL level investigator certification and their KDHE Lead Activity Firm license to the enrollment application.
  • If using a contractor for Lead Hazard Risk Assessments, the LHD must attach the contractor’s KDHE Risk Assessor or EBL level investigator certification and the contractor's KDHE Lead Activity Firm license.
  • Licensed LHDs must enroll with their own National Provider Identifier (NPI) (type 1) to provide the covered services with taxonomy code 251K00000X.
  • LHDs will be enrolled with a new PT/PS 13/132 - Local Health Agency/Lead Hazard Risk Assessments.

KDHE Bureau of Air, Kansas Residential Lead Hazard Prevention Program, will issue the certifications and the Lead Activity Firm license. LHDs will need one of the certifications (Risk Assessor or EBL level investigator) and the Lead Activity Firm license to enroll as the new provider specialty. LHDs would directly employ an individual to perform lead hazard risk assessments.

If the LHD decides to contract with an already established Lead Activity Firm, the LHD would first need to get a copy of the Lead Activity Firm license from the contractor, and a KDHE issued certification for either a risk assessor or an EBL level investigator for an employee of the contracted Lead Activity Firm. The LHD would submit those for enrolling under the new provider type. The contractor would perform the Lead Hazard Risk Assessments for the

LHD and the LHD would bill for the services and then reimburse the contractor for the Lead Hazard Risk Assessments.

Training and Certification Requirements:

The employee or contractor performing a Lead Hazard Risk Assessment must be certified by KDHE as an EBL-level investigator or Risk Assessor and be employed by a Licensed Lead Activity Firm.

To become a Risk Assessor, one must complete the Lead Inspector and Risk Assessor Training here.

To become an EBL-level investigator, one must complete the Lead Inspector and Risk Assessor Training here.

Once the Lead Inspector and Risk Assessor Trainings are completed, the person wanting to become an EBL-level investigator should email kdhe.lead@ks.gov and inform KDHE of their wish to be enrolled in the EBL training. Certification can be obtained by following K.A.R. 28-72- 6 and K.A.R. 28-72-6a and 6b, which describe the application process and requirements for the certification of risk assessors and application process and requirements for the certification of an elevated blood lead level investigator.

To become a licensed Lead Activity Firm, follow the process listed at K.A.R. 28-72-10, which describes the application process and  licensure renewal requirements for Lead Activity Firms

Note: The effective date of the policy is September 1, 2024. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the KMAP bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.

For the changes resulting from this provider bulletin, view the updated Kan Be Healthy – Early and Periodic Screening, Diagnostic, and Treatment Fee-for-Service Provider Manual, pages 4 – 6 and 14; and the Professional Fee-for-Service Provider Manual Section, 8420, pages 8-103 – 8-106.