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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : Appendix C. Lead Screening : C.4 Environmental Lead Investigation Services : C.4.2.1 Requesting an Environmental Lead Investigation

C.4.2.1
For the purpose of requesting an ELI, a health-care provider is a physician, nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant (PA) who conducts blood lead tests for a THSteps client. Health-care providers may submit a request for an ELI after a blood lead test has been conducted and there is evidence of persistent and confirmed EBLLs for the client. An EBLL is defined as a BLL of 10µg/dL or higher.
An ELI may be considered medically necessary if the results of the most recent blood lead test indicate any of the following:
Note:
The ELI must be requested as soon as possible and no later than 30 days after obtaining the most recent BLL that indicates medical necessity. The health-care provider must maintain in the client’s medical record the ELI request and the documentation of the BLL that indicates medical necessity.
The health-care provider can request an ELI by completing Form Pb-101 “Environmental Lead Investigation Request” and submitting it to the TX CLPPP. TX CLPPP will review the request and determine whether the criteria for an ELI have been met. If an ELI request meets the TX CLPPP criteria, TX CLPPP sends a referral for an ELI to a state or local health department that is enrolled as a THSteps provider so that it can be assigned to a certified lead risk assessor. A certified lead risk assessor conducts an ELI using a completed Pb-103 Texas Elevated Blood Lead Level Investigation Questionnaire (all pages).
An ELI can be performed under one of the following circumstances:
If a previous investigation of the current home or primary residence has been performed and there has been a change in the client’s residential environment, TX CLPPP will determine whether the criteria have been met for an additional ELI.

Texas Medicaid & Healthcare Partnership
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