N.J. Admin. Code § 8:51-2.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:51-2.4 - Case management

(a) Whenever a child has a confirmed blood lead level of 3.5 ug/dL to four and 9/10 ug/dL, the local board of health shall provide written guidance about common sources of lead exposure and written guidance on how to prevent such exposure to the parent(s) or guardian(s) of the child within seven days of notification to the local board of health of such confirmed blood lead level.

(b) Whenever a child has a confirmed blood lead level of five g/dL or greater, the local board of health shall provide for case management of the child and his or her family.

(c) Whenever a child has a confirmed blood lead level of five ug/dL or greater, a public health nurse shall perform case management consisting of:

1. A home visit in accordance with 8:51-2.5;

2. Education, both written and verbal, and counseling of the primary caregiver about the effects and prevention of lead poisoning;

3. In the case of a child with two confirmed blood lead levels of five to nine g/dL or one confirmed blood lead level of 10 to 44 g/dL, a review of the lead Hazard Assessment Questionnaire, available at N.J.A.C. 8:51 Appendix A, with the lead inspector/risk assessor certified by the Department to ensure that the child's environment has been evaluated for non-paint lead hazards and that the environmental evaluation has been performed in accordance with N.J.A.C. 8:51-4.2;

4. Monitoring blood lead retesting and results in cooperation with the primary care provider according to N.J.A.C. 8:51A;

5. Determining whether or not the child has a regular provider of medical care, and, if not, referral to a physician or licensed health care facility to provide primary medical care to the child;

6. Assisting the family in arranging for a medical evaluation, venous follow-up blood lead tests and related medical treatment in cooperation with the child's physician;

7. Arranging for lead screening, when indicated, of siblings and other children at least six months and less than 72 months of age living in the same household, in accordance with N.J.A.C. 8:51A, and of pregnant women living in the same household;

8. Assessing the need for emergency relocation funding and initiating collaboration with the appropriate agencies.

9. Ensuring that a hazard assessment is completed at all proposed relocation addresses;

10. Education about blood lead at or above the blood lead reference value, its possible effects on children, and lead hazards that may be present on the premises;

11. Education and counseling about nutrition and its role in reducing lead absorption;

12. Education and counseling about personal hygiene and housekeeping measures that parents can take to reduce their child's exposure to lead hazards;

13. The completion of case management assessments.

i. Public health nurses may complete additional assessments as they determine are appropriate;

14. Referrals to appropriate community resources including, but not limited to: Department of Children and Families; Federally Qualified Health Center; New Jersey Family Care/Medicaid; the local subcode official for housing; Special Child Health Services; Women, Infants and Children; transportation services; and other community services;

15. Monitoring of all followup activities to ensure that medical, environmental and educational interventions are delivered in a timely, safe and coordinated manner according to current standards of care; and

16. Referral, in writing, of children under active case management who move from the jurisdiction of one board of health to another, if a forwarding address is available.

(d) Whenever a child has a confirmed blood lead level of 45 g/dL or greater case management shall:

1. Be performed by a public health nurse;

2. Comply with (b) above; and

3. Consist of:

i. Recommending to the primary care provider immediate hospitalization of any child that has a confirmed blood lead level of 45 [micro]g/dL or greater;

ii. Ensuring that the child is removed from the source of lead hazard and relocated to lead safe housing, as determined by the local board of health;

iii. Assessing the need for emergency relocation funding and collaborating with the appropriate agencies and the hospital discharge planner to complete the application process before hospital discharge;

iv. Ensuring that environmental intervention is completed at the relocation residence before hospital discharge in conformance with 8:51-4.1(b)5;

v. Assisting the family in identifying a pharmacy and obtaining required prescriptions before discharge from the hospital;

vi. Teaching the child's caregiver the medication regimen and proper administration of the medication and monitoring compliance with the medication regimen;

vii. Collaborating with the health insurance carrier case manager to ensure proper administration of the medication;

viii. Collaborating with the primary care provider and the health insurance carrier case manager to ensure timely medical follow-up during and after chelation;

ix. Monitoring blood lead retesting and results in cooperation with the primary care provider according to CDC recommendations;

x. Maintaining ongoing communication with the primary care provider and the health insurance carrier case manager regarding the child's response to the treatment regime; neurodevelopmental reassessments, the referral process and the abatement status of the primary residence;

xi. Monitoring of all follow-up activities to ensure that medical, environmental and educational interventions are delivered in a timely, safe and coordinated manner according to current standards of care; and

xii. Recommending to the primary care provider to communicate regarding medical treatment with the New Jersey Poison Information and Education System (NJPIES) at 1-800-222-1222 or www.njpies.org.

(e) The local board of health shall ensure that each case set forth at (b) above is assigned to a case manager as follows:

1. Assignments shall be made within one business day from the date of notification;

2. When an assigned case no longer has an active case manager, the case shall be reassigned within one business day; and

3. When a child is temporarily relocated to another jurisdiction, the case shall remain with the original case manager.

(f) The case manager shall discharge children from case management when all of the following conditions are met:

1. Environmental hazards have been eliminated by abatement or managed by interim controls;

2. A follow-up venous blood lead test result has declined to below 3.5 ug/dL after three months from the last blood lead at or above the blood lead reference value.

3. All assessments and referrals have been completed;

4. All elements of the care plan have been achieved;

5. The Case Closure Form, available at N.J.A.C. 8:51 Appendix K, is completed;

6. Plans have been completed with the physician and the primary caregiver for long-term developmental follow-up; and

7. Completion of a minimum of three documented attempts of contact by the local board of health when a child with blood lead at or above the blood lead reference value has moved and cannot be located.

i. One documented attempt shall be a certified letter from the local board of health.

N.J. Admin. Code § 8:51-2.4

Amended by 49 N.J.R. 3168(a), effective 9/18/2017

Amended by 56 N.J.R. 1976(b), effective 10/7/2024