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childhood lead poisoning prevention branch

Proposal to Increase the Childhood Lead Poisoning Prevention Fee

Fiscal Year 2021-22

January 15, 2021

Prepared by:

California Department of Public Health

Center for Healthy Communities

Childhood Lead Poisoning Prevention Branch

 

Proposal to Increase the Childhood Lead Poisoning Prevention Fee

Table of Contents

I.     Background: The Childhood Lead Poisoning Prevention (CLPP) Program

II.    Goals of the CLPP Program

III.  CLPP Fee Increase Discussion

IV.  Timeline for CLPP Fee Increase and CLPP Fee Assessment Cycle

Appendices

A.   Fee increase Formulas and Program Data

B.   CLPP Program Audits, Mandates, and BCPs from 1999 to 2020

C.   California Department of Public Health Organization Charts

D.   List of Local Health Jurisdiction Cooperative Agreements and Funding Allocations

E.   Legal Settlements' Impact on CLPP Fund

F.    Health & Safety Code §105310

I. Background: The Childhood Lead Poisoning Prevention Program

BACKGROUND: The State of California established a CLPP Program by legislation in 1986 (Health and Safety Code (HSC) §124125, et seq). Special funding for the CLPP Program was established in 1991 (HSC §105275, et seq). Today, the CLPP Branch is largely supported by fees assessed and collected annually from lead polluters (e.g., paint and petroleum industries as historical polluters, and industrial air emitters). There are approximately 400 fee payers, billed annually for $22 million, but approximately $21.5 million is collected. Collection is lower than the billed amount due to annual applications for reassessment or exemption of fees and/or non-payment by feepayers. The assessments are collected on April 1 in partnership between the California Department of Tax and Fee Administration (CDTFA) and the CLPP Branch. The fees are deposited into the CLPP Fund. The fees support state operations, and of the $21.5 million annual revenue, approximately 70% ($16 million) is allocated to local health jurisdictions to conduct lead poisoning prevention and case management. An additional $3.1 million has been allocated annually from fund reserve in recent years to support new program mandates.

In recent years, increased expenditure demands, originating from federal guidelines, new state mandates, necessary programmatic improvements, and implementing corrective actions for audit findings from the California State Auditor (CSA), have exceeded fee revenue. The CLPP Branch was able to cover its expenditures due to historical legal settlements that provided additional fee reserves to the fund from 2007 to present (see table for the CLPP Fund Historical Revenue FY 2007-2019). 

Childhood Lead Poisoning Prevention Fund Historical Revenue FY 2007-2019 (dollars in thousands)

Fiscal YearFund Balance - Beginning YearPrior/Current Year AdjustmentsRevenue – CLPP Fees

Total Resources (pre-expenditure)

Fund Balance – Post Total Disbursement
2007-082,40416,94235,54455,56638,417
2008-0938,417-9218,75457,82138,649
2009-1038,64913,049
27,84879,77260,806
2010-1160,806-7,65519,83073,21954,590
2011-1254,59017,31520,07083,11563,032
2012-1363,0322,72124,31990,28669,023
2013-1469,0232,95921,79393,94872,697
2014-1572,6972,37220,56295,82874,017
2015-1674,0173,93920,66798,94677,232
2016-1777,23298921,245100,03171,704
2017-1871,7045,61521,29999,62369,519
2018-1969,519Not Shown on FCS21,16792,24063,978
2019-20*63,978Not Shown on FCS20,66784,94640,103

Data Source: CLPP Fund (0080) Condition Statements from Department of Finance.

From FY 2012-16 (four years), the CLPP Fund averaged $3M "Prior/Current Year" adjustments per year with CLPP Fee revenues of $22M and expenditures of $22M. In FY 2015-16, the CLPP Fund accumulated the highest reserve fund balance at $77M, after disbursements. In FY 2016-17, the fund resources before expenditures peaked at $100M. The Protecting Children from Damaging Effects of Lead Exposure BCP became effective in FY 2016-17. In that year, the CLPP Fee appropriation authority increased to $28.3M.

*Amounts projected on Fund Condition Statement prior to end of fiscal year reconciliation.


Historical settlements that bolstered CLPP Fund reserve for fiscal year (FY) 2006-07 forward were initiated after promulgation of fee regulations in 2002 that changed fee assessment and increased fee collection. In 2004, a billing error for 2002 and 2003 fees was discovered that led 25% of assessed feepayers to petition the subsequent re‑billing. Final decisions for the majority of 2004 petitions were reached in late 2006 and early 2007, with some high-profile petitions not reaching resolution until early 2009. One significant petition was not resolved until after a Sacramento Superior Court decision in late 2010. Settlement of these petitions increased yearly adjustment and fee collections for FYs 2006-07, 2009-10, and 2011-12 as follows:

  1. FY 2006-07: Increase of $13.942 million in past year billings over average prior year adjustment (PYA)[1], and $13.554 million increase in Fee revenue over authority[2]. 

  2. FY 2009-10: Increase of $10.049 million in past year billings and settlements over average PYA, and $5.848 million increase in Fee revenue.
  3. FY 2011-12: Increase of $14.315 million in past year billings and settlements over average PYA.

[1] Average prior year adjustment was calculated using data for FYs 2012-13 to 2015-16 at $3.0 million where expenditures remained steady.

[2] Fee authority set at $22 million since 2002.

Due to reduced fee collections in 2004 and 2005 from the petitions, a General Fund loan was taken to sustain operations and repaid in FY 2010-11. In FY 2008-09 expenditures rose above revenues due to financial strain from ongoing petitions and economic downturn. Appendix E provides additional detail for legal settlements' impact on CLPP Fund.

From FY 2012-13, CLPP Fund reserves grew steadily. However, from FYs 2016-17 to 2018-19 , expenditures began to significantly outpace revenues at an annual average of 36%. In FY 2019-20, expenditures outpaced revenues by 113% due to the impact of additional program mandates and increased workload, as discussed in the Childhood Lead Poisoning Prevention Program Mandates and Workload History sections of this report. The following table describes the utilization of CLPP Fund reserve to support CLPP Program operations through FY 2019-20 without a fee increase.

Due to reduced fee collections in 2004 and 2005 from the petitions, a General Fund loan was taken to sustain operations and repaid in FY 2010-11. In FY 2008-09 expenditures rose above revenues due to financial strain from ongoing petitions and economic downturn. Appendix E provides additional detail for legal settlements' impact on CLPP Fund.

From FY 2012-13, CLPP Fund reserves grew steadily. However, from FYs 2016-17 to 2018-19 , expenditures began to significantly outpace revenues at an annual average of 36%. In FY 2019-20, expenditures outpaced revenues by 113% due to the impact of additional program mandates and increased workload, as discussed in the Childhood Lead Poisoning Prevention Program Mandates and Workload History sections of this report. The following table describes the utilization of CLPP Fund reserve to support CLPP Program operations through FY 2019-20 without a fee increase. 

CLPP Fund Reserve Use FY 2016-2019 (dollars in Thousands)

Fiscal Year

CLPP Fees Collected

CLPP Fund Expenditure

Annual Overage

Total Reserve Used

2016-1721,24528,327
7,0827,082
2017-1821,29931,1048,805
15,887
2018-1921,167
28,2627,09522,982
2019-2020,66744,84323,79146,773

Data Source: CLPP Fund (0080) Fund Condition Statements from Department of Finance.


At present, settlement reserves will be depleted by FY 2021-22 end, and a new fee structure is needed to keep the program solvent.

Lead as an Environmental Hazard

Lead is a toxic heavy metal that persists indefinitely as a historical pollutant from leaded gasoline and paint, smelting, mining, manufacturing, and industrial emissions. Lead effects all bodily organ systems, but the typical health effects in children are neurological, including delayed learning, Attention Deficit Hyperactivity Disorder, lower IQ (impacting school performance and future earnings), and behavioral problems. In young children whose brains are still developing, even a small amount of lead can cause learning disabilities, behavioral problems, and anemia. At higher levels, lead exposure can result in seizures, coma, and even death. Childhood lead poisoning can also lead to health effects later in life, including hypertension, kidney disease, and reproductive problems. HSC §105275 and §124165 enable the CLPP Program to perform multiple functions to reduce childhood lead exposure and avert these outcomes.

Childhood Lead Poisoning Prevention Program Mandates

The California Department of Public Health (CDPH) CLPP Branch conforms to Centers for Disease Control and Prevention (CDC) guidance by providing services to children exposed to lead contamination in their environment. In accordance with updated guidance, the CLPP Branch lowered its blood lead level (BLL) criteria for cases of lead poisoning, and redefined a full case at 15 micrograms per deciliter (mcg/dL) or persistent values of 10 mcg/dL; with basic services provided at 5mcg/dL. Services include providing outreach, education, and health services to all children identified with BLLs of 5 mcg/dL and greater, which recognizes that there is no safe level of lead exposure to children. Within the first year of the lowered level, the program experienced a six-fold increase in lead poisoning cases and a two-fold increase in the number of children needing services.

New program mandates include an expanded definition of environmental risk factors that may contribute to lead exposure and poisoning, emphasis to improve delivery of program services, in coordination with Department of Health Care Services (DHCS) to ensure Medi-Cal eligible beneficiaries are served, and improved reporting requirements to be achieved with procurement of a new information technology data system that will enable CDPH and local health programs to work more efficiently (See Appendix B for CLPP Program Mandates and Resource Requirements).

Workload History

The CLPP Program has experienced significant workload increases at both the state and local level. From FYs 2016-17 through 2019-20, there have been over 400 new cases of lead poisoning per year; children with BLLs greater than or equal to 5 mcg/dL with increased services from 4,232 to 8,500 children (see table below for CLPP Program Workload History).

CLPP Program Workload History by Fiscal Year

Workload Measure

2012-132013-142014-152015-162016-172017-182018-192019-20
Blood Lead Tests reported to CLPP Branch and processed1/662,388627,244619,628606,313599,221574,996553,748538,986
New Cases of Lead Poisoning2/265177184188
570
558419424
Children with BLL > 5 mcg/dL (not cases), receiving some services3/6,4114,3224,2323,8808,9708,6528,1008,588

1/  Some children are tested more than once; reporting to CLPP Branch is required by law.

2/  Cases through FY 2015-16 based on criteria of BLL > 20 mcg/dL or persistent values > 15 mcg/dL; beginning in FY 2016-17 cases are based on criteria of BLL > 15 mcg/dL or persistent values > 10 mcg/dL. CDPH rounds BLLs to the nearest whole number (for example, 5 includes 4.5 mcg/dL and 10 includes 9.5 mcg/dL.

3/  Most services noted are provided by local programs. Since July 1, 2016, local programs must provide specified case management services to children with blood lead levels 5 mcg/dL and higher and lower levels as resources allow. Prior to July 2016, local programs provided some services to children with levels lower than 10 mcg/dL as resources allowed.


II. Goals of the Childhood Lead Poisoning Prevention Program

The CLPP Branch currently strives to achieve six goals as part of its mission statement and work. (See Appendices C-1 and C-2 for organization charts):

  • An informed public able to protect children from lead exposures.
  • Well-supported, effective local programs to detect, manage, and prevent childhood lead poisoning.
  • Fully developed capacity to track lead exposure statewide, and to monitor the management of lead-burdened children.
  • Strong infrastructure enabling the prevention of children's exposure to lead through partnerships with government agencies, community-based organizations, and private sector.
  • Full compliance with federal and state statutory and regulatory requirements.
  • Continued state and national leadership through research, policy development, and standard setting.

Local Health Programming

The majority of direct services to children are provided by 50 local programs, including 47 counties and 3 cities, under contract with the CLPP Branch. Funding for local programs is provided based on the population of children under 21; number of low-income children; children with elevated lead levels; and children living in older housing. Local CLPP Programs provide services to all California children based on BLLs. These services are free regardless of insurance status. The local programs also carry out public health nursing case management and environmental investigation to identify sources of lead for children with high BLLs. Other services provided include extensive outreach and education activities to families, communities, and health care providers, promoting screening to reduce lead exposure in their communities and identifying additional sources of lead exposure.

The CLPP Branch provides services at eleven local level counties that choose not to contract with the CLPP Branch. The services include public health nursing case management, home visits and nutritional counseling by public health nurses, lead testing and environmental investigation by environmental professionals, and community outreach by health educators. The CLPP Branch also performs statewide surveillance, data analysis, oversight, and outreach, lends technical assistance, and assists programs with services not available locally (see Appendix D for a list of Local Agencies Cooperative Agreements with Funding Allocations) for each county.

The State Childhood Lead Poisoning Prevention Activities

The CLPP Branch is responsible for the following activities HSC §124125 et seq., §105275 et seq., and §105250 et seq.: 

  • Sets policies and establishes regulations; oversees activities of local CLPP programs; provides direct services in health jurisdictions without a local CLPP program; develops educational materials; promotes screening and case identification through outreach activities and written materials; tracks cases of children with increased BLLs and potential sources of exposure; seeks to assure the quality of local CLPP services; and provides scientific and technical expertise.
  • Maintains a database on lead screening and lead-poisoned children and their case management, monitors and assists with case management of lead‑poisoned children, identifies sources of poisoning, and guides intervention strategies.
  • Implements the Lead-Related Construction (LRC) Program that develops regulations for lead-safe construction practices, provides training accreditation and worker certification, conducts related enforcement and compliance activities, and offers technical assistance to state and local housing and environmental agencies[3].

[3] Environmental enforcement is supported by the CLPP Fund. The LRC Fund solely supports accreditation and certification for lead abatement construction workers, supervisors, planners, and investigators.


III. CLPP Fee Increase Discussion

The CLPP Branch has not adjusted its fees for inflation and the number of children served since 2002, while expenditure needs have steadily grown. As such, the CLPP Fund is projected to be in a deficit by FY 2021-22. The proposed CLPP fee increase will address the increased workload.

Expenditures

Total program expenditures increased due to changes in the BLL guidelines published by the CDC, new mandates, replacement of an outdated information technology system, and the findings of CSA Report 2019-105. Specifically, total program expenditures are increasing due to the reasons indicated below.

  • The CLPP Branch is mandated to implement a standard of care at least as stringent as the new CDC BLL guidelines which estimated over 500 new lead poisoning cases.
  • Mandates that require increased public reporting.
  • Designing and implementing the new Surveillance, Health, Intervention, and Environmental Lead Database (SHIELD) to replace the Reporting and Surveillance System for Childhood Lead Exposure (RASSCLE) II.
  • CSA Report 2019-105 findings recommending more equitable allocation of local assistance dollars to underfunded counties experiencing a higher incidence of lead poisoning.

Total new expenditures include $13.3 million in FY 2020-21, $14.7 million in FY 2021-22, $14.6 million in FY 2022-23, and $12.9 million for FY 2023-24 forward.

The CLPP Fund status quo table illustrates the CLPP Fund structural deficit when comparing total revenue against total expenditures from FYs 2019‑20 through 2022-23 without a CLPP Fee increase.

Status Quo - Without CLPP Fee Increase by Fiscal Year (Dollars)

 2020-212021-222022-23
Total Resources Without Fee increase$61,656,069$38,981,883$14,885,286
Total Expenditures $43,642,186
$45,064,597$44,964,821
Balance$18,013,883-$6,082,714-$30,079,535


The CLPP Fund without the CLPP Fee increase illustrates that increases in expenditures without a fee adjustment is unsustainable. The annual revenue of $22 million and depleting CLPP Fund reserve will not cover the projected program expenditures of $44.8 million in FY 2021-22. 

Projection - With CLPP Fee Increase by Fiscal Year (Dollars)

 2021-222022-232023-24
Total Resources with Fee increase$48,314,883$47,551,826$46,887,465
Total Expenditures $45,064,597$44,964,821$43,300,378
Balance$3,250,286
$2,586,465$3,587,087


Revenue

The CLPP Fee was established and set at $16 million annually by a legislative mandate  in 1993. The first, and only, adjustment occurred in 2002, increasing the assessed fee level to $22 million, adjusting for inflation and number of children served.

 CLPP Fee Increase Methodology

The CLPP Fee ("Fee") increase currently proposed was calculated using methods compliant with Health and Safety Code Section (HSC) 105310(c). The calculation method uses the two adjustment factors specified in HSC 105310(c):

  1. Number of Children Served (#CS)
  2. Change in California Consumer Price Index (∆CPI)[4]

[4] Change in CPI as determined by the Department of Industrial Relations (DIR) (data was elicited from the Department of Finance (DOF) website as published using DIR formula).

These factors, as applied in Appendix A, result in a total increase in CLPP Fee collection of $22 million, increasing authority from $22 million to $44 million. The Fee implementation plan includes a stepped increase of $22 million over two years. The Fee implementation plan includes the collection of an additional $8 million in 2021 for use in FY 2021-22 and the collection of another additional $14 million in 2022 for use in FY 2022-23 (see table in Section IV below).

Fee Increase Supporting Documentation

Additional information regarding the calculation of the CLPP Fee Increase and data applied to the increase is available in Appendix A, CLPP Fee Increase Formulas and Program Data. 


IV. Timeline for CLPP Fee Increase and Fee Assessment Cycle

CLPP Fee Implementation

The following table illustrates the proposed CLPP Fee increase over two years.

Year
Fee Collection Calendar Year (CY) / Expenditure Fiscal Year (EFY)

Baseline Fee Assessment Level (USD)

Proposed Year-to-Year Fee Increase (USD)

Annual Fee Assessment Level (USD)
1
CY 2021 / EFY 2021
$22,000,000
$8,000,000 $30,000,000
2CY 2022 / EFY 2022$30,000,000
$14,000,000 $44,000,000
Total Proposed Fee Increase Collected​-
​-
$22,000,000

 -

Existing statute, HSC §105310, allows an annual adjustment based on children served and CPI. Baseline fee assessment level is $22 million.


CLPP Fee Implementation Milestones

  • CLPP Fee Increase Assessment Cycle:
    • January 2021: Provide Fee Assessment Year 2020 list to the California Department of Tax and Fee Administration (CDTFA) for reconciliation. Send CLPP Fee Adjustment Notification to feepayers.
    • February 2021: Send final Assessment Year package (fee payer lists and letters) to CDTFA.
    • March 2021: CDTFA sends the letters and assessment forms to fee payers for collection of the Assessment Year 2020.
    • April 2021: Fees are due and payable on April 1, 2021.
    • July 2021: 2020 CLPP Fee revenues become available for expenditure.


Appendices List

A.   Fee Increase Formulas and Program Data

B.   Childhood Lead Poisoning Prevention Program Audits, Mandates, and BCPs from 1999 to 2020

C.   CDPH Organization Charts: 

D.   List of Local Health Jurisdiction Cooperative Agreements and Funding Allocations

E.   Legal Settlements' Impact on CLPP Fund

F.    Health & Safety Code §105310

Appendix A: CLPP Fee Increase Formulas and Program Data

Definitions of Formula Abbreviations:

%∆ – Percent Change

BL – Baseline Year

#CS – Number of Children Served

CPI – Consumer Price Index

CY – Current Year

Overall Formula to Determine an Adjusted Fee Cap:

Adjusted%20Fee%201

Authority for this fee adjustment formula is drawn from Health and Safety Code Section (HSC) §105310. HSC §105310 specifies an annual adjustment of the CLPP Fee using two factors: 1) number of children receiving services from the CLPP program, and 2) increase in annual average of CPI as recorded by the Department of Industrial Relations.

CPI data for this formula was retrieved from Department of Finance who publishes annual CPI change data using the formula developed by Department of Industrial Relations.

Number of children served data was retrieved from the Reporting and Surveillance System for Childhood Lead Exposure (RASSCLE) II for all children up to, and including, 21 years of age with blood lead levels of 4.5mcg/dL or higher.

Proof of Formula for Adjusted Fee Cap:

 Adjusted Fee = $22M X [(CPI CY - CPI BL / CPI BL) + (#CS CY - #CS BL / #CS BL) + 1]

 Adjusted Fee = $22M X [(300.385 - 255.303 / 255

Adjusted Fee = $22M X [(0.17658) + (1

Adjusted Fee = #22M X [2

Adjusted Fee = $51,554,140

Administrative Adjustment Pursuant to HSC §105310(f):

HSC §105310(f) allows for administrative adjustment to CLPP Fee collection to no more than is reasonably necessary to implement the program. While calculated CLPP Fee authority is $51.5 million, only $44 million is required to implement the program.

Formulas to Determine a CPI Adjustment for Future Fee Increases:

CPI Fee Adjustment = Initial Fee times Inflation Rate

New fee cap equals initial fee plus CPI fee adjustment

Inflation rate equals CPI CPY minus CPI BL divided by CPI BL

Proof of Formula to Determine CPI Adjustment for a Future Fee Increase:

This formula is not effectuated for the proposed CLPP Fee increase and is included as proof of concept for future CPI increases for CLPP Fee authority as determined necessary.

Inflation Rate of 3.1% is projected by the Department of Finance using the Department of Industrial Relations' formula mandated by Statute.

CPI adjusted fee equals total fee times inflation rate

CPI Adjusted fee equals $44M times 0.031

CPI Adjusted Fee equals $1,364,000

In accordance with HSC §105310(f), allowing administrative adjustment of the CLPP Fee to no more than reasonably allowed for implementing the program, the CPI Fee adjustment is applied at $1 million.

New fee cap equals initial fee plus CPI fee adjustment

New Fee cap equals $44M plus $1M

New fee cap equals $45,000,000

CPI and Number of Children Served Program Data

Calendar Year (CY)Consumer Price Index (CPI)1/%∆CPI Year-to-Year%∆CPI Over BaselineNumber of Children Served (#CS)2/%∆#CS Year-to-Year%∆#CS Over Baseline
2016255.303-
-
6,907-
-
2017262.8022.92.99,41036.236.2
2018272.5103.76.612,21829.876.9
2019281.9163.510.114,05315.0103.5
2020291.4413.413.514,6564.3
112.2
2021300.3853.116.514,9662.1116.7
2022309.635-
-
-
-
-

1/ CPI as published by Department of Finance using Department of Industrial Relations formula.

2/ #CS as retrieved from RASSCLE II for children up to 21 years of age with BLLs of 4.5 mcg/dL or above.


Appendix B: Childhood Lead Poisoning Prevention Program Audits, Mandates, and BCPs from 1999 to 2020

Document TypeTitleDateImpact

Budget Change Proposal

 

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for FY 2020-21: Protecting Children from the Damaging Effects of Lead ExposureMay 2020

Effective for FY 2020-21 this BCP approved continuing services from the May 2016 BCP Protecting Children from the Harmful Effects of Lead Exposure at an  annual expenditure authority of $8.2M ongoing ($1.4M S/O, $6.8M L/A, CLPP Fund).

 

Audit

 

Childhood Lead Levels: Millions of Children in Medi-Cal Have Not Received Required Testing for Lead Poisoning

 

January 2020

This audit determined that over a nine-year period, millions of children enrolled in Medi-Cal did not receive necessary blood lead tests; that while the federal average lead testing rate is 45%, California's rate is 36%; that CDPH has not publicized legally required analyses of areas of the State experiencing childhood lead exposure; that CDPH has not prioritized reducing lead in high-risk areas before children are poisoned; and, that CDPH has not effectively managed the lead prevention program.

Budget Change Proposal

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for Fiscal Year 2019-20: Childhood Lead Poisoning Prevention Program Information Technology Project Implementation (SHIELD)

January 2019

BCP responds to HSC §124151 mandate for an electronic database to support blood lead test reporting, case management, and lead exposure assessment.

  • Increased annual expenditure authority for the database for FYs 2019-20 through 2021-22, with an ongoing appropriation thereafter, and established 8 permanent positions ($8M 2019-20, $9.3M 2020-21, $5.9M 2021-22, $3.4M ongoing).
  • Effective for FY 2019-20.
Budget Change Proposal

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for Fiscal Year 2019-20: Childhood Lead Poisoning Prevention Program Reporting (SB 1097 and SB 1041)

January 2019

BCP responds to mandates for data collection, analysis, and reporting from SB 1041 and SB 1097.

  • Increased annual expenditure authority to establish 2 positions ($769,000 ongoing, CLPP Fund).
  • Effective for FY 2019-20.

 

LegislationStats. 2018, Ch. 691 (SB 1097)September 2018

Amended HSC §105295 to impose new reporting requirements for program annual reports and incorporates select data and privacy law.

LegislationStats. 2018, Ch. 690 (SB 1041)September 2018

Added §105286 to the HSC to mandate that the program conduct outreach to providers regarding the program's standard of care, screening of Medi-Cal children, and to allow this outreach through channels that serve the provider community.

Amended HSC §105285 to redefine the goal of the program to screen all children at risk of lead exposure.

Amended HSC §105295 to impose new reporting requirements for program annual reports and incorporates select data and privacy law.

Amended HSC §124125 to mandate closer collaboration with DHCS for the screening of Medi-Cal children.

Made clarifying changes to HSC §105300.

Legislation
Stats. 2018, Ch. 676 (AB 2370)September 2018

Added HSC §1596.7996 and §1597.16; amended HSC §1596.866 and §1596.8661 to require CDPH to collaborate with Department of Social Services to provide educational outreach materials and/or subject matter consultation for Childhood Lead Poisoning Prevention. Estimated costs are $100,000 ongoing.

Budget Change Proposal

 

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for Fiscal Year 2018-19: Expanded Lead Testing for California Children (AB 1316)

Expanded Lead Testing for California Children, Continued

January 2018

BCP responds to the mandate for regulations development to include environmental risk factors in the program's standard of care and the expansion of lead screening from AB 1316.

  • Increased expenditure authority to establish 2 positions to develop regulations, provide data analysis, and provide data reporting support for additional blood lead tests ($276,000, CLPP Fund).

Legislation

 

Stats. 2017, Ch. 507 (AB 1316)October 2017

Added §124151 to the HSC to mandate the use of an electronic database to support electronic laboratory reporting of blood lead tests, case management, and assessment of lead exposures.

Amended HSC §105280 to redefine the terms "appropriate case management" and "lead poisoning" in the Childhood Lead Poisoning Prevention Act of 1991.

Amended HSC §105285 to mandate that CDPH develop their standard of care to include environmental risk factors, that children determined 'at risk' pursuant to the standard of care to be screened, and that CLPP fees may not be used to fund blood lead screening.

Amended HSC §124125 to mandate annual reporting of the program's progress.

Amended HSC §124130 to mandate new reporting requirements for electronic submission of blood lead tests.

Made clarifying changes to HSC §105290, §105310, and §124150.

Budget Change Proposal

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for Fiscal Year 2016-17: Childhood Lead Poisoning Prevention Mapping

May 2016Allowed the CLPP Program Geographic Information System (GIS) mapping of lead-poisoned children to assist in identifying locations of persistent lead exposure. Uses CLPP Fund of $180,000 (2016) and $320,000 (2017).

Budget Change Proposal

 

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for Fiscal Year 2016-17: Protecting Children from the Damaging Effects of Lead Exposure

 

January 2016

BCP response to the lowered Centers for Disease Control and Prevention (CDC) 2012 guidelines for blood lead levels and case management.

  • Increased annual expenditure authority to increase annual local assistance allocations ($6.8M) and established 7 positions ($1.4M) for four years, until FY 2020-21, to deliver services to children at the lowered criteria ($8.2M, CLPP Fund).

Audit

 

Department of Finance: Office of State Audits and Evaluations: A Special Report: California Department of Public Health Review of Special Funds

 

July 2011

This financial audit identified the following weaknesses in the CLPP Branch's administration of the CLPP Special Fund:

  • Branch does not regularly and routinely review Board of Equalization (BOE) reports for the CLPP Fund.
  • Budgeting could be improved with additional communication between CDPH and BOE.
  • Revenue spikes resulted from litigation regarding fee collection; future litigation could result in similar spikes.

Legislation

 

Stats. 2009 4X, Ch. 5 (ABX4 5)July 2009

Amended HSC §105250 to direct Lead-Related Construction (LRC) fees to be deposited into the LRC Special Fund (3155) and appropriated $500,000 for deposit into the LRC Special Fund.

Reorganization

 

Department of Health Services ReorganizationJuly 2007

Effective date of Stats. 2006, CH. 241 (SB 162) was July 1, 2007. Department of Health Services (DHS) reorganization to DHCS and CDPH implemented.

LegislationStats. 2006, Ch. 538 (SB 1852)September 2006

Added §105256 to the HSC to allow for the local enforcement of lead abatement orders.

LegislationStats. 2006, Ch. 477 (AB 2861)September 2006

Amended HSC §105280 to promulgate new definitions of key program terms.

Legislation

Stats. 2006, Ch. 241 (SB 162)

September 2006

Reorganized the DHS into DHCS and CDPH.

Added §131050-§131052 to the HSC, vesting CDPH with the powers and duties of the Childhood Lead Poisoning Prevention Program (CLPPP).

Added §131200 to the HSC, giving CDPH regulatory authority over its vested statutes.

Special Audit Implementation Review

 

Implementation of State Auditor's Recommendations: Audits Released in January 2001 Through January 2003: Special Report to Assembly and Senate Standing/ Policy Committees

 

February 2003

This implementation review found the following:

  • No action taken by program to identify Medi-Cal and Child Health and Disability Prevention providers who failed to screen children.
  • All findings with partial corrective action stood, but had additional improvement.
  • Corrective action was taken to secure federal abatement funding.

Legislation

 

Stats. 2002, Ch. 931 (SB 460)September 2002

Added §105251-105257 to the HSC to institute Lead-Related Construction certification and accreditation requirements.

Amended HSC §124130 to update laboratory reporting of blood lead levels.

Audit Implementation Review

 

Implementation of State Auditor's Recommendations: Audits Released in 2000 and 2001February 2002

This implementation review found the following:

  • No action taken by program to identify Medi-Cal and CDPH providers who failed to screen children.
  • Partial corrective action taken on blood lead testing mandates, local enforcement, and local outreach.
  • Corrective action taken for enforcement and evaluation of statewide screening, provider outreach, and local case management.
  • Action pending for staffing shortages and federal funding stability.

Budget Change Proposal

 

Childhood Lead Poisoning Prevention Branch Budget Change Proposal for Fiscal Year 2002-03: Fixing Childhood Lead Audit Problems

 

 

 

 

 

December 2001

BCP responds to the findings of the State Auditor's report and a lawsuit against the program regarding screening denials.

  • Established 30 positions ($2.3M annually, CLPP Fund)
  • Increased annual expenditure authority for reporting and processing of lead tests ($1.1M ongoing, CLPP Fund).
  • Increased annual expenditure authority to develop and support state enforcement of lead abatement orders. ($500,000 state operations (S/O), $2.5M local assistance (L/A), $3M ongoing, CLPP Fund).
  • Established one-time contract to field-test study of lead poisoning in California ($200,000, CLPP Fund).
  • Established one-time contract to field-test outreach by community-based organizations to increase screening and case identification ($400,000, CLPP Fund).
LegislationStats. 2001, Ch. 524 (AB 945)October 2001

Added §105291 to the HSC, allowing Certified Industrial Hygienists to perform environmental investigations.

 

Audit

 

California State Auditor: Department of Health Services: Additional Improvements Are Needed to Ensure Children Are Adequately Protected from Lead Poisoning

 

May 2001

This follow-up audit examined progress made from the 1999 audit, showed continued findings, and elicited additional findings.

The program still had not met its mandates for blood lead testing, determining the extent of childhood lead poisoning in California, outreach to physicians, local case management, and local abatement authority, measuring the effectiveness of contracted local partners, and ensuring federal funding stability.

It was found that the program needed to design enforcement and evaluation criteria for its statewide screening requirement, and that ongoing staffing shortages, litigation, and projected funding shortfalls had limited the program's ability to respond as required.

Audit Implementation Review

Implementation of State Auditor's RecommendationsFebruary 2001

This implementation review found that corrective action had been taken on the development of a school abatement curriculum. Partial corrective action was taken on all other findings.

Audit

 

California State Auditor: Department of Health Services: Has Made Little Progress in Protecting California's Children from Lead Poisoning

 

April 1999

This audit found that the program had not met its mandates for blood lead testing, determining the extent of childhood lead poisoning in California, outreach to physicians, local case management, and local abatement enforcement, measuring the effectiveness of contracted local partners, developing a school abatement curriculum, and ensuring federal funding stability.


Appendix C-1: Center for Healthy Communities
Center for Healthy Communities organizational chart

Appendix C-2: Childhood Lead Poisoning Prevention Branch

Childhood Lead Poisoning Prevention Branch organizational chart

Appendix D: Local Health Jurisdiction Cooperative Agreements - FY 2020-2023 (3 years)

FY 2020-23 Contracted CLPP Local Jurisdiction Allocations

Local CLPP Program
State AllocationFederal AllocationTotal Allocation
Alameda
789,935 204,561 994,496
Amador72,305  - 72,305
Berkeley72,305 27,516 99,821
Butte100,439 36,852 137,291
Calaveras72,305  - 72,305
Colusa72,305  - 72,305
Contra Costa285,324 64,150 349,474
Del Norte72,305  - 72,305
El Dorado72,533  - 72,533
Fresno1,055,107 356,227 1,411,334
Glenn72,305  - 72,305
Humboldt120,507 14,105 134,612
Imperial108,805 34,774 143,579
Kern594,712 174,396 769,108
Lake72,305 1,807 74,112
Lassen72,305  - 72,305
Long Beach297,474 92,224 389,698
Los Angeles4,895,361 1,884,404 6,779,765
Madera125,578 19,210 144,788
Marin74,872 24,161 99,033
Mariposa72,305  - 72,305
Modoc72,305 16,477 88,782
Monterey415,501 124,362 539,863
Nevada81,505 17,165 98,670
Orange1,017,150 373,004 1,390,154
Pasadena120,009 27,629 147,638
Placer85,247  - 85,247
Plumas72,305  - 72,305
Riverside662,906 185,007 847,913
Sacramento1,203,596 149,928 1,353,524
San Bernardino853,913 162,337 1,016,250
San Diego1,252,516 168,719 1,421,235
San Francisco435,139 257,077 692,216
San Joaquin489,809 270,003 759,812
San Luis Obispo84,410 21,156 105,566
San Mateo271,979 105,373 377,352
Santa Clara854,157 111,323 965,480
Santa Cruz171,737 59,304 231,041
Shasta72,305 32,547 104,852
Siskiyou72,305 17,605 89,910
Solano139,135 28,788 167,923
Sonoma207,089  - 207,089
Stanislaus351,597 67,760 419,357
Sutter74,469 45,063 119,532
Tehama81,958  - 81,958
Tulare285,985 113,469 399,454
Tuolumne72,305  - 72,305
Ventura288,270 85,955 374,225
Yolo101,349 11,953 113,302
Yuba73,626 21,895 95,521
Total$19,135,969 $5,408,286 $24,544,255


Appendix E: Legal Settlements' Impact on CLPP Fund

CHILDHOOD LEAD POISONING PREVENTION FUND

Childhood Lead Poisoning Prevention Fees (Fund 0080) Fund Condition Excerpt for FY 2006-07 through FY 2016-17

Showing only the years of spike resulting from legal decisions (Dollars in thousands)


2006-072007-082008-092009-102010-112011-122012-132013-142014-152015-162016-17
Beginning Balance12,5562,40438,41738,64960,80654,59063,03269,02372,69674,01677,231
Prior/current year adjusted-1,92416,942-9213,049-7,65517,3154/2,7212,9592,3723,939989
Balance, adjusted
10,63219,34638,32551,69853,15171,90565,75371,98275,06877,95578,220

Revenues and Transfers:

4129200 (125600) Other regulatory fees

9,309
35,5441/18,7542/27,8483/19,83020,07024,31921,79320,56220,66721,245
4163000 (150300) Income from surplus money investments811676741222238202213172194322564
4171400 (161000) Escheat of Unclaimed Checks & Warrants001
40010300
4171400 Cost Recoveries - Delinquent Receivables00000000011
161400 Miscellaneous Revenue00000001000
Totals, Revenues10,12036,22019,49628,07420,06820,27224,53321,96620,75920,99021,810
Totals, Transfers from Other Funds:00000000000
Totals, Transfers to Other Funds:00000-9,062000
00
Totals, Revenues and Transfers10,12036,22019,49628,07420,06811,21024,53321,96620,75920,99021,810
Totals, Resources20,75255,56657,82179,77273,21983,11590,28693,94895,82798,945100,030

Expenditures:

Totals, Disbursement

18,34817,14919,17218,96618,62920,08321,26321,25221,81121,71428,327
FUND BALANCE (Reserve for economic uncertainties)2,40438,41738,64960,80654,59063,03269,02372,69674,01677,23171,704

1/ BOE fee collections including past fee assessments, after BOE hearings ruled in CDPH favor.

2/ Total amount received by BOE from July 2008 through May 2009. This includes fees for 2008/09 billings and one-time payment on past years' billings.

3/ The higher amount of collections in FY 2009-10 was due to one-time back payments and interest on fees owed from prior years.

4/ $24 million settlement collected by the Board of Equalization in December 19, 2011. This one time payment was the result of a final legal settlement, including interest on fees owed from past years' billings. The large part of the difference is because last year's fund condition statement did not match the SCO fund condition statements. DPH's FCS was higher than SCO by $9.3 million, so a reduction had to be made for last year's error. That issue aside, there was also an additional $1.7 million in PY adjustments that were not included in the original DPH submission. ($24.9 + 1.7 - 9.3 = $17.3M)


Appendix F: Health & Safety Code § 105310

State of California
HEALTH AND SAFETY CODE
Section 105310

105310. 
(a) There is hereby imposed a fee on manufacturers and other persons formerly, presently, or both formerly and presently engaged in the stream of commerce of lead or products containing lead, or who are otherwise responsible for identifiable sources of lead that have significantly contributed historically, currently contribute, or both have significantly contributed historically and contribute currently to environmental lead contamination.
(b) The department shall, by regulation, establish specific fees to be assessed on manufacturers and other parties formerly, presently, or both formerly and presently engaged in the stream of commerce of lead or products containing lead, or who are otherwise responsible for identifiable sources of lead that, as determined by the department, have significantly contributed historically, currently contribute, or both have significantly contributed historically and contribute currently to environmental lead contamination. To the maximum extent practicable, the fees shall be assessed on the basis of the following criteria:
(1) A person’s past and present responsibility for environmental lead contamination.
(2) A person’s “market share” responsibility for environmental lead contamination. This section shall not apply to, and no fee shall be assessed upon, any retailer of lead or products containing lead.
(c) The fee shall be assessed and collected annually by the State Board of Equalization. The annual fee assessment in subdivision (a) shall be adjusted by the department to reflect both of the following:
(1) The increase in the annual average of the California Consumer Price Index, as recorded by the California Department of Industrial Relations, for the most recent year available.
(2) The increase or decrease in the number of children in California who are receiving services pursuant to this chapter. This adjustment of fees shall not be subject to the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(d) (1) A fee shall not be assessed upon a person if that person can demonstrate, as determined by the department, that his or her industry did not contribute in any manner, as described in this section, to environmental lead contamination.
(2) A fee shall not be assessed upon a party if that party demonstrates, as determined by the department, that the lead, or the product containing lead, with which it is currently, or was historically, associated does not currently, or did not historically, result in quantifiably persistent environmental lead contamination.
(e) The fee imposed pursuant to this section shall be administered and collected by the State Board of Equalization in accordance with Part 22 (commencing with Section 43001) of Division 2 of the Revenue and Taxation Code. The fees shall be deposited in the Childhood Lead Poisoning Prevention Fund, which is hereby created in the State Treasury. Moneys in the fund shall be expended for the purposes of this chapter, including the State Board of Equalization’s costs of collection and administration of fees, upon appropriation by the Legislature. All interest earned on the moneys that have been deposited into the Childhood Lead Poisoning Prevention Fund shall be retained in that fund.
(f) The fees collected pursuant to this section and the earnings therefrom shall be used solely for the purposes of implementing this chapter. The department shall not collect fees pursuant to this section in excess of the amount reasonably anticipated by the department to fully implement this chapter. The department shall not spend more than it collects from the fees and the earnings in implementing this chapter. In no fiscal year shall the department collect more than sixteen million dollars ($16,000,000) in fees, as adjusted for inflation pursuant to subdivision (b).
(g) It is the intent of the Legislature, in subsequent legislation, to appropriate and deposit into the Childhood Lead Poisoning Prevention Fund the sum of one hundred twenty-eight thousand dollars ($128,000) from the General Fund on July 1, 1992, to the Controller for allocation as loans as follows:
(1) Seventy-eight thousand dollars ($78,000) to the department, for the purposes of adopting regulations to establish the fee schedule authorized by this section. The State Board of Equalization shall repay the amount of this appropriation, on or before June 30, 1993, with interest at the pooled money investment rate, from fees collected pursuant to this section.
(2) Fifty thousand dollars ($50,000) to the State Board of Equalization, for the purposes of implementing this section. The State Board of Equalization shall repay the amount of this appropriation on or before June 30, 1993, with interest at the pooled money investment rate, from fees collected pursuant to this section.
(h) Regulations adopted for fee assessment and collection pursuant to this section shall be exempt from review by the Office of Administrative Law. 
(Amended by Stats. 2017, Ch. 507, Sec. 5. (AB 1316) Effective January 1, 2018.)

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