Indiana Lead-Safe and Healthy Homes Newsletter

Improving Kids’ Environment (IKE) and the Indiana Lead-Safe Task Force publish this newsletter every two or three months at no charge for anyone interested in issues and events involving lead poisoning prevention and healthy homes in Indiana. Distribution is by email or fax – preferably by e-mail. Contact the editor, Tom Neltner, at mccabe@ikecoalition.org or 317-442-3973 if you want to contribute articles, edit the draft newsletter, contribute an article, or want to get on or off the distribution list. All editions are available on IKE’s web page at http://www.ikecoalition.org/publications.htm.

SB-538 passed the Indiana House unanimously on April 11. The Senate is expected to concur with the House amendments and send the bill to the Governor for his signature. Since his administration supported the bill, he should sign it.

The House Public Health Committee adopted an amendment that made two critical improvements to the bill that passed the Senate.

First, it required Indiana Medicaid to meet the federal mandate to reimburse health departments for case management and environmental services by July 15, 2005. The House later removed this provision based on concerns from ISDH and FSAA that it could not meet the deadline. Senator Gard approved of the change only after receiving a joint letter from Commissioner Monroe of ISDH and Secretary Roob of FSSA. The letter assured Senator Gard that they would get the reimbursement in place and report on progress to the Health Finance Committee. Click here for letter.

Second, it required ISDH to submit an annual report to the General Assembly by March 15 of each year for the prior calendar year. The report must include ten elements that will make clear how well Indiana is doing to find lead poisoned children, protect them from further exposure, and whether future children living in the home will be protected. The ten items are:

(2) The number of children who had a blood test result of at least 10 micrograms of lead per deciliter of blood.

(3) The number of children identified under subdivision (2) who received a blood test to confirm that they had lead poisoning

(4) The number of children identified under subdivision (3) who had lead poisoning.

(5) The number of children identified under subdivision (4) who had a blood test result of less than ten micrograms of lead per deciliter of blood.

(7) The number of risk assessments performed for children identified under subdivision (4) and the average number of days taken to perform the risk assessment.

(8) The number of housing units in which risk assessments performed under subdivision (7) documented lead hazards as defined by 40 CFR 745.

(9) The number of housing units identified under subdivision (8) that were covered by orders issued under IC 13-14-10-2 or by another governmental authority to eliminate lead hazards.

(10)The number of housing units identified under subdivision (9) for which lead hazards have been eliminated within thirty days, three months, and six months.

Thanks to Rep. Vaneta Becker of Evansville for sponsoring the bill and supporting the committee amendment and to Senator Gard for her leadership and shepherding the bill through the process.

Indiana could document that only 8.0% of the required blood lead tests for Medicaid children were performed in 2004. The rate is based on the number of children receiving at least one initial or periodic screen. Federal Medicaid requires 100% testing.

Beyond being unacceptably low, IKE is particularly disappointed with the 8.0% rate because it reflects a downward trend. Indiana could document 11.0% in 2002 and 8.9% in 2003. The numbers are based on the Indiana’s CMS-Form 416 report submitted each March for the prior calendar year. Check out the year-to-year tally in this summary the past six years.

SB-538 should improve Indiana’s blood lead testing rates since it will require FSSA to develop performance measures for lead screening, publicize the results as part of a broader accountability program for managed care organizations, and provide incentives to MCOs to improve performance.

The bill passed the Senate 27-21. State Rep. Borror of Fort Wayne, the chair of the Committee on Commerce, Economic Development and Small Business, did not give the bill a hearing in the House. As a result, the bill died. The homebuilders association and apartment association opposed the bill. Maybe next year the bill will pass!

Carbon monoxide is a silent killer. The invisible, odorless, tasteless gas is generated by combustion such as a furnace, water heater, over, space heater or car. Its victims often fall asleep and die. Each year hundreds of Hoosiers go to the emergency room with carbon monoxide poisoning. Several die. The Underwriter Laboratory-approved alarms, after a 1998 revision, work well with few false alarms. IKE’s biggest concern with the alarms is that they only alarm under life-threatening conditions – not at levels that can seriously impair the health of residents.

Special thanks to Dr. Mary Jean Brown of CDC! On March 16, 2005, she sent a letter to Senator Gard regarding health department and environmental agency coordination in response to an inquiry by Senator Gard. Click here to view the letter. The introduced version of SB-538 required ISDH to share the addresses of lead poisoned children with IDEM. IDEM balked at the requirement claiming that it would be required to file civil suit to clean-up each home under existing statutory mandates. Apparently, IDEM believed it would have cost $1.6 million to implement.

· “Action taken to correct lead hazards in housing in which children with lead poisoning currently live is an essential part of an effective program.”

· “Failure to forge viable partnerships between health and environmental agencies to address residential lead paint hazards will have a direct and tangible impact on the number of children affected by lead and could prevent hundreds of children from achieving their full potential.”

· Since both CDC and HUD “require that funded state and local agencies show evidence of such relationships, these partnerships will be essential to obtaining future resources.”

On March 22, 2005, IDEM’s Commissioner Easterly sent Tom Neltner a letter explaining its position on protecting children from lead poisoning. Commissioner Easterly was responding to Tom Neltner’s inquiry to the Eric Holcomb, Governor Daniels’ Director for Intergovernmental Relations. Click here for a copy of the letter.

Commissioner Easterly explained that IDEM’s “primary role concerning lead-based paint has been to provide the licensing mechanism and insure that the lead-based paint abatement is conducted properly.” He went on to state that “enacting SB 538, as introduced, would have been the beginning of requiring IDEM to become the responsible entity for pursuing homeowners that have substances within their home that cause health problems.” “Taking a new policy direction is expected from time to time, however the primary mission of the IDEM is to help protect our environment through permitting, monitoring, and enforcement activities.”

The letter raises many questions given IDEM’s responsibility to enforce a statutory prohibition on the use of dangerous work practices regarding lead-based paint in pre-1960 and, beyond lead, enforcing detailed asbestos rules. It also suggests a withdrawal by IDEM from its leading role as coordinator and educator on issues dealing environmental pollutants in indoor air such as in homes, child care and schools.

Senator Gard indicated that she will get ISDH and IDEM together during the summer to identify any gaps in enforcement of regulations designed to protect children’s environmental health and determine the best way to fill them. Thanks to Senator Gard!

1. Dwellings and child occupied facilities that have poisoned a child will not poison another child. Ninety-five percent will be made lead safe. Baseline: Currently unavailable;

2. 90% of rental units built before 1940 identified and tested for lead. Baseline: 126,214 units;

3. 80% of rental units built before 1940 that have been identified to have lead hazards made lead safe. Baseline: Currently unavailable;

4. 60% of housing units built before 1960 identified and tested for lead. Baseline: 1,048,060 units; and

5. 80% of housing units built before 1960 and identified with lead hazards are made lead safe. Baseline: Currently unavailable

IKE did some research to see whether Indiana has the professionals to pull it off and how the totals compare to Illinois and Ohio. These adjacent states have about twice the population as Indiana.

Category	Indiana	Illinois	Ohio
Risk Assessors	202	417	426
Inspectors	141	94	16*
Lead Clearance Examiners	11	0	4
Abatement Contractors	9	191	398
Supervisors	69
Works	48	1481	504

Based on these numbers, Indiana needs more professionals and more training to achieve the goals. As it stands, each risk assessor will have to conduct more than 500 risk assessments a year. Most of these risk assessors only do a few risk assessments each year now.

ISDH Commissioner Monroe to be Keynote at IN Lead-Safe and Healthy Homes Conference

IKE is pleased to announce that Dr. Judith Monroe will be the keynote speaker on November 8 at the Indiana Lead-Safe and Healthy Homes Conference. Dr. Moore was appointed to be the new Commissioner for ISDH by Governor Daniels on March 7, 2005.

Dr. Monroe received her bachelor degree from Eastern Kentucky University in 1975 and her M.D. from the University of Maryland in 1983. She also completed a family medicine residency at the University of Cincinnati in 1986, a fellowship in rural faculty development at East Tennessee State University in 1990, and a mini-fellowship in obstetrics at the University of Wisconsin in 1993. She has served as a successful rural, university and community hospital clinician, educator and executive. She is also an accomplished strategist, scholar, educator and business leader. For more information, check out her biography at www.in.gov/isdh/about/about_shc.htm.

In a February 16, 2005 letter from Family and Social Services Administration (FSSA) to ISDH, Indiana Medicaid essentially told ISDH to completely rework ISDH’s December 23, 2004 proposal for Medicaid reimbursement to health departments for case management and environmental investigations of lead poisoned children. Click here for a copy of the letter.

As a result of the stalemate, ISDH and FSSA were not able to fulfill their October 18, 2004 commitment to the Indiana Joint Select Commission on Medicaid Oversight. They committed to have a reimbursement system in place by the first quarter of 2005.

In response, IKE worked with several legislators to get an amendment to SB-538 passed in the House Public Health Committee. The amendment would have required action by July 15, 2005. The requirement was dropped by a second reading amendment after ISDH’s Commissioner Monroe and FSSA’s Secretary Roob sent Senator Gard a joint letter committing to establishing a reimbursement in a timely manner as long as the process is not cost prohibitive. They also committed to reporting progress to the Health Finance Commission. Click here for a copy of the letter.

When finalized, the reimbursement will be a major advance for Indiana. It will allow for 50% of actual expenses by ISDH and local health departments to provide services to lead poisoned children. The reimbursement could reach 75% in some circumstances. The system would not cost Indiana Medicaid any state funds since the match would come from the health departments. It should free up state and local resources as well. Many other states already provide this reimbursement.

HUD released its SuperNOFA (Notice of Funding Availability) on March 23, 2005. As part of the SuperNOFA, HUD’s Office of Healthy Homes and Lead Hazard Control is offering more than $150 million in grants to make homes lead-safe and healthier. Applications must be submitted electronically. They are due on June 7. Go to http://www.hud.gov/offices/lead/index.cfm for more information.

In 2004, Indiana went zero for nine in its applications. We are hoping for much better results this year.

Indianapolis is privileged to host the national Affordable Comfort Conference on May 16 to 21, 2005. It is an outstanding opportunity to learn how to make housing affordable, comfortable, safe and healthy.

Registrants will be able to chose from 57 short courses and 96 sessions categorized in 18 tracks. The information offered will range from Home Performance Business to Heating & Cooling to Weatherization, covering a broad spectrum of lessons from industry leaders in their field of expertise.

The official conference kick-off, being hosted by Indiana Community Action Association (INCAA) as well as the Indiana utility companies, will be held at the NCAA Hall of Champions. Offering a picnic and ice cream social, this will be one of the chances to network while enjoying festivities.

The Apartment Owners & Manager’s Association of Terre Haute recently revised its Code of Ethics and Guidelines. All members must sign a pledge to follow the code. The new code states “I will adhere to lead-based paint safety in housing constructed prior to 1978 and I will provide my residents with the appropriate pamphlet and disclosure form mandated by law.” Click here for a copy. Thanks to John Robinson and Mike Mahurin of the Association for taking a lead in revising the code. It is a good step forward!

The Lead Poisoning Prevention Coalition of Vigo County will gather 250 volunteers on May 7 to educate residents of its highest risk neighborhoods about lead poisoning. The volunteers will distribute door tages that inform residents and provide a free coupon for a lead test at the well child clinic. On hang door tags on homes that are at high risk of poisoning children. Contact Jeri Taylor at Vigo County Health Department for more information.

In January, on behalf of Katrina Snow, Tom Neltner filed a 90-day notice of intent to sue a Terre Haute landlord for failing to clean-up lead hazards at a duplex that poisoned a tenant’s three children. The 90-day notice is required before filing a citizen suit under the Resource Conservation and Recovery Act (RCRA). The landlord immediately responded by committing to demolishing the building or abating the hazards.

The landlord opted to demolish the building. IDEM informed the landlord that the demolition was probably a lead abatement project under state rules and that a lead abatement contractor was required to do the work. The landlord and IDEM are discussing options. The former tenant has agreed to hold off on filing the citizen suit until the issue is resolved.

New Council President Steve Talley of the Indianapolis City-County Council issued his Children First Agenda in January 2005. His agenda states that “the primary responsibility of the City-County Council is to provide a safe and healthy environment to raise and educate our children and protect the citizens of Marion County.” He wants to see more done to prevent and reverse the number of elderly, children and domestic abuse cases. “Other areas that need the focus of the Council includes:

§ Lead-Safe Indiana Task Force Meeting in Indy. All are welcome to attend these meetings to discuss lead poisoning and healthy homes issues across Indiana. It is a great networking and planning opportunity. Contact Tom Neltner at mccabe@ikecoalition.org or at 317-442-3973 for details. All meetings will be at the Environmental Management Institute, 5610 Crawfordsville Road, Suite 15. We will try to coordinate the meetings with Indiana EPAC’s Housing Subcommittee meetings.

§ Indiana Lead Elimination Plan Advisory Committee in Indy. The committee is charged with advising ISDH on the state’s implementation of the state lead elimination plan. The meetings are held at HUD’s offices at 151 N. Delaware St., Suite 1200 and are open to the public.

o Free EPA & HUD-Approved Lead Safe Work Practices Course. Contact Masimax at 866-232-5419 or on-line at www.leadsafetraining.org.

§ South Bend on March 24 at the County-City Building, 8th floor, Health Department, 227 West Jefferson Blvd., South Bend, IN 46601. Contact Kathleen Britton at KBRITTON@co.st-joseph.in.us or (574) 245-6763 for details.

o Accredited Lead Training at the Environmental Management Institute in Indy. Contact EMI at 800-488-8842 or www.envtlmgmt.org.

o Train the Trainer – HUD-Approved Lead-Safe Work Practices by the Environmental Management Institute on May 17 in Indy at the Affordable Comfort Conference

o National Affordable Comfort in Indianapolis on May 16 to 21, 2005. See www.affordablecomfort.org.

o Indiana Lead-Safe and Healthy Homes Conference in Indianapolis on November 8 and 9, 2005

Thanks for improving kids' environment! If you have any questions or comments about this newsletter, IKE, or the Indiana Lead-Safe Task Force, contact Tom Neltner at mccabe@ikecoalition.org, 317-442-3973 or 5244 Carrollton Avenue, Indianapolis, IN 46220-3181. If you need more information on national events, check out the Alliance Alert Newsletter at www.afhh.org and click on newsletter.

IKE publishes a newsletter on a regular basis that describes IKE’s efforts beyond healthy homes and lead hazard control. Contact Tom Neltner at mccabe@ikecoalition.org if you want to subscribe to either of those newsletters.