HBA-JRA, MPM H.B. 2202 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 2202 By: Tillery Public Education 7/26/1999 Enrolled BACKGROUND AND PURPOSE Prior to the 76th Legislature, there were no school-based health clinics across the state that provided health services to children without access to health care due to lack of providers or extreme poverty. H.B. 2202 authorizes a school district to establish school-based student health centers (centers) to meet these needs and authorizes the centers to provide services to a student only if the district obtains written consent from the student's parent, guardian, or person having legal control of the student. Furthermore, this bill authorizes a district to seek assistance in establishing and operating a health center from any public health agency located in the community, and requires a public health agency, upon request, to cooperate and provide assistance to a district to the extent possible; and authorizes the district and a public health agency to, by agreement, jointly establish, operate, and fund a health center. This bill also requires the commissioner of public health to administer a program to award grants to assist districts with the costs of operating health centers and to adopt rules establishing procedures for awarding the grants. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of public health in SECTION 1 (Section 38.011, Education Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Chapter 38, Education Code, by adding Section 38.011, as follows: Sec. 38.011. SCHOOL-BASED HEALTH CENTERS. (a) Authorizes a school district (district) in this state, if the district identifies the need, to design a model in accordance with this section for the delivery of cooperative health care programs for students and their families and to compete for grants awarded under this section. Authorizes the model to provide for the delivery of conventional health services and disease prevention of emerging health threats specific to the district. (b) Authorizes a district to establish a school-based health center at one or more campuses in the district to meet the health care needs of students and their families on the recommendation of an advisory council established under Subsection (g). Authorizes a district to contract with a person to provide services at a school-based health center. (c) Authorizes a school-based health center to provide services to a student only if the district or provider with whom the district contracts obtains the written consent of the student's parent, guardian, or other person having legal control of the student on a consent form developed by the district or provider. Authorizes the student's parent, guardian, or other person having legal control of the student to give consent for a student to receive ongoing services or to limit consent to one or more services provided on a single occasion. Provides that the consent form must list every service the health center delivers in a format that complies with applicable state and federal laws and which allows a person to consent to one or more categories of services. Sets forth the permissible categories of services. (d) Prohibits reproductive services, counseling, or referrals from being provided through a school-based health center using grant funds awarded under this section. Provides that any service using grant funds must be provided by an appropriate professional who is properly licensed, certified, or otherwise authorized under state law to provide the service. (e) Requires the staff of a school-based health center and the person whose consent is obtained under Subsection (c) to jointly identify any health-related concerns of a student that may be interfering with the student's well-being or ability to succeed in school. (f) Requires the staff of the center, if it is determined that a student needs a referral for mental health services, to notify the person whose consent is required under Subsection (c), verbally and in writing, of the basis for the referral. Prohibits this referral from being provided unless the person provides written consent for the type of service to be provided and provides specific written content for each treatment occasion. (g) Authorizes the board of trustees of a district to establish and appoint members to a local health education and health care advisory council to make recommendations to the district on the establishment of school-based health centers and to assist the district in ensuring that local community values are reflected in the operation of each center and in the provision of health education. Provides that a majority of the council members must be parents of students enrolled in the district. Requires the board of trustees to also appoint at least one person from certain groups in addition to the appointees who are parents of students. (h) Authorizes a district to seek assistance in establishing and operating a school-based health center from any public agency in the community. Requires a public health agency, on request, to jointly cooperate with a district and to the extent practicable, considering the resources of the agency, to provide assistance. Authorizes a district and public health agency, by agreement, to jointly establish, operate, and fund a school-based health center. (i) Provides that if a school-based health center is located in an area described by Subsection (j), a certain protocol shall take place among the district, staff, and providers in order to provide service delivery. (j) Make the requirements prescribed by Subsection (i) applicable only to a school-based health center serving an area that is located in a county with a population no greater than 50,000 or that has been designated under state or federal law as falling within certain categories of those that are underserved. (k) Requires the staff of a school-based health center, if a person receiving a medical service from the center has a primary care physician, to provide notice of the service to the physician in order to allow the physician to maintain the person's medical history. (l) Requires the staff of a school-based health center, before delivering a medical service to a person with a primary care physician under the state Medicaid program, a state children's health program, or a private health insurance or health benefit plan, to notify the physician for the purposes of sharing medical information and obtaining authorization for delivering the medical service. (m) Requires a school district or provider with whom the district contracts to seek all available sources of funding to compensate the district or provider for services provided by a school-based health center, including money available under the state Medicaid program, a state children's health plan program, private health insurance or health benefit plans, or the ability of those using a school-based clinic to pay for the services. (n) Requires the commissioner of public health, subject to the availability of federal or state appropriated funds, to administer a program under which grants are awarded to assist districts with the costs of operating school-based health centers in accordance with this section. Requires the commissioner, by rules adopted in accordance with this section, to establish procedures for awarding grants. (o) Prohibits a district from receiving more than $250,000 per biennium through grants awarded under this section. Provides that a district must provide matching funds in accordance with rules adopted under Subsection (n) to be eligible for a grant. Authorizes the matching funds to be obtained from any source available to the district, including inkind contributions, community or foundation grants, individual contributions, and local governmental agency operating funds. (p) Provides that the rules adopted under Subsection (n) must provide certain provisions with respect to grants awarded to districts. (q) Requires the commissioner of public health to adopt rules establishing standards for health care centers funded through grants that place primary emphasis on delivery of health services and secondary emphasis on population-based models that prevent emerging health threats. (r) Provides that all programs should be designed to reduce student absenteeism, increase a student's ability to meet the student's academic potential, and stabilize the physical well-being of a student. (s) Requires the commissioner of public health, based on statistics obtained from every school-based health center in this state, to issue an annual report to the legislature containing certain information regarding the health centers. Requires the commissioner, in obtaining statistics for the report, to ensure that data is collected for each county and aggregated appropriately according to geographical region. (t) Requires the commissioner of public health to require client surveys to be conducted in school-based health centers funded through grants provided under this section, and the results of those surveys must be included in the annual report required under Subsection (s). SECTION 2. Amends Chapter 38, Education Code, by adding Section 38.012, as follows: Sec. 38.012. NOTICE CONCERNING HEALTH CARE SERVICES. Provides that, before expanding or changing the health care services available at a school from those that were available on January 1, 1999, the board of trustees must hold a public hearing at which all information on the proposed health care services is disclosed and an opportunity for public comment is provided and approve the expansion or change by a record vote. SECTION 3. Amends Chapter 38, Education Code, by adding Section 38.0095, as follows: Sec. 38.0095. PARENTAL ACCESS TO MEDICAL RECORDS. Entitles a parent or guardian of a student to access to the student's medical records maintained by a school district. Requires the school district to provide a copy of the student's medical records to the parent or guardian on request. Prohibits the district from imposing a charge for the copies in excess of that authorized for the providing a copy of public information. SECTION 4. Provides that this Act takes effect only if a specific appropriation for the implementation of this Act is provided in H.B. No. 1 (General Appropriations Act), Acts of the 76th Legislature, Regular Session, 1999. SECTION 5.Emergency clause. Effective date: upon passage.