BILL ANALYSIS

C.S.H.B. 2891

By: Talarico

Public Education

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Symptomatic hypoglycemia occurs when a person's glucose levels drop to life-threatening levels. On average, individuals with Type 1 diabetes suffer from symptomatic hypoglycemia twice a week. If left untreated, this condition can cause seizures, unconsciousness, and death. Glucagon—a hormone that raises blood glucose levels—is an emergency medication that treats severe hypoglycemia. In a school setting, school personnel play a critical role in administering glucagon to students experiencing a diabetes-related emergency. Due to financial constraints, health insurance limitations, and other obstacles, many families are unable to provide their child's school with prescribed glucagon medication. While many schools would like to have undesignated glucagon available in cases where a diabetic student does not have this medication on campus, current law does not allow school personnel to store or administer undesignated glucagon. C.S.H.B. 2891 seeks to allow school district campuses, open-enrollment charter schools, and private schools to maintain and administer undesignated glucagon.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTION 2 of this bill.

ANALYSIS

C.S.H.B. 2891 amends the Health and Safety Code to authorize a public school district, open-enrollment charter school, or private school to adopt and implement a policy regarding the maintenance, administration, and disposal of glucagon medication at each campus in the district or school. The adopted policy must provide that a school nurse or an unlicensed diabetes care assistant may:

· administer glucagon medication to a student who is reasonably believed to be experiencing hypoglycemia and for whom:

o a diabetes management and treatment plan has been submitted to the district or school; and

o an individualized health plan has been developed for the student; and

· carry glucagon medication prescribed in the name of the district or school on the nurse's or assistant's person to administer to the student.

The bill prohibits the adopted policy from requiring a district or school to make certain expenditures that would result in a negative fiscal impact on the district or school. The bill requires the medication to be stored in a secure location of a campus that adopts the policy and be easily accessible to a school nurse and unlicensed diabetes care assistant.

C.S.H.B. 2891, with respect to a charter school or private school that adopts the policy, authorizes:

· the applicable parent or guardian to submit a diabetes management and treatment plan to the school; and

· the applicable school to seek school employees who are not health care professionals to serve as unlicensed diabetes care assistants for the purposes of administering glucagon medication.

The bill makes the following statutory provisions applicable to a charter school or private school as if they were a public school district and private or charter school employees as if they were district employees:

· the requirement for the applicable school to review a student's diabetes management and treatment plan;

· the requirement for the school principal, and school nurse, if applicable, to develop an individualized health plan for a student with diabetes in collaboration with the student's parent or guardian and, to the extent practicable, the physician responsible for the student's diabetes treatment and a teacher;

· the requirement for an unlicensed diabetes care assistant to serve under the supervision of the principal and the prohibition against subjecting a school employee to any penalty or disciplinary action for refusing to serve as an unlicensed diabetes care assistant;

· the requirement for training, in accordance with guidelines developed by the Texas Diabetes Council, to be provided to an unlicensed diabetes care assistant; and

· the prohibition against subjecting a school employee to any disciplinary proceeding resulting from an action taken in compliance with statutory provisions relating to the care of students with diabetes, as applicable.

C.S.H.B. 2891 requires the executive commissioner of the Health and Human Services Commission, in consultation with the commissioner of education, to adopt rules regarding the maintenance, administration, and disposal of glucagon medication at a school campus.

C.S.H.B. 2891 authorizes a physician or a person who has been delegated prescriptive authority in accordance with state law to prescribe the medication to a district, charter school, or private school that adopts the policy authorized under the bill's provisions. The bill requires a person who prescribes the medication to provide the district, charter school, or private school with a standing order for the administration of the medication to an applicable student. The standing order is not required to be patient-specific and the medication may be administered without a previously established physician-patient relationship. The bill establishes that supervision or delegation by a physician is adequate if the physician periodically reviews the order and is available through direct telecommunication as needed. The bill authorizes a pharmacist to dispense the medication to a district, charter school, or private school that adopts the policy without requiring the name or any other identifying information relating to the user.

C.S.H.B. 2891 defines "glucagon medication" as any medication used to treat hypoglycemia that contains glucagon. The bill revises certain definitions for purposes of statutory provisions relating to the care of students with diabetes, as follows:

· "school," unless the context clearly indicates otherwise, is a school district; and

· "school employee," unless the context clearly indicates otherwise, is a person who is employed by a school, a local health department that assists a school under those provisions, or another entity with which a school has contracted to perform its duties under those provisions.

C.S.H.B. 2891 applies beginning with the 2023-2024 school year.

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2023.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 2891 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

The substitute includes a requirement for a district, charter school, or private school policy adopted under the introduced and substitute versions to provide that the school nurse or an unlicensed diabetes care assistant may administer glucagon medication to a student who is reasonably believed to be experiencing hypoglycemia and for whom a diabetes management and treatment plan has been submitted to the district or school and an individualized health plan has been developed for the student. The introduced did not include this requirement. Whereas the introduced included an authorization for an unlicensed diabetes care assistant to carry undesignated glucagon medication on his or her person, the substitute omits this authorization. Instead, the substitute includes a requirement for a district, charter school, or private school policy to provide that the school nurse or an unlicensed diabetes care assistant may carry the medication prescribed in the name of the district or school on the nurse's or assistant's person for purposes of administering the medication to an applicable student.

The substitute makes certain statutory provisions relating to the care of students with diabetes applicable to charter schools and private schools, whereas the introduced did not.

Whereas the introduced required a supply of glucagon medication to be stored in a secure location at each campus of any district, charter school, or private school and be accessible to unlicensed diabetes care assistants and the school nurse, the substitute limits the requirement to a district, charter school, and private school that adopts the policy authorized in the introduced and substitute. The introduced authorized a physician or person who has been delegated prescriptive authority to prescribe glucagon medication in the name of any district, charter school, or private school and a pharmacist to dispense glucagon medication to any district, charter school, or private school without requiring the name or any other identifying information relating to the user. The substitute similarly limits these authorizations with respect to a district, charter school, and private school that adopts the policy.

The substitute includes a requirement for a physician or an applicable person who has been delegated prescriptive authority to provide to an applicable district, charter school, or private school a standing order for the administration of glucagon medication and provisions relating to such a standing order, whereas the introduced did not include the requirement or those provisions.

The substitute changes the definition of "glucagon medication" from any medication used to treat low blood sugar that contains the hormone glucagon, as in the introduced, to any medication used to treat hypoglycemia that contains glucagon. The substitute revises the definition of "school" and "school employee" for purposes of statutory provisions relating to the care of students with diabetes, whereas the introduced did not revise those definitions.