By Tillery H.B. No. 2202 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to health centers on public school campuses. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Chapter 38, Education Code, is amended by adding 1-5 Section 38.011 to read as follows: 1-6 Sec. 38.011. SCHOOL-BASED HEALTH CENTERS. (a) A school 1-7 district in this state may, if the district identifies the need, 1-8 design a model in accordance with this section for the delivery of 1-9 cooperative health care programs for students and their families 1-10 and may compete for grants awarded under this section. The model 1-11 may provide for the delivery of conventional health services and 1-12 disease prevention of emerging health threats that are specific to 1-13 the district. 1-14 (b) On the recommendation of an advisory council established 1-15 under Subsection (g), a school district may establish a 1-16 school-based health center at one or more campuses in the district 1-17 to meet the health care needs of students and their families. A 1-18 district may contract with a person to provide services at a 1-19 school-based health center. 1-20 (c) A school-based health center may provide services to a 1-21 student only if the district or the provider with whom the district 1-22 contracts obtains the written consent of the student's parent, 1-23 guardian, or other person having legal control of the student on a 1-24 consent form developed by the district or provider. The student's 2-1 parent, guardian, or other person having legal control of the 2-2 student may give consent for a student to receive ongoing services 2-3 or may limit consent to one or more services provided on a single 2-4 occasion. The consent form must list every service the 2-5 school-based health center delivers in a format that complies with 2-6 all applicable state and federal laws and allows a person to 2-7 consent to one or more categories of services. The permissible 2-8 categories of services are: 2-9 (1) family and home support; 2-10 (2) health care, including immunizations; 2-11 (3) dental health care; 2-12 (4) health education; and 2-13 (5) preventive health strategies. 2-14 (d) Reproductive services, counseling, or referrals may not 2-15 be provided through a school-based health center using grant funds 2-16 awarded under this section. Any service provided using grant funds 2-17 must be provided by an appropriate professional who is properly 2-18 licensed, certified, or otherwise authorized under state law to 2-19 provide the service. 2-20 (e) The staff of a school-based health center and the person 2-21 whose consent is obtained under Subsection (c) shall jointly 2-22 identify any health-related concerns of a student that may be 2-23 interfering with the student's well-being or ability to succeed in 2-24 school. 2-25 (f) If it is determined that a student is in need of a 2-26 referral for mental health services, the staff of the center shall 2-27 notify the person whose consent is required under Subsection (c) 3-1 verbally and in writing of the basis for the referral. The 3-2 referral may not be provided unless the person provides written 3-3 consent for the type of service to be provided and provides 3-4 specific written consent for each treatment occasion. 3-5 (g) The board of trustees of a school district may establish 3-6 and appoint members to a local health education and health care 3-7 advisory council to make recommendations to the district on the 3-8 establishment of school-based health centers and to assist the 3-9 district in ensuring that local community values are reflected in 3-10 the operation of each center and in the provision of health 3-11 education. A majority of the members of the council must be 3-12 parents of students enrolled in the district. In addition to the 3-13 appointees who are parents of students, the board of trustees shall 3-14 also appoint at least one person from each of the following groups: 3-15 (1) teachers; 3-16 (2) school administrators; 3-17 (3) licensed health care professionals; 3-18 (4) the clergy; 3-19 (5) law enforcement; 3-20 (6) the business community; 3-21 (7) senior citizens; and 3-22 (8) students. 3-23 (h) A school district may seek assistance in establishing 3-24 and operating a school-based health center from any public health 3-25 agency in the community. On request, a public health agency shall 3-26 cooperate with a district and to the extent practicable, 3-27 considering the resources of the agency, may provide assistance. A 4-1 district and a public health agency may, by agreement, jointly 4-2 establish, operate, and fund a school-based health center. 4-3 (i) If a school-based health center is located in an area 4-4 described by Subsection (j), the school district and the advisory 4-5 council established under Subsection (g) shall make a good faith 4-6 effort to identify and coordinate with existing providers to 4-7 preserve and protect existing health care systems and medical 4-8 relationships in the area. The council shall keep a record of 4-9 efforts made to coordinate with existing providers. 4-10 (j) The requirements prescribed by Subsection (i) apply only 4-11 to a school-based health center serving an area that: 4-12 (1) is located in a county with a population not 4-13 greater than 50,000; or 4-14 (2) has been designated under state or federal law as: 4-15 (A) a health professional shortage area; 4-16 (B) a medically underserved area; or 4-17 (C) a medically underserved community by the 4-18 Center for Rural Health Initiatives. 4-19 (k) If a person receiving a medical service from a 4-20 school-based health center has a primary care physician, the staff 4-21 of the center shall provide notice of the service the person 4-22 received to the primary care physician in order to allow the 4-23 physician to maintain a complete medical history of the person. 4-24 (l) The staff of a school-based health center shall, before 4-25 delivering a medical service to a person with a primary care 4-26 physician under the state Medicaid program, a state children's 4-27 health plan program, or a private health insurance or health 5-1 benefit plan, notify the physician for the purpose of sharing 5-2 medical information and obtaining authorization for delivering the 5-3 medical service. 5-4 (m) A school district or the provider with whom the district 5-5 contracts shall seek all available sources of funding to compensate 5-6 the district or provider for services provided by a school-based 5-7 health center, including money available under the state Medicaid 5-8 program, a state children's health plan program, private health 5-9 insurance or health benefit plans, or the ability of those using a 5-10 school-based clinic to pay for the services. 5-11 (n) Subject to the availability of federal or state 5-12 appropriated funds, the commissioner of education and the 5-13 commissioner of public health shall jointly administer a program 5-14 under which grants are awarded to assist school districts with the 5-15 costs of operating school-based health centers in accordance with 5-16 this section. The commissioners, by rules adopted in accordance 5-17 with this section, shall establish procedures for awarding grants. 5-18 (o) A school district may not receive more than $250,000 per 5-19 biennium through grants awarded under this section. To be eligible 5-20 to receive a grant, a district must provide matching funds in 5-21 accordance with rules adopted under Subsection (n). The matching 5-22 funds may be obtained from any source available to the district, 5-23 including in-kind contributions, community or foundation grants, 5-24 individual contributions, and local governmental agency operating 5-25 funds. 5-26 (p) The rules adopted under Subsection (n) must provide 5-27 that: 6-1 (1) grants are awarded to school districts on an 6-2 annual basis through a competitive process; and 6-3 (2) a preference is given to school districts that are 6-4 located in rural areas or that have low property wealth per 6-5 student. 6-6 (q) The commissioner of education and the commissioner of 6-7 public health are partners in administering the grants. The Texas 6-8 Education Agency and the Texas Department of Health shall enter 6-9 into a memorandum of understanding that prescribes the duties of 6-10 each agency and commissioner. The memorandum must provide that: 6-11 (1) the commissioner of public health is responsible 6-12 for administering the state and federal funds used to provide the 6-13 grants; 6-14 (2) the commissioner of public health shall adopt 6-15 rules establishing standards for health care delivery in a 6-16 school-based health center funded through a grant that place 6-17 primary emphasis on delivery of physical health services and 6-18 secondary emphasis on population-based models that prevent emerging 6-19 health threats; 6-20 (3) all programs shall be designed to meet the 6-21 following goals: 6-22 (A) reducing student absenteeism; 6-23 (B) increasing a student's ability to meet the 6-24 student's academic potential; and 6-25 (C) stabilizing the physical well-being of a 6-26 student; and 6-27 (4) the commissioner of education may determine which 7-1 school districts receive grants. 7-2 (r) Based on statistics obtained from every school-based 7-3 health center in this state, the commissioner of education and the 7-4 commissioner of public health shall jointly issue an annual report 7-5 to the legislature about the relative efficacy of services 7-6 delivered by school-based health centers and any increased academic 7-7 success of students at campuses served by those centers, with 7-8 special emphasis on any increased attendance, decreased drop-out 7-9 rates, improved student health, and improved performance on student 7-10 assessment instruments administered under Subchapter B, Chapter 39. 7-11 In obtaining statistics for preparation of the report required by 7-12 this subsection, the commissioners shall ensure that data is 7-13 collected for each county and aggregated appropriately according to 7-14 geographical region. 7-15 (s) The commissioner of education and the commissioner of 7-16 public health shall require client surveys to be conducted in 7-17 school-based health centers funded through grants provided under 7-18 this section, and the results of those surveys must be included in 7-19 the annual report required under Subsection (r). 7-20 SECTION 2. Chapter 38, Education Code, is amended by adding 7-21 Section 38.012 to read as follows: 7-22 Sec. 38.012. NOTICE CONCERNING HEALTH CARE SERVICES. (a) 7-23 Before a school district or school may expand or change the health 7-24 care services available at a school in the district from those that 7-25 were available on January 1, 1999, the board of trustees must: 7-26 (1) hold a public hearing at which the board discloses 7-27 all information on the proposed health care services, including: 8-1 (A) all health care services to be provided; 8-2 (B) whether federal law permits or requires any 8-3 health care service provided to be kept confidential from parents; 8-4 (C) whether a child's medical records will be 8-5 accessible to the child's parent; 8-6 (D) information concerning grant funds to be 8-7 used; 8-8 (E) the titles of persons who will have access 8-9 to the medical records of a student; and 8-10 (F) the security measures that will be used to 8-11 protect the privacy of students' medical records; and 8-12 (2) approve the expansion or change by a record vote. 8-13 (b) A hearing under Subsection (a) must include an 8-14 opportunity for public comment on the proposal. 8-15 (c) If, after January 1, 1999, a school district expands or 8-16 changes the health care services available at a school in the 8-17 district, the district must provide to parents or other persons 8-18 having legal control of students at the school, annually: 8-19 (1) the information specified under Subsection (a); 8-20 and 8-21 (2) a summary of complaints the district has received 8-22 during the preceding year concerning health care services provided 8-23 by the district at the school. 8-24 SECTION 3. Chapter 38, Education Code, is amended by adding 8-25 Section 38.0095 to read as follows: 8-26 Sec. 38.0095. PARENTAL ACCESS TO MEDICAL RECORDS. (a) A 8-27 parent or guardian of a student is entitled to access to the 9-1 student's medical records maintained by a school district. 9-2 (b) On request of a student's parent or guardian, the school 9-3 district shall provide a copy of the student's medical records to 9-4 the parent or guardian. The district may not impose a charge for 9-5 providing the copy that exceeds the charge authorized by Section 9-6 552.261, Government Code, for providing a copy of public 9-7 information. 9-8 SECTION 4. A school district must provide information 9-9 required under Section 38.012(c), Education Code, as added by this 9-10 Act, annually beginning January 1, 2000. 9-11 SECTION 5. The importance of this legislation and the 9-12 crowded condition of the calendars in both houses create an 9-13 emergency and an imperative public necessity that the 9-14 constitutional rule requiring bills to be read on three several 9-15 days in each house be suspended, and this rule is hereby suspended, 9-16 and that this Act take effect and be in force from and after its 9-17 passage, and it is so enacted.