1-1     By:  Tillery (Senate Sponsor - West)                  H.B. No. 2202
 1-2           (In the Senate - Received from the House May 14, 1999;
 1-3     May 14, 1999, read first time and referred to Committee on
 1-4     Education; May 14, 1999, reported favorably by the following vote:
 1-5     Yeas 6, Nays 0; May 14, 1999, sent to printer.)
 1-6                            A BILL TO BE ENTITLED
 1-7                                   AN ACT
 1-8     relating to health centers on public school campuses.
 1-9           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-10           SECTION 1.  Chapter 38, Education Code, is amended by adding
1-11     Section 38.011 to read as follows:
1-12           Sec. 38.011.  SCHOOL-BASED HEALTH CENTERS.  (a)  A school
1-13     district in this state may, if the district identifies the need,
1-14     design a model in accordance with this section for the delivery of
1-15     cooperative health care programs for students and their families
1-16     and may compete for grants awarded under this section.  The model
1-17     may provide for the delivery of conventional health services and
1-18     disease prevention of emerging health threats that are specific to
1-19     the district.
1-20           (b)  On the recommendation of an advisory council established
1-21     under Subsection (g), a school district may establish a
1-22     school-based health center at one or more campuses in the district
1-23     to meet the health care needs of students and their families.  A
1-24     district may contract with a person to provide services at a
1-25     school-based health center.
1-26           (c)  A school-based health center may provide services to a
1-27     student only if the district or the provider with whom the district
1-28     contracts obtains the written consent of the student's parent,
1-29     guardian, or other person having legal control of the student on a
1-30     consent form developed by the district or provider.  The student's
1-31     parent, guardian, or other person having legal control of the
1-32     student may give consent for a student to receive ongoing services
1-33     or may limit consent to one or more services provided on a single
1-34     occasion.  The consent form must list every service the
1-35     school-based health center delivers in a format that complies with
1-36     all applicable state and federal laws and allows a person to
1-37     consent to one or more categories of services.  The permissible
1-38     categories of services are:
1-39                 (1)  family and home support;
1-40                 (2)  health care, including immunizations;
1-41                 (3)  dental health care;
1-42                 (4)  health education; and
1-43                 (5)  preventive health strategies.
1-44           (d)  Reproductive services, counseling, or referrals may not
1-45     be provided through a school-based health center using grant funds
1-46     awarded under this section.  Any service provided using grant funds
1-47     must be provided by an appropriate professional who is properly
1-48     licensed, certified, or otherwise authorized under state law to
1-49     provide the service.
1-50           (e)  The staff of a school-based health center and the person
1-51     whose consent is obtained under Subsection (c) shall jointly
1-52     identify any health-related concerns of a student that may be
1-53     interfering with the student's well-being or ability to succeed in
1-54     school.
1-55           (f)  If it is determined that a student is in need of a
1-56     referral for mental health services, the staff of the center shall
1-57     notify the person whose consent is required under Subsection (c)
1-58     verbally and in writing of the basis for the referral.  The
1-59     referral may not be provided unless the person provides written
1-60     consent for the type of service to be provided and provides
1-61     specific written consent for each treatment occasion.
1-62           (g)  The board of trustees of a school district may establish
1-63     and appoint members to a local health education and health care
1-64     advisory council to make recommendations to the district on the
 2-1     establishment of school-based health centers and to assist the
 2-2     district in ensuring that local community values are reflected in
 2-3     the operation of each center and in the provision of health
 2-4     education.  A majority of the members of the council must be
 2-5     parents of students enrolled in the district.  In addition to the
 2-6     appointees who are parents of students, the board of trustees shall
 2-7     also appoint at least one person from each of the following groups:
 2-8                 (1)  teachers;
 2-9                 (2)  school administrators;
2-10                 (3)  licensed health care professionals;
2-11                 (4)  the clergy;
2-12                 (5)  law enforcement;
2-13                 (6)  the business community;
2-14                 (7)  senior citizens; and
2-15                 (8)  students.
2-16           (h)  A school district may seek assistance in establishing
2-17     and operating a school-based health center from any public health
2-18     agency in the community.  On request, a public health agency shall
2-19     cooperate with a district and to the extent practicable,
2-20     considering the resources of the agency, may provide assistance.  A
2-21     district and a public health agency may, by agreement, jointly
2-22     establish, operate, and fund a school-based health center.
2-23           (i)  If a school-based health center is located in an area
2-24     described by Subsection (j), the school district and the advisory
2-25     council established under Subsection (g) shall make a good faith
2-26     effort to identify and coordinate with existing providers to
2-27     preserve and protect existing health care systems and medical
2-28     relationships in the area.  The council shall keep a record of
2-29     efforts made to coordinate with existing providers.
2-30           (j)  The requirements prescribed by Subsection (i) apply only
2-31     to a school-based health center serving an area that:
2-32                 (1)  is located in a county with a population not
2-33     greater than 50,000; or
2-34                 (2)  has been designated under state or federal law as:
2-35                       (A)  a health professional shortage area;
2-36                       (B)  a medically underserved area; or
2-37                       (C)  a medically underserved community by the
2-38     Center for Rural Health Initiatives.
2-39           (k)  If a person receiving a medical service from a
2-40     school-based health center  has a primary care physician, the staff
2-41     of the center shall provide notice of the service the person
2-42     received to the primary care physician in order to allow the
2-43     physician to maintain a complete medical history of the person.
2-44           (l)  The staff of a school-based health center shall, before
2-45     delivering a medical service to a person with a primary care
2-46     physician under the state Medicaid program, a state children's
2-47     health plan program, or a private health insurance or health
2-48     benefit plan, notify the physician for the purpose of sharing
2-49     medical information and obtaining authorization for delivering the
2-50     medical service.
2-51           (m)  A school district or the provider with whom the district
2-52     contracts shall seek all available sources of funding to compensate
2-53     the district or provider for services provided by a school-based
2-54     health center, including money available under the state Medicaid
2-55     program, a state children's health plan program, private health
2-56     insurance or health benefit plans, or the ability of those using a
2-57     school-based clinic to pay for the services.
2-58           (n)  Subject to the availability of federal or state
2-59     appropriated funds, the commissioner of education and the
2-60     commissioner of public health shall jointly administer a program
2-61     under which grants are awarded to assist school districts with the
2-62     costs of operating school-based health centers in accordance with
2-63     this section.  The commissioners, by rules adopted in accordance
2-64     with this section, shall establish procedures for awarding grants.
2-65           (o)  A school district may not receive more than $250,000 per
2-66     biennium through grants awarded under this section.  To be eligible
2-67     to receive a grant, a district must provide matching funds in
2-68     accordance with rules adopted under Subsection (n).  The matching
2-69     funds may be obtained from any source available to the district,
 3-1     including in-kind contributions, community or foundation grants,
 3-2     individual contributions, and local governmental agency operating
 3-3     funds.
 3-4           (p)  The rules adopted under Subsection (n) must provide
 3-5     that:
 3-6                 (1)  grants are awarded to school districts on an
 3-7     annual basis through a competitive process; and
 3-8                 (2)  a preference is given to school districts that are
 3-9     located in rural areas or that have low property wealth per
3-10     student.
3-11           (q)  The commissioner of education and the commissioner of
3-12     public health are partners in administering the grants.  The Texas
3-13     Education Agency and the Texas Department of Health shall enter
3-14     into a memorandum of understanding that prescribes the duties of
3-15     each agency and commissioner.  The memorandum must provide that:
3-16                 (1)  the commissioner of public health is responsible
3-17     for administering the state and federal funds used to provide the
3-18     grants;
3-19                 (2)  the commissioner of public health shall adopt
3-20     rules establishing standards for health care delivery in a
3-21     school-based health center funded through a grant that place
3-22     primary emphasis on delivery of physical health services and
3-23     secondary emphasis on population-based models that prevent emerging
3-24     health threats;
3-25                 (3)  all programs shall be designed to meet the
3-26     following goals:
3-27                       (A)  reducing student absenteeism;
3-28                       (B)  increasing a student's ability to meet the
3-29     student's  academic potential; and
3-30                       (C)  stabilizing the physical well-being of a
3-31     student; and
3-32                 (4)  the commissioner of education may determine which
3-33     school districts receive grants.
3-34           (r)  Based on statistics obtained from every school-based
3-35     health center in this state, the commissioner of education and the
3-36     commissioner of public health shall jointly issue an annual report
3-37     to the legislature about the relative efficacy of services
3-38     delivered by school-based health centers and any increased academic
3-39     success of students at campuses served by those centers, with
3-40     special emphasis on any increased attendance, decreased drop-out
3-41     rates, improved student health, and improved performance on student
3-42     assessment instruments administered under Subchapter B, Chapter 39.
3-43     In obtaining statistics for preparation of the report required by
3-44     this subsection, the commissioners shall ensure that data is
3-45     collected for each county and aggregated appropriately according to
3-46     geographical region.
3-47           (s)  The commissioner of education and the commissioner of
3-48     public health shall require client surveys to be conducted in
3-49     school-based health centers funded through grants provided under
3-50     this section, and the results of those surveys must be included in
3-51     the annual report required under Subsection (r).
3-52           SECTION 2.  Chapter 38, Education Code, is amended by adding
3-53     Section 38.012 to read as follows:
3-54           Sec. 38.012.  NOTICE CONCERNING HEALTH CARE SERVICES.  (a)
3-55     Before a school district or school may expand or change the health
3-56     care services available at a school in the district from those that
3-57     were available on January 1, 1999, the board of trustees must:
3-58                 (1)  hold a public hearing at which the board discloses
3-59     all information on the proposed health care services, including:
3-60                       (A)  all health care services to be provided;
3-61                       (B)  whether federal law permits or requires any
3-62     health care service provided to be kept confidential from parents;
3-63                       (C)  whether a child's medical records will be
3-64     accessible to the child's parent;
3-65                       (D)  information concerning grant funds to be
3-66     used;
3-67                       (E)  the titles of persons who will have access
3-68     to the medical records of a student; and
3-69                       (F)  the security measures that will be used to
 4-1     protect the privacy of students' medical records; and
 4-2                 (2)  approve the expansion or change by a record vote.
 4-3           (b)  A hearing under Subsection (a) must include an
 4-4     opportunity for public comment on the proposal.
 4-5           (c)  If, after January 1, 1999, a school district expands or
 4-6     changes the health care services available at a school in the
 4-7     district, the district must provide to parents or other persons
 4-8     having legal control of students at the school, annually:
 4-9                 (1)  the information specified under Subsection (a);
4-10     and
4-11                 (2)  a summary of complaints the district has received
4-12     during the preceding year concerning health care services provided
4-13     by the district at the school.
4-14           SECTION 3.  Chapter 38, Education Code, is amended by adding
4-15     Section 38.0095 to read as follows:
4-16           Sec. 38.0095.  PARENTAL ACCESS TO MEDICAL RECORDS.  (a)  A
4-17     parent or guardian of a student is entitled to access to the
4-18     student's medical records maintained by a school district.
4-19           (b)  On request of a student's parent or guardian, the school
4-20     district shall provide a copy of the student's medical records to
4-21     the parent or guardian.  The district may not impose a charge for
4-22     providing the copy that exceeds the charge authorized by Section
4-23     552.261, Government Code, for providing a copy of public
4-24     information.
4-25           SECTION 4.  A school district must provide information
4-26     required under Section 38.012(c), Education Code, as added by this
4-27     Act, annually beginning January 1, 2000.
4-28           SECTION 5.  The importance of this legislation and the
4-29     crowded condition of the calendars in both houses create an
4-30     emergency and an imperative public necessity that the
4-31     constitutional rule requiring bills to be read on three several
4-32     days in each house be suspended, and this rule is hereby suspended,
4-33     and that this Act take effect and be in force from and after its
4-34     passage, and it is so enacted.
4-35                                  * * * * *