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 * * * * *