HBA-MPM C.S.H.B. 2202 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2202 By: Tillery Public Education 5/5/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Currently, there are no school-based health clinics across the state that provide health services to children without access to health care due to lack of providers or extreme poverty. C.S.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 education and commissioner of public health to jointly 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 education and 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 an appropriate person 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 or counseling from being provided through a schoolbased health center using grand 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. (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 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, or private health insurance or health benefit plans. (m) Requires the commissioner of education and the commissioner of public health, subject to the availability of federal or state appropriated funds, to jointly 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 commissioners, by rules adopted in accordance with this section, to establish procedures for awarding grants. (n) 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 (m) 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. (o) Provides that the rules adopted under Subsection (n) must provide certain provisions with respect to grants awarded to districts. (p) Provides that the commissioner of education and commissioner of public health are partners in administering the grants. Requires the Texas Education Agency and Texas Department of Health to enter into a memorandum of understanding prescribing the duties of each agency and commissioner. Provides that the memorandum must include certain provisions with respect to the duties and responsibilities of each commissioner and agency the goals of the programs developed. Requires the commissioner of public health to adopt rules establishing standards for health care delivery in a school-based health center funded through a grant, with certain emphases. (q) Requires the commissioner of education and commissioner of public health, based on statistics obtained from every school-based health center in this state, to jointly issue an annual report to the legislature containing certain information regarding the health centers. Requires the commissioners, in obtaining statistics for the report, to ensure that data is collected for each county and aggregated appropriately according to geographical region. (r) Requires the commissioner of education and 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 (q). SECTION 2.Emergency clause. Effective date: upon passage. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 2202 differs from the original in SECTION 1 (proposed Section 38.011 (School-Based Health Centers), Education Code), by changing the title from "School-Based Student Health Centers" to "School-Based Health Centers" and modifies it as follows: (a) The substitute 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, and authorizes the model to provide for the delivery of conventional health services and disease prevention of emerging health threats specific to the district. Subsection (a) of the original bill authorized a district to establish a school-based student health center at one or more campuses in the district to meet the health care needs of students without other access to health care, after consultation with the appropriate campus-level planning and decision-making committees (committee) established under Subchapter F (District-Level and Site-Based Decision-Making), Chapter 11 (School Districts), Education Code. The original also authorized the health center to provide services in mental health care, physical health care, including immunizations, family and home support, health education, or social services. (b) The substitute introduces new text for this subsection. Please see the Section-by-Section analysis. (c) Redesignated from Subsection (b) of the original. Authorizes a school-based health center, rather than a school-based student health center, to provide services to a student only if the district or provider with whom the district contracts, rather than solely the district, 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 an appropriate person 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) The substitute introduces new text for this subsection. Please see the Section-by-Section Analysis. (e) Redesignated from Subsection (c). Includes a student's well-being among those concerns to be addressed by relevant persons with respect to a student's ability to succeed in school. Deletes text requiring those parties to jointly accept responsibility for addressing those concerns. Makes conforming changes. (f) The substitute introduces new text for this subsection. Please see the Section-by-Section Analysis. (g) The substitute introduces new text for this subsection. Please see the Section-by-Section Analysis. (h) Redesignated from Subsection (d). Makes conforming and nonsubstantive changes. (i)-(k) The substitute introduces new text for these subsections. Please see the Section-bySection Analysis. (l) Redesignated from Subsection (e) of the original. Includes a state children's health plan program among those resources available to compensate the district or provider for services provided by a school-based health center. Makes conforming changes. (m) Redesignated from Subsection (f) of the original. The substitute requires the commissioner of education and the commissioner of public health, subject to the availability of federal or state appropriated funds, to jointly 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, and requires the commissioners, by rules adopted in accordance with this section, to establish procedures for awarding grants. The original required the Texas Education Agency (agency) to award grants to assist districts with the costs of operating health centers in accordance with this section, subject to available appropriations. The original further required the State Board of Education (board), after consultation with the Health and Human Services Commission (commission), by rule, to establish procedures for awarding grants under this subsection. The original provided that the procedures must include a statewide competitive process under which the agency evaluates proposals submitted by districts according to guidelines and objectives adopted by the board with assistance from the commission and prohibited the agency from awarding more than $250,000 per health center location. (n) Redesignated from Subsection (g) of the original and adds additional text prohibiting a district from receiving more than $250,000 per biennium through grants awarded under this section. Includes in-kind contributions among those sources from which the district may obtain matching funds. Makes conforming changes. (o)-(r) The substitute introduces new text for these subsections. Please see the Section-bySection Analysis. SECTION 2 of the original is deleted. That SECTION required the agency, with assistance from the commission, to evaluate the impact of the health centers operating in this state on student health and student readiness to learn and succeed in school, and to submit a report on this evaluation to the legislature which included recommendations for state funding of health centers no later than January 15, 2001. (Please note that text regarding an evaluation (report) of the school-based health centers is addressed in Subsection (q) of the substitute.) SECTION 2 (long emergency clause) of the substitute is redesignated from SECTION 3 of the original.