BILL NUMBER: SB 118 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 7, 2015
INTRODUCED BY Senator Liu
JANUARY 14, 2015
An act to amend Sections 124174, 124174.2, and 124174.6 of the
Health and Safety Code, and to amend Section 1 of Chapter 381 of the
Statutes of 2008, relating to public health.
LEGISLATIVE COUNSEL'S DIGEST
SB 118, as amended, Liu. School-Based Health and Education
Partnership Program.
Existing law requires the State Department of Public Health, in
cooperation with the State Department of Education, to establish a
Public School Health Center Support Program to assist health centers
in schools and school districts. Existing law establishes a grant
program within the Public School Health Center Support Program to
provide technical assistance, and funding for the expansion,
renovation, and retrofitting of existing school health centers and
the development of new school health centers. These provisions also
provide funding for sustainability grants in amounts between $25,000
and $125,000. Existing law authorizes school health centers to
provide physical, mental, and oral health assessments, screenings,
and services.
This bill would rename the program the School-Based Health and
Education Partnership Program. The bill would instead provide funding
for the expansion and renovation of existing school health centers.
The bill would change the amount of the sustainability grants that
are available pursuant to the program to between $50,000 and
$100,000, but would make those grants available on a one-time basis
and would revise the purposes for which they may be used. The bill
would also authorize population health grants in amounts between
$50,000 and $125,000 for a funding period of up to 3 years, as
specified. The bill would authorize school health centers to
provide alcohol and substance abuse assessments, screening, and
services.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 124174 of the Health and Safety Code is amended
to read:
124174. The following definitions govern the construction of this
article, unless the context requires otherwise:
(a) "Program" means the School-Based Health and Education
Partnership Program.
(b) "School health center" means a center or program, located at
or near a local educational agency, that provides age-appropriate
health care services at the program site or through referrals. A
school health center may conduct routine physical, mental
health, physical health, mental health,
alcohol and substance abuse, and oral health assessments, and
provide referrals for any services not offered onsite. A school
health center may serve two or more nonadjacent schools or local
educational agencies.
(c) For purposes of this section, "local educational agency" means
a school, school district, charter school, or county office of
education if the county office of education serves students in
kindergarten, or any grades from 1 to 12, inclusive.
(d) "Department" means the State Department of Public Health.
SEC. 2. Section 124174.2 of the Health and Safety Code is amended
to read:
124174.2. (a) The department, in cooperation with the State
Department of Education, shall establish the School-Based Health and
Education Partnership Program.
(b) The program, in collaboration with the State Department of
Education, shall perform the following program functions:
(1) Provide technical assistance to school health centers on
effective outreach and enrollment strategies to identify children who
are eligible for, but not enrolled in, the Medi-Cal program, Covered
California, or any other applicable health insurance affordability
program for children.
(2) Serve as a liaison between organizations within the
department, including, but not limited to, prevention services,
primary care, and family health.
(3) Serve as a liaison between other state entities, as
appropriate, including, but not limited to, the State Department of
Health Care Services, the Department of Managed Health Care, and the
Office of Emergency Services.
(4) Provide technical assistance to facilitate and encourage the
establishment, retention, or expansion of, school health centers. For
purposes of this paragraph, technical assistance may include, but is
not limited to, identifying available public and private sources of
funding, which may include federal Medicaid funds, funds from
third-party reimbursements, and available federal or foundation grant
moneys.
(c) The department shall consult with interested parties and
appropriate stakeholders, including the California School-Based
Health Alliance and representatives of youth and parents, in carrying
out its responsibilities under this article.
SEC. 3. Section 124174.6 of the Health and Safety Code is amended
to read:
124174.6. The department shall establish a grant program within
the School-Based Health and Education Partnership Program to provide
technical assistance, funding for the expansion and renovation of
existing school health centers, and the development of new school
health centers, in accordance with the following procedures and
requirements:
(a) A school health center receiving grant funds pursuant to this
section shall meet or have a plan to meet the following requirements:
(1) Strive to provide a comprehensive set of services including
medical, oral health, mental health, alcohol and substance abuse,
health education, and related services in response to community
needs.
(2) Provide primary and other health care services, provided or
supervised by a licensed professional, which may include all of the
following:
(A) Physical examinations, immunizations, and other preventive
medical services.
(B) Diagnosis and treatment of minor injuries and acute medical
conditions.
(C) Management of chronic medical conditions.
(D) Basic laboratory tests.
(E) Referrals to and followup for specialty care.
(F) Reproductive health services.
(G) Nutrition services.
(H) Mental health and alcohol and substance abuse
services provided or supervised by an appropriately licensed mental
health or alcohol and substance abuse professional may
include: assessments, crisis intervention, counseling, treatment, and
referral to a continuum of services including emergency psychiatric
care, evidence-based mental health or alcohol and substance
abuse treatment services, community support programs, inpatient
care, and outpatient programs. School health centers providing
mental health and alcohol and substance abuse services as
specified in this section shall consult with the local county
mental behavioral health department for
collaboration in planning and service delivery.
(I) Oral health services that may include preventive services,
basic restorative services, and referral to specialty services.
(3) Strive to address the population health of the entire school
campus by focusing on prevention services, such as group and
classroom education, schoolwide prevention programs, and community
outreach strategies.
(4) Strive to provide integrated and individualized support for
students and families and to act as a partner with the student or
family to ensure that health, social, or behavioral challenges are
addressed.
(5) Work in partnership with the school nurse, if one is employed
by the local educational agency, to provide individual and family
health education; school or districtwide health promotion; first aid
and administration of medications; facilitation of student enrollment
in health insurance programs; screening of students to identify the
need for physical, mental health, physical
health, mental health, alcohol and substance abuse, and oral
health services; referral and linkage to services not offered onsite;
public health and disease surveillance; and emergency response
procedures. A school health center may receive grant funding pursuant
to this section if the local educational agency does not employ a
school nurse. However, it is not the intent of the Legislature that a
school health center serve as a substitute for a school nurse
employed by a local educational agency.
(6) Have a written contract or memorandum of understanding between
the local educational agency and the health care provider or any
other community providers that ensures coordination of services,
ensures confidentiality and privacy of health information consistent
with applicable federal and state laws, and integration of services
into the school environment.
(7) Serve all registered students in the school regardless of
ability to pay.
(8) Be open during all normal school hours, or on a more limited
basis if resources are not available, or on a more expansive basis if
dictated by community needs and resources are available.
(9) Establish protocols for referring students to outside services
when the school health center is closed.
(10) Facilitate transportation between the school and the health
center if the health center is not located on local educational
agency property.
(b) Planning grants shall be available in amounts between
twenty-five thousand dollars ($25,000) and fifty thousand dollars
($50,000) for a 6- to 12-month period to be used for the costs
associated with assessing the need for a school health center in a
particular community or area, and developing the partnerships
necessary for the operation of a school health center in that
community or area. Applicants for planning grants shall be required
to have a letter of interest from a local educational agency if the
applicant is not a local educational agency. Grantees provided
funding pursuant to this subdivision shall be required to do all of
the following:
(1) Seek input from students, parents, school nurses, school staff
and administration, local health providers and, if applicable,
special population groups on community health needs, barriers to
health care, and the need for a school health center.
(2) Collect data on the school and community to estimate the
percentage of students that lack health insurance and the percentage
that are eligible for Medi-Cal benefits, or other public programs
providing free or low-cost health services.
(3) Assess capacity and interest among health care providers in
the community to provide services in a school health center.
(4) Assess the need for specific cultural or linguistic services
or both.
(c) Facilities and startup grants shall be available in amounts
between twenty thousand dollars ($20,000) and two hundred fifty
thousand dollars ($250,000) per year for a three-year period for the
purpose of establishing a school health center, with the potential
addition of one hundred thousand dollars ($100,000) in the first year
for facilities construction, purchase, or renovation. Grant funds
may be used to cover a portion or all of the costs associated with
designing, retrofitting, renovating, constructing, or buying a
facility, for medical equipment and supplies for a school health
center, or for personnel costs at a school health center. Preference
will be given to proposals that include a plan for cost sharing among
schools, health providers, and community organizations for
facilities construction and renovation costs. Applicants for
facilities and startup grants offered pursuant to this subdivision
shall be required to meet the following criteria:
(1) Have completed a community assessment determining the need for
a school health center.
(2) Have a contract or memorandum of understanding between the
local educational agency and the health care provider, if other than
the local educational agency, and any other provider agencies
describing the relationship between the local educational agency and
the school health center.
(3) Have a mechanism, described in writing, to coordinate services
to individual students among school and school health center staff
while maintaining confidentiality and privacy of health information
consistent with applicable state and federal laws.
(4) Have a written description of how the school health center
will participate in the following:
(A) School and districtwide health promotion, coordinated school
health, health education in the classroom or on campus,
program/activities that address nutrition, fitness, or other
important public health issues, or promotion of policies that create
a healthy school environment.
(B) Outreach and enrollment of students in health insurance
programs.
(C) Public health prevention, surveillance, and emergency response
for the school population.
(5) Have the ability to provide the linguistic or cultural
services needed by the community. If the school health center is not
yet able to provide these services due to resource limitations, the
school health center shall engage in an ongoing assessment of its
capacity to provide these services.
(6) Have a plan for maximizing available third-party reimbursement
revenue streams.
(d) Sustainability grants shall be available on a one-time basis
in amounts between fifty thousand dollars ($50,000) and one hundred
thousand dollars ($100,000) for the purpose of developing new and
leveraging existing funding streams to support a sustainable funding
model for school health centers. Examples of existing funding streams
include local educational agency funds available under the local
control funding formula, the federal Patient Protection and
Affordable Care Act (Public Law 111-148), or the Mental Health
Services Act. Applicants for sustainability grants offered pursuant
to this subdivision shall be required to meet all of the criteria
described in subdivision (c), in addition to both of the following
criteria:
(1) The applicant shall be eligible to become or already be an
approved Medi-Cal provider.
(2) The applicant shall have the ability and procedures in place
for billing public insurance programs and managed care providers.
(3) The applicant shall seek reimbursement and have procedures in
place for billing public and private insurance that covers students
at the school health center.
(e) Population health grants shall be available in amounts between
fifty thousand dollars ($50,000) and one hundred twenty-five
thousand dollars ($125,000) for a funding period of up to three years
to fund interventions to implement population health outcomes and
target specific health or education risk factors including, but not
limited to, obesity prevention programs, asthma prevention programs,
early intervention for mental health, and alcohol and substance abuse
prevention. Applicants for population health grants offered pursuant
to this subdivision shall be required to meet all of the criteria
described in subdivision (c).
(f) The department shall award technical assistance grants through
a competitive bidding process to qualified contractors to support
grantees receiving grants under subdivisions (b), (c), (d), and (e).
A qualified contractor means a vendor with demonstrated capacity in
all aspects of planning, facilities development, startup, and
operation of a school health center.
(g) The department shall also develop a request for proposal (RFP)
process for collecting information on applicants, and determining
which proposals shall receive grant funding. The department shall
give preference for grant funding to the following schools:
(1) Schools in areas designated as federally medically underserved
areas or in areas with medically underserved populations.
(2) Schools with a high percentage of low-income and uninsured
children and youth.
(3) Schools with large numbers of limited English proficient (LEP)
students.
(4) Schools in areas with a shortage of health professionals.
(5) Low-performing schools with Academic Performance Index (API)
rankings in the deciles of three and below of the state.
(h) Moneys shall be allocated to the department annually for
evaluation to be conducted by an outside evaluator that is selected
through a competitive bidding process. The evaluation shall document
the number of grantees that establish and sustain school health
centers and describe the challenges and lessons learned in creating
successful school health centers. The evaluator shall use data
collected pursuant to Section 124174.3, if it is available, and work
in collaboration with the School-Based Health and Education
Partnership Program. The department shall post the evaluation on its
Internet Web site.
(i) This section shall be implemented only to the extent that
funds are appropriated to the department in the annual Budget Act or
other statute for implementation of this article.
SEC. 4. Section 1 of Chapter 381 of the Statutes of 2008 is
amended to read:
Section 1. The Legislature finds and declares all of the
following:
(a) (1) School health centers provide quality, age and
developmentally appropriate primary health care and other support
services on or near a public school campus.
(2) School health centers are primarily located in areas where
children are underserved, lack health insurance, and face significant
barriers to care.
(3) School health centers provide an optimal setting to promote
healthy lifestyles such as good nutrition and fitness and provide
preventive health care services such as obesity prevention to
children and families.
(4) School health centers increase access to care, reduce health
disparities and provide potential savings through better preventive
care and reduced emergency department utilization, drug utilization,
and inpatient treatment services.
(5) Children do better in school if they are healthy and have
received all of their immunizations and preventive annual exams.
(6) School health centers can be integral to providing the entire
school community with prevention and health integration services by
working collaboratively with school staff and administrators to meet
the spectrum of health and prevention needs in a school community.
(7) School health centers have proven to be particularly important
to the Latino population, with recent estimates showing that
approximately 49 percent of youth served at high school health
centers and 66 percent of children served at elementary school health
centers, are Latino.
(8) School health centers support educational achievement, help
increase attendance rates, and allow educational resources to be more
effectively targeted toward learning.
(9) The federal Patient Protection and Affordable Care Act (Public
Law 111-148) contains provisions that recognize the importance of
school health centers in the delivery of quality, affordable health
care and that would call for their expansion. Under the health care
reform, California is developing new strategies to increase access to
health care and reduce health care costs through investing in
prevention services. School health centers are important sites
through which to increase child and adolescent access to health care
services and early identification of chronic diseases, such as asthma
or obesity, and high-risk behaviors, such as mental health
disorders, substance abuse, and teen pregnancy, that significantly
impact health care costs later in life.
(10) Additionally, through education finance reform, California
has increased accountability strategies for local educational
agencies that highlight the need for schools to address important
health-related indicators, such as chronic absenteeism.
(11) School-based health centers serve as an effective foundation
upon which schools and communities can build and implement a
community schools strategy providing a range of wrap-around services
to students and their families.
(b) It is the intent of the Legislature to support existing school
health centers and expand the number of health centers in California
and that funds should be placed within the School-Based Health and
Education Partnership Program, as defined under Article 10
(commencing with Section 124174) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code.