BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Kevin de León, Chair AB 588 (Fox) - School Athletics: Concussions Amended: May 13, 2013 Policy Vote: Education 9-0 Urgency: No Mandate: No Hearing Date: June 24, 2013 Consultant: Jacqueline Wong-Hernandez This bill meets the criteria for referral to the Suspense File. Bill Summary: AB 588 extends existing concussion policies to private and charter schools, and requires the currently-required concussion and head injury information sheet to contain specific information. Fiscal Impact: Head injury requirements: Potentially significant workload for charter schools and private schools. Medi-Cal: Potentially significant ongoing state costs, to the extent that affected students are enrolled in Medi-Cal. Background: Existing law, enacted by AB 25 (Hayashi) Ch. 456/2011 requires any school district which offers athletics to require that an athlete suspected of sustaining a concussion or head injury to be removed from the activity, and be evaluated and cleared by a licensed health care provider before returning to the activity. Proposed Law: This bill requires any charter school or private school, if it offers an athletic program, to immediately remove an athlete from an athletic activity for the remainder of the day if he or she is suspected of sustaining a concussion or head injury, and prohibits the athlete from returning to the activity until the athlete is evaluated by a licensed health care provider, trained in the management of concussions, and acting within the scope of his or her practice, and the athlete receives written clearance from the licensed health care provider to return to the activity. This bill also requires that all schools and school districts subject to these requirements provide, on a yearly basis, a concussion and head injury information sheet which includes, at a minimum, information regarding concussions and their symptoms, to be signed and AB 588 (Fox) Page 1 returned by the athlete and athlete's parent or guardian before the athlete's initiating practice or competition. Staff Comments: This bill requires a charter school or a private school that offers athletics to comply with recently-enacted statutory requirements concerning head injuries and concussions (which currently apply only to school districts). Specifically, this bill requires that an athlete suspected of sustaining head injury or concussion: A) be removed from the activity for the remainder of the day; and B) not be permitted to return to the activity until he or she is evaluated by a licensed health care provider, trained in the management of concussions, acting within the scope of his or her practice. This bill specifies that the athlete shall not be permitted to return to the activity until he or she receives written clearance to return to the activity from that licensed health care provider. Enforcement would be done by individual schools, at the local level, and any enforcement activities would be costs to those entities. Staff notes, however, that charter schools are primarily funded by Proposition 98/General Fund, and this bill would add cost pressure to school budgets. This bill also sets minimum requirements for notification content, which are unlikely to drive any significant additional costs. The provisions of this bill will result in increased workload for charter schools. While the provisions of this bill do not constitute a reimbursable state mandate, both because charter schools are not currently eligible for mandate reimbursement and they are not required to offer athletics, it functionally mandates new activities for any charter school which provide athletics; they must either comply or cancel their athletics programs. These requirements are virtually identical to the California Interscholastic Federation (CIF) Bylaw 313, which all high schools who are members of CIF (virtually all California high schools participating in athletics) are required to follow as a condition of membership and competition. A clarification listed below Bylaw 313 in CIF's published rules indicates that the scope of practice for a "licensed health care provider" will limit the evaluation to a medical doctor or doctor of osteopathy. Schools already in compliance with CIF rules should not incur additional costs for this provision. AB 588 (Fox) Page 2 While most participating high schools likely comply with the CIF bylaws, this bill is intended to give greater force to the specified safety measures. The intent is to increase compliance by raising the issue to a state law rather than a competition membership requirement; the practice would have force of law. This bill also applies to elementary and middle schools; most middle schools (and some elementary schools) also offer athletics, but are not CIF members (as its jurisdiction is over high school athletics). It is not known how many middle or elementary school students suffer head injuries during athletics, but these students would be subject to the new requirements. Staff further notes that the medical evaluation requirements apply to any student who "is suspected of sustaining a head injury," not only students suspected of sustaining concussions. By increasing the enforcement of medical examinations for middle and high school athletes, this bill will likely result increased state costs in the Medi-Cal program; this program provides no-cost medical coverage for children whose families meet certain income eligibility requirements. There are more than 2 million school-aged children enrolled in Medi-Cal statewide, and enrollment is projected to increase as most of the 850,000 children currently served by the Healthy Families program are moved from that program to Medi-Cal as part of the implementation of the federal Affordable Care Act. Medi-Cal generally receives 50% federal and 50% state (General Fund) funding. It is not known how many of these school-aged Medi-Cal participants attend charter schools or private schools - private school attendance is likely very low. It is also not known how many of those students participate in school athletics programs, nor how many of them sustain head injuries each year and would, thus, require doctors' evaluations. To the extent that additional office visits are required of children enrolled in Medi-Cal, those costs would be borne in part by the General Fund.