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: August 30, 2013                                
          Consultant: Jacqueline Wong-Hernandez                       
          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  

          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  

          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)  

          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