BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Kevin de León, Chair SB 1172 (Steinberg) - Pupil Health: Vision Appraisals Amended: April 23, 2014 Policy Vote: Education Urgency: No Mandate: Yes Hearing Date: May 12, 2014 Consultant: Jacqueline Wong-Hernandez This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 1172 requires school vision appraisals to include tests for near vision, and expands current requirements (in scope and frequency) for school nurses and teachers to observe student's eyes to also include observation of the appearance and behavior of student's eyes, and requires observation to be continual and regular. Fiscal Impact: Vision testing requirements: Potentially substantial reimbursable mandate to increase the number of required vision tests, and the scope of those tests. Continual monitoring: The requirement for "continual and regular observation of the pupil's eyes" by teachers and school nurses could result in significant local costs, and could be an additional reimbursable mandate to the extent that costs could be proven. Background: Existing law requires school districts to provide for the testing of the sight and hearing of each student enrolled in the district. The test is to be given only by: a) duly qualified supervisors of health employed by the district; b) certificated employees of the district or county office of education (COE) who possess the qualifications prescribed by the Commission on Teacher Credentialing; c) contract with an agency duly authorized to perform those services by the county superintendent of schools, under guidelines established by the State Board of Education; or, d) accredited schools or colleges or optometry, osteopathic medicine, or medicine. (Education Code § 49452) Non-medical certificated employees of a school district or COE may be authorized to give vision tests if the employee meets specified requirements. SB 1172 (Steinberg) Page 1 Existing law requires, upon first enrollment in an elementary school, and at least every third year thereafter until the child has completed grade 8, the vision of students to be appraised by the school nurse or other authorized person. The evaluation must include tests for visual acuity and color vision, however, color vision is to be appraised once and only on male students. Gross external observation of the child's eyes, visual performance, and perception are to be done by the school nurse and the classroom teacher. The evaluation may be waived if the parents present a certificate from a physician and surgeon, a physician assistant or an optometrist, and parents may opt-out based on religious beliefs. (EC § 49455) A report must be made to the parent when a visual or other defect has been noted by the supervisor of health or his/her assistant. (EC § 49456) Proposed Law: This bill requires school vision appraisals to include tests for near vision, and expands current requirements for school nurses and teachers to observe student's eyes to also include observation of the appearance and behavior of student's eyes, and requires observation to be continual and regular. Specifically, this bill: 1) Adds appraisal of near vision to currently-required tests for visual acuity and color vision. 2) Adds the observation of the appearance and behavior of student's eyes, and specifies that this observation is to be continual and regular, to the current requirement that school nurses and classroom teachers observe student's eyes, visual performance, and perception. 3) Modifies the frequency of vision appraisals from upon first enrollment and at least every third year thereafter until the student has completed grade 8, to kindergarten or upon first enrollment, and grades 2, 5 and 8. 4) Requires the California Department of Education (CDE) to adopt guidelines to implement this bill, including training requirements and a method of testing for near vision. Related Legislation: SB 430 (Wright) requires a pupil to receive a vision examination from a physician, optometrist, or SB 1172 (Steinberg) Page 2 ophthalmologist and requires that screening to include a test for binocular function, refraction, and eye health. SB 430 is pending in the Assembly Health Committee. Staff Comments: This bill expands vision testing requirements, including an increased minimum number of screenings, likely resulting in a significant reimbursable state mandate on school districts. Current law requires specified personnel to administer vision screenings upon a student's enrollment, and then at least every third year through 8th grade. For a student who enrolls in kindergarten, the screening requirement would be, minimally: kindergarten, 3rd grade, and 6th grade, for a total of 3 administrations. This bill requires screenings "during the kindergarten year or upon first enrollment or entry in a California school district of a pupil?and in grades 2, 5, and 8," which (for any student enrolling before 2nd grade) would require a minimum of 4 administrations. This bill also expands the scope of the vision screenings to include near vision. If each of the more than 1,000 school districts statewide claimed even the $1,000 minimum mandate claim to conduct additional (and more extensive) vision screenings, state costs would exceed $1 million. This bill also requires "continual and regular observation of the pupil's eyes" by teachers and school nurses. What constitutes continual and regular observation is unclear, but it is reasonable to consider that to be more than once in a school year. This creates cost pressure to employ additional school nurses to observe pupils' eyes, as well as pressure on a teacher's time. To the extent that costs could be proven, this requirement could constitute an additional reimbursable mandate.