BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 402 (Mitchell) - Pupil health: vision examinations.
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|Version: May 4, 2015 |Policy Vote: ED. 7 - 0, HEALTH |
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|Urgency: No |Mandate: No |
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|Hearing Date: May 18, 2015 |Consultant: Jillian Kissee |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: Requires a pupil's vision to be examined by a
physician, optometrist, or ophthalmologist, as specified, and
requires the pupil's parent or guardian to provide the results
of the examination to the pupil's school. This bill prohibits a
school from denying admission to a pupil or taking any other
adverse action against a pupil if his or her parent or guardian
fails to provide the results of the examination. If the results
of the examination are not provided to the school, this bill
requires a pupil's vision to instead be appraised pursuant to
existing law, as specified.
Fiscal
Impact:
Increased costs to Medi-Cal: To the extent students shift from
having their vision appraised by a school nurse or other
person, as authorized in current law, to having a more
expansive examination conducted by a physician, optometrist,
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or ophthalmologist as a result of this bill, it could
potentially drive significant costs to the state through the
Medi-Cal program. See staff comments.
Administrative costs: The CDE indicates that this bill will
result in costs in the low tens of thousands General Fund. Of
this, $25,000 is one-time to adopt regulations governing the
requirements included in this bill. About $6,000 will be
necessary to provide participation data.
Mandate: The bill will likely result in a reimbursable state
mandate for activities imposed on schools such as: tracking
students that have taken a comprehensive exam and those that
need to be screened at the school site and staff training on
the bill's new requirements.
Background:
Current law:
1. Requires, during kindergarten or upon first enrollment
in an elementary school, and in grades 2, 5, and 8, the
vision of students to be appraised by the school nurse or
other authorized person. The appraisal must include tests
for visual acuity and color vision, however, color vision
is to be appraised once and only on male students.
Continual and regular observation of students' eyes,
appearance, behavior, visual performance and perception are
to be done by the school nurse and the classroom teacher.
The appraisal 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. (Education Code § 49455)
2. Requires a report to 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)
3. 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 specified
personnel.
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4. Provides that:
A. An employee of a school district or of a
county superintendent of schools to be authorized to
give vision tests and be designated a "duly qualified
supervisor of health" if the employee is a physician
and surgeon or osteopath, a school nurse, or an
optometrist.
B. Non-medical certificated employees of a school
district or county office of education may be
authorized to give vision tests if the employee has
specified documentation. (California Code of
Regulations, Title 5, § 591)
Proposed Law:
This bill makes changes to the vision examination required
under existing law. It requires that upon first enrollment in a
California school district at an elementary school and at least
every second year thereafter (instead of grades 2, 5, and 8)
until the student completed grade 8, the student's vision must
be examined by a physician, optometrist, or ophthalmologist.
The parent or guardian of the student must provide results of
the vision examination to the school.
The examination is required test for the following:
Distance and near visual acuity
Eye tracking
Binocular vision skills, including both eye teaming and
convergence, accommodation, color vision, depth perception,
intraocular pressure, pupil evaluation, objective and
subjective refraction, and eye health evaluations.
This bill prohibits a school from denying admission to a student
or taking any other action against a student if the student's
parent or guardian fails to provide the results of the vision
examination to the school. The school nurse or other person, as
specified, must appraise the student's vision in kindergarten or
upon first enrollment or entry, and in grades 2, 5, and 8.
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This bill requires the CDE to adopt regulations governing these
provisions, including training requirements, and must provide
participation data.
Related
Legislation:1.
AB 1840 (Campos), Chapter 803, Statutes of 2014, authorized a
child's vision to be appraised by using an eye chart or any
scientifically validated photo screening test, among other
things.
SB 430 (Wright, 2013) would have deleted the existing
requirement for appraisal upon first enrollment in an elementary
school by the school nurse or other authorized person, and
replaced it with a requirement that a pupil receive a vision
examination from a physician, optometrist, or ophthalmologist,
as specified. SB 430 failed in the Assembly Health Committee
without being heard.
Staff
Comments: This bill requires that students' vision be examined
by a physician, optometrist, or ophthalmologist every other year
until grade 8 and requires the student's parent or guardian to
provide results of the vision examination to the school. If the
results of the examination are not provided to the school, this
bill requires that the student's vision, instead, be appraised
pursuant to existing law. Because this bill does not require a
school district to take any adverse action, such as denying the
student admission for failure to provide the school with
examination results, the rate at which students will receive
this examination is unknown. To the extent they do, and are
eligible for Medi-Cal benefits, this bill could drive
significant increases in costs to the state. The Affordable
Care Act requires health plans to cover essential health
benefits such as pediatric services which include vision care.
In 2013-14, there were approximately 2.4 million students
enrolled in kindergarten and grades 2, 4, 6, and 8. Assuming 10
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percent of these students get the vision examination as
prescribed in this bill, and roughly one-half of the children in
the state are covered by Medi-Cal, this bill could increase
costs to the Medi-Cal program of about $6 million in a mix of
federal and General Fund (assuming a Medi-Cal rate of $50 per
exam).
Though not a state-level cost driver, those families that are
not eligible for Medi-Cal would likely incur out-of-pocket costs
such as co-pays for their child to receive the examination
required by this bill.
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