Amended in Senate April 1, 2014

Senate Bill No. 1055

Introduced by Senator Liu

February 18, 2014

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 1055, as amended, Liu. Public School Health Center Support 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.

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.

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 shall 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,
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, begin delete and end delete 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, begin insert alcohol and substance abuse, end insert
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 services provided or supervised by an
appropriately licensed mental health professional may include:
assessments, crisis intervention, counseling, treatment, and referral
to a continuum of services including emergency psychiatric care,
community support programs, inpatient care, and outpatient
programs. School health centers providing mental health services
as specified in this section shall consult with the local county
mental 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 school or school district, 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, 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 school or school district 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 school or school district.

(6) Have a written contract or memorandum of understanding
between the school district 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 school or school district
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 school or district if the applicant
is not a local education 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 begin insert , end insert if applicable,
special population begin delete groups, end delete begin insert groups end insert on community health needs,
barriers to health care begin insert , end insert 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 school district and the health care provider, if other than the
district, and any other provider agencies describing the relationship
between the district 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 school district funds available
under the begin delete Local Control Funding Formula, end delete begin insert local control funding
formula, end insert federal Patient Protection and Affordable Care begin delete Act, end delete begin insert Act end insert
begin insert (Public Law 111-148), end insert or 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 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), begin delete and end delete
begin delete (d). end delete begin insert (d), and (e). end insert 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 begin insert end insert
begin insert (Public Law 111-148) end insert 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 and obesity, and high-risk
health 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 school districts 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.