Amended in Senate April 1, 2014

Senate Bill No. 1239

Introduced by Senator Wolk

February 20, 2014

begin delete An act to amend Section 49427 of the Education Code, relating to pupil health. end delete begin insert An act to add Section 49428 to the Education Code, to add Section 1371.34 to the Health and Safety Code, and to add Section 10133.68 to the Insurance Code, relating to pupil health care services. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 1239, as amended, Wolk. begin delete Pupil health: school health services. end delete begin insert Pupil health care services: school nurses. end insert

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(1) Existing law requires the governing board of a school district to give diligent care to the health and physical development of pupils, and authorizes the governing board of a school district to employ properly certified persons for the work. Existing law authorizes a school nurse, subject to approval by the governing board of the school district, to perform various pupil health services, including, among others, evaluating the health and developmental status of pupils, and designing and implementing health maintenance plans to meet the individual health needs of pupils.

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This bill, on and after July 1, 2016, would require the governing board of a school district that is eligible for concentration funding pursuant to the provisions of the local control funding formula to employ at least one school nurse as a supervisor of health, and would require a supervisor of health to supervise other school nurses, registered nurses, or other licensed vocational nurses employed by a school district and, if applicable, a nurse of a county office of education under contract, as provided. The bill would require the governing board of a school district to consider specified factors in determining the number of nurses to be supervised by the supervisor of health, including, among others, the acuity of pupil health care needs. Because the bill would require school districts to perform new duties, the bill would impose a state-mandated local program.

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(2) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the reimbursement of claims and the resolution of claim and coverage disputes, as specified. Existing law requires a health care service plan to reimburse providers for emergency services and care provided to its enrollees until the care results in stabilization of the enrollee and also requires group plans to authorize and permit assignment of the enrollee’s right to reimbursement for covered health care services to the State Department of Health Care Services when services are provided to a Medi-Cal beneficiary. Existing law provides for the direct payment of group insurance medical benefits by a health insurer to the person or persons furnishing or paying for hospitalization or medical or surgical aid or, in the case of a Medi-Cal beneficiary, to the State Department of Health Care Services, as specified. Existing law provides that specified services provided by a local educational agency are covered Medi-Cal benefits and authorizes providers to bill for those services.

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This bill would require a health care service plan or health insurer to reimburse a school district for the health care services provided by a school nurse, registered nurse, or licensed vocational nurse employed by, or under contract with, a school district to an enrollee or insured that would otherwise be covered by the enrollee’s plan contract or the insured’s health insurance policy and would authorize the school district to submit a claim to a health care service plan or health insurer for reimbursement of the cost of those services. Because a willful violation of the bill’s requirements with respect to health care service plans would be a crime, the bill would impose a state-mandated local program.

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(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

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This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.

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With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

end insert begin delete

Existing law establishes criteria for employment of school medical personnel, and declares the intent of the Legislature that fundamental school health services be maintained, by the governing board of each school district and each county superintendent of schools, at a level that is adequate to accomplish specified goals, including, among others, fulfilling existing state requirements and policies regarding pupil health.

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This bill would make a nonsubstantive change to these provisions.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert (a) end insert begin insert   end insert begin insert The Legislature finds and declares both of the following: end insert

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(1) The health needs of pupils are not being adequately met in California’s schools due to a lack of qualified health professionals employed by school districts who have access to local school campuses.

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(2) Nurses are uniquely qualified to attend to the primary care of pupils suffering from chronic and acute health conditions.

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(b) It is therefore the intent of the Legislature in enacting this act to ensure that a school district that is eligible for concentration funding under the local control funding formula employ at least one school nurse, in accordance with standards accepted by national professional nursing organizations.

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begin insert SEC. 2. end insert   

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begin insert Section 49428 is added to the end insert begin insert Education Code end insert begin insert , to read: end insert

begin insert

begin insert 49428. end insert   

(a) The governing board of a school district that is
eligible to receive concentration funding under the local control
funding formula pursuant to subdivision (f) of Section 42238.02
shall employ at least one school nurse as a supervisor of health.
The supervisor of health shall supervise other school nurses,
registered nurses, or licensed vocational nurses employed by the
school district and, if applicable, a school nurse of a county office
of education under contract pursuant to subdivision (d).

(b) The governing board of a school district shall consider the
following factors in determining the number of nurses to be
supervised by the supervisor of health:

(1) The acuity of pupil health care needs.

(2) The distance and travel time between schools under the
supervision of the school nurse.

(3) The total healthy pupil population at each schoolsite.

(c) A registered nurse or licensed vocational nurse shall provide
health care services to pupils under the supervision of a school
nurse.

(d) A school district may contract with a county office of
education for the services of a school nurse employed by the county
office of education.

(e) This section shall not apply to schools served by a school
health center, as defined in Section 124174 of the Health and Safety
Code. However, the Legislature encourages schools with a school
health center to also employ a school nurse.

(f) For purposes of this section, the following definitions apply:

(1) “Licensed vocational nurse” means a licensed vocational
nurse licensed under Chapter 6.5 (commencing with Section 2840)
of Division 2 of the Business and Professions Code.

(2) “Registered nurse” means a registered nurse licensed under
Chapter 6 (commencing with Section 2700) of Division 2 of the
Business and Professions Code.

(3) “School nurse” has the same meaning as set forth in Section
49426.

(g) This section shall be operative on July 1, 2016.

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begin insert SEC. 3. end insert   

end insert

begin insert Section 1371.34 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

begin insert

begin insert 1371.34. end insert   

A health care service plan shall reimburse a school
district for the health care services provided by a school nurse,
registered nurse, or licensed vocational nurse employed by, or
under contract with, a school district, pursuant to Section 49428
of the Education Code, to an enrollee of the plan that would
otherwise be covered by the enrollee’s plan contract. The school
district may submit a claim to a health care service plan for
reimbursement of the services described in this section. The
enrollee shall not be responsible for any share of the cost of
providing the services described in this section.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 10133.68 is added to the end insert begin insert Insurance Code end insert begin insert , to
read: end insert

begin insert

begin insert 10133.68. end insert   

A health insurer shall reimburse a school district
for the health care services provided by a school nurse, registered
nurse, or licensed vocational nurse employed by, or under contract
with, a school district, pursuant to Section 49428 of the Education
Code, to an insured of the insurer that would otherwise be covered
by the insured’s policy of health insurance. The school district
may submit a claim to a health insurer for reimbursement of the
services described in this section. The insured shall not be
responsible for any share of the cost of providing the services
described in this section.

end insert

begin insert

begin insert SEC. 5. end insert   

end insert begin insert

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for certain
costs that may be incurred by a local agency or school district
because, in that regard, this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.

end insert begin insert

However, if the Commission on State Mandates determines that
this act contains other costs mandated by the state, reimbursement
to local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.

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begin delete

  

SECTION 1.  

Section 49427 of the Education Code is amended
to read:

49427.  

(a) It is the intent of the Legislature that the governing
board of each school district and each county superintendent of
schools maintain fundamental school health services at a level that
is adequate to accomplish all of the following:

(1) Preserve pupils’ ability to learn.

(2) Fulfill existing state requirements and policies regarding
pupil health.

(3) Contain health care costs through preventive programs and
education.

(b) The Legislature finds and declares that the provision of these
services may be in jeopardy due to the current caseloads in the
public schools, and that failure to maintain adequate health services
and standards will result in pupils’ poorer health and ability to
learn.

end delete