BILL ANALYSIS �
SENATE COMMITTEE ON EDUCATION
Carol Liu, Chair
2013-2014 Regular Session
BILL NO: SB 1239
AUTHOR: Wolk
AMENDED: April 21, 2014
FISCAL COMM: Yes HEARING DATE: April 30, 2014
URGENCY: No CONSULTANT:Daniel Alvarez
NOTE : This bill has been referred to the Committees on
Education and Health. A "do pass" motion should include
referral to the Committee on Health.
SUBJECT : Pupil health care services: school nurses.
SUMMARY
This bill requires school districts that are eligible to
receive concentration funding under the Local Control
Funding Formula (LCFF) to employ at least one school nurse
as a supervisor of health, as specified. (The bill does
not require the expenditure of LCFF concentration funds,
but rather uses the formula as a means for identifying
school districts).
BACKGROUND
Current law defines a school nurse as a registered nurse
(RN) currently licensed under the Nursing Practices Act,
and who has completed the additional educational
requirements for, and possesses a current credential in
school nursing pursuant to Education Code Section 44877.
School nurses may perform, if authorized by a local
governing board, a number of services including, but not
limited to, conducting immunization programs, assessing and
evaluating the health and developmental status of pupils,
and consulting with, conducting in-service training to, and
serving as a resource person to teachers and
administrators. (Education Code � 49426)
Chapter 47, Statutes of 2013, created the Local Control
Funding Formula (LCFF), which consolidated most of the
state's categorical programs with the discretionary revenue
limit funding to create a new student formula phased in
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over eight years. The formula generally works as follows:
Districts will receive a uniform base grant for every
district, adjusted by grade span level, plus additional
funds for pupils with greater educational needs, defined as
low-income, English learner and foster youth students.
Districts will get a supplemental 20 percent of the base
grant based on the numbers of these students enrolled in a
district, and even more in a concentration grant, 22.5
percent above the base level, when the identified students
make up more than 55 percent of a district's enrollment.
Districts will have broad discretion over how to use the
base grants. The funding law says that districts must
expand or improve services for high-needs pupils in
proportion to the additional funding that these pupils
bring to the district. The transition to the new formula
began in the 2013-14 school year. Full implementation of
the new funding formula is projected to take eight years.
School districts will have more authority than before to
decide how to spend their money. But they will also face
new obligations to show that their spending improved pupil
performance. Districts must adopt a Local Control and
Accountability Plan (LCAP), after taking into account
suggestions from teachers, parents and the community, and
update it annually. The plan must spell out the district's
goals for improving pupil outcomes according to eight
priorities set by the state, and align spending to meet the
goals. Districts that fail to meet their goals and improve
pupil outcomes will receive assistance from county offices
of education and through a new agency, the California
Collaborative for Educational Excellence. Districts that
are persistently failing could be subject to state
intervention or even a state takeover.
ANALYSIS
This bill requires a school district that is eligible to
receive concentration funding under the Local Control
Funding Formula to employ at least one school nurse a
supervisor of health. (The bill does not require the
expenditure of LCFF concentration funds for this purpose,
but rather uses the formula as a means for identifying
school districts). More specifically, this bill:
1) Requires a school district that is eligible to receive
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concentration funding under the Local Control Funding
Formula to employ at least one school nurse a
supervisor of health.
2) Requires the supervisor of health to 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, as specified.
3) Requires the governing board of school district to
consider the following factors in determining the
number of nurses to be supervised by the supervisor of
health:
a) The acuity of pupil health care needs.
b) The distance and travel time between schools
under the supervision of the school nurse.
c) The total healthy pupil population at each
schoolsite.
4) Requires that a registered nurse or licensed
vocational nurse provide health care services to
pupils under the supervision of a school nurse.
5) Specifies that this measure does not apply to schools
served by a school health center, as specified.
However, the bill states the Legislature encourages
schools with a school health center to also employ a
school nurse.
6) Permits the governing board of school district to bill
a pupil's health insurer, or the Medi-Cal program or
both, for the cost of health care services provided to
the pupil.
7) Requires any nurses hired pursuant to this measure
shall supplement, and not supplant, existing employees
of the school district.
8) Defines the following:
a) Licensed vocational nurse as a licensed
vocational nurse licensed under the Business and
Professions Code, as specified.
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b) Registered nurse as a registered nurse
licensed under the Business and Professions Code,
as specified.
C) School nurse has the same meaning as set
forth in Education Code Section 49426.
9) Includes a local mandate cost disclaimer whereby if
the Commission on State Mandates determines this
measure contains costs mandated by the state,
reimbursement to school districts for those costs
shall be made consistent with the Government Code.
STAFF COMMENTS
1) Need for the bill . According to the author's office,
this bill seeks to address the shortage of school
nurses that has resulted from multiple years of state
budget cuts and to create incentives to attract and
retain qualified nurses, especially in disadvantaged
schools. This bill ensures access to a school nurse
for the neediest students, particularly in the
districts identified by the state's Local Control
Funding Formula. This bill enables school districts
to cover the salary of a school nurse and a student's
healthcare needs on campus by billing the student's
private health insurance or Medi-Cal. Studies have
proven that there is a connection between health and
academic failure, with poor health affecting a
student's attendance, grades, and ability to learn in
school. School nurses help students monitor and manage
their chronic diseases. Moreover, students without
chronic diseases also benefit from school nurses
through health assessments that help students with
learning disabilities, emotional, and behavioral
problems.
2) Nurse to student ratios . There has been a long
standing shortage of school nurses in California.
Many pupils do not have regular access to a school
nurse. California has about 2,300 school nurses,
averaging one nurse for every 2,600 of the state's
approximately 6 million public school students. But
this varies widely among school districts, reaching as
high as 1:13,635. The National Association of School
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Nurses recommends nurse to pupil ratios of 1:750 for
students in general population. In addition, a 2014
report by the Lucille Packard Foundation found that
57% of California public school districts report
having no school nurse personnel. These districts
serve about 1.2 million students, about 20 percent of
all public school students in the state.
3) The premise of the LCFF is to basically allow school
districts, charter schools, and county offices of
education greater funding flexibility in return for
accountability toward meeting eight state priorities,
as well as any additional local priorities. This bill
may be interpreted as an unwinding of the local
control feature by mandating school districts to hire
additional nurses in compliance with this measure;
notwithstanding that the bill contains no requirement
for utilizing LCFF funds for school nurses.
Under LCFF, school districts are not prohibited from
hiring additional nurses or other healthcare personnel
if they so choose; the general requirement are that
school districts must have a nexus between the
funding, services, and academic outcomes for pupils.
For example, a school district may determine that
having social workers on school campuses is beneficial
for a number of reasons - linking students with
critical social services, mental health and health
care - and that will lead to greater academic success.
This measure will require the hiring of a supervisor
school nurse irrespective of whether a school district
that is "eligible" for an LCFF concentration grant
determines other higher priorities or options for
serving the health care needs of their students.
4) Health insurance and Medi-Cal . In an attempt to limit
the fiscal exposure of school districts that will be
required to hire school nurses, the bill allows a
school district to bill either a pupil's health
insurer or the state's Medi-Cal program. Existing law
authorizes local education agencies to bill Medi-Cal
for nursing services; the intent of the measure is to
expand this authority to include private health
insurers. It is unclear whether the income generated
from billings will cover the actual cost of employing
nurses. In addition, it is highly probable that LEA,
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who met the required criteria, will experience
additional administrative costs that are less likely
to be recovered through reimbursements, and will
likely lead to unknown potentially significant state
mandated costs.
5) Threshold for requiring additional nurses . This bill
requires school districts, with concentrations of
English language learner and low-income pupils in
excess of 55 percent of their student enrollments, to
employ at least one supervising nurse. Does this mean
that school districts that do not meet the LCFF
concentration threshold are somehow better off from a
health (supervising school nurse) perspective?
Applying the LCFF funding criteria in this area may
not be the most analytically defensible approach to
providing health services to pupils in schools; LCFF
was based on the identified pupil populations having
greater educational needs, and therefore greater
costs. At this point in time, the California
Department of Education could not definitively
indicate how many LEAs would meet the "concentration"
threshold of the LCFF. The author may wish to
continue to consider alternative methods for
determining nursing or health care needs for
California school pupils.
6) Previous legislation . AB 2454 (Torlakson) from 2010,
required school districts to employ one nurse for
every 750 pupils enrolled in the district and
authorized school districts to bill a pupil's health
insurance. This bill was held under submission by the
Assembly Appropriations Committee.
SUPPORT
American Nurses Association\ California
California School Nurses Organization
California Nurses Association
Folsom Cordova Unified School District
Los Angeles County Office of Education School Nurses
Lodi Unified Certificated School Nurses
Manteca Unified School District
Marin County Office of Education
Marin School Nurse Organization
River Oak Charter School
San Joaquin County Office of Education
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21 individuals
OPPOSITION
California Association of Health Plans