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SB-118 School-Based Health and Education Partnership Program.(2015-2016)

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SB118:v97#DOCUMENT

Amended  IN  Assembly  August 17, 2015
Amended  IN  Senate  April 07, 2015

CALIFORNIA LEGISLATURE— 2015–2016 REGULAR SESSION

Senate Bill No. 118


Introduced by Senator Liu
(Principal coauthor: Assembly Member Ridley-Thomas)

January 14, 2015


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 118, as amended, Liu. School-Based Health and Education Partnership 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, 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. Existing law authorizes school health centers to provide physical, mental, and oral health assessments, screenings, and services.
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. The bill would authorize school health centers to provide alcohol and substance abuse assessments, screening, and services.
This bill would incorporate additional changes in Section 124174.6 of the Health and Safety Code proposed by AB 766 that would become operative if this bill and AB 766 are both chaptered and become effective on or before January 1, 2016, and this bill is chaptered last.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   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 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 health, mental health, alcohol and substance abuse, 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, 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 services, including medical, oral health, mental health, alcohol and substance abuse, 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 and alcohol and substance abuse services provided or supervised by an appropriately licensed mental health or alcohol and substance abuse professional may include: assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, evidence-based mental health or alcohol and substance abuse treatment services, community support programs, inpatient care, and outpatient programs. School health centers providing mental health and alcohol and substance abuse services as specified in this section shall consult with the local county behavioral 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 local educational agency, 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 health, mental health, alcohol and substance abuse, 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 local educational agency 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 educational agency.
(6) Have a written contract or memorandum of understanding between the local educational agency 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 ensures 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 local educational agency 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 local educational agency if the applicant is not a local educational 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, if applicable, special population groups on community health needs, barriers to health care, 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 local educational agency and the health care provider, if other than the local educational agency, and any other provider agencies describing the relationship between the local educational agency 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 local educational agency funds available under the local control funding formula, the federal Patient Protection and Affordable Care Act (Public Law 111-148), or the 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 the 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 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), (d), and (e). 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. 3.5.

 Section 124174.6 of the Health and Safety Code is amended to read:

124174.6.
 The department shall establish a grant program within the Public School Health Center Support School-Based Health and Education Partnership Program to provide technical assistance, and funding for the expansion, renovation, expansion and retrofitting 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 services, including medical, oral health, mental health, alcohol and substance abuse, 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 and alcohol and substance abuse services provided or supervised by an appropriately licensed mental health or alcohol and substance abuse professional may include: assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, evidence-based mental health or alcohol and substance abuse treatment services, community support programs, inpatient care, and outpatient programs. School health centers providing mental health and alcohol and substance abuse services as specified in this section shall consult with the local county mental behavioral 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.

(3)

(5) Work in partnership with the school nurse, if one is employed by the school or school district, local educational agency, 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, physical health, mental health, alcohol and substance abuse, 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 local educational agency 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. educational agency.

(4)

(6) Have a written contract or memorandum of understanding between the school district local educational agency 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 ensures integration of services into the school environment.

(5)

(7) Serve all registered students in the school regardless of ability to pay.

(6)

(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.

(7)

(9) Establish protocols for referring students to outside services when the school health center is closed.

(8)

(10) Facilitate transportation between the school and the health center if the health center is not located on school or school district local educational agency 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 local educational agency if the applicant is not a local education educational 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 providers and, if applicable, special population groups, groups on community health needs, barriers to health care care, 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 local educational agency and the health care provider, if other than the district, local educational agency, and any other provider agencies describing the relationship between the district local educational agency 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 twenty-five fifty thousand dollars ($25,000) ($50,000) and one hundred twenty-five thousand dollars ($125,000) per year for a three-year period ($100,000) for the purpose of operating a school health center, or enhancing programming at a fully operational school health center, including oral health or mental health services. developing new and leveraging existing funding streams to support a sustainable funding model for school health centers. Examples of existing funding streams include local educational agency funds available under the local control funding formula, the federal Patient Protection and Affordable Care Act (Public Law 111-148), or the 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).

(e)

(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), (d), and (d) (e). A qualified contractor means a vendor with demonstrated capacity in all aspects of planning, facilities development, startup, and operation of a school health center.

(f)

(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. youth or children and youth who receive free or low-cost insurance through Medi-Cal.
(3) Schools with large numbers of limited English proficient 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.

(g)

(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, 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 Public School Health Center Support School-Based Health and Education Partnership Program. The department shall post the evaluation on its Internet Web site.

(h)

(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 (Public Law 111-148) 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 or obesity, and high-risk 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 local educational agencies 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.

SEC. 5.

 Section 3.5 of this bill incorporates amendments to Section 124174.6 of the Health and Safety Code proposed by both this bill and Assembly Bill 766. It shall only become operative if (1) both bills are enacted and become effective on January 1, 2016, (2) each bill amends Section 124174.6 of the Health and Safety Code, and (3) this bill is enacted after Assembly Bill 766, in which case Section 3 of this bill shall not become operative.