Bill Text: CA AB1940 | 2021-2022 | Regular Session | Enrolled

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Bill Title: School-Based Health Center Support Program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2022-09-27 - Vetoed by Governor. [AB1940 Detail]

Download: California-2021-AB1940-Enrolled.html

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Enrolled  August 29, 2022

Passed  IN  Senate  August 24, 2022

Passed  IN  Assembly  August 25, 2022

Amended  IN  Senate  August 11, 2022

Amended  IN  Assembly  March 17, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill

No. 1940

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Introduced by Assembly Member Salas

February 10, 2022

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An act to amend Section 49419 of the Education Code, and to amend Sections 124174, 124174.2, 124174.3, and 124174.4 of, to amend and renumber Section 124174.6 of, and to repeal Section 124174.5 of, the Health and Safety Code, relating to pupil health.

LEGISLATIVE COUNSEL'S DIGEST

AB 1940, Salas. School-Based 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 school health centers, which are defined as centers or programs, located at or near local educational agencies, that provide age-appropriate health care services at the program site or through referrals, as specified.

This bill would rename the program as the School-Based Health Center Support Program and would redefine a school-based health center to mean a student-focused health center or clinic that is located at or near a school or schools, is organized through school, community, and health provider relationships, and provides age-appropriate, clinical health care services onsite by qualified health professionals. The bill would authorize a school-based health center to provide primary medical care, behavioral health services, or dental care services onsite or through mobile health or telehealth.

Existing law requires the department, subject to an appropriation, to establish 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. Existing law requires a health center receiving grant funds to meet or have a plan to meeting specified requirements relating to the provision of certain services.

This bill would make changes to certain service requirements relating to, among other things, primary medical care, substance use disorder services, population health, and integrated and individualized support.

Existing law requires, subject to an appropriation, that planning grants under the program be available in amounts between $25,000 and $50,000 for a 6- to 12-month period for specified uses.

This bill would instead require, subject to an appropriation, that planning grants be available in amounts between $50,000 and $100,000, inclusive, for up to a 24-month period.

Existing law requires, subject to an appropriation, that facilities and startup grants be available in amounts between $20,000 and $250,000 per year for a 3-year period for the purpose of establishing a school health center, with the potential addition of $100,000 in the first year for facilities construction, purchase, or renovation.

This bill would instead require, subject to an appropriation, that facilities and startup grants be available in amounts between $300,000 and $850,000, inclusive, for a 3-year period. The bill would make certain changes to preference-related criteria.

Existing law requires, subject to an appropriation, that sustainability grants be available in amounts between $25,000 and $125,000 per year for a 3-year period for the purpose of operating a school health center, or enhancing programming at a fully operational school health center, and sets forth certain criteria for those grants.

This bill would delete those provisions and would instead require, subject to an appropriation, that expansion grants be available in amounts between $150,000 and $300,000, inclusive, for up to a 3-year period for the purpose of renovating and improving an existing school-based health center or enhancing and expanding programming at a fully operational school-based health center, as specified. The bill would set forth certain eligibility- and preference-related criteria for these grants.

Existing law requires the program, in collaboration with the State Department of Education, to act as a liaison for school-based health centers.

This bill would delete that provision.

Existing law requires the State Department of Education to establish an Office of School-Based Health Programs for the purpose of assisting local educational agencies regarding the current health-related programs under the purview of the department, as specified.

This bill would require the office to work with the State Department of Public Health in supporting the School-Based Health Center Support Program. The bill would make conforming changes to related provisions.

The bill would make additional changes to the program, including, among others, changes relating to outreach and enrollment strategies for children eligible for certain health care coverage programs, consultation with specified stakeholders, data collection from health centers, and preference-related criteria for the above-described grant funding.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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Bill Text

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

SECTION 1.

 The Legislature finds and declares all of the following:

(a) (1) School-based health centers provide quality, age- and developmentally appropriate comprehensive health care and other support services on or near a public school campus.

(2) Where resources and partnerships are available, comprehensive school-based health centers best meet child, adolescent, family, and community needs when the school-based health center offers an integrated model of primary medical care, behavioral health services, and other health services to address the needs of the whole child. School-based health centers may also include dental or vision care, substance use disorder services, nutrition counseling, schoolwide health education, and youth engagement and leadership opportunities.

(3) School-based health centers are primarily located in areas where children are underserved, experience health and education disparities, and face significant barriers to care.

(4) School-based 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. School-based health centers support educational achievement, help increase attendance rates, and address the whole-child needs of students.

(6) School-based health centers can be integral to the Community Schools model by providing the entire school community with prevention and health integration services. School-based health centers work collaboratively with school staff and administrators to meet the spectrum of health and prevention needs in a school community.

(7) Despite effectiveness of school-based health centers and the awareness that students are best supported with access to health care and supportive services in schools, California has never provided direct state funding for school-based health centers.

(b) It is the intent of the Legislature to support existing, and expand the number of, school-based health centers in California. The Legislature finds and declares that funds should be placed within the School-Based Health Center Support Program, as described in Article 10 (commencing with Section 124174) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code.

SEC. 2.

 Section 49419 of the Education Code is amended to read:

49419.

 (a) The department shall, no later than January 1, 2022, establish an Office of School-Based Health Programs for the purpose of assisting local educational agencies regarding the current health-related programs under the purview of the department. The scope of the office shall include collaborating with the State Department of Health Care Services and other departments and offices involved in the provision of school-based health services. The scope of the office shall also include assisting local educational agencies with information on, and participation in, the following school-based health programs:

(1) The Administrative Claiming process described in Section 14132.47 of the Welfare and Institutions Code.

(2) The Local Educational Agency Medi-Cal Billing Option Program described in Section 14132.06 of the Welfare and Institutions Code.

(3) All other programs under the federal Early and Periodic Screening, Diagnostic, and Treatment services entitlement supporting the provision of health services to eligible pupils, including screening, diagnostic, and treatment services to prevent, identify, or address physical and behavioral health needs.

(4) Providing consultation and technical assistance to local educational agencies on school-based nursing and health services.

(5) Coordinating school health program activities with public health, social services, environmental, and local educational agencies, and other public and private entities.

(6) Participating in the development of policies, standards, and guidelines, interpreting updates, and disseminating policies, standards, guidelines, and procedures to enhance coordinated school health programs.

(7) Promoting quality assurance in school health services by initiating and coordinating a quality assurance program that includes needs assessment, data collection and analysis, and evidenced-based practices.

(8) Initiating, participating in, and using research studies related to a coordinated school health program, the health needs of children and youth, school nursing practice, and related issues.

(9) Additional school-based health efforts available to local educational agencies through the California Health and Human Services Agency and its offices and departments.

(10) Working with the State Department of Public Health in supporting the School-Based Health Center Support Program pursuant to Article 10 (commencing with Section 124174) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code.

(b) The office shall advise the department on opportunities for effective coordination between health and education systems at the state, regional, and local levels to advance school-based health programs, and on strategies to leverage school-based Medi-Cal programs to sustain school-based health services.

(c) The office shall collaborate with the local educational agency selected to provide guidance around Medi-Cal billing pursuant to Section 49422.

(d) The office may provide technical assistance to local educational agencies on matters such as expanding services, simplifying the administration of school-based health programs, and increasing local educational agency participation in, and maximizing allowable federal financial participation in, the school-based health programs.

(e) The office shall assist in the development of the telehealth guidelines required pursuant to Section 49429.

(f) The office shall provide technical assistance, outreach, and informational materials to local educational agencies on allowable services and on the submission of claims. The office shall not otherwise provide informational materials related to the State Department of Health Care Services’ school-based health programs that have not been approved by the State Department of Health Care Services, as the State Department of Health Care Services is the sole state agency with authority from the federal Centers for Medicare and Medicaid Services to define allowable services and submit claims for federal matching funds.

(g) The office shall oversee the School Health Demonstration Project established pursuant to Section 49421.

(h) The office may form, or participate in, advisory groups for technical assistance and other purposes as deemed necessary.

(i) To the extent necessary, the State Department of Health Care Services shall make available to the office any information on other school-based dental, health, and mental health programs, and school-based health centers, that may receive Medi-Cal funding.

(j) (1) This section shall not prohibit the department from using an existing branch or division within the department to serve as the office, in lieu of establishing a new office, for purposes of implementing this section.

(2) This section shall not limit or modify Section 14132.06 of the Welfare and Institutions Code.

SEC. 3.

 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 a School-Based Health Center Support Program.

(b) (1) “School-based health center” means a student-focused health center or clinic that meets all of the following conditions:

(A) Is located at or near a school or schools.

(B) Is organized through school, community, and health provider relationships.

(C) Provides age-appropriate, clinical health care services onsite by qualified health professionals.

(2) A school-based health center may provide primary medical care, behavioral health services, or dental care services onsite or through mobile health or telehealth.

(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. 4.

 Section 124174.2 of the Health and Safety Code is amended to read:

124174.2.

 (a) The department, in cooperation with the Office of School-Based Health Programs in the State Department of Education, shall establish a School-Based Health Center Support Program.

(b) The program, in collaboration with the State Department of Education, shall perform the following program functions:

(1) Provide technical assistance to school-based 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, health equity, oral health, behavioral health, 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-based 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, state demonstration projects or incentive programs, and available federal or foundation grant moneys.

(c) The department shall consult with interested parties and appropriate health and education stakeholders, including the California School-Based Health Alliance and representatives of youth and parents, in carrying out its responsibilities under this article.

SEC. 5.

 Section 124174.3 of the Health and Safety Code is amended to read:

124174.3.

 (a) The department shall establish standardized data collection procedures and collect data specified in subdivision (c) from school-based health centers on an ongoing basis. School-based health centers shall report data to the department only to the extent that state funding is provided to school-based health centers under the program.

(b) The data collected pursuant to this section shall be submitted in a format determined by the department in accordance with applicable state and federal requirements for confidentiality and protected health information.

(c) Data collected pursuant to this section shall include the following:

(1) The name of the primary contact person, telephone numbers, including facsimile physical address, and the email address, if applicable, for each school-based health center.

(2) The annual number of schoolage children receiving health services or mental health services from the school-based health center.

(3) The type and volume of services provided by the school-based health centers.

(4) The funding mechanisms used by the school-based health centers.

(5) Information on other programs offered by school-based health centers with an emphasis on preventative health services that address health issues unique to schoolage children, including, but not limited to, childhood obesity, asthma, immunizations against communicable diseases, and child and adolescent mental health disorders.

(d) This section shall be implemented only to the extent funds are appropriated for this purpose in the Budget Act or pursuant to the enactment of legislation subsequent to the addition of this section.

SEC. 6.

 Section 124174.4 of the Health and Safety Code is amended to read:

124174.4.

 The Office of School-Based Health Programs in the State Department of Education, in collaboration with the department, shall perform the following functions:

(a) Coordination of programs within the State Department of Education that support school-based health centers.

(b) The provision of technical assistance to facilitate and encourage the establishment, retention, and expansion of school-based health centers in local educational agencies. For purposes of this subdivision, “technical assistance” may include the provision of information to local educational agencies and other entities regarding the utilization of facilities, liability insurance, cooperative agreements with community-based providers, and other issues pertinent to school-based health centers.

SEC. 7.

 Section 124174.5 of the Health and Safety Code is repealed.

SEC. 8.

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

124174.5.

 The department shall establish a grant program within the School-Based Health Center Support Program to provide technical assistance, and funding for the expansion, renovation, and retrofitting of existing school-based health centers, and the development of new school-based health centers, in accordance with the following procedures and requirements:

(a) A school-based health center receiving grant funds pursuant to this section shall meet or have a plan to meet all of the following requirements:

(1) Provide primary medical care. The health center may also provide other health care services, including behavioral health, dental care, health education, and related services in response to community needs.

(2) Strive to provide a comprehensive and integrated set of health care services, provided or supervised by licensed or credentialed professionals, which may include 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 or credentialed 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-based 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) Substance use disorder services, including education, prevention, screening, early interventions, counseling, and referral to treatment services.

(J) 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, including, but not limited to, group and classroom education, schoolwide prevention programs, and community outreach strategies within the school’s Multi-Tiered System of Support or other similar framework employed by the local educational agency.

(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) Strive to integrate the school-based health center in the school or local educational agency’s community school model, if applicable.

(6) 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, 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-based 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-based health center serve as a substitute for a school nurse employed by a local educational agency.

(7) 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 integration of services into the school environment.

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

(9) 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.

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

(11) Facilitate transportation between the school and the school-based health center if the health center is not located on school or school district property.

(b) Planning grants shall be available in amounts between fifty thousand dollars ($50,000) and one hundred thousand dollars ($100,000), inclusive, for up to a 24-month period to be used for the costs associated with assessing the need for a school-based health center in a particular community or area, and developing the partnerships necessary for the operation of a school-based 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-based 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 or private health care coverage 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-based 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 three hundred thousand dollars ($300,000) and eight hundred fifty thousand dollars ($850,000), inclusive, for a three-year period for the purpose of establishing a school-based health center. Grant funds may be used to cover a portion or all of the costs associated with designing, retrofitting, renovating, constructing, or buying a facility or mobile health unit, for medical equipment and supplies for a school-based health center, or for personnel costs at a school-based health center. Preference will be given to proposals that include a plan for cost sharing among local educational agencies, health providers, and community organizations or that identify match funding for facilities construction and renovation costs. Preference will be given to proposals that include plans to provide integrated primary medical care and behavioral health services. 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-based 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 district and the school-based health center.

(3) Have a mechanism, described in writing, to coordinate services to individual students among school and school-based 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-based 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-based health center is not yet able to provide these services due to resource limitations, the school-based 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) Expansion grants shall be available in amounts between one hundred fifty thousand dollars ($150,000) and three hundred thousand dollars ($300,000), inclusive, for up to a three-year period for the purpose of renovating and improving an existing school-based health center or enhancing and expanding programming at a fully operational school-based health center, including adding physical health, oral health, or behavioral health services. Preference will be given to proposals that increase access to comprehensive health care services at the school-based health center by adding staff or services or expanding the facility. Applicants for expansion grants offered pursuant to this subdivision shall be required to meet all of the criteria described in subdivision (c), in addition to all 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, managed care health plans, or county mental health plans.

(3) The applicant shall develop a plan to sustain expanded services at the school-based health center after the grant period.

(e) The department shall award technical assistance grants through a competitive bidding process to qualified contractors to support grantees receiving grants under subdivisions (b), (c), and (d). A qualified contractor means a vendor with demonstrated capacity in all aspects of planning, facilities development, startup, and operation of a school-based health center.

(f) The department, in collaboration with the Office of School-Based Health Programs in the State Department of Education, 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 school-based health centers serving any of the following:

(1) Areas designated as federally medically underserved areas or with medically underserved populations or areas with a shortage of health professionals.

(2) Areas experiencing health disparities in child and adolescent access to primary care, behavioral health, preventive health, or oral health services.

(3) Schools in which more than 55 percent of pupils served are unduplicated pupils, as defined in Section 42238.02 of the Education Code.

(g) 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-based health centers, and describe the challenges and lessons learned in creating successful school-based health centers. The evaluator shall use data collected pursuant to Section 124174.3, if the data are available, and work in collaboration with the School-Based Health Center Support Program. The department shall post the evaluation on its internet website.

(h) 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.