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MOORPARK CITY COUNCIL
AGENDA REPORT
TO:
Honorable
City Council
FROM:
Deborah S.
Traffenstedt,
City Clerk
DATE: September 24, 1999 (CC Meeting of 9/29/99)
SUBJECT: Consider City's Position on AB -1363
BACKGROUND
Councilmember Evans has requested that this item be included on
the City Council's Special Meeting agenda, so as to allow the
Council to consider whether or not to take a City position on
this legislation. Attached to this report is the current
status, history, and text of AB -1363.
STAFF RECOMMENDATION
Direct staff as deemed appropriate.
Attachments: AB -1363 Status, History and Text
000053
AB 1363 Assembly Bill - Status
CURRENT BILL STATUS
MEASURE : A.B. No. 1363
AUTHOR(S) Davis.
TOPIC School health centers.
+LAST AMENDED DATE 08/31/1999
TYPE OF BILL :
Inactive
Non- Urgency
Non - Appropriations
Majority Vote Required
Non- State - Mandated Local Program
Fiscal
Non -Tax Levy
LAST HIST. ACT. DATE: 09/14/1999
LAST HIST. ACTION Enrolled and to the Governor at 3 p.m.
31 DAYS IN PRINT 03/29/1999
TITLE An act to add Article 2.1 (commencing with Section
123665) to Chapter 3 of Part 2 of Division 106 of the
Health and Safety Code, and to amend Section 12693.37 of
the Insurance Code, relating to child health.
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AB 1363 Assembly Bill - History Page 1 of 1
COMPLETE BILL HISTORY
BILL NUMBER : A.B. No. 1363
AUTHOR Davis
TOPIC School health centers.
TYPE OF BILL :
Inactive
Non - Urgency
Non - Appropriations
Majority Vote Required
Non - State - Mandated Local Program
Fiscal
Non -Tax Levy
BILL HISTORY
1999
Sept. 14 Enrolled and to the Governor at 3 p.m.
Sept. 7 Senate amendments concurred in. To enrollment. (Ayes 41. Noes 36.
Page 3951.)
Sept. 2 In Assembly. Concurrence in Senate amendments pending. May be
considered on or after September 4 pursuant to Assembly Rule 77.
Sept. 2 Read third time, passed, and to Assembly. (Ayes 22. Noes 15. Page
2860.)
Sept. 1 Read second time. To third reading.
Aug. 31 Read third time, amended. To second reading.
Aug. 26 Read second time, amended, and to third reading.
Aug. 25 From committee: Amend, and do pass as amended. (Ayes 7. Noes
5 ) .
July 15 From committee: Do pass, and re -refer to Com. on APPR.
Re- referred. (Ayes 6. Noes 2.).
July 7 Read second time, amended, and re- referred to Com. on INS.
July 6 From committee: Amend, do pass as amended, and re -refer to Com. on
INS. (Ayes 6. Noes 2.).
June 21 In committee: Set, second hearing. Hearing canceled at the request
of author.
June 21 From committee chair, with author's amendments: Amend, and re -refer
to committee. Read second time, amended, and re- referred to Com.
on H. & H.S.
June 8 In committee: Set, first hearing. Hearing canceled at the request
of author.
May 26 Referred to Coms. on H. & H.S. and INS.
May 20 In Senate. Read first time. To Com. on RLS. for assignment.
May 20 Read third time, passed, and to Senate. (Ayes 42. Noes 30. Page
1763.)
May 17 Read second time. To third reading.
May 13 From committee: Do pass. (Ayes 14. Noes 7.) (May 12).
Apr. 21 From committee: Do pass, and re -refer to Com. on APPR.
Re- referred. (Ayes 9. Noes 5.) (April 20).
Apr. 14 In committee: Hearing postponed by committee.
Naar. 23 Referred to Com. on HEALTH.
Mar. 1 Read first time.
Feb. 27 From printer. May be heard in committee March 29.
Feb. 26 Introduced. To print.
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BILL NUMBER: AB 1363 ENROLLED
BILL TEXT
PASSED THE ASSEMBLY SEPTEMBER 7, 1999
PASSED THE SENATE SEPTEMBER 2, 1999
AMENDED IN SENATE AUGUST 31, 1999
AMENDED IN SENATE AUGUST 26, 1999
AMENDED IN SENATE JULY 7, 1999
AMENDED IN SENATE JUNE 21, 1999
INTRODUCED BY Assembly Member Davis
FEBRUARY 26, 1999
An act to add Article 2.1 (commencing with Section 123665) to
Chaoter 3 of Part 2 of Division 106 of the Health and Safety Code,
and to amend Section 12693.37 of the Insurance Code, relating to
child health.
LEGISLATIVE COUNSEL'S DIGEST
AB 1363, Davis. School health centers.
Existing law establishes the Healthy Families Program to arrange
for the provision of health services to eligible children. This
program is managed by the Managed Risk Medical Insurance Board.
Existing law reouires the board to contract with a broad range of
health plans in an area, if available, to ensure that subscribers
have a choice from among a reasonable number and types of competing
health plans. Existing law requires the board in each geographic
area to designate a community provider plan that is the participating
plan with the highest percentage of traditional and safety net
providers and to give a family contribution discount to subscribers
selecting that plan.
This bill would authorize the board to include school -based health
centers as traditional and safety net providers that meet certain
requirements. The bill would provide guidelines for the creation of
school -based and school- linked health centers, providing
comprehensive primary care to students in public schools. The bill
would establish requirements and guidelines for those providers, and
would set forth student rights and responsibilities.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature recognizes the growing importance
of school -based health clinics as an integral part of expanding
access to health care for children.
(b) The Legislature supports the provision of guidelines, as
outlined in this act, for any school that may enter into contracts
with health care providers.
SEC. 2. Article 2.1 (commencing with Section 123665) is added to
Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, to
read:
Article 2.1. School Health Centers
123665. The following definitions shall govern the construction
of this article, unless the context requires otherwise.
(a) "School -based health center" means a center that is dedicated
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to providing a comprehensive, primary care program offering age
appropriate primary medical, mental health, disease prevention, and
health education services, primarily providing care onsite, and may
include the provision of linkages and referrals to primary care
providers. They may serve two or more nonadjacent schools.
(b) "School- linked health center" means a primary care program
offering age appropriate primary medical, mental health, disease
prevention, and health education services and is located nearby one
or more schools, but not on a school campus. It may enter into
formal agreements with one or more schools regarding, among other
things, referral, confidentiality, and feedback. Services provided
by a school- linked health center based on local need and expertise
may be made available by referral.
(c) "School health center" includes any school -based health center
and school- linked health center participating under Section. 12693.37
of the Insurance Code.
123666. School health center levels include the following:
(a) Level I: Capable of performing as a primary care provider 365
days per year, or formally linked with an organization that can
provide primary care 365 days per year.
(b) Level II: Provides comprehensive services, including medical
care and treatment and mental health care, but not able to act as
primary care provider all year.
(c) Level III: Provides limited services, including direct
medical treatment of illness and injuries, on a part -time, regularly
scheduled basis.
(d) Level IV: Provides limited direct services such as counseling
and Child Health and Disability Prevention Program examinations and
immunizations, on a regularly scheduled, part -time basis, but does
not provide medical care or treatment of illnesses.
(e) Level V: Primarily provides information and referral
services, with occasional sessions for Child Health and Disability
Prevention Program testing, sports physicals, or immunizations.
123667. A school health center shall implement a comprehensive
primary care program offering medical, mental health, health
promotion, and disease prevention services. A school health center
shall offer a comprehensive range of preventive and primary care
services.
123668. It is the intent of the Legislature that basic medical
services provided by a school health center may include, but not be
Limited to, all of the following:
(a) Well -child or adolescent examinations, consisting of a
comprehensive health history, including an assessment of high -risk
behavior for adolescents, complete physical assessment, screening
procedures, and anticipatory guidance appropriate to age.
(b) Immunizations.
(c) The services specified by the Child Health and Disability
Prevention Program.
(d) The services specified by the guidelines for adolescent
preventive services prepared by the American Medical Association, as
appropriate.
(e) Diagnosis and treatment of acute illness and injury.
(f) Basic diagnostic laboratory tests, including pregnancy tests.
(g) Prescriptions or dispensing of commonly used medications for
identified health conditions, in accordance with medical practice and
pharmacy practice statutes.
(h) Acute management and ongoing monitoring of chronic conditions,
in conjunction with a student's regular doctor, such as asthma,
diabetes, and seizure disorder.
(i) Individual health education and anticipatory guidance for
students and parents.
(j) Linkages and referrals to primary care providers, when
appropriate.
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123669. A school health center may provide basic mental health
services that may include all of the following:
(a) Mental health assessment.
(b) Individual, group, and family counseling.
(c) Consultation with school administrators, parents, teachers,
and students.
(d) Crises intervention.
123669.1. If offered, reproductive health services for
adolescents may include any or all of the following:
(a) Information on human sexuality including abstinence.
(b) Pelvic examinations.
(c) Diagnosis and treatment of sexually transmitted diseases.
(d) Testing and counseling for human immunodeficiency virus or
acquired immune deficiency syndrome.
(e) Prescribing, dispensing, or referring for birth control,
including condoms.
123669.2. Drug and alcohol services, when offered by a school
health center, may include:
(a) Assessment of student substance abuse problems.
(b) Prevention, intervention, and treatment services.
123669.3. Other specialized services for adolescents may include:
(a) Treatment of acne, weight management, and other common
adolescent concerns.
(b) Violence prevention and intervention services utilizing
assessment and direct counseling.
123670. (a) School health center services shall be easily
accessible and designed to eliminate or diminish barriers to health
care for students, and to encourage participation by parents or
guardians. Local providers and school districts shall determine
their parental consent policy in accordance with state law.
(b) A school health center shall establish procedures for the
availability of primary care providers, and access to routine,
urgent, and emergency care, telephone appointments, and advice.
Performance on these dimensions of access shall be assessed against
the standards outlined in Section 123671.
123671. A school health center shall operate each day, unless
otherwise determined by local need, when school is in session and at
regularly scheduled hours in a manner that:
(a) Ensure services are accessible either onsite or through formal
referral.
(b) Include before or after school hours at least one day per
week.
(c) To the maximum extent possible, enables participation of
working parents or guardians in the health care of their child.
(d) To the maximum extent possible, permits scheduled appointments
that do not unnecessarily interrupt the student's classroom time.
(e) Publicly notice available services in a public location and in
multiple languages, as appropriate for the student population.
123671.1. Appointments shall be made available at convenient
hours and according to the following guidelines:
(a) Immediate response to emergency or crisis situations including
calling "911."
(b) Urgent appointments whenever possible within the same day or
referred to a more readily available provider.
123671.2. Each school health center shall have in place and shall
publicize telephone answering methods that notify students and
parents or guardians of where and how to access 24 -hour backup
medical and mental health services when the school 'health center is
not open. Appropriate referral arrangements to ensure continuity of
services are made for afterhours and when the school health center is
closed.
123671.3. A school health center, in response to the cultural and
:language needs of the student body, shall ensure the school health
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center staff is educated in cultural diversity, and that translation
services, appropriate to the major school population, are provided by
staff or interpreters in a manner that ensures confidentiality.
123671.4. A school health center shall not deny access to health
care services to students based upon insurance status or ability to
pay.
123671.5. A school health center shall not discriminate with
regard to race, color, religion, national origin, age, handicap, sex,
or sexual orientation.
123671.6. A school health center shall act to ensure
confidentiality of specified student information and records are
pro- ected.
123671.7. A school health center shall have a formal process in
place to assess student and parent satisfaction with the services
provided. Assessment methods may include confidential survey
instruments, telephone surveys, and focus groups.
123672. A school health center shall be user - friendly, providing
a private, safe, confidential, and comfortable environment for the
students it serves. The floor plan shall include walls and closable
doors for examination, treatment, and counseling rooms. School
health centers shall comply with appropriate licensing agencies.
123672.1. A school health center shall be accessible to
individuals with disabilities and conform to requirements of the
An;ericans with Disabilities Act of 1990.
123672.4. A school health center shall have current fire and
building safety certificates. Electrical and mechanical equipment
shall be in safe working order. If located within a school building
or other building with inspection certificates, the school 'health
center is not required to seek independent safety certificates.
123672.5. A school health center shall be in compliance with laws
and regulations governing health facilities.
(a) A school health center staff shall have the training,
supplies, and equipment necessary to follow universal precautions as
defined by the Occupational Safety and Health Administration and
other sources as applicable, including environmental sanitation,
cleaning and sterilization of equipment and supplies, and disposal of
hazardous and medical waste.
(b) A school health center shall comply with laws and regulations
regarding reportable diseases and conditions and employee health
practices.
(c) The school health center shall comply with the federal
Clinical Laboratory Improvement Amendments of 1988 (42 U.S.C. Sec.
263a) and regulations adopted pursuant thereto regarding laboratory
operations.
123672.6. To ensure student confidentiality and communication
with backup providers and community resources, a school health center
shall be equipped with sufficient computer, telephone, photocopy,
and fax capabilities.
123673. Health care for students in a school health center shall
be provided by licensed, registered, or certified health
professionals.
123673.1. Agencies sponsoring school health centers shall have
written policies and procedures for the credentialing process that
include the original credentialing, recredentialing, recertification,
or reappointment of primary care providers who fall under its scope
of authority and action.
123673.2. The initial credentialing process shall be ongoing and
up to date. At a minimum, the agencies sponsoring school health
centers shall obtain and review verification of the following from
primary sources:
(a) A current, valid license to practice.
(b) Clinical privileges in good standing at the hospital
designated by the practitioner as the primary admitting facility, as
applicable.
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(c) A valid drug enforcement agency or controlled dangerous
substances certificate as applicable.
(d) Graduation from an accredited medical or professional school
and completion of a residency or board certification, as applicable.
(e) Work history.
(f) Current adequate malpractice insurance according to community
norms.
(g) Professional liability claims history.
(h) Fingerprinting as required by state law.
123673.3. An applicant for employment in a school health center
shall complete an application for employment and credentialing that
includes a release of information authorization signed by the
applicant. The applicant shall attest to the correctness and
completeness of the application. The employment application shall
include a statement by the applicant regarding all of the following:
(a) Reasons for any inability to perform the essential functions
of the position, with or without accommodation.
(b) Lack of impairment due to chemical dependency or substance
abuse.
(c) History of loss of license or felony convictions, or both.
(d) History of limitation of privileges or disciplinary activity.
123673.4. Provider agencies sponsoring school health centers may
request information on the practitioner from recognized monitoring
organizations. The organizations may include, but are not limited
to:
(a) The National Practitioner Data Bank or other appropriate,
available data bank.
(b) The State Board of Medical Examiners, Board of Nursing,
Department of Regulatory Agencies, or other available, appropriate
resources.
(c) Medicare and Medi -Cal agencies.
123673.5. School health centers shall have a process for the
periodic verification of credentials, including recredentialing,
reappointment, or recertification, that is ongoing and up to date.
The process shall be implemented at least every two years.
123673.6. At a minimum, the recredentialing, recertification, or
reappointment process shall include verification from primary sources
of.
(a) A current, valid license to practice.
(b) Clinical privileges in good standing at the hospital
designated by the practitioner as the primary admitting facility, as
applicable.
(c) A valid Drug Enforcement Agency or Controlled Dangerous
Substances certificate as applicable.
(d) Graduation from an accredited medical or professional school.
(e) Completion of a residency or board certification, as
applicable. Verification may be through review of source already on
file at the sponsoring agency or agencies.
(f) Current, adequate malpractice insurance according to community
norms.
(a) Professional liability claims history.
(h) The recredentialing process includes a current statement by
the applicant regarding lack of impairment due to:
(1) Physical and mental health.
(2) Chemical dependency or substance abuse.
123673.7. If a school health center directly provides mental
health or substance abuse treatment services, providers of these
services shall meet applicable licensure or certification regulations
and undergo all appropriate credentialing procedures. The providers
shall have the experience or education necessary to provide
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appropriate services to the school population.
123673.8. If a school health center contracts with any other
agency for the provision of services, including but not limited to,
mental health or substance abuse, the contracted agency shall be
licensed, if providers of the services are subject to licensure. The
contracts shall incorporate provider credentialing standards
outlined in this article and the contractor shall be responsible for
ensuring that the standards are met. The subcontractor is subject to
performance review and quality audits.
123673.9. A school health center shall ensure that staff
participate in professional development programs to update and
enhance their knowledge of child and adolescent health, diversity,
and other issues as identified by each school health center. This
participation shall be documented on an annual basis.
123673.1_0. Ail school health center staff shall be trained in
emergency care, including first aid, cardiopulmonary resuscitation,
or basic and advanced life support, and the Heimlich maneuver. Each
school health center shall have a written emergency plan for
disasters and for crisis interventions that is consistent with the
school's plans and coordinated with the community emergency response
system. School health center staff shall be trained in implementing
the plan.
123674. A school health center shall be organized and
administered in a manner that ensures it serves the health and health
related needs of students in a high quality and cost - effective
manner, promotes easy access to services during the school year,
assists students in learning how to utilize services within and
outside the school health center, and works with the student's
primary care provider and insurer or managed care organization to
facilitate continuity of care.
123675. Each school health center shall have an organizational
chart reflecting clear lines of authority for school health center
administration, the role of the backup provider, managed care
organizations, and the school. This chart shall be reviewed
periodically and revised by the school health center as needed.
123675.1. Onsite school health center staff may include:
(a) Nurse practitioner or physician assistant.
(b) Medical director or physician preceptor (family practice,
pediatrician, or adolescent specialist).
(c) Clinically trained mental health practitioner (master's level
social worker, psychologist, psychiatric nurse, marriage, family, and
child counselor, or mental health staff working toward a master's
degree).
(d) Medical receptionist, secretary, or medical support staff
(health aide, medical assistant, or licensed practical or vocational
nurse).
(e) A school health center administrator, who may be located
offsite, who shall act as a liaison with sponsoring agencies, and who
shall be responsible for overall management of one or more school
health centers.
123675.2. School health center staff positions, other than those
specified in Section 123675.1, may include:
(a) School nurse.
(b) Health educator.
(c) Dental hygienist, dentist, or dental assistant.
(d) Registered dietician or nutritionist.
(e) Substance abuse prevention- intervention specialist at middle
or high schools.
(f) Other Healthy Start staff.
123676. A school health center shall keep written clinic policies
and procedures onsite regarding parental consent for treatment
easily referenced by school health center staff that provide for:
(a) Written permission of a parent or guardian.
(b) Incorporating the rights of minors to consent to their own
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treatment as provided for by law, including consent for testing and
treatment of sexually transmitted diseases, diagnosis and treatment
of substance abuse, mental health services, and family planning
counseling and services.
(c) Written permission from parent or guardian or student, as
appropriate, to share information with the student's primary care
provider, managed care organization, insurer, and school nurse.
123676.1. School health center enrollment and registration
procedures provide for effective collection of information regarding
students' third -party billing resources and primary care provider.
123676.2. A school health center's staff shall make every effort
to involve the student's family in the health care provided to the
student, as is age appropriate, and with the student's consent as
necessary.
123676.3. A school health center shall operate under written
adnin_strative policies and procedures. The policies shall
accurately describe the services provided, including job
descriptions, qualifications, responsibilities, and supervision of
all school health center personnel. A school health center shall
ensure that staff are assigned responsibilities consistent with their
education and experience, and are supervised, periodically
evaluated, and knowledgeable of the policies and procedures of the
school health center and its parent organizations.
123676.5. A school health center shall provide medical and mental
health care in accordance with written medical and mental health
protocols, that include protocols for diagnosing, treating, and
managing medical and mental health emergencies, and for dispensing of
medications. The protocols shall be written in collaboration with
the provider agencies sponsoring the school health center and the
school district, as appropriate to meet state standards.
123676.6. A school health center shall be integrated into the
school district and school environment, with all parties
demonstrating a commitment for mutual respect.
(a) (1) There shall be a formal memorandum of understanding
between the sponsoring provider agencies and the school district or
school building administration.
(2) The memorandum of understanding shall outline the
collaborative relationship between the school health center staff and
school personnel.
(b) Meetings between the school district or school building
administration and the school health center or its sponsoring
provider agencies shall convene on a regular basis.
(c) The school district and sponsoring provider agencies may
perform joint interviews in hiring school health center staff.
(d) The school may assist the school health center in providing
health services by:
(1) Facilitating parental consent for school health center
services.
(2) Helping to obtain information on insurance status.
(3) Providing in -kind school or school health staff.
(4) Facilitating access to school health information.
(5) Establishing a community advisory committee pursuant to
Section 123681.
(6) Maintaining student confidentiality.
(7) identifying at -risk students and those in need of care, and
referring them to appropriate services.
(8) Integrating related school and school health center service
programs.
(9) Allowing medical and mental health appointments during school
hours.
(e) In those schools in which there is a Healthy Start program, an
existing school health center shall be an integral part of Healthy
Start.
(f) The school may assist the school health center with facility
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issues by:
(1) Providing adequate space at no cost, which may include
renovations to the space.
(2) Maintaining clinic space, utilities, and janitorial services.
(3) Providing confidential access to copiers, fax machines,
telephones, and computers.
(g) The relationship of the school health center with the school
involves routinely publicizing school health center services to the
student body and families at least twice a year. Methods for
marketing the school health center services may include:
(1) Contacts during the school registration process.
(2) PTA or PTSA meeting attendance.
(3) Mailouts, send -home notes, and intercom announcements.
(4) Bulletin boards and posters.
(5) Student newspapers and newsletters.
(6) Referrals from teachers and other staff to school health
center services.
(7) School health center staff attendance at appropriate faculty
meetings.
123677. A school health center shall be in compliance with laws
and regulations governing health care programs, including child abuse
reporting requirements.
123678. A school health center shall collaborate with local
public and private providers, such as public health, community
physicians, social services, and mental health, to colocate their
staff and other resources in the school health center. Colocation of
related services within the school health center may be implemented
to eliminate duplication of community services and remove access
barriers to prevention and early intervention services.
123678.1. To the maximum extent possible, a school health center
shall seek reimbursement for services from all sources, including
Medi -Cal, managed care plans, and other third -party payers. Each
school health center shall have procedures in place to avoid
duplicate billing.
123678.2. A school health center shall have written policies and
procedures for billing third -party payers and charging students or
families.
123678.3. If reimbursed by a student's insurer, a school health
center shall adhere to utilization management procedures and
pharmaceutical formularies as required.
123678.4. A school health center shall determine charges based on
current utilization, services, costs, staffing patterns, and hours
of operation.
123678.5. If a school health center charges students or their
families for services, the charges shall be based on ability to pay,
or otherwise calculated at levels that do not create financial
barriers to care.
123679. A school health center may develop a collaborative
re ationship with other health care providers, insurers, managed care
organizations, the school nurse and school health program, students,
and parents or guardians, with the goal of reducing duplication of
services, or fragmented or discontinuous care.
123680. A school health center may coordinate care and the
exchange of information necessary for the provision of proper health
care between the school 'health center and a student's primary care
provider or managed care organization. A school health center shall
adopt written policies addressing coordination of care that include
student confidentiality, and which shall be honored by managed care
organizations.
123680.1. A school health center may operate in accordance with a
written agreement for referring students to community -based health
care providers when the school health center is not able to provide a
service required by the student. The agreement shall include a
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mechanism for linking referral information between the provider and
the school health center about the outcomes of a referral.
123680.2. A school health center shall refer students enrolled in
a managed care organization who require specialty medical or
surgical services to their primary care providers or managed care
organizations to obtain a referral to a specialist. The school
health center shall document in the student's record that the
referral was made and followup on the outcome of a referral.
123680.3. A school health center may ensure appropriate
communication with each enrolled student's primary care provider or
managed care organization, if applicable, for all general medical
visits. The school health center shall obtain the student's or
parent's written permission to share information with the primary
care provider. Communication for urgent situations shall take place
by telephone or fax. Any referral to a specialist shall be
coordinated through a student's primary care provider or managed care
organization, as appropriate. There shall be procedures in place to
protect confidential information.
123681. A school health center may establish or participate in a
community advisory committee that holds at least two meetings a year
to obtain community input on the design of services, the integration
of the school health center services with community resources, and
student health center policy and program matters. The committee
shall include, but is
not limited to, school administrators, school nurse and school health
staff, parents, teachers, students, and representatives of local
agencies which traditionally relate to the school. The advisory
committee shall have a parent majority. Those parents chosen for
membership on the committee shall have a child or children who attend
the school, or are in a feeder pattern served by a school health
center. The functions of the committee may be performed by an
existing schoolwide governance or advisory group.
123681.1. A school health center's staff shall work with school
staff to coordinate care of individual students, meet the needs of
groups of students at risk for specific health problems, address the
health and health education needs of the entire student population,
and act as a resource regarding school staff health issues.
123681.2. A school health center shall promote collaboration and
the exchange of information related to meeting a student's health
needs with school staff. The exchange of information shall be
consistent with all applicable state confidentiality and consent
requirements. School staff shall include, but are not limited to:
(a) School nurses.
(b) Teachers and specialty program staff.
(c) School administrators.
(d) School psychologists.
(e) Counselors.
123681.3. When the school has a Healthy Start program, the school
health center staff shall work closely with that program to maintain
communication, a smooth flow of referrals between the various
programs, and to avoid duplication of efforts.
123681.4. A school health center's staff shall respond to
referrals from the school health staff on a timely basis through an
agreed upon method of communication.
123681.5. A school health center shall provide written
authorization to the school nurse for medications to be taken during
school hours.
123681.6. A school health center shall inform the school nurse of
in-nunizations given to students so that the dates can be entered on
the student's immunization record.
123681.7. A school health center staff shall participate in
appropriate school programs and activities to provide comprehensive
health education to students, such as health fairs, classroom
presentation, and other special events, as time permits.
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123681.8. A school health center shall develop and distribute
written materials to the community and perform other promotional
activities that define and promote its goals and services. The
materials may be translated into other languages, if appropriate.
123681.9. A school health center shall encourage students to
assume responsibility for their own health care by providing
information about the appropriate use of school health center
services and community resources.
123682. A school health center shall develop and implement a
quality management and improvement program that monitors and
evaluates the appropriateness and effectiveness of the services
provided.
123683. A school health center may collect and aggregate data on
students enrolled to use its services, including demographics,
service utilization, diagnosis, and health status. Data collection
and aggregation shall occur on a regular basis, either quarterly or
at intervals deemed appropriate by the school health center and its
sponsors. This information shall be used to assess the quantity as
well as the quality of services provided.
123684. A school health center shall establish measurable
objectives relating to quality of service and improved health status,
using established baselines for performance. The objectives may
include a timeframe.
123684.1. A school health center shall assess its performance in
the use of preventive health services through the quality management
and improvement program. At least annually, each school health
center shall monitor and evaluate a minimum of two of the following
preventive services, and take action to improve the use of preventive
services and health outcomes for students:
(a) Childhood and adolescent immunization.
(b) Risk factor screening, testing, or counseling related to:
(1) Tobacco use.
(2) Nutrition.
(3) Exercise.
(4) Weight.
(5) Hypertension.
(6) Motor vehicle injury.
(7) Injury prevention and safety.
(8) Unintended pregnancy, including abstinence and pregnancy
prevention.
(9) Early and adequate prenatal care.
(10) Parenting education.
(11) Sexually transmitted diseases.
(12) Human immunodeficiency virus, including testing and
counseling.
(13) Alcohol and other substance abuse screening and prevention.
(14) Mental health screening and counseling, including screening
for sexual abuse and assaults.
(15) Psychosocial factors, such as social support and school
performance.
(16) Interpersonal violence.
(17) Dental health.
(18) Hyperlipidemia.
(19) Tuberculosis testing.
123684.2. Quality improvement may be measured through a
computerized system for tracking student health information, medical
record review, or a combination of both methods.
123684.3. A school health center shall inform all students about
the health promotion and preventive health services available to them
and encourage students to seek appropriate services.
123684.4. One person, either at the school health center or the
sponsoring provider agency, shall be designated by the school health
center as the quality management and improvement coordinator.
123684.5. A school health center shall adopt written specified
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quality assurance policies and procedures that include all of the
following:
(a) Provider credentials and maintenance pursuant to Section
123673.
(b) Professional continuing education.
(c) Preemployment procedures.
(d) Staff and program evaluation.
(e) Complaint and incident review.
(f) Corrective actions and timeframes.
123685. (a) A school health center shall establish a health
record system that provides for consistency, confidentiality, storage
and security of records for documenting significant student health
information, and the health care services delivered to address these
problems.
(b) A school health center's health records shall be maintained in
a manner that is current, detailed, confidential, organized, and
permits effective student care and quality review.
123686. School health center health records shall document
student health needs and care from the time of enrollment in the
school health center. A computerized tracking system may be used to
record information.
123686.1. School health center health records shall be in
conformity with good professional medical practice and appropriate
health management.
123686.2. As necessary, information regarding a patient's
previous health history prior to enrollment in the school health
center, may be requested and shall be included in the school health
center's health record. Examples may include past medical and
psychosocial history, serious accidents, operations, illnesses,
prenatal care, and birth, and immunization records.
123687. A school health center shall maintain a confidential
health record for each student receiving services at the school
health center. The school health center may separately maintain
records in need of a higher degree of confidentiality including, but
not limited to, mental health services, substance abuse treatment,
and human immunodeficiency virus testing records. Access to the
records shall be restricted to designated perscnnel that may include
the primary care provider.
123687.1. A school health center shall ensure that its health
records are compatible with the medical record system of its
sponsoring provider agencies.
123687.2. A school health center shall lock and store records and
copies of records in a secure manner that protects them from
unauthorized use. The school health center shall have policies in
place for identifying who shall have access to health records.
School health center health records shall be maintained separately
from school records.
123688. The rights and responsibilities of enrolled student
members and their families shall be clearly defined in a written
statement and translated into appropriate languages. This written
statement shall be provided at the time of enrollment for review at
the school health center by any interested party.
123688.1. A school health center shall demonstrate its commitment
to treating students in a manner that respects their rights through
a written statement of principles that recognizes the rights of
enrolled students to:
(a) Be provided with information about the school health center,
its services, the staff providing care, and patients' rights and
responsibilities.
(b) Participate in decisionmaking regarding their health care.
(c) Be greeted with respect and recognition of their dignity and
reed for privacy.
(d) Voice grievances regarding the care provided by the school
health center through an official, written procedure.
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123688.2. A school health center shall have a written policy that
addresses students' responsibility for cooperating with those
providing health care services. The written policy shall address
students' responsibility for:
(a) Providing, to the extent possible, accurate information that
the professional staff needs in order to care for the student
appropriately.
(b) Following instructions and guidelines given by those providing
health care services.
123688.3. A school health center shall provide a copy of its
policies on students' rights and responsibilities to all
participating providers and directly to students.
123688.4. A school health center shall inform prospective and
enrolled students and their families about services provided, access
to services, charges, and scheduling. Students and their families
shall be informed that benefits covered and payments required by
their insurer or managed care organization may differ from those of
the school health center.
123688.5. Students shall be provided a written statement that
includes information on the following:
(a) The school health center's policy on referrals for specialty
care.
(b) Provisions for after -hours and emergency coverage.
(c) Benefits and services that are included in the school health
center's services.
(d) Benefits and services that are excluded in the school health
center's services, and procedures for obtaining them.
(e) Charges to enrolled students, if applicable, including policy
on payment of charges and copayments and fees for which the enrolled
student is responsible.
(f) Procedures for notifying those students affected by the
termination of any services or the termination of any service
delivery office or site.
(g) Procedures for voicing complaints or grievances, and for
recommending changes in policies and services.
123688.6. A school health center shall ensure that services
offered are accessible, including, but not limited to, all of the
following:
(a) The points of access to primary care, specialty care, and
hospital services are identified for students.
(b) Students are informed about how to obtain the names,
qualifications, and titles of the professionals providing or
responsible for their care.
123688.7. A school health center shall ensure that the
confidentiality of specified student information and records is
protected, including, but not limited to, the following:
(a) The school health center shall have written confidentiality
policies and procedures that protect the student's and his or her
family's right to privacy.
(b) The school health center shall ensure that offices or sites
have implemented mechanisms that guard against unauthorized or
inadvertent disclosure of confidential information to persons inside
and outside the school health center who should not have access to
that information.
(c) Students shall be offered the opportunity to approve or refuse
the release of identifiable personal information by the school
health center, except when that release is required by law.
123688.8. It is not the intent of the Legislature that the
guidelines contained in this article replace existing licensing
requirements.
SEC. 3. Section 12693.37 of the Insurance Code is amended to read:
12693.37. (a) The board shall contract with a broad range of
health plans in an area, if available, to ensure that subscribers
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have a choice from among a reasonable number and types of competing
health plans. The board shall develop and make available objective
criteria for health plan selection and provide adequate notice of the
application process to permit all health plans a reasonable and fair
opportunity to participate. The criteria and application process
shall allow participating health plans to comply with their state and
federal licensing and regulatory obligations, except as otherwise
provided in this chapter. Health plan selection shall be based on
the criteria developed by the board.
(b) (1) In its selection of participating plans the board shall
take all reasonable steps to assure the range of choices available to
each applicant, other than a purchasing credit member, shall include
olar.s that include in their provider networks and have signed
contracts with traditional and safety net providers.
(2) Participating health plans shall be required to submit to the
board on an annual basis a report summarizing their provider network.
The report shall provide, as available, information on the provider
network as it relates to:
(A) Geographic access for the subscribers.
(B) Linguistic services.
(C) The ethnic composition of providers.
(D) The number of subscribers who selected traditional and safety
net providers.
(c) (1) The board shall not rely solely on the Department of
Corporations' determination of a health plan network's adequacy or
geographic access to providers in the awarding of contracts under
this part. The board shall collect and review demographic, census,
and other data to provide to prospective local initiatives, health
plans, or specialized health plans, as defined in this act, specific
provider contracting target areas with significant numbers of
uninsured children in low - income families. The board shall give
priority to those plans, on a county -by- county basis, that
demonstrate that they have included in their prospective plan
networks significant numbers of providers in these geographic areas.
(2) Targeted contracting areas are those ZIP Codes or groups of
ZIP Codes or census tracts or groups of census tracts that have a
percentage of uninsured children in low- income families greater than
the overall percentage of uninsured children in low- income families
in that county.
(d) In each geographic area, the board shall designate a community
provider plan that is the participating health plan that has the
highest percentage of traditional and safety net providers in its
network. Subscribers selecting that plan shall be given a family
contribution discount as described in Section 12693.43.
(e) The board shall have the discretion to include any
school -based health center as a traditional and safety net provider,
if it meets the definition of a Level I school health center as
defined in subdivision (a) of Section 123666, and the school -based
health center offers services to students without regard to their
ability to pay.
(f) The board shall establish reasonable limits on health plan
administrative costs.
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