H 3771 General Bill, By Cobb-Hunter, D.W. Beatty, A.W. Byrd, Canty, Clyburn, 
Govan, J. Hines, Inabinett, W.D. Keyserling, Lloyd, D.E. McTeer, Moody-Lawrence, 
J.H. Neal, Richardson, T.F. Rogers and J.M. White

Similar(S 606)
 A Bill to amend Title 59, Chapter 65, Code of Laws of South Carolina, 1976,
 relating to attendance of pupils, by adding Article 7 so as to enact the
 School Health Act of 1995 so as to require pre-school health assessments as a
 prerequisite to attending kindergarten or first grade and to provide
 exceptions; and to amend Title 20, Chapter 7, relating to the Children's Code,
 by adding Article 28 so as to direct each school district in conjunction with
 the Department of Health and Environmental Control to convene a school health
 planning committee to assess the health status of children and to develop and
 implement a school-based health services program to complement existing health
 services to be provided for students at the option of the parents and to
 provide for the services to be provided, confidentiality of records, and
 billing and program review procedures.

   03/08/95  House  Introduced and read first time HJ-8
   03/08/95  House  Referred to Committee on Education and Public
                     Works HJ-8

A BILL

TO AMEND TITLE 59, CHAPTER 65, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO ATTENDANCE OF PUPILS, BY ADDING ARTICLE 7 SO AS TO ENACT THE SCHOOL HEALTH ACT OF 1995 SO AS TO REQUIRE PRE-SCHOOL HEALTH ASSESSMENTS AS A PREREQUISITE TO ATTENDING KINDERGARTEN OR FIRST GRADE AND TO PROVIDE EXCEPTIONS; AND TO AMEND TITLE 20, CHAPTER 7, RELATING TO THE CHILDREN'S CODE, BY ADDING ARTICLE 28 SO AS TO DIRECT EACH SCHOOL DISTRICT IN CONJUNCTION WITH THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL TO CONVENE A SCHOOL HEALTH PLANNING COMMITTEE TO ASSESS THE HEALTH STATUS OF CHILDREN AND TO DEVELOP AND IMPLEMENT A SCHOOL-BASED HEALTH SERVICES PROGRAM TO COMPLEMENT EXISTING HEALTH CARE SERVICES TO BE PROVIDED FOR STUDENTS AT THE OPTION OF THE PARENTS AND TO PROVIDE FOR THE SERVICES TO BE PROVIDED, CONFIDENTIALITY OF RECORDS, AND BILLING AND PROGRAM REVIEW PROCEDURES.

Whereas, South Carolina and the Nation are dependent upon the physical, educational, emotional, and social well-being of their children; and

Whereas, in order to attain the highest level of school attendance, to promote excellence of academic performance and achievement, and to significantly reduce school dropout rates, the State must act to improve and safeguard the physical, mental, and social well-being of the student population of the state's public schools; and

Whereas, children's poor health status, high-risk behaviors, family discord, inadequate health insurance coverage, inappropriate use of hospital emergency rooms, and poor use of existing health care services have prompted public policymakers to consider a broader role for school health services; and

Whereas, the school's ability to reach children, youth, and their families who are disenfranchised from the health care system and at highest risk for poor health and potentially health-threatening behaviors is unmatched; and

Whereas, the challenge of addressing the health care needs of children can be met by school-based health service programs provided through the relocation and co-location of public and private service providers on the school site; and

Whereas, it is an obligation of all state and local governmental entities, along with private sector providers, to cooperate and collaborate in order to ensure that all of this state's children's health care needs are met; and

Whereas, school health programs are designed to supplement rather than supplant the responsibility of the family for meeting the health needs of children and to only be delivered with informed consent by the child's parent or guardian; and

Whereas, the General Assembly finds that health services delivered as a part of the total school health program should be carried out to comprehensively appraise, protect, and promote the health of students and are designed to encourage parents to devote attention to their child's health, identify health problems, and encourage the use of their physicians, dentists, and other community health providers and agencies; Now, therefore,

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1. This act may be cited as the School Health Act of 1995.

SECTION 2. Title 59, Chapter 65 of the 1976 Code is amended by adding:

Section 59-65-710. (A) Beginning with the 1997-1998 school year, except as provided for in subsection (B) or (C), before entering public school a student must have a health assessment conducted if the student has not previously been enrolled in a public school in this State and the student is:

(1) entering four-year-old kindergarten, kindergarten, or the first grade; or

(2) entering the second or a higher grade and is under nine years old.

(B) If a student has not had a health assessment, the student may obtain an extension and enter public school if the student's parent or guardian signs a statement on a form provided by the school district stating that a health assessment has been scheduled and the results of the assessment will be submitted to the district within ninety days of the student entering school.

(C) A health assessment is not required for a student who is an adherent of a religious denomination whose religious teachings are opposed to such assessments, and the student's parent or guardian, submits a statement to that effect.

(D) The health assessment must be conducted by a physician, physician assistant, registered nurse, nurse practitioner, or someone acting under the direction of a physician, nurse practitioner, or nurse and must include, but is not limited to, a health history, physical examination, and screening tests as are medically indicated to determine hearing ability, vision ability, nutrition adequacy, and appropriate growth and development. The results of the health assessment must be submitted to school districts and must have been conducted within twelve months of being submitted.

Section 59-65-720. The school district shall exclude from attendance any student who has not submitted the results of a health assessment unless a statement is submitted as provided for in Section 59-65-710(B) or the student is exempt from having an assessment conducted pursuant to Section 59-65-710(C). If a student is excluded from attendance, the school district shall notify in writing the student's parent or guardian stating:

(1) the reason for the exclusion;

(2) that the student will continue to be excluded until the student has complied with the requirements of this article; and

(3) that upon written request the parent or guardian has the right to a hearing before the school board.

Section 59-65-730. Information contained in the health assessment and the results of the health assessment are confidential and must not be disclosed or made public except:

(1) to appropriate school district personnel to the extent necessary to administer this article and to protect the health of the student;

(2) if a medical emergency exists, to medical personnel to the extent necessary to protect the health of the student and the health care provider;

(3) if the parent or guardian of a student under eighteen years of age consents or if the student is eighteen years of age or older, if the student consents;

(4) if no person can be identified in the information to be disclosed and the disclosure is for statistical or research purposes.

Section 59-65-740. The Department of Health and Environmental Control and the State Department of Education jointly shall promulgate regulations necessary to carry out this article. The regulations shall include, but are not limited to, tests to be included in the health assessment and procedures for taking corrective action and conducting follow up on problems identified in the assessment."

SECTION 3. Title 20, Chapter 7 of the 1976 Code is amended by adding:

Section 20-7-6305. (A) Each school district in conjunction with the Department of Health and Environmental Control shall convene a district health planning committee which at a minimum must be composed of representatives from the local departments of education, health, social services, mental health, alcohol and other drug abuse services, and juvenile justice and from the local school board, public and private health care providers, private nonprofit community-based child advocacy organizations and parents, teachers and, where appropriate, students. Each committee shall conduct an assessment of the status of the health of the children and youth in the district, of the health needs of the district children and youth, and of the community resources available and needed to address these health needs.

(B) Based on the assessment, the committee shall develop by July 1, 1996, a school health services program which must:

(1) be an interagency multidisciplinary service delivery plan to meet the comprehensive health needs of the district's children and youth and which may be a multidistrict or multicounty plan;

(2) assign the responsibility for the provision of services and, to the extent possible, provide services by and through a coordinated referral system to existing resources available in schools and communities including, but not limited to, public and private health providers, health agencies, and social services agencies;

(3) identify the physical sites for the delivery of services and, whenever practical, deliver services on the school site;

(4) identify and maximize the use of all existing available federal, state, local, and private funding sources.

(C) A school health services program must include:

(1) Health and nursing services including, but not limited to, preventive services directed at eliminating destructive lifestyle behaviors; formulating individual student health care plans, consulting with students and their families about the student's plan and other health needs; coordinating student health care; assessing, evaluating, and treating minor illnesses and injuries; providing temporary emergency care pending other disposition; administering medications; referring for intervention and remediation of specific health problems; follow-up for illnesses and injuries; assisting families in obtaining medical, dental, and other health care; counseling and must include, but is not limited to, these health and nursing screening and assessment services:

(a) health assessments, as provided for in Section 59-65-710;

(b) oral health screenings;

(c) vision screenings;

(d) hearing screenings;

(e) scoliosis screenings;

(f) growth and development screenings.

Health and nursing services must be provided by or under the direction of a physician, physician assistant, registered nurse, or nurse practitioner.

For purposes of this item `screening' means presumptive identification of unknown or unrecognized diseases or defects by application of tests that can be given with ease and rapidity to apparently healthy persons.

(2) Nutrition services including, but not limited to, nutrition assessment, intervention, and counseling for students with diseases or medical conditions that place the student at risk for nutritional problems or who require nutrition therapy; and programs that offer opportunities for students to experience learning through classroom nutrition and health education.

(3) Counseling and social work services including, but not limited to, services that are broad-based, comprehensive individual, family and group assessments, interventions and referrals which promote the mental, emotional, and social health of students.

(a) Social services including, but not limited to, services that are designed to enhance the economic and social well-being of students and their families;

(b) Mental health services including, but not limited to, mental health assessment and counseling of students and their families. Mental health services include those provided in, or accessible to, schools by community mental health centers administered by the Department of Mental Health.

(c) Alcohol and other drug abuse services including, but not limited to, services that educate students and their families about the health and social problems resulting from the use and abuse of alcohol, tobacco, and other drugs and services that prevent or treat use and abuse of alcohol, tobacco, and other drugs.

(4) Health education in a school setting that is planned and carried out with the purpose of maintaining, reinforcing, or enhancing the health, health-related skills, and health attitudes and practices that are conducive to their good health and that promote wellness, health maintenance, and disease prevention.

Section 20-7-6310. No school health services program may:

(1) provide abortion counseling or advocate abortion in any way or refer a student to an organization for abortion counseling;

(2) distribute at a public school a contraceptive or abortifacient drug or device or similar device.

Section 20-7-6315. In addition to the requirements for a school health services program as provided for in Section 20-7-6305, the program also may include, but is not limited to:

(1) healthy school environment component which addresses the physical and aesthetic surroundings and the psycho-social climate and culture of the school. Factors that influence the physical environment include, but are not limited to, the school building and the area surrounding it, biological or chemical agents that may be detrimental to health, and physical conditions including, but are not limited to, temperature, noise, and lighting;

(2) health promotion programs for school staff that provide health assessments, health education, and health related fitness activities.

Section 20-7-6320. The district health planning committee shall formulate charges and a sliding fee schedule for appropriate services under the program and also shall develop and implement procedures for billing third party providers.

Section 20-7-6325. Annually before the commencement of the school year, the school district shall notify parents of the services available to students and families under the district's school health services program. In order for a student to have access to or receive services under the program, the student's parent or guardian annually must sign a consent form provided by the district.

Section 20-7-6330. Services provided under the program must complement services provided by existing health care providers; however, if the student does not have a primary care provider, primary care services may be provided to the student under the program. When a student has a primary care provider and services are rendered at a school site or school-linked facility, to the extent it is necessary for continuity of care, as provided for in regulation, the student's primary care provider must be notified that the services were provided.

Section 20-7-6335. A student's health record and information obtained on a student, including records and information on or pertaining to the student's family, in connection with the school health services program or services rendered under the program are confidential and must not be disclosed or made public unless:

(1) to appropriate school district personnel to the extent necessary to administer the school health services program and to protect the health of the student;

(2) a medical emergency exists, to medical personnel to the extent necessary to protect the health of the student and the health of the medical personnel;

(3) the parent or guardian of a student under eighteen years of age consents or if the student is eighteen years of age or older, if the student consents; and

(4) no person can be identified in the information to be disclosed and the disclosure is for statistical or research purposes.

Section 20-7-6340. For administrative purposes, the principal of each school has immediate supervisory authority over the health personnel working on the school site.

Section 20-7-6345. (A) The Department of Health and Environmental Control and the Department of Education shall convene an expanded school health services statewide committee of public and private sector representatives of the health and business communities. The committee shall develop a competitive grant process, solicit proposals, and award grants for expanded services under the school health services program to schools and school districts where there is a high incidence of medically underserved and high-risk children. Criteria for evaluating the incidence of medically underserved and high-risk children include, but are not limited to, rates of communicable diseases, inappropriate use of hospital emergency rooms, low birthweight babies, infant mortality, teenage pregnancy, teenage suicide, juvenile delinquency and crime, school dropout, child abuse and neglect, family violence, substance abuse, and enrollment in special education programs for handicapped children. Grant awards are dependent upon the availability of funding. Grants must be awarded to schools and school districts whose proposals are based on innovative, creative, and collaborative services and programs which have the greatest potential for promoting the health and well-being of medically underserved high risk students; however, the awarding of grants is dependent upon the availability of funding.

(B) Expanded school health services funded under this section must not include the distribution of any contraceptive or abortifacient drug or device or similar device and must not include abortion counseling, abortion services, or referral to an organization for abortion counseling or abortion services and may not advocate abortion in any way.

Section 20-7-6350. (A) The Department of Health and Environmental Control and the Department of Education shall:

(1) oversee the delivery and coordination of school health services programs and periodically review and evaluate the effectiveness and adequacy of these programs;

(2) collect and compile budget and financial information on each school health services program;

(3) report on the development of the school health services programs and on the results of the periodic program reviews and submit district program budget and financial reports to the Governor, the Human Services Coordinating Council, and the Joint Legislative Committee on Children and Families.

(B) Upon review of the reports submitted by the Department of Health and Environmental Control and the Department of Education, the Human Services Coordinating Council shall develop in conjunction with these departments a joint budget request for expanded school health services programs. The council shall provide advisory assistance to the district health advisory committees as needed including, but are not limited to, recommendations for promoting coordination and collaboration in the planning process and in the delivery of services and for maximizing the use of federal funds. The council also shall develop a single form to capture basic referral information to be used by the member agencies and their respective local entities.

Section 20-7-6355. In the absence of negligence, no person may be liable for any injury caused by an act or omission in the administration services under the school health services program, as provided for in this article.

Section 20-7-6360. The Department of Health and Environmental Control and the Department of Education jointly shall promulgate regulations to carry out this article."

SECTION 4. The school health services programs, as provided for in Section 20-7-6305 of the 1976 Code as added by Section 3 of this act, may be implemented in school year 1996-1997, following the completion of the program planning process but must be implemented no later than the first day of the 1997-1998 school year.

SECTION 5. This act takes effect upon approval by the Governor.