REPORT TITLE:
School/Adolescent Health Care


DESCRIPTION:
Requires the director of health, with the assistance of the
superintendent of education, to establish and operate as a
demonstration project, not less than one school-based health
clinic in each of the seven department school districts.
Provides different types of health services for a flat fee based
on a student's ability to pay for these services.  Requires that
a student produce a signed parental consent form to be eligible
to receive most services.  Prohibits the performance of abortions
at a clinic and the referral of students to abortion services.
Holds a student financially responsible for services provided by
a clinic without parental consent.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                            264         
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO SCHOOL-BASED HEALTH CARE FOR ADOLESCENTS.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Definitions.  As used in this Act, unless the
 
 2 context otherwise requires:
 
 3      "Parent" includes a parent, custodian, or guardian.
 
 4      "Records" include the results of laboratory screenings and
 
 5 tests.
 
 6      "Student" means a person enrolled at either a three-year
 
 7 (grades ten through twelve) public high school or a four-year
 
 8 (grades nine through twelve) public high school.
 
 9      SECTION 2.  School-based health clinics; establishment of
 
10 demonstration project.(a)  The director of health, with the
 
11 assistance of the superintendent of education, shall establish
 
12 and operate as a demonstration project, not less than one school-
 
13 based health clinic in each of the seven departmental school
 
14 districts established in section 13-1(d), Hawaii Revised
 
15 Statutes.
 
16      (b)  Each clinic shall provide the following types of health
 
17 services to eligible students:
 
18      (1)  Physical examinations for athletic activities;
 
19      (2)  Laboratory screening (e.g., throat cultures,
 
20           mononucleosis, diabetes, urinalysis, hematocrit, Pap
 

 
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 1           smears, and sickle cell anemia);
 
 2      (3)  Sexually transmitted disease testing;
 
 3      (4)  Immunization (e.g., mumps, measles, rubella, polio, and
 
 4           DPT);
 
 5      (5)  Nutrition counseling;
 
 6      (6)  Drug and substance abuse counseling;
 
 7      (7)  Family counseling;
 
 8      (8)  Individual counseling about sexuality;
 
 9      (9)  Pregnancy testing;
 
10     (10)  Prenatal care;
 
11     (11)  Mental health screening and referrals; and
 
12     (12)  Referrals to other agencies.
 
13      (c)  Nothing in this section shall be construed to limit the
 
14 types of health services that may be provided by a clinic, except
 
15 that the performance of abortions at a clinic and the referral of
 
16 students to abortion services by clinic personnel shall be
 
17 expressly prohibited.
 
18      (d)  Immediately after the establishment but prior to the
 
19 operation of a clinic, the principal of each school participating
 
20 in the demonstration project shall appoint a nine-member board of
 
21 directors, which shall be responsible for making policy decisions
 
22 related to the operation of and services to be offered by the
 
23 center.  The board shall consist of not less than two parents of
 

 
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                                     H.B. NO.           
                                            
                                                        


 1 students enrolled at the school, two students enrolled at the
 
 2 school, one teacher assigned to the school, one administrator
 
 3 assigned to the school, one member from the community served by
 
 4 the school, and one health professional.
 
 5      SECTION 3.  Eligibility; consent of parent required;
 
 6 exceptions.(a)  Except as provided by section 577A-2, Hawaii
 
 7 Revised Statutes, no student shall be eligible to receive
 
 8 services unless a clinic receives a consent form signed by the
 
 9 student and the student's parent.
 
10      (b)  Notwithstanding subsection (a), a student who has
 
11 reached the age of majority shall not be required to obtain the
 
12 permission of a parent to be eligible to receive services.
 
13      SECTION 4.  Provision of health services; ability to pay.
 
14 (a)  The director of health, with the assistance of the director
 
15 of human services, shall adopt a fixed fee for all services
 
16 provided by a clinic.  The fees shall be adopted by the director
 
17 of health pursuant to chapter 91, Hawaii Revised Statutes, but
 
18 shall be exempt from the public notice and hearing requirements.
 
19 The fees shall be based on a student's ability to pay for the
 
20 services.
 
21      (b)  Notwithstanding subsection (a), no eligible student
 
22 shall be denied the right to receive requested services for lack
 
23 of the ability to pay for these services.
 

 
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 1      SECTION 5.  Confidentiality of records.  Except as otherwise
 
 2 provided by law, all student-medical records shall be considered
 
 3 confidential information.
 
 4      SECTION 6.  Financial responsibility.  If a student receives
 
 5 services for the diagnosis, examination, or administration of
 
 6 medication in the treatment of venereal diseases, pregnancy, or
 
 7 family planning services without the consent of a parent, then
 
 8 the parent of the student shall not be liable for the legal
 
 9 obligations resulting from the furnishing of these services by a
 
10 clinic.  A student who receives these services from a clinic
 
11 shall assume financial responsibility for the cost of the
 
12 services.  Notwithstanding any other law to the contrary, no
 
13 spouse or parent whose consent has not been obtained for these
 
14 services shall be liable for the cost of services incurred by the
 
15 student.
 
16      SECTION 7.  Limitation of actions.  Notwithstanding any
 
17 other law to the contrary, an action to recover any debt founded
 
18 upon any contract, obligation, or liability made pursuant to this
 
19 Act shall not commence until a student has reached the age of
 
20 majority; provided that the action shall commence not more than
 
21 two years after the date a student reaches the age of majority.
 
22      SECTION 8.  Personnel.  The director of health shall appoint
 
23 and remove without regard to chapters 76 and 77, physicians,
 

 
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                                     H.B. NO.           
                                            
                                                        


 1 nurse-practitioners nurses, counselors, social workers, and any
 
 2 other persons as the department of health may employ to implement
 
 3 to this Act.
 
 4      SECTION 9.  Reports to the legislature.  The director of
 
 5 health shall report to the legislature on the experience of the
 
 6 demonstration project not less than thirty days prior to the
 
 7 convening of each regular session.  The report shall include but
 
 8 not be limited to:
 
 9      (1)  The number of students served and the types of health
 
10           services provided by the demonstration project;
 
11      (2)  The operating cost of the demonstration project,
 
12           including income collected through fees, monetary
 
13           donations, private grants-in-aid, and in-kind services;
 
14      (3)  Quantifiable changes in high-risk behaviors among
 
15           students receiving services through the demonstration
 
16           project;
 
17      (4)  Recommended changes to improve the demonstration
 
18           project, including recommendations on the advisability
 
19           of continuing the project; and
 
20      (5)  Any other information that the department of health may
 
21           determine to be necessary to assist the legislature in
 
22           evaluating the efficacy, cost-effectiveness, and
 
23           intangible merits of the demonstration project.
 

 
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 1      SECTION 10.  There is appropriated out of the general
 
 2 revenues of the State of Hawaii the sum of $           or so much
 
 3 thereof as may be necessary for fiscal year 1999-2000 and the
 
 4 same sum or so much thereof as may be necessary for fiscal year
 
 5 2000-2001, for the department of health to carry out the purposes
 
 6 of this Act, including the hiring of necessary staff.
 
 7      SECTION 11.  The sums appropriated shall be expended by the
 
 8 department of health.
 
 9      SECTION 12.  There is appropriated out of the general
 
10 revenues of the State of Hawaii the sum of $           or so much
 
11 thereof as may be necessary for fiscal year 1999-2000 and the
 
12 same sum, or so much thereof as may be necessary for fiscal year
 
13 2000-2001 for the department of education to carry out the
 
14 purposes of this Act.
 
15      SECTION 13.  The sum appropriated shall be expended by the
 
16 department of education.
 
17      SECTION 14.  This Act shall take effect upon its approval,
 
18 except that sections 10 to 13 shall take effect on July 1, 1999,
 
19 and shall be repealed on June 30, 2002.
 
20 
 
21                           INTRODUCED BY:  _______________________