REPORT TITLE:
School/Adolescent Health Care


DESCRIPTION:
Requires the director of health, with the assistance of the
superintendent of education, to establish and operate fewer than
one school-based health center in each of the seven department
school districts.  Provides different types of health services
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 center and the referral of students to abortion
services.  Holds a student financially responsible for services
provided by a center without parental consent. (HB264 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        264
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
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. Children require access to health care to
 
 2 maintain good health.  When they become sick or are injured, most
 
 3 children have access to a health care professional.  However, too
 
 4 many children in the United States, particularly those from poor
 
 5 families, are at risk for multiple health problems.  Poor
 
 6 children may experience two to three times the usual incidence
 
 7 for certain medical conditions, many of which are preventable.
 
 8 The most common health problems affecting children today include
 
 9 injuries, chronic illnesses such as asthma, and mental health
 
10 problems.  In addition, children are now engaging more frequently
 
11 in risky behaviors that may lead to health problems, including
 
12 smoking, binge drinking, and unsafe sex.
 
13      The number of children at risk for poor health has increased
 
14 as children have lost access to care because their parents have
 
15 lost their health insurance.  Currently, about sixteen percent,
 
16 or eleven million, of America's children are uninsured.  Even for
 
17 children who do have health insurance, barriers to health care
 
18 exist.  For example, parents may be unable to miss work to take
 
19 their child to see a doctor.  And in many low-income communities,
 
20 health care facilities are few and often inadequate.
 

 
Page 2                                                     264
                                     H.B. NO.           H.D. 2
                                                             
                                                        

 
 1      The purpose of this Act is to provide adolescents with
 
 2 access to quality, affordable health care in an environment that
 
 3 is familiar, non-threatening and encouraging through school-based
 
 4 health centers.  These centers would also provide access to
 
 5 mental health services in a non-threatening and non-stigmatizing
 
 6 place, since services would be provided as part of a broad array
 
 7 of services.  The school-based health centers can play a
 
 8 strategic role in the delivery of school-based mental health
 
 9 assessments, intake, referrals, and services as required by the
 
10 Felix v.Cayetano consent decree.
 
11      SECTION 2.  Definitions.  As used in this Act, unless the
 
12 context otherwise requires:
 
13      "Parent" includes a parent, custodian, or guardian.
 
14      "Records" include the results of laboratory screenings and
 
15 tests.
 
16      "Student" means a person enrolled at either a three-year
 
17 (grades ten through twelve) public high school or a four-year
 
18 (grades nine through twelve) public high school.
 
19      SECTION 3.  School-based health centers; establishment.  (a)
 
20 The director of health, with the assistance of the superintendent
 
21 of education, shall establish and operate no fewer than one
 
22 school-based health center in each of the seven departmental
 
23 school districts established in section 13-1(d), Hawaii Revised
 
24 Statutes.
 

 
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                                     H.B. NO.           H.D. 2
                                                             
                                                        

 
 1      (b)  The provision of the following types of basic health
 
 2 services to eligible students shall be considered for each
 
 3 center:
 
 4      (1)  Mental health screening, counseling, and referrals;
 
 5      (2)  Physical examinations for athletic activities;
 
 6      (3)  Immunization for such diseases as mumps, measles,
 
 7           rubella, diphtheria, and polio;
 
 8      (4)  Nutrition counseling;
 
 9      (5)  Family counseling;
 
10      (6)  Substance abuse counseling; and
 
11      (7)  Individual counseling about sexuality;
 
12      (c)  The following types of referrals shall be considered
 
13 for each center:
 
14      (1)  Laboratory screening, including throat cultures,
 
15           mononucleosis, diabetes, urinalysis, hematocrit, Pap
 
16           smears, and sickle cell anemia;
 
17      (2)  Sexually transmitted disease testing;
 
18      (3)  Pregnancy testing; and
 
19      (4)  Prenatal care.
 
20      (d)  Referrals, when necessary and appropriate, to a primary
 
21 care physician and other health and social agencies for
 
22 appropriate services and care shall be considered for each
 
23 center.
 

 
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                                     H.B. NO.           H.D. 2
                                                             
                                                        

 
 1      (e)  Nothing in this section shall be construed to limit the
 
 2 types of health services that may be provided by a center, except
 
 3 that the performance of abortions at a center and the referral of
 
 4 students to abortion services by center personnel shall be
 
 5 expressly prohibited.
 
 6      (f)  Prior to the establishment and operation of a center,
 
 7 the principal of the school and the school/community-based
 
 8 management council, in consultation with at least one health care
 
 9 professional, shall make policy decisions related to the
 
10 operation of the center and determine the services to be offered
 
11 by the center.  
 
12      SECTION 4.  Eligibility; consent of parent required;
 
13 exceptions.  (a)  Except as provided by section 577A-2, Hawaii
 
14 Revised Statutes, no student shall be eligible to receive
 
15 services unless the center receives a consent form signed by the
 
16 student and the student's parent.
 
17      (b)  Notwithstanding subsection (a), a student who has
 
18 reached the age of majority shall not be required to obtain the
 
19 permission of a parent to be eligible to receive services.
 
20      SECTION 5.  Provision of health services; ability to pay.
 
21 (a)  The director of health, with the assistance of the director
 
22 of human services, shall seek as many possibilities of
 
23 reimbursement as practicable, including federal or private
 
24 foundation funds, for all services provided by a center.
 

 
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                                     H.B. NO.           H.D. 2
                                                             
                                                        

 
 1      (b)  Notwithstanding subsection (a), no eligible student
 
 2 shall be denied the right to receive requested services for lack
 
 3 of the ability to pay for these services.
 
 4      SECTION 6.  Confidentiality of records.  Except as otherwise
 
 5 provided by law, all student medical records shall be considered
 
 6 confidential information when approved by the student's parent.
 
 7      SECTION 7.  Financial responsibility.  If a student receives
 
 8 services for the diagnosis, examination, or administration of
 
 9 medication in the treatment of venereal diseases, pregnancy, or
 
10 family planning services without the consent of a parent, then
 
11 the parent of the student shall not be liable for the legal
 
12 obligations resulting from the furnishing of these services by a
 
13 center.  A student who receives these services from a center
 
14 shall assume financial responsibility for the cost of the
 
15 services.  Notwithstanding any other law to the contrary, no
 
16 spouse or parent whose consent has not been obtained for these
 
17 services shall be liable for the cost of services incurred by the
 
18 student.
 
19      SECTION 8.  Limitation of actions.  Notwithstanding any
 
20 other law to the contrary, any action to recover any debt founded
 
21 upon any contract, obligation, or liability made or incurred
 
22 pursuant to this Act shall not commence until a student has
 
23 reached the age of majority; provided that the action shall
 
24 commence not more than two years after the date a student reaches
 
25 the age of majority.
 

 
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                                     H.B. NO.           H.D. 2
                                                             
                                                        

 
 1      SECTION 9.  Personnel.  The director of health may employ
 
 2 without regard to chapters 76 and 77 physicians, nurse-
 
 3 practitioners, nurses, counselors, social workers, and all other
 
 4 persons that the director of health deems necessary or desirable
 
 5 to implement this Act.
 
 6      SECTION 10.  Reports to the legislature.  The director of
 
 7 health shall report to the legislature on the experience of each
 
 8 school-based health center not less than thirty days prior to the
 
 9 convening of each regular session.  The report shall include:
 
10      (1)  The number of students served and the types of health
 
11           services provided;
 
12      (2)  The operating cost, including income collected through
 
13           fees, monetary donations, private grants, and in-kind
 
14           services;
 
15      (3)  Quantifiable changes in high-risk behaviors among
 
16           students receiving services through the center;
 
17      (4)  Recommended changes to improve the center; and
 
18      (5)  Any other information that the department of health may
 
19           determine to be necessary to assist the legislature in
 
20           evaluating the efficacy, cost-effectiveness, and
 
21           intangible merits of the center.
 
22      SECTION 11.  There is appropriated out of the general
 
23 revenues of the State of Hawaii the sum of $1 or so much thereof
 

 
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                                     H.B. NO.           H.D. 2
                                                             
                                                        

 
 1 as may be necessary for fiscal year 1999-2000 and the same sum or
 
 2 so much thereof as may be necessary for fiscal year 2000-2001 for
 
 3 school-based health centers, including the hiring of necessary
 
 4 staff.
 
 5      The sums appropriated shall be expended by the department of
 
 6 health for the purposes of this Act.
 
 7      SECTION 12.  There is appropriated out of the general
 
 8 revenues of the State of Hawaii the sum of $1 or so much thereof
 
 9 as may be necessary for fiscal year 1999-2000 and the same sum or
 
10 so much thereof as may be necessary for fiscal year 2000-2001 for
 
11 school-based health centers.
 
12      The sums appropriated shall be expended by the department of
 
13 education for the purposes of this Act.
 
14      SECTION 13.  This Act shall take effect upon its approval,
 
15 except that sections 10 and 11 shall take effect on July 1, 1999.