School/Adolescent Health Care

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)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                    
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 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.

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                                     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.