*SB0272.1*
January 26, 2024
SENATE BILL No. 272
_____
DIGEST OF SB 272 (Updated January 24, 2024 3:34 pm - DI 55)
Citations Affected: IC 12-7; IC 12-15; IC 16-19; IC 20-19; IC 20-26;
IC 20-34.
Synopsis: School based health centers and student health. Authorizes
a school corporation to contract with a health care provider, a health
system, or community partner to establish a school based health center
for the purpose of providing primary health services to students.
Requires that a school based health center be a legal entity separate
from the school corporation, that student participation in the services
provided by the school based health center be voluntary, and that health
records be maintained by a school based health center in compliance
with federal confidentiality requirements. Requires each school
corporation to employ at least one registered nurse who holds a
bachelor of science degree in nursing to coordinate health services in
the school corporation. Requires the office of the secretary of family
and social services to apply to the United States Department of Health
and Human Services for a state plan amendment to allow school based
health centers to seek Medicaid reimbursement for health services
provided by school based health centers. Requires the state department
of health to develop first aid guidelines for school emergencies.
Requires the state department of education to publish those first aid
guidelines for school emergencies on its Internet website. Prohibits a
school corporation from conducting a vision test or an audiometer test
on a student without the prior written consent of the student's parent or
guardian.
Effective: July 1, 2024.
Zay, Crider
January 16, 2024, read first time and referred to Committee on Insurance and Financial
Institutions.
January 25, 2024, reported favorably — Do Pass; reassigned to Committee on
Appropriations.
SB 272—LS 6698/DI 152 January 26, 2024
Second Regular Session of the 123rd General Assembly (2024)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2023 Regular Session of the General Assembly.
SENATE BILL No. 272
A BILL FOR AN ACT to amend the Indiana Code concerning
education.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-7-2-170.2 IS ADDED TO THE INDIANA
2 CODE AS A NEW SECTION TO READ AS FOLLOWS
3 [EFFECTIVE JULY 1, 2024]: Sec. 170.2. "School based health
4 center", for purposes of IC 12-15-1-16, means a health clinic that:
5 (1) is located in or near a school or school facility of a school
6 corporation;
7 (2) is organized or promoted through school, community, or
8 health care provider relationships;
9 (3) provides primary health services to children by health
10 care providers, in accordance with state and federal law; and
11 (4) meets any other requirements necessary for the operation
12 of a school based health center.
13 SECTION 2. IC 12-15-1-16, AS AMENDED BY P.L.35-2022,
14 SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
15 JULY 1, 2024]: Sec. 16. (a) Each:
16 (1) school corporation, including a school based health center;
17 or
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1 (2) school corporation's employed, licensed, or qualified provider;
2 must enroll in a program to use federal funds under the Medicaid
3 program (IC 12-15-1 et seq.) with the intent to share the costs of
4 services that are reimbursable under the Medicaid program and that are
5 provided to eligible children by the school corporation or school based
6 health center. However, a school corporation or a school corporation's
7 employed, licensed, or qualified provider is not required to file any
8 claims or participate in the program developed under this section.
9 (b) The secretary and the department of education may develop
10 policies and adopt rules to administer the program developed under this
11 section.
12 (c) The federal reimbursement for services provided under this
13 section must be distributed to the school corporation. The state shall
14 retain the nonfederal share of the reimbursement for Medicaid services
15 provided under this section.
16 (d) The office of Medicaid policy and planning, with the approval
17 of the budget agency and after consultation with the department of
18 education, shall establish procedures for the timely distribution of
19 federal reimbursement due to the school corporations. The distribution
20 procedures may provide for offsetting reductions to distributions of
21 state tuition support or other state funds to school corporations in the
22 amount of the nonfederal reimbursements required to be retained by the
23 state under subsection (c).
24 (e) Before December 1, 2024, the office may shall apply to the
25 United States Department of Health and Human Services for a state
26 plan amendment to allow school corporations and school based health
27 centers to seek Medicaid reimbursement for medically necessary,
28 school based Medicaid covered services that are provided under federal
29 or state mandates. If the state plan amendment is approved and
30 implemented, services may be provided by a qualified provider in a
31 school setting or school based health center to Medicaid enrolled
32 students. Subject to subsection (f), the services may be pursuant to any
33 of the following:
34 (1) An individualized education program (as defined in
35 IC 20-18-2-9).
36 (2) A plan developed under Section 504 of the federal
37 Rehabilitation Act, 29 U.S.C. 794.
38 (3) A behavioral intervention plan (as defined in IC 20-20-40-1).
39 (4) A service plan developed under 511 IAC 7-34.
40 (5) An individualized health care plan.
41 The office may, in consultation with the department of education,
42 develop any necessary state plan amendment under this subsection. The
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1 office may apply for any state plan amendment necessary to implement
2 this subsection.
3 (f) Services under subsection (e) may not include the following:
4 (1) An abortion.
5 (2) Counseling for abortion procedures.
6 (3) Referrals for abortion services.
7 (4) Abortifacients.
8 (5) Contraceptives.
9 (g) If the state plan amendment described in subsection (e) is
10 approved and implemented, the medically necessary, school based
11 Medicaid covered services described in subsection (e):
12 (1) may only be performed by a qualified provider;
13 (2) must be within the qualified provider's scope of practice; and
14 (3) must be provided in accordance with this article and
15 administrative rules concerning the Medicaid program.
16 SECTION 3. IC 16-19-3-32.7 IS ADDED TO THE INDIANA
17 CODE AS A NEW SECTION TO READ AS FOLLOWS
18 [EFFECTIVE JULY 1, 2024]: Sec. 32.7. (a) The state department
19 shall develop and publish on its website first aid guidelines for
20 school emergencies for use by schools in Indiana.
21 (b) The first aid guidelines for school emergencies described in
22 subsection (a) must include at least the following:
23 (1) General emergency guidelines and information on
24 administering emergency assistance before emergency
25 medical personnel arrive to an individual who is sick or
26 injured.
27 (2) Standard precautions for handling blood and bodily fluids
28 in school settings, including handwashing procedures, and the
29 disposal and clean up of infectious waste.
30 (3) First aid procedures for injuries and illnesses, including
31 bleeding, chest pain, shock, concussions, heat emergencies,
32 seizures, and poisoning.
33 (4) Emergency procedures for chemical, biological, radiologic,
34 nuclear, or explosive events or bomb threats.
35 (5) Instructions for managing behavioral and mental health
36 emergencies, including suicide risk and active shooter
37 situations.
38 (6) Emergency care procedures in life threatening medical
39 situations, including cardiopulmonary resuscitation,
40 automated external defibrillator use, and emergency choke
41 saving methods.
42 (7) Guidelines concerning parent or guardian notification for
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1 an incident described in this subsection.
2 SECTION 4. IC 20-19-3-11.9 IS ADDED TO THE INDIANA
3 CODE AS A NEW SECTION TO READ AS FOLLOWS
4 [EFFECTIVE JULY 1, 2024]: Sec. 11.9. The department shall
5 publish on its website the first aid guidelines for school
6 emergencies developed by the Indiana department of health under
7 IC 16-19-3-32.7.
8 SECTION 5. IC 20-26-22.5 IS ADDED TO THE INDIANA CODE
9 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
10 JULY 1, 2024]:
11 Chapter 22.5. School Health Services
12 Sec. 1. As used in this chapter, "health care provider" has the
13 meaning set forth in IC 16-18-2-163(a).
14 Sec. 2. As used in this chapter, "health records" has the
15 meaning set forth in IC 16-18-2-168(a).
16 Sec. 3. (a) As used in this chapter, "health services" means
17 prevention, assessment, intervention, and referral services
18 available to students of a school corporation that meet the criteria
19 set forth in section 7 of this chapter.
20 (b) The term does not include services provided in a school
21 based health center.
22 Sec. 4. As used in this chapter, "informed consent" has the
23 meaning set forth in IC 16-36-7-16.
24 Sec. 5. As used in this chapter, "school based health center"
25 means a health clinic that:
26 (1) is located in or near a school or school facility of a school
27 corporation;
28 (2) is organized or promoted through school, community, or
29 health care provider relationships;
30 (3) provides primary health services to children by health
31 care providers, in accordance with state and federal law; and
32 (4) meets any other requirements necessary for the operation
33 of a school based health center.
34 Sec. 6. (a) Except as provided in subsection (b), a school
35 corporation shall employ at least one (1) registered nurse who
36 holds a bachelor of science in nursing to coordinate health services
37 in the school corporation.
38 (b) A school corporation may employ a registered nurse who
39 does not hold a bachelor of science in nursing to coordinate health
40 services in the school corporation if the registered nurse:
41 (1) was employed by the school corporation on June 30, 2000,
42 to coordinate health services; and
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1 (2) has been continuously employed by the school corporation
2 to coordinate health services described in subdivision (1) since
3 June 30, 2000.
4 Sec. 7. A school corporation shall provide health services to
5 students in accordance with:
6 (1) all state and federal laws and regulations;
7 (2) the applicable standard of care; and
8 (3) the first aid guidelines for school emergencies, developed
9 by the Indiana department of health under IC 16-19-3-32.7.
10 Sec. 8. A school corporation may contract with a health care
11 provider, health system, or community partner to establish a
12 school based health center for the purpose of providing primary
13 health services to students if the following requirements are met:
14 (1) The school based health center must be a distinct legal
15 entity that is separate from the school corporation.
16 (2) The establishment of a school based health center may not
17 replace the role of school nurses who are employed by the
18 school corporation to provide first aid and emergency
19 services.
20 (3) Student participation in services provided by a school
21 based health center must be voluntary.
22 (4) The school based health center or school corporation may
23 not offer an incentive to a student or parent of a student in
24 exchange for participation in services provided by the school
25 based health center.
26 (5) A student, if the student is an adult or emancipated minor,
27 or a student's parent or guardian must provide written
28 informed consent for the student to receive services at a
29 school based health center, and the parent must be present at
30 the time the student receives services at a school based health
31 center.
32 (6) Services provided at a school based health center must be
33 provided by a health care provider.
34 (7) A health care provider employed by or working in a school
35 based health center must maintain health records in
36 accordance with the federal Health Insurance Portability and
37 Accountability Act (HIPAA).
38 (8) Except as required by law, a school or school corporation
39 may not access a student's health records.
40 (9) A school, school corporation, or health care provider may
41 not be obligated to violate this section, including participating
42 in a grant program that requires a school, school corporation,
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1 or health care provider to violate this section.
2 Sec. 9. The state board shall amend any rules necessary to
3 comply with this section.
4 SECTION 6. IC 20-34-3-12, AS AMENDED BY P.L.164-2023,
5 SECTION 52, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
6 JULY 1, 2024]: Sec. 12. (a) For purposes of this section, "modified
7 clinical technique" means a battery of vision tests that includes:
8 (1) a visual acuity test to determine an individual's ability to see
9 at various distances;
10 (2) a refractive error test to determine the focusing power of the
11 eye;
12 (3) an ocular health test to determine any external or internal
13 abnormalities of the eye; and
14 (4) a binocular coordination test to determine if the eyes are
15 working together properly.
16 (b) For purposes of this section, "vision screening" means the testing
17 of visual acuity to determine an individual's ability to see at various
18 distances using:
19 (1) the Snellen chart;
20 (2) Sloan letter charts;
21 (3) HOTV letter or LEA symbol charts for younger students; or
22 (4) technology devices, including photoscreens or autorefractors,
23 for a child who is unable to perform the tests described in
24 subdivisions (1) through (3);
25 at a distance of either ten (10) or twenty (20) feet for distance vision,
26 depending on the calibration of the chart being used, and a distance of
27 fourteen (14) inches for near vision.
28 (c) The modified clinical technique shall be performed by an
29 ophthalmologist licensed as a physician under IC 25-22.5 or an
30 optometrist licensed under IC 25-24.
31 (d) Subject to subsection (l), the governing body of each school
32 corporation shall conduct a vision test for each student enrolling in or
33 transferring into:
34 (1) either kindergarten or grade 1;
35 (2) grade 3;
36 (3) grade 5; and
37 (4) grade 8;
38 and for each student suspected of having a visual defect.
39 (e) The vision test for students in kindergarten and grade 1 shall be
40 conducted using the modified clinical technique unless a waiver is
41 granted under section 13 of this chapter. If a waiver is granted for a
42 school corporation, the governing body shall conduct a vision screening
SB 272—LS 6698/DI 152 7
1 described in subsection (b) upon each student's enrollment in
2 kindergarten or grade 1.
3 (f) Each student described in subsection (d)(2), (d)(3), and (d)(4),
4 and each student suspected of having a visual defect shall be tested
5 using a vision screening of the student's visual acuity.
6 (g) The following standards apply for a vision screening under
7 subsections (e) and (f):
8 (1) A student in kindergarten or grade 1 who is unable to read
9 with each eye the 20/30 line of the Snellen chart or the 20/32 line
10 of the Sloan letters, HOTV, or LEA symbol optotypes shall be
11 recommended for further examination based upon the
12 recommendation of the individual performing the screening.
13 (2) A student:
14 (A) in grade 3, grade 5, or grade 8; or
15 (B) suspected of having a visual defect;
16 who is unable to read with each eye the 20/30 line of the Snellen
17 chart or the 20/32 line of the Sloan letters shall be recommended
18 for further examination based upon the recommendation of the
19 individual performing the screening.
20 (3) If a student at any grade level is recommended for further
21 examination, the school must provide a written recommendation
22 for further examination to the parent or legal guardian of the
23 student.
24 (h) Records of all tests shall be made and continuously maintained
25 by the school corporation to provide information useful in protecting,
26 promoting, and maintaining the health of students. The Indiana
27 department of health, in consultation with the state board, shall adopt
28 rules concerning vision testing equipment, qualifications of vision
29 testing personnel, visual screening procedures, and criteria for failure
30 and referral in the screening tests based on accepted medical practice
31 and standards.
32 (i) The school corporation's governing body and the superintendent
33 shall receive annually the following information concerning the tests
34 conducted under this section:
35 (1) The number of students eligible for testing, by grade.
36 (2) The number of students tested, by grade.
37 (3) The number of students by grade who were tested using the
38 modified clinical technique.
39 (4) The number of students by grade who were tested using a
40 vision screening.
41 (5) The number of students by grade who passed a test.
42 (6) The number of students by grade who failed a test or were
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1 referred for further testing.
2 (7) The name of the individual or department that supervised the
3 testing.
4 (j) Each school corporation shall annually provide to the
5 department, for each school within the school corporation, the
6 following information concerning the tests conducted under this
7 section:
8 (1) the number of students tested by grade;
9 (2) the number of students by grade who were tested using the
10 modified clinical technique;
11 (3) the number of students by grade who were tested using a
12 vision screening;
13 (4) the number of students who passed a test by grade; and
14 (5) the number of students who failed a test or who were referred
15 for further testing.
16 (k) Not later than October 1 each year, the department shall report
17 for the previous school year:
18 (1) a compilation of the information received from school
19 corporations under subsection (j);
20 (2) information received under section 13 of this chapter,
21 including:
22 (A) the number of school corporations that applied for a
23 waiver;
24 (B) the number of waivers approved;
25 (C) the number of waivers denied;
26 (D) the name of each school corporation that applied for a
27 waiver and whether the waiver was approved or denied; and
28 (E) the reason for the approval or denial;
29 (3) the total number of students eligible for testing; and
30 (4) the total number of students tested;
31 to the legislative council in electronic format under IC 5-14-6.
32 (l) The governing body of a school corporation may not conduct
33 a vision test described in subsection (d) on a student without the
34 prior written consent of the student's parent or guardian if the
35 student is an unemancipated minor.
36 SECTION 7. IC 20-34-3-14, AS ADDED BY P.L.1-2005,
37 SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
38 JULY 1, 2024]: Sec. 14. (a) The governing body of each school
39 corporation shall annually conduct an audiometer test or a similar test
40 to determine the hearing efficiency of the following students:
41 (1) Students in grade 1, grade 4, grade 7, and grade 10.
42 (2) A student who has transferred into the school corporation.
SB 272—LS 6698/DI 152 9
1 (3) A student who is suspected of having hearing defects.
2 (b) A governing body may appoint the technicians and assistants
3 necessary to perform the testing required under this section.
4 (c) Records of all tests shall be made and continuously maintained
5 by the school corporation to provide information that may assist in
6 diagnosing and treating any student's auditory abnormality. However,
7 diagnosis and treatment shall be performed only on recommendation
8 of an Indiana physician who has examined the student.
9 (d) The governing body may adopt rules for the administration of
10 this section.
11 (e) The governing body of a school corporation may not conduct
12 an audiometer test or a similar test described in subsection (a) on
13 a student without the prior written consent of the student's parent
14 or guardian if the student is an unemancipated minor.
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COMMITTEE REPORT
Madam President: The Senate Committee on Insurance and
Financial Institutions, to which was referred Senate Bill No. 272, has
had the same under consideration and begs leave to report the same
back to the Senate with the recommendation that said bill DO PASS
and be reassigned to the Senate Committee on Appropriations.
(Reference is to SB 272 as introduced.)
BALDWIN, Chairperson
Committee Vote: Yeas 6, Nays 1
SB 272—LS 6698/DI 152