2023 -- H 5857
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LC002238
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S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
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A N A C T
RELATING TO EDUCATION -- SCHOOL AND YOUTH PROGRAMS CONCUSSION ACT
Introduced By: Representatives Baginski, Noret, Casimiro, and McNamara
Date Introduced: March 01, 2023
Referred To: House Education
It is enacted by the General Assembly as follows:
SECTION 1. Title 16 of the General Laws entitled "EDUCATION" is hereby amended by 1
adding thereto the following chapter: 2
CHAPTER 91.2 3
SCHOOL AND YOUTH PROGRAMS CONCUSSION ACT 4
16-91.2-1. Definitions. 5
For the purpose of this section, the following terms shall have the following meanings: 6
(1) "Athletic trainer" means an athletic trainer licensed under chapter 60 of title 5, who is 7
working under the supervision of a physician. 8
(2) "Coach" means any volunteer or employee of a school who is responsible for organizing 9
and supervising students to teach them or train them in the fundamental skills of an interscholastic 10
athletic activity. "Coach" refers to both head coaches and assistant coaches. 11
(3) "Concussion" means a complex pathophysiological process affecting the brain caused 12
by a traumatic physical force or impact to the head or body, which may include temporary or 13
prolonged altered brain function resulting in physical, cognitive, or emotional symptoms or altered 14
sleep patterns and which may or may not involve a loss of consciousness. 15
(4) "Game official" means a person who officiates at an interscholastic athletic activity, 16
such as a referee or umpire, including, but not limited to, persons enrolled or provided as game 17
officials by the Rhode Island Interscholastic League. 18
(5) "Interscholastic athletic activity" means any organized school-sponsored or school-19
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sanctioned activity for students, generally outside of school instructional hours, under the direction 1
of a coach, athletic director, or band leader, including, but not limited to, baseball, basketball, 2
cheerleading, cross country track, fencing, field hockey, football, golf, gymnastics, ice hockey, 3
lacrosse, marching band, rugby, soccer, skating, softball, swimming and diving, tennis, track 4
(indoor and outdoor), ultimate Frisbee, volleyball, water polo, and wrestling. All interscholastic 5
athletics are deemed to be interscholastic activities. 6
(6) "Licensed healthcare professional" means a person who has experience with concussion 7
management and who is a nurse licensed under chapter 34 or title 5, a psychologist licensed under 8
chapter 44 of title 5 and specializes in the practice of neuropsychology, a physical therapist licensed 9
under chapter 40 of title 5, an occupational therapist licensed under chapter 40.1 of title 5, a 10
physician assistant under chapter 54, of title 5, or an athletic trainer. 11
(7) "Nurse" means a person who is employed by or volunteers at a school and is licensed 12
under chapter 34 of title 5, as a registered nurse, practical nurse, or advanced practice registered 13
nurse. 14
(8) "Physician" means a physician licensed to practice medicine in all of its branches by 15
the board of medical licensure and discipline. 16
(9) "Physician assistant" means a physician assistant licensed under chapter 54 of title 5; 17
(10) "School" means any public or private elementary or secondary school, including a 18
charter school. 19
(11) "Student" means an adolescent or child enrolled in a school. 20
(12) "Youth sports programs" means any program organized for recreational and/or athletic 21
competition purposes by any school district or by any school participating in Rhode Island 22
interscholastic league competition, and whose participants are nineteen (19) years of age or 23
younger. 24
16-91.2-2. School district guidelines to be developed and implemented. 25
(a) The governing body of each public or charter school and the appropriate administrative 26
officer of a private school with students enrolled who participate in an interscholastic athletic 27
activity shall appoint or approve a concussion oversight team. Each concussion oversight team shall 28
establish a return-to-play protocol, based on peer-reviewed scientific evidence consistent with the 29
Centers for Disease Control and Prevention guidelines, for a student's return to interscholastic 30
athletics practice or competition following a force or impact believed to have caused a concussion. 31
(b) Each concussion oversight team shall also establish a return-to-learn protocol, based on 32
peer-reviewed scientific evidence consistent with the Centers for Disease Control and Prevention 33
guidelines, for a student's return to the classroom after that student is believed to have experienced 34
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a concussion, whether or not the concussion took place while the student was participating in an 1
interscholastic athletic activity. 2
(c) Each concussion oversight team shall include to the extent practicable at least one 3
physician. If a school employs an athletic trainer, the athletic trainer shall be a member of the school 4
concussion oversight team to the extent practicable. If a school employs a nurse, the nurse shall be 5
a member of the school concussion oversight team to the extent practicable. At a minimum, a school 6
shall appoint a person who is responsible for implementing and complying with the return-to-play 7
and return-to-learn protocols adopted by the concussion oversight team. At a minimum, a 8
concussion oversight team may be composed of only one person and this person need not be a 9
licensed healthcare professional; provided, however, the person shall not be a coach. A school may 10
appoint other licensed healthcare professionals to serve on the concussion oversight team. 11
16-91.2-3. Student participation in interscholastic activity -- Concussion brochure. 12
(a) A student shall not participate in an interscholastic athletic activity for a school year 13
until the student and the student's parent or guardian or another person with legal authority to make 14
medical decisions for the student have signed a form for that school year that acknowledges 15
receiving and reading written information that explains concussion prevention, symptoms, 16
treatment, and oversight and that includes guidelines for safely resuming participation in an athletic 17
activity following a concussion. The form shall be approved by the commissioner of elementary 18
and secondary education. 19
(b) The commissioner shall develop, publish, and disseminate a brochure to educate the 20
parents and the general public on the effects of concussions in children and discuss how to look for 21
concussion warning signs in children, including, but not limited to, delays in the learning 22
development of children. The brochure shall be distributed free of charge by schools to any child 23
or the parent or guardian of a child who may have sustained a concussion, regardless of whether or 24
not the concussion occurred while the child was participating in an interscholastic athletic activity. 25
This brochure shall satisfy the written information required in subsection (a) of this section. 26
(c) This section shall also apply to youth sports programs. 27
16-91.2-4. Removal of student from practice or competition upon suspicion of 28
sustaining a concussion. 29
(a) A student shall be removed from an interscholastic athletics practice or competition 30
immediately if one of the following persons believes the student might have sustained a concussion 31
during the practice or competition: 32
(1) A coach; 33
(2) A physician; 34
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(3) A game official; 1
(4) An athletic trainer; 2
(5) The student's parent or guardian or another person with legal authority to make medical 3
decisions for the student; 4
(6) The student; or 5
(7) Any other person deemed appropriate under the school's return-to-play protocol. 6
(b) This section shall also apply to youth sports programs. 7
16-91.2-5. Requirements for return to practice or competition. 8
(a) A student removed from an interscholastic athletics practice or competition under § 16-9
91.2-4 shall not be permitted to practice or compete again following the force or impact believed 10
to have caused the concussion until: 11
(1) The student has been evaluated, using established medical protocols based on peer-12
reviewed scientific evidence consistent with Centers for Disease Control and Prevention guidelines, 13
by a treating physician (chosen by the student or the student's parent or guardian or another person 14
with legal authority to make medical decisions for the student), an athletic trainer, an advanced 15
practice registered nurse, or a physician assistant; 16
(2) The student has successfully completed each requirement of the return-to-play protocol 17
established under this section necessary for the student to return to play or practice; 18
(3) The student has successfully completed each requirement of the return-to-learn protocol 19
established under this section necessary for the student to return to learn; 20
(4) The treating physician, the athletic trainer, or the physician assistant has provided a 21
written statement indicating that, in the physician's professional judgment, it is safe for the student 22
to return to play or practice and return to learn or the treating advanced practice registered nurse, 23
the athletic trainer or the physician assistant has provided a written statement indicating that it is 24
safe for the student to return to play or practice and return to learn; and 25
(5) The student and the student's parent or guardian or another person with legal authority 26
to make medical decisions for the student: 27
(i) Have acknowledged that the student has completed the requirements of the return-to-28
play and return-to-learn protocols necessary for the student to return to play or practice; 29
(ii) Have provided the treating physician's, athletic trainer's, advanced practice registered 30
nurse's, or physician assistant's written statement under subsection (a)(4) of this section to the 31
person responsible for compliance with the return-to-play and return-to-learn protocols under § 16-32
91.2-2(c) and the person who has supervisory responsibilities under subsection (b) of this section; 33
and 34
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(iii) Have signed a consent form indicating that the person signing: 1
(A) Has been informed concerning and consents to the student participating in returning to 2
play or practice in accordance with the return-to-play and return-to-learn protocols; 3
(B) Understands the risks associated with the student returning to play or practice and 4
returning to learn and will comply with any ongoing requirements in the return-to-play and return-5
to-learn protocols; and 6
(C) Consents to the disclosure to appropriate persons, consistent with the federal Health 7
Insurance Portability and Accountability Act of 1996 (Pub, L. 104-191), of the treating physician's, 8
athletic trainer's, physician assistant's, or advanced practice registered nurse's written statement 9
under subsection (a)(4) of this section and, if any, the return-to-play and return-to-learn 10
recommendations of the treating physician, the athletic trainer, the physician assistant, or the 11
advanced practice registered nurse, as the case may be. 12
(b) A coach of an interscholastic athletics team may not authorize a student's return to play 13
or practice or return to learn. The district superintendent, or designee, in the case of a public 14
elementary or secondary school, the chief school administrator, or designee, in the case of a charter 15
school, or the appropriate administrative officer, or designee, in the case of a private school shall 16
supervise an athletic trainer or other person responsible for compliance with the return-to-play 17
protocol and shall supervise the person responsible for compliance with the return-to-learn 18
protocol. The person who has supervisory responsibilities under this subsection may not be a coach 19
of an interscholastic athletics team. 20
16-91.2-6. Mandatory training for coaches and game officials. 21
(a)(1) The Rhode Island interscholastic league shall approve, for coaches, game officials, 22
and non-licensed healthcare professionals, training courses that provide for not less than two (2) 23
hours of training in the subject matter of concussions, including evaluation, prevention, symptoms, 24
risks, and long-term effects. The league shall maintain an updated list of individuals and 25
organizations authorized by the league to provide the training. 26
(2) The following persons shall take a training course in accordance with subsection (a)(4) 27
of this section from an authorized training provider at least once every two (2) years: 28
(i) A coach of an interscholastic athletic activity; 29
(ii) A nurse, licensed healthcare professional, or non-licensed healthcare professional who 30
serves as a member of a concussion oversight team either on a volunteer basis or in their capacity 31
as an employee, representative, or agent of a school; and 32
(iii) A game official of an interscholastic athletic activity. 33
(3) A physician who serves as a member of a concussion oversight team shall, to the 34
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greatest extent practicable, periodically take an appropriate continuing medical education course in 1
the subject matter of concussions. 2
(4) For purposes of subsection (a)(2) of this section: 3
(i) A coach, game official, or non-licensed healthcare professional, as the case may be, 4
shall take a course described in subsection (a)(1) of this section; 5
(ii) An athletic trainer shall take a concussion-related continuing education course from an 6
athletic trainer continuing education sponsor approved by the commissioner; 7
(iii) A nurse shall take a concussion-related continuing education course from a nurse 8
continuing education sponsor approved by the commissioner; 9
(iv) A physical therapist shall take a concussion-related continuing education course from 10
a physical therapist continuing education sponsor approved by the commissioner; 11
(v) A psychologist shall take a concussion-related continuing education course from a 12
psychologist continuing education sponsor approved by the commissioner; 13
(vi) An occupational therapist shall take a concussion-related continuing education course 14
from an occupational therapist continuing education sponsor approved by the commissioner; and 15
(vii) A physician assistant shall take a concussion-related continuing education course from 16
a physician assistant continuing education sponsor approved by the commissioner. 17
(5) Each person described in subsection (a)(2) of this section shall submit proof of timely 18
completion of an approved course in compliance with subsection (a)(4) of this section to the district 19
superintendent, or designee, in the case of a public elementary or secondary school, the chief school 20
administrator, or designee, in the case of a charter school, or the appropriate administrative officer, 21
or designee, in the case of a private school. 22
(6) A physician, licensed healthcare professional, or non-licensed healthcare professional 23
who is not in compliance with the training requirements under this subsection shall not serve on a 24
concussion oversight team in any capacity. 25
(7) A person required under this subsection to take a training course in the subject of 26
concussions shall complete the training prior to serving on a concussion oversight team in any 27
capacity. 28
(b) The governing body of each public or charter school and the appropriate administrative 29
officer of a private school with students enrolled who participate in an interscholastic athletic 30
activity shall develop a school-specific emergency action plan for interscholastic athletic activities 31
to address the serious injuries and acute medical conditions in which the condition of the student 32
may deteriorate rapidly. The plan shall include a delineation of roles, methods of communication, 33
available emergency equipment, and access to and a plan for emergency transport. This emergency 34
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action plan shall be: 1
(1) In writing; 2
(2) Reviewed by the concussion oversight team; 3
(3) Approved by the district superintendent, or designee, in the case of a public elementary 4
or secondary school, the chief school administrator, or designee, in the case of a charter school, or 5
the appropriate administrative officer, or designee, in the case of a private school; 6
(4) Distributed to all appropriate personnel; 7
(5) Posted conspicuously at all venues utilized by the school; and 8
(6) Reviewed annually by all athletic trainers, first responders, coaches, school nurses, 9
athletic directors, and volunteers for interscholastic athletic activities. 10
16-91.2-7. All other youth sports programs. 11
All other youth sports programs not specifically addressed by this chapter are encouraged 12
to follow the guidance set forth in this chapter for all program participants who are age nineteen 13
(19) and younger. 14
16-91.2-8. Rules and regulations. 15
The commissioner of education shall promulgate rules and regulations as necessary to 16
administer this chapter, including, but not limited to, rules governing the informal or formal 17
accommodation of a student who may have sustained a concussion during an interscholastic athletic 18
activity or practice. 19
SECTION 2. Chapter 16-91 of the General Laws entitled "School and Youth Programs 20
Concussion Act" is hereby repealed in its entirety. 21
CHAPTER 16-91 22
School and Youth Programs Concussion Act 23
16-91-1. Findings of fact. 24
The general assembly hereby finds and declares: (1) Concussions are one of the most 25
commonly reported injuries in children and adolescents who participate in sports and recreational 26
activities. A concussion is caused by a blow or motion to the head or body that causes the brain to 27
move rapidly inside the skull. The risk of catastrophic injuries or death is significant when a 28
concussion or head injury is not properly evaluated and managed. 29
(2) Concussions are a type of brain injury that can range from mild to severe and can disrupt 30
the way the brain normally works. Concussions can occur in any organized or unorganized sport 31
or recreational activity and can result from a fall or from players colliding with each other, the 32
ground, or with obstacles. Concussions occur with or without loss of consciousness, but the vast 33
majority occurs without loss of consciousness. 34
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(3) Continuing to play with a concussion or symptoms of a head injury leaves the young 1
athlete especially vulnerable to greater injury and even death. The general assembly also recognizes 2
that, despite having generally recognized return-to-play standards for concussion and head injury, 3
some affected youth athletes are prematurely returned to play resulting in actual or potential 4
physical injury or death to youth athletes in the state of Rhode Island. 5
(4) Concussions can occur in any sport or recreational activity, furthermore, symptoms of 6
concussions may manifest themselves after the injury during school hours and in the classroom 7
setting. All school nurses, coaches, parents, and athletes shall be advised of the signs and symptoms 8
of concussions as well as the protocol for treatment. 9
16-91-2. Definitions. 10
For the purpose of this section, the term “youth sports programs” means any program 11
organized for recreational and/or athletic competition purposes by any school district or by any 12
school participating in Rhode Island Interscholastic League Competition, and whose participants 13
are nineteen (19) years of age or younger. 14
16-91-3. School district’s guidelines to be developed and implemented. 15
(a) The department of education and the department of health shall work in concert with 16
the Rhode Island Interscholastic League to develop and promulgate guidelines to inform and 17
educate coaches, teachers, school nurses, youth athletes, and their parents and/or guardians of the 18
nature and risk of concussion and head injury, including continuing to play after concussion or head 19
injury. A concussion and head injury information sheet shall be signed and returned by the youth 20
athlete and the athlete’s parent and/or guardian prior to the youth athlete’s return to practice or 21
competition. 22
(b) School districts are required to use training materials made available by the United 23
States Center for Disease Control and Prevention entitled “Heads Up: Concussion in the High 24
School Sports/Concussion in Youth Sports” and any updates or amendments thereto, or training 25
materials substantively and substantially similar thereto. The department of education shall post 26
training materials made available by the Center for Disease Control and Prevention and the Rhode 27
Island Interscholastic League on its website. All coaches and volunteers involved in a youth sport 28
or activity covered by this chapter must complete a training course and a refresher course annually 29
thereafter in concussions and traumatic brain injuries. All school nurses must complete a training 30
course and an annual refresher course in concussions and traumatic brain injuries. Teachers and 31
teachers’ aides are strongly encouraged to complete the training course in concussions and 32
traumatic brain injuries. Training may consist of videos, classes, and any other generally accepted 33
mode and medium of providing information. 34
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(c) School districts are encouraged to have all student athletes perform baseline 1
neuropsychological testing, computerized or otherwise. Parents and/or guardians shall be provided 2
with information as to the risk of concussion and/or traumatic brain injuries prior to the start of 3
every sport season and they shall sign an acknowledgement as to their receipt of such information. 4
(d) A youth athlete, who is suspected of sustaining a concussion or head injury in a practice 5
or game, shall be removed from competition at that time. 6
(e) A youth athlete, who has been removed from play, may not return to play until the 7
athlete is evaluated by a licensed physician who may consult with an athletic trainer, all of whom 8
shall be trained in the evaluation and management of concussions. The athlete must receive written 9
clearance to return to play from that licensed physician. 10
(f) All school districts are encouraged to have an athletic trainer, or similarly trained 11
person, at all recreational and athletic events addressed by this statute. 12
16-91-4. All other youth sports program. 13
All other youth sports programs not specifically addressed by this statute are encouraged 14
to follow the guidance set forth in this statute for all program participants who are age nineteen 15
(19) and younger. 16
SECTION 3. This act shall take effect on July 1, 2024. 17
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO EDUCATION -- SCHOOL AND YOUTH PRO GRAMS CONCUSSION ACT
***
This act would modernize and update the prior chapter on this subject by requiring the 1
development of school district concussion guidelines, a brochure for the students and parents, the 2
procedures for removal and return of a student from or to practice or competition and mandatory 3
concussion training for coaches and game officials. 4
This act would take effect on July 1, 2024. 5
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