HB250 HD1

SECTION 1. The legislature finds that the Hawaii keiki: healthy and ready to learn program (Hawaii keiki program) is designed to improve access to, and the quality of, school-based health services available to Hawaii's public school students by coordinating and expanding existing efforts of community partners and resources. This partnership program with the University of Hawaii at Manoa school of nursing and dental hygiene supports the department of education in achieving student, school, and system success by providing school health nursing and primary care services to public schools in five complex areas.

In 2015, the legislature appropriated general funds to improve access to, and increase the quality of, health services available to Hawaii's public school students. This appropriation led to the expansion of the Hawaii keiki program, with five advanced practice registered nurses and five registered nurses serving seven complex areas across three islands. During this time, the Hawaii keiki program also established five school-based health centers.

The legislature further finds that the department of education is working with other state agencies, partnering organizations, and families to improve attendance, behavior, and course marks by partnering to coordinate wraparound services that address non-school factors that impede student success. Further, through the Hawaii keiki program collaboration, the departments of health and human services have identified the extent of services provided within each department targeted to public school children and the need to coordinate internal departmental activity and cross departmental efforts to develop sustainable school-based health services.

The legislature additionally finds that chronic absenteeism, poor health, and delayed or limited access to health care and preventive services continue to hinder academic success and meeting the needs of the whole child. The legislature acknowledges that the Hawaii keiki program is an effective means by which to continue collaboration between health, human services, and education policymakers and providers to achieve sustainable, comprehensive school-based health services in the State to improve the academic and health outcomes of Hawaii's public school students. Working with each complex area superintendent and school principals, the Hawaii keiki program builds and enhances school-based health services that reflect the specific needs of the individual complex area according to student demographics, staffing, available support services, and access to health care within the community, including:

(1) Providing comprehensive screening for physical and behavioral health conditions;

(2) Providing referrals to primary and behavioral health care and patient-centered medical home services;

(3) Preventing and controlling communicable diseases and other health problems;

(4) Providing emergency care for illness or injury; and

(5) Collaborating with community partners, including federally qualified health centers, the Hawaii chapter of the American Academy of Pediatrics, Hui for Excellence in Education Coalition, and other key stakeholders to develop and implement a comprehensive plan to implement school-based health.

The legislature also finds that the expected cost to continue and expand the Hawaii keiki program to include students from pre-kindergarten through high school in the fifteen department of education complex areas statewide; expand the program to allow the Hawaii state public charter school commission to launch the program in two public charter schools serving disadvantaged keiki; provide access to preventive oral health services and establish a pilot oral health screening and preventative services program on a neighbor island; enhance data collection, sharing, analysis, and reporting; and engage in interdepartmental school health coordination, is $4,000,000 annually, in addition to a one-time allocation of $500,000 for an evidence based vision screening tool. These funds will additionally establish school health services coordinator roles in the department of health and the MedQUEST division of the department of human services.

The purpose of this Act is to formally establish the Hawaii keiki: healthy and ready to learn program, provide funding to expand and sustain the program, and appropriate funds to establish school health service coordinators in the departments of health and human services to increase coordination and facilitate departmental and interdepartmental activities related to comprehensive school-based health services.

SECTION 2. Chapter 302A, Hawaii Revised Statutes, is amended by adding two new sections to be appropriately designated and to read as follows:

"§302A-A Hawaii keiki: healthy and ready to learn program. (a) There is established within the department the Hawaii keiki: healthy and ready to learn program to provide school-based health services. The department shall convene the program in collaboration with the department of health, department of human services, University of Hawaii at Manoa school of nursing and dental hygiene, community providers, and other health care and education stakeholders to increase access to and reimbursement for school-based wellness and health services.

(1) The department shall also partner with the public health nursing branch of the department of health pursuant to a memorandum of understanding between the department, department of health, and the Hawaii keiki: healthy and ready to learn program, and each federally qualified health center and rural health clinic geographically situated within each participating complex of schools; and

(2) The Hawaii keiki: healthy and ready to learn program shall be precluded from providing services at any school where a school-based clinic established pursuant to a memorandum of understanding or contract between a federally qualified health center or rural health clinic and the department exists or may exist in the future; provided that precluded services shall include any service that duplicates any service that is either provided or offered at a school-based clinic.

(b) The program shall be funded through appropriations to the special fund established under section 302A-B. The department or the program may also seek:

(1) Private funding sources, including federal grants and private, nonprofit, and not-for-profit organizations to support the continuation and expansion of school-based health services in the department; and

(2) Federal reimbursement for school-based health services.

§302A-B Hawaii keiki: healthy and ready to learn special fund. (a) There is established within the state treasury the Hawaii keiki: healthy and ready to learn special fund into which shall be deposited:

(1) Appropriations made by the legislature to the fund;

(2) Federal or state grant funds;

(3) Grant funds from private and nonprofit organizations;

(4) Federal reimbursements;

(5) Any interest that accrues upon the balance in the fund; and

(6) Any other moneys designated for the fund.

(b) Moneys in the special fund shall be used to support the operations of the Hawaii keiki: healthy and ready to learn program.

SECTION 3. Section 36-27, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Except as provided in this section, and notwithstanding any other law to the contrary, from time to time, the director of finance, for the purpose of defraying the prorated estimate of central service expenses of government in relation to all special funds, except the:

(1) Special out-of-school time instructional program fund under section 302A-1310;

(2) School cafeteria special funds of the department of education;

(3) Special funds of the University of Hawaii;

(4) State educational facilities improvement special fund;

(5) Convention center enterprise special fund under section 201B-8;

(6) Special funds established by section 206E-6;

(7) Aloha Tower fund created by section 206J-17;

(8) Funds of the employees' retirement system created by section 88-109;

(9) Hawaii hurricane relief fund established under chapter 431P;

(10) Hawaii health systems corporation special funds and the subaccounts of its regional system boards;

(11) Tourism special fund established under section 201B‑11;

(12) Universal service fund established under section 269‑42;

(13) Emergency and budget reserve fund under section 328L‑3;

(14) Public schools special fees and charges fund under section 302A-1130;

(15) Sport fish special fund under section 187A-9.5;

[[](16)[]] Neurotrauma special fund under section 321H-4;

[[](17)[]] Glass advance disposal fee established by section 342G-82;

[[](18)[]] Center for nursing special fund under section 304A‑2163;

[[](19)[]] Passenger facility charge special fund established by section 261-5.5;

[[](20)[]] Solicitation of funds for charitable purposes special fund established by section 467B-15;

[[](21)[]] Land conservation fund established by section 173A-5;

[[](22)[]] Court interpreting services revolving fund under section 607-1.5;

[[](23)[]] Trauma system special fund under section 321-22.5;

[[](24)[]] Hawaii cancer research special fund;

[[](25)[]] Community health centers special fund;

[[](26)[]] Emergency medical services special fund;

[[](27)[]] Rental motor vehicle customer facility charge special fund established under section 261-5.6;

[[](28)[]] Shared services technology special fund under section 27-43;

[[](29)[]] Automated victim information and notification system special fund established under section 353-136;

[[](30)[]] Deposit beverage container deposit special fund under section 342G-104;

[[](31)[]] Hospital sustainability program special fund under [[]section 346G-4[]];

[[](32)[]] Nursing facility sustainability program special fund under [[]section 346F-4[]];

[[](33)[]] Hawaii 3R's school improvement fund under section 302A-1502.4;

[[](34)[]] After-school plus program revolving fund under section 302A-1149.5; [~~and~~

[](35)[]] Civil monetary penalty special fund under section 321‑30.2[,]; and

(36) Hawaii keiki: healthy and ready to learn special fund under section 302A-B,

shall deduct five per cent of all receipts of all other special funds, which deduction shall be transferred to the general fund of the State and become general realizations of the State. All officers of the State and other persons having power to allocate or disburse any special funds shall cooperate with the director in effecting these transfers. To determine the proper revenue base upon which the central service assessment is to be calculated, the director shall adopt rules pursuant to chapter 91 for the purpose of suspending or limiting the application of the central service assessment of any fund. No later than twenty days prior to the convening of each regular session of the legislature, the director shall report all central service assessments made during the preceding fiscal year."

SECTION 4. Section 302A-853, Hawaii Revised Statutes, is amended to read as follows:

"§302A-853 Administration of medication. School health aides may assist students by administering oral and topical medication, and in emergency situations, other premeasured medication; provided that:

(1) If the student receiving the medication is a minor, a parent or guardian requests and authorizes the administration of medication;

(2) The medication has been prescribed by a licensed physician[,] as defined in section 334-1, a licensed advanced practice registered nurse as defined in section 457-2.7, or by a practitioner with prescriptive authority;

(3) The administration of the medication is with the approval of the department of health[;] or the Hawaii keiki: healthy and ready to learn program under section 302A-A; and

(4) The administration of the medication is necessary for the health of the student and for the student's attendance at school."

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 for a school health services coordinator within the department of health.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 for a school health services coordinator within the department of human services.

The sums appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 for an evidence-based vision screening and eye assessment tool appropriate for children in kindergarten through grade twelve as part of the Hawaii keiki: healthy and ready to learn program.

The sums appropriated shall be expended by the department of education for the purposes of this Act.

SECTION 8. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 to be deposited into the Hawaii keiki: healthy and ready to learn special fund.

The sums appropriated shall be expended by the department of education for the purposes of this Act.

SECTION 9. There is appropriated out of the general revenues of the State of Hawaii the sum of $2,899,348 or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 to implement, expand, and sustain the Hawaii keiki: healthy and ready to learn program.

The sums appropriated shall be expended by the department of education for the purposes of this Act.

SECTION 10. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 11. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 12. This Act shall take effect on July 1, 2050.

HOUSE OF REPRESENTATIVES	H.B. NO.	250
THIRTIETH LEGISLATURE, 2019		H.D. 1
STATE OF HAWAII