Existing law requires the governing board of any school district to give diligent care to the health and physical development of pupils.

This bill would would, commencing with the 202425 school year, require school districts, county offices of education, and charter schools, on or before the start of the 202425 school year, to adopt a comprehensive asthma management plan, as specified. The bill would authorize local educational agencies to meet this requirement if the local educational agency has previously adopted an asthma management plan, as provided. schools to, upon receiving notice from a parent or guardian that a pupil has asthma, create an individualized asthma action plan for that pupil. The bill would encourage local educational agencies to provide professional development for school staff that includes, among other things, information about symptoms and common triggers of asthma. By imposing new duties on local educational agencies, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law requires the governing board of any school district to give diligent care to the health and physical development of pupils.

This bill would require school districts, county offices of education, and charter schools, on or before the start of the 202425 school year, to adopt a comprehensive asthma management plan, as specified. The bill would authorize local educational agencies to meet this requirement by consulting with and adopting regulations consistent with the California School Boards Associations asthma management sample administrative regulations. if the local educational agency has previously adopted an asthma management plan, as provided. By imposing new duties on local educational agencies, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law requires the governing board of any school district to give diligent care to the health and physical development of pupils.

This bill would require school districts, county offices of education, and charter schools, on or before the start of the 202425 school year, to adopt a comprehensive asthma management plan, as specified. The bill would authorize local educational agencies to meet this requirement by consulting with and adopting regulations consistent with the California School Boards Associations asthma management sample administrative regulations. By imposing new duties on local educational agencies, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Date of Hearing: August 23, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

SBPCA Bill Id:SB 283

Author:(Ochoa Bogh) – As Amended Ver:August 14, 2023

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill requires every local educational agencies (LEAs) to create individualized asthma action plan for students who have asthma.

Specifically, this bill requires an LEA, beginning with the 2024-25 school year, upon receiving notice from the student’s parent or guardian, to create an individualized asthma action plan for a student who has asthma. In addition, the bill encourages LEAs to provide professional development for school staff that includes information about asthma symptoms, common triggers of asthma, ways to reduce acute asthma symptoms, and emergency response procedures for students with asthma.

FISCAL EFFECT:

Ongoing Proposition 98 General Fund costs, of an unknown but potentially significant amount, to LEAs to create an individualized asthma action plans for each student who has asthma. The state has about 5.9 million students, which would equate to about 850,000 required action plans.

If each plan took three hours of staff time to complete at a cost of $35, costs would be in the tens of millions of dollars one-time, with lower annual costs to develop plans for students newly enrolling at a public school. Costs could be lower to the extent schools use existing plan resources and templates and to the extent schools develop Individualized Health and Support Plans for students with asthma already, as described in more detail in comment 2.

If the Commission on State Mandates determines the bill’s requirements to be a reimbursable state mandate, the state must to reimburse these costs to LEAs or provide funding through the K-12 Mandate Block Grant.

COMMENTS:

1. Purpose. According to the author:

With asthma on the rise, it is imperative that school districts provide school staff with education and support services so they can quickly identify and assist students with asthma. SB 283 will provide reassurance to students with asthma and their parents during school hours and could possibly save lives.

1. Background. Asthma is a chronic lung disease and the leading cause of absenteeism for students. The California Department of Public Health (CDPH) reports, in the 2019-2020 fiscal year, 14.5% of children ages five through 17 had been diagnosed with asthma by a healthcare provider.

State agencies have developed several resources for schools to help students manage asthma. The California Department of Education developed jointly with health professionals “Guidelines for the Management of Asthma in California Schools.” In addition, CDPH also developed a “My Asthma Plan” form, available in multiple languages, to be completed by a school nurse in collaboration with a student’s physician and parent or guardian, detailing the student’s specific symptoms, medications, and actions to be taken when asthma symptoms are present.

Individualized Health and Support Plan. An Individualized Health and Support Plan, also referred to as a “care plan,” is used by LEAs as a medical management tool for providing medically necessary healthcare services to a Medi-Cal enrolled student with a chronic health condition, such as asthma. In addition, under specified conditions, schools can be reimbursed for a portion of the cost of services provided to a student under a care plan. To develop the care plan, a parent notifies their child’s school that their child has a health condition and the school’s nurse reaches out to the parent for a health history and contact information for the student’s physician. Once the care plan is completed and approved by the parent, the school nurse generally shares the plan with the parent, the school secretary, and the student’s teachers, including the student’s physical education teacher. According to the California School Nurses Organization, in the case of a student with asthma, schools typically use the “My Asthma Plan” form as their care plan template. In addition, the California School Nurses Organization indicates it offers a training module for school nurses and other school staff on asthma care.

1. Related Legislation. AB 1283 (Chen) authorizes an LEA to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered, among other provisions. The bill is pending in the Senate Appropriations Committee.

Analysis Prepared by: Natasha Collins / APPR. / (916) 319-2081

Date of Hearing: July 12, 2023

ASSEMBLY COMMITTEE ON EDUCATION

Al Muratsuchi, Chair

SBPCA Bill Id:SB 283

Author:(Ochoa Bogh) – As Amended Ver:March 23, 2023

SENATE VOTE: 40-0

SUBJECT: Pupil health: asthma management

SUMMARY: Requires all local educational agencies (LEAs) to adopt a comprehensive asthma management plan by the start of the 2024-25 school year. Specifically, this bill:

1. Requires LEAs to adopt a comprehensive asthma management plan by the start of the 2024-25 school year that includes a plan for the following:
   1. Identifying students with asthma;
   2. Creating individualized asthma plans for those students with asthma;
   3. Providing professional development for school staff that includes information about symptoms and common triggers of asthma, ways to reduce acute symptoms, and emergency response procedures.
2. Authorizes LEAs to meet the requirement in (1) if they have previously adopted an asthma management plan meeting these provisions.
3. Defines “local educational agency” as a school district, county office of education (COE), or charter school.

EXISTING LAW:

1. Authorizes students to carry and self-administer inhaled asthma medication during the schoolday if specified materials in writing are submitted to the LEA. (Education Code (EC) 49423.1)
2. Requires a school district, in order for a student to carry and self-administer prescription inhaled asthma medication, to obtain a written statement from the physician detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken, and confirming that the student is able to self-administer inhaled asthma medication, and a written statement from the parent or guardian consenting to the self-administration, providing a release for the school nurse or other designated school personnel to consult with the health care provider of the student regarding any questions that may arise with regard to the medication, and releasing the school district and school personnel from civil liability if the self-administering student suffers an adverse reaction. (EC 49423.1)
3. Establishes the Office of School-Based Health at the California Department of Education (CDE) for the purpose of assisting LEAs regarding the current health-related programs under the purview of the CDE, and requires the scope of the office to include collaborating with the Department of Health Care Services (DHCS) and other departments in the provision of school-based health services, and assisting LEAs with information on, and participation in specified school-based health programs. (EC 49419)
4. Requires the governing board of any school district to give diligent care to the health and physical development of pupils, and authorizes it to employ properly certified persons to conduct this work. (EC 49400)
5. Expresses the policy of the state that school facilities provide healthy indoor air quality, including adequate ventilation, to students, teachers, and other occupants in order to protect health, reduce sick days, and improve student productivity and performance. (EC 17660)
6. Authorizes the use of modernization and new facility construction apportionments to promote indoor air quality, including by installing or updating air filtration systems to limit student exposure to harmful air pollutants. (EC 17072.35 and 17074.25)
7. In federal law, establishes the Individuals with Disabilities Education Act (IDEA), in order to ensure that all children with disabilities have a free appropriate public education (FAPE) that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living, among other purposes. (20 U.S.C. Section 1400)
8. In federal law, the Rehabilitation Act of 1973, prohibits an individual with a disability, as defined, from, solely by reason of his or her disability, being excluded from the participation in, being denied the benefits of, or being subjected to discrimination under any program or activity receiving federal financial assistance. (29 U.S.C. Section 794)

FISCAL EFFECT: According to the Senate Appropriations Committee: “By requiring LEAs to adopt comprehensive asthma management plans, this bill could result in a reimbursable state mandate. The Proposition 98 General Fund costs are estimated to be in the hundreds of thousands to low millions of dollars each year and would create additional cost pressure on the K-12 Mandates Block Grant.”

COMMENTS:

Need for the bill. According to the author, “With asthma on the rise, it is imperative that school districts provide school staff with education and support services so they can quickly identify and assist students with asthma. SB 283 will provide reassurance to students with asthma and their parents during school hours and could possibly save lives.”

Asthma in school-aged children. Asthma is a chronic lung disease and the leading cause of absenteeism for students. It affects 10% of school-aged children nationwide and accounts for 5.2 million absences annually. The California Department of Public Health (CDPH) reports that in 2019-2020, 14.5% of children ages 5 through 17 had been diagnosed with asthma by a healthcare provider. Children between the ages of 5-17 years experienced 58.4 asthma-related visits to emergency departments in 2019 per 10,000 persons, compared to a rate of 42.6 for all ages. While rare, the recorded asthma death rates per one million state residents from 2017 through 2019 were 1.1 for children ages 0-17 and 11.5 for adults 18 years of age and older.

Asthma often starts during childhood as children’s immune systems are still developing. While the exact cause of asthma is unknown, certain factors combined can contribute to a child developing asthma including:

• Family history (parent or sibling having asthma);
• Exposure to things in the environment (allergens such as cigarette smoke or pollution); and
• Viral infections (which affect the lungs).

Asthma can also be triggered or set off by various elements such as:

• Indoor allergens (pet dander or dust mites);
• Outdoor allergens (mold or pollens);
• Physical activity;
• Infections (colds, influenza, or COVID-19);
• Poor air quality or very cold air; and
• Certain medications such as pain relievers.

Management of symptoms for asthma. While there is no cure for asthma, treatment meant to alleviate symptoms include quick relief and long-term treatments. Treatments range from taking pills, utilizing a nebulizer (a machine that turns liquid medicine into mist to be more easily inhaled), to using an inhaler (a handheld, portable device that delivers medication to the user’s lungs).

Long-term medication for asthma is known as controller medication and is taken daily as an inhaled corticosteroid utilizing an inhaler. Taken consistently, corticosteroids decreases inflammation in the airways of the lungs and helps to prevent asthma flare-ups, and are considered the most effective long-term medication for control and management of asthma.

Quick relief or “rescue medication” rapidly opens the airways of the lungs and relieves symptoms during an asthma flare-up. Bronchodilator medications such as long-acting beta-agonists (LABAs) can be combined with a corticosteroid in order to relax the muscles lining the airways that carry air to the lungs allowing the tubes to remain open and making breathing easier.

Guidance for managing asthma in schools. "Guidelines for the Management of Asthma in California Schools" was developed jointly by health professionals in the CDE and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders. Available resources through CDPH also include a “My Asthma Plan” form, available in multiple languages, to be completed by a school nurse in collaboration with a student’s physician and parent or guardian, detailing the student’s specific symptoms, medications, and actions to be taken when asthma symptoms are present.

The CDPH guidance suggests that an asthma management program at a school encompass the following key action items:

• Establishing a team to develop, implement, and monitor the asthma management program;
• Identify and track students who have asthma; and
• Provide care, support services, and resources for students who have asthma.

The report notes that effective school asthma management programs can produce the following positive results:

• A healthier and supportive learning environment for students with asthma;
• Reduced absences due to students having fewer asthma attacks as a result of symptoms being treated earlier;
• Students may have fewer symptoms and be more alert in the classroom when their asthma is under control;
• Appropriate emergency response as school staff know how to recognize and respond to asthma emergencies;
• Improved access and adherence to appropriate asthma medications; and
• Full student participation in physical activities as teachers and coaches know how to prevent exercise-induced asthma or how to respond if symptoms appear.

The California School Boards Association (CSBA) offers sample district policies on asthma management. This bill requires schools to develop comprehensive asthma plans as well as to create individualized asthma plans for those students with asthma. CSBA offers sample policy templates that a board may use to develop asthma management plans, covering the following topics:

• Identification of students with asthma;
• Individualized asthma management;
• Education/professional development and support services; and
• Environmental assessment.

Meeting the needs of students with asthma. When a current student has been diagnosed with asthma or when the student registers for school, school officials assess whether the student is identified as disabled, pursuant to Section 504 or the IDEA, or if the student requires an asthma action plan. These are discussed in the following sections.

Individual education program (IEP). The IDEA is the primary federal program that authorizes state and local aid for special education and related services for children with disabilities. To qualify for an IEP, a student must meet two criteria: the student must have a disability that affects their ability to learn or access education; and the student must require special education services in order to make progress in their education. IDEA covers 13 disability categories, one of which is “other health impairment.” In order for a student with asthma to qualify for an IEP, a determination would have to be made that the condition impacts their ability to learn.

504 plans. Section 504 of the Rehabilitation Act of 1973 prohibits an individual with a disability in the United States, as defined, from, solely by reason of his or her disability, being excluded from the participation in, being denied the benefits of, or being subjected to discrimination under any program or activity receiving federal financial assistance, including public schools. Section 504 regulations require that public schools provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities.

To be protected under Section 504, a student must be determined to 1) have a physical or mental impairment that substantially limits one or more major life activities, 2) have a record of such an impairment, or 3) be regarded as having such an impairment. Major life activities include activities such as walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning. Unlike under IDEA, students do not need to have one of a list of specified disabling conditions. Some students who do not qualify for an IEP under the IDEA may qualify for a 504 plan. Process requirements for the development of 504 plans are less specific than IEPs in several ways.

The determination that a student has a “substantial limitation” must be made on an individualized basis. Section 504 requires that a group of knowledgeable persons (sometimes constituted as a team) draw upon information from a variety of sources in making this determination. Unlike under the IDEA, the composition of group is not specified. This team develops a 504 plan which delineates the services and/or changes to the learning environment required to meet the needs of the child as adequately as other students.

Individualized School Healthcare Plans. Children with a chronic health condition, such as asthma, who do not qualify for an IEP or 504 plan may require an Individualized Health and Support Plan (IHSP), often referred to as a care plan. Under specified conditions, schools can be reimbursed for a portion of the cost of services provided to a student under a care plan, particularly if the student is eligible for Medi-Cal. According to the Department of Health Care Services (DHCS), a care plan should identify the healthcare needs of the student, and include, at minimum:

• Medical necessity for services authorized by a medical practitioner;
• Treatment services to be provided to the student;
• Plan for the duration and frequency of services;
• Necessary training, supervision, and monitoring of designated school staff;
• Plan for evaluating and reporting outcomes and changes; and
• A method to ensure and document safe, consistent provision of services to the student.

Schools have practices in place to respond to students with asthma. According to the California School Nurses Organization (CSNO), in the case of a student with asthma, the student’s individualized health plan is typically based upon the “My Asthma Plan” form noted above. As the parent notifies the school that a student has asthma, the school nurse, assigned to that school, reaches out to the parent for a health history and contact information for the student’s physician. Once the asthma plan is completed, and approved by the parent, the school nurse generally shares the plan with the parent, the school secretary, the student’s teacher(s), including the physical education teacher.

The CSNO offers a training module for school nurses, or other school staff, on asthma care. They note that as each student’s asthma situation is unique, the best practice is to complete the individual asthma action plans, rather than requiring a schoolwide plan.

Recommended Committee Amendments. Staff recommends that the bill be amended as follows:

1. Remove codified naming of section as “Adilene’s Law” and reference in an uncodified section.
2. Remove the requirement for all LEAs to adopt a comprehensive asthma management plan.
3. Require LEAs, upon notification from the parent or guardian that a student has asthma, to develop an individualized asthma action plan for that student.
4. Encourage LEAs to provide professional development on asthma to employees with connection to students with asthma.

Arguments in support. According to Regional Asthma Management and Prevention (RAMP), “Asthma is one of the most common chronic diseases among school aged children, with about

12% of children under 18 diagnosed with asthma. In most cases, proper asthma management, including quality clinical care and reducing exposure to environmental asthma triggers, can prevent the severe exacerbations that cause emergency department visits and hospitalizations. Because children spend a significant part of their day at schools, schools are vital partners in helping students properly manage their asthma. That is why RAMP and many of our partners across the state have worked with schools to implement a range of strategies to better support students with asthma. Comprehensive asthma management plans are a great tool to identify the needs of students with asthma, develop strategies to address those needs, and, vitally, ensure teachers and staff are trained to understand asthma and what to do during an asthma emergency.

By requiring LEAs to adopt comprehensive asthma management plans, SB 283 will encourage

schools to identify and implement best practices towards making their schools asthma-friendly

and ensure schools are adequately prepared to support their students with asthma.”

Related legislation. AB 1283 (Chen) of the 2023-24 session authorizes an LEA to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered. Authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress. Requires the SPI to establish minimum standards of training for the administration of stock albuterol inhalers and review the standards every five years or sooner.

AB 743 (Eduardo Garcia), Chapter 101, Statutes of 2019, requires a school district to accept the written statement from a physician who is contracted with a binational health plan for the purposes of authorizing a pupil to carry and self-administer inhaled asthma medication that the pupil is required to administer during the regular schoolday.

AB 2132 (Reyes), Chapter 832, Statutes of 2004, authorizes a pupil to carry and self-administer inhaled asthma medication during the schoolday if specified requirements are met.

REGISTERED SUPPORT / OPPOSITION:

Support

Breathe California

Community Action to Fight Asthma

Consumer Attorneys of California

Los Angeles County Office of Education

Regional Asthma Management and Prevention

Opposition

None on file

Analysis Prepared by: Debbie Look / ED. / (916) 319-2087

 THIRD READING  

Bill No: SB 283

Author: Ochoa Bogh (R)

Amended: 3/23/23

Vote: 21

SENATE EDUCATION COMMITTEE: 7-0, 3/22/23

AYES: Newman, Ochoa Bogh, Cortese, Glazer, McGuire, Smallwood-Cuevas, Wilk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/18/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

SUBJECT: Pupil health: asthma management

SOURCE: Author

DIGEST:

This bill requires local educational agencies (LEAs) to adopt comprehensive asthma management plans before the 2024-25 school year. The plans shall identify pupils with asthma, create individualized asthma plans for those pupils, and provide professional development for school staff.

ANALYSIS:

Existing law:

1. Authorizes a pupil who is required to take, during the regular schoolday, medication prescribed for the pupil by a physician or surgeon, to be assisted by the school nurse or other designated school personnel or may carry and self-administer inhaled asthma medication if the school district receives the appropriate written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken and a written statement from the parent, foster parent, or guardian of the pupil requesting that the school district assist the pupil in the matters set forth in the statement of the physician or surgeon. (Education Code (EC) § 49423.1)
2. Specifies in order for a pupil to carry and self-administer prescription inhaled asthma medication, the school district shall obtain both a written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken, and confirming that the pupil is able to self-administer inhaled asthma medication, and a written statement from the parent, foster parent, or guardian of the pupil consenting to the self-administration, providing a release for the school nurse or other designated school personnel to consult with the health care provider of the pupil regarding any questions that may arise with regard to the medication, and releasing the school district and school personnel from civil liability if the self-administering pupil suffers an adverse reaction by taking medication pursuant to this section. (EC § 49423.1)
3. Establishes the Office of School-Based Health at the California Department of Education (CDE) for the purpose of assisting LEAs regarding the current health-related programs under the purview of the CDE, and requires the scope of the office to include collaborating with the Department of Health Care Services (DHCS) and other departments in the provision of school-based health services, and assisting LEAs with information on, and participation in specified school-based health programs. (EC § 49419)
4. Requires the governing board of any school district to give diligent care to the health and physical development of pupils, and authorizes it to employ properly certified persons to conduct this work. (EC § 49400)

This bill:

1. Requires LEAs to adopt a comprehensive asthma management plan on or before the 2024-25 school year.
2. Specifies the comprehensive asthma management plan shall include, but is not limited to:
   1. Identifying pupils with asthma.
   2. Creating individualized asthma plans for those pupils with asthma.
   3. Providing professional development for school staff that includes, but is not limited to, information about symptoms, common triggers of asthma, ways to reduce acute symptoms, and emergency response procedures.
3. Clarifies that an LEA may satisfy the requirement to adopt an asthma management plan if that plan meets all the requirements in 2).
4. Defines “local educational agency” as a school district, county office of education, or charter school.

Comments

1. Need for the bill. According to the author “On October 31, 2019, Adilene Carrasco suffered a severe asthma attack at her middle school. A trip with her science class to the school’s athletic field to celebrate Halloween quickly became serious as Adilene began having difficulties breathing. After alerting a nearby teacher, Adilene walked from the athletic field to her classroom several times without adult supervision. Only one fellow classmate accompanied her.

“When her condition worsened to the point she was unable to stand or speak, she had to be transported to the nurse’s office by golf cart. It was there that the school nurse started CPR. By the time paramedics transported her to the closest hospital, Adilene was unresponsive. Nine days later, on November 9, 2019, Adilene passed away. She was only 13 years old.

“Unfortunately, Adilene’s case is not unique. Asthma is the leading chronic illness among school-aged children and one of the most common causes of school absenteeism. In 2008, the California School Board Association (CSBA) issued Administrative Regulation (AR) 5141.23, a sample document intended to guide school districts in formulating asthma management policies. Since then, many school districts have adopted CSBA’s AR on asthma management, including – most recently – the school district which oversees the middle school Adilene attended. However, many school districts still lack a comprehensive asthma management plan despite CSBA’s recommendation almost 15 years ago.

“SB 283 would require LEAs to adopt a comprehensive asthma management plan similar to CSBA’s AR 5141.23 to ensure there are procedures in place to protect students with asthma. With asthma on the rise, it is imperative that school districts provide school staff with education and support services so they can quickly identify and assist students with asthma. SB 283 will provide reassurance to students with asthma and their parents during school hours and could possibly save lives.”

1. Asthma In School Aged Children. According to the California Asthma Dashboard, in 2019-2020, an estimated 12% of California children ages 1-17 had been diagnosed with asthma at some point in their lives, a decrease from 16% in 2005. While asthma does not result in hospitalization for most children, there were 7,670 hospitalizations for asthma among children ages 0-17 statewide in 2019.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of pediatric hospitalization. It also is the top reason for missed school days, accounting for more than 5.2 million absences annually. Asthma rates vary by region, demographics, environment, physician diagnostic practices, and access to care. Although identifying the impact of independent risk factors for asthma is difficult, children of color and those from low-income families are disproportionately at high risk for severe symptoms, missed school days, and hospital visits.

By race and ethnicity, African Americans in California suffer the most severe disparities. Compared to non-Hispanic Whites, asthma prevalence among African Americans is 40% higher, rates of emergency department (ED) visits and hospitalizations are about 4 times higher, and death rates are about two times higher. California’s American Indian\Alaska Native, Pacific Islander, and Filipino populations also are more adversely affected by asthma compared to non-Hispanic Whites.

1. School-Based Health Centers. According to the California School-Based Health Alliance, SBHCs are uniquely situated to bring healthcare professionals and educators together to address the multifaceted needs of children, youth, and families. Some SBHCs serve only students, while others benefit family members or the school community. SBHCs offer a range of health services, with the most common being primary medical services. Many SBHCs play an essential role in managing students’ chronic illnesses, such as asthma and diabetes, and in responding to acute injuries or illnesses on campus. Some SBHCs in secondary schools offer reproductive health services, such as abstinence counseling, pregnancy prevention, and STD/HIV testing and treatment. Other services provided by SBHCs include dental care, mental health counseling, and youth development programs. Local school boards give final approval to the services provided by the SBHC. Standard services provided by SBHCs in California, and the percentage of SBHCs offering them, include:

• Medical services 85%;
• Mental health services 70%;
• Reproductive health 60%;
• Dental prevention 65%;
• Dental treatment 35%; and
• Youth engagement programs 51%

California SBHCs are funded through various sources that depend on their lead agencies, student populations, communities, and local resources. These funding sources include reimbursement from Medi-Cal and other third-party payers; local, state, and federal grants; private foundation or corporate grants; subsidies from their lead organizations; donations; and/or in-kind contributions from school districts and other partners.

In June 2021, the Legislature made an included unprecedented investments of $4.4 billion in the California Child and Youth Behavioral Health Initiative, with a special focus on school-based services and supports.

1. The Management Of Asthma In California Schools. CDPH “Guidelines for the Management of Asthma in California Schools" and "Asthma Action Plan for Schools and Families" assist schools in effectively managing this chronic disease. The "Guidelines for the Management of Asthma in California Schools" were developed jointly by health professionals in the CDE and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders. 

Further, the asthma program in the CDPH, California Breathing, works to improve the respiratory health of Californians and reduce asthma-related health disparities through education and environmental interventions where we live, work, learn, and play. Strategic Plan guides its work for Asthma in California, a document encompassing all aspects of asthma-related research, policy, and services.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee, by requiring LEAs to add new procedures to their school safety plans, this bill could result in a reimbursable state mandate. The extent of these costs is unknown, but based on the existing Comprehensive School Safety Plan I and II mandates, the Proposition 98 General Fund costs could be in the tens of thousands to low hundreds of thousands of dollars each year. A precise amount would ultimately depend on the scope of the activities that LEAs would need to comply. This could also create additional, unknown cost pressure on the K-12 Mandates Block Grant.

SUPPORT: (Verified 5/19/23)

Consumer Attorneys of California

Los Angeles County Office of Education

Regional Asthma Management and Prevention

OPPOSITION: (Verified 5/19/23)

None received

ARGUMENTS IN SUPPORT: According to the Los Angeles County of Education “Asthma is the leading chronic illness among school-aged children and one of the most common causes of school absenteeism. According to the Centers for Disease Control, it is likely that 1 in 10 students suffer from asthma. In the United States, asthma kills more than 300 children and young adults under 24 each year; although, according to Rutgers Medical School, the number may be much higher. This is because the official cause of death (e.g., acute respiratory failure) may not reflect an asthma-inciting event if the individual was already in cardiac arrest upon arrival at the emergency department. SB 283 would require LEAs to adopt a comprehensive asthma management plan similar to CSBA’s AR 5141.23 to ensure there are procedures in place to protect students with asthma.”

Prepared by: Kordell Hampton / ED. / (916) 651-4105

5/20/23 12:41:14

**** END ****

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

SB 283 (Ochoa Bogh) - Pupil health: asthma management

Bill Summary:

This bill requires local educational agencies (LEAs) to adopt comprehensive asthma management plans before the 2024-25 school year. The plans shall identify pupils with asthma, create individualized asthma plans for those pupils, and provide professional development for school staff.

Fiscal Impact:

By requiring LEAs to adopt comprehensive asthma management plans, this bill could result in a reimbursable state mandate. The Proposition 98 General Fund costs are estimated to be in the hundreds of thousands to low millions of dollars each year and would create additional cost pressure on the K-12 Mandates Block Grant.

Background:

Existing law authorizes a pupil who is required to take, during the regular schoolday, medication prescribed for the pupil by a physician or surgeon, to be assisted by the school nurse or other designated school personnel or may carry and self-administer inhaled asthma medication if the school district receives the appropriate written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken and a written statement from the parent, foster parent, or guardian of the pupil requesting that the school district assist the pupil in the matters set forth in the statement of the physician or surgeon.

Existing law provides that in order for a pupil to carry and self-administer prescription inhaled asthma medication, the school district shall obtain both a written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken, and confirming that the pupil is able to self-administer inhaled asthma medication, and a written statement from the parent, foster parent, or guardian of the pupil consenting to the self-administration, providing a release for the school nurse or other designated school personnel to consult with the health care provider of the pupil regarding any questions that may arise with regard to the medication, and releasing the school district and school personnel from civil liability if the self-administering pupil suffers an adverse reaction by taking medication pursuant to this section.

Proposed Law:

This bill requires LEAs to adopt a comprehensive asthma management plan on or before the 2024-25 school year which shall include, but is not limited to: identifying pupils with asthma; creating individualized asthma plans for those pupils with asthma; and providing professional development for school staff that includes, but is not limited to, information about symptoms, common triggers of asthma, ways to reduce acute symptoms, and emergency response procedures.

This bill provides that an LEA may satisfy the requirement to adopt a comprehensive asthma management by consulting with and adopting regulations consistent with the California School Boards Association’s asthma management sample administrative regulations. This bill also specifies that LEAs may comply with the bill if their current asthma management plan is consist with the requirements.

Staff Comments:

This bill requires school districts to adopt comprehensive asthma management plans before the 2024-25 school year. The plans shall identify pupils with asthma, create individualized asthma plans for those pupils, and provide professional development for school staff. Consistent with previous determinations by the Commission on State Mandates regarding school safety plans, the Commission is likely to determine the activities required by this bill to be a higher level of service and therefore a reimbursable state mandate. The associated costs could be significant, potentially in the hundreds of thousands to low millions of dollars each year. Alternatively, if school districts elect not to submit mandate claims to the Commission, there could be pressure for the state to increase the K-12 Mandates Block grant. The amount of funding provided through the block grant is tied to the mandates that the Commission has approved as well as the costs for those mandates. School districts that choose to participate in the block grant receive a per-student amount to cover the cost of the various state mandated activities in lieu of submitting mandate claims for reimbursement. Charter schools may participate in the block grant, but are not eligible to submit mandate claims nor receive reimbursement from the state. The 2022 Budget Act includes $242.3 million for the K-12 Mandates Block Grant.

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SENATE COMMITTEE ON EDUCATION

Senator Josh Newman, Chair

2023 - 2024 Regular

Bill No: SB 283 Hearing Date: March 22, 2023

Subject: Pupil health: asthma management.

SUMMARY

This bill requires local educational agencies (LEA), on or before the 2024-25 school year, to adopt comprehensive asthma management plans, which includes, but are not limited to, identifying pupils with asthma, creating individualized asthma plans for those pupils, and professional development for school staff.

BACKGROUND

Existing Law

Education Code (EDC)

1. Authorizes a pupil who is required to take, during the regular schoolday, medication prescribed for the pupil by a physician or surgeon, to be assisted by the school nurse or other designated school personnel or may carry and self-administer inhaled asthma medication if the school district receives the appropriate written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken and a written statement from the parent, foster parent, or guardian of the pupil requesting that the school district assist the pupil in the matters set forth in the statement of the physician or surgeon. (EDC § 49423.1)
2. Specifies in order for a pupil to carry and self-administer prescription inhaled asthma medication, the school district shall obtain both a written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken, and confirming that the pupil is able to self-administer inhaled asthma medication, and a written statement from the parent, foster parent, or guardian of the pupil consenting to the self-administration, providing a release for the school nurse or other designated school personnel to consult with the health care provider of the pupil regarding any questions that may arise with regard to the medication, and releasing the school district and school personnel from civil liability if the self-administering pupil suffers an adverse reaction by taking medication pursuant to this section. (EDC § 49423.1)
3. Establishes the Office of School-Based Health at the California Department of Education (CDE) for the purpose of assisting LEAs regarding the current health-related programs under the purview of the CDE, and requires the scope of the office to include collaborating with the Department of Health Care Services (DHCS) and other departments in the provision of school-based health services, and assisting LEAs with information on, and participation in specified school-based health programs. (EDC § 49419)
4. Requires the governing board of any school district to give diligent care to the health and physical development of pupils, and authorizes it to employ properly certified persons to conduct this work. (EDC § 49400)

Health and Safety Code (HSC)

1. Requires the California Department of Public Health (CDPH), to the extent funding is appropriated annually in the Budget Act or other statute, to establish Public School Health Center Support Program (PSHCSP), in collaboration with the CDE, to assist in establishing, expanding, and sustaining school-based health centers (SBHCs), as specified. Requires CDPH to establish a grant program for LEAs for these purposes. (HSC §124174)
2. Permits School Based Health Centers (SBHC) to provide age-appropriate health care services at the program site, including conducting routine physical, mental, and oral health assessments onsite, and providing referrals for any services not offered onsite. Permits a SBHC to serve two or more nonadjacent schools or LEAs. (HSC §124174)

California Code of Regulation (CCR)

1. Specifies that school districts are not precluded from utilizing community-based service providers, including volunteers, individuals completing counseling-related internship programs, and state licensed individuals and agencies to assist in providing pupil personnel services, provided that such individuals and agencies are supervised in their school-based activities by an individual holding a pupil personnel services authorization. (CCR, Title 5, § 80049.1(c))

ANALYSIS

This bill requires LEAs, on or before the 2024-25 school year to adopt comprehensive asthma management plans, which include, but are not limited to, identifying pupils with asthma, creating individualized asthma plans for those pupils, and professional development for school staff. Specifically, this bill:

1. Requires LEAs to adopt a comprehensive asthma management plan on or before the 2024-25 school year.
2. Specifies the comprehensive asthma management plan shall include, but is not limited to:
   1. Identifying pupils with asthma.
   2. Creating individualized asthma plans for those pupils with asthma.
   3. Providing professional development for school staff that includes, but is not limited to, information about symptoms, common triggers of asthma, ways to reduce acute symptoms, and emergency response procedures.
3. Authorizes an LEA may satisfy the requirement to adopt a comprehensive asthma management by consulting with and adopting regulations consistent with the California School Boards Association’s asthma management sample administrative regulations.
4. Defines “local educational agency” as a school district, county office of education, or charter school.

STAFF COMMENTS

1. Need for the bill. According to the author “On October 31, 2019, Adilene Carrasco suffered a severe asthma attack at her middle school. A trip with her science class to the school’s athletic field to celebrate Halloween quickly became serious as Adilene began having difficulties breathing. After alerting a nearby teacher, Adilene walked from the athletic field to her classroom several times without adult supervision. Only one fellow classmate accompanied her.

“When her condition worsened to the point she was unable to stand or speak, she had to be transported to the nurse’s office by golf cart. It was there that the school nurse started CPR. By the time paramedics transported her to the closest hospital, Adilene was unresponsive. Nine days later, on November 9, 2019, Adilene passed away. She was only 13 years old.

“Unfortunately, Adilene’s case is not unique. Asthma is the leading chronic illness among school-aged children and one of the most common causes of school absenteeism. In 2008, the California School Board Association (CSBA) issued Administrative Regulation (AR) 5141.23, a sample document intended to guide school districts in formulating asthma management policies. Since then, many school districts have adopted CSBA’s AR on asthma management, including – most recently – the school district which oversees the middle school Adilene attended. However, many school districts still lack a comprehensive asthma management plan despite CSBA’s recommendation almost 15 years ago.

“SB 283 would require LEAs to adopt a comprehensive asthma management plan similar to CSBA’s AR 5141.23 to ensure there are procedures in place to protect students with asthma. With asthma on the rise, it is imperative that school districts provide school staff with education and support services so they can quickly identify and assist students with asthma. SB 283 will provide reassurance to students with asthma and their parents during school hours and could possibly save lives.”

1. Asthma In School Aged Children. According to the California Asthma Dashboard, in 2019-2020, an estimated 12% of California children ages 1-17 had been diagnosed with asthma at some point in their lives, a decrease from 16% in 2005. While asthma does not result in hospitalization for most children, there were 7,670 hospitalizations for asthma among children ages 0-17 statewide in 2019.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of pediatric hospitalization. It also is the top reason for missed school days, accounting for more than 5.2 million absences annually. Asthma rates vary by region, demographics, environment, physician diagnostic practices, and access to care. Although identifying the impact of independent risk factors for asthma is difficult, children of color and those from low-income families are disproportionately at high risk for severe symptoms, missed school days, and hospital visits.

By race and ethnicity, African Americans in California suffer the most severe disparities. Compared to non-Hispanic Whites, asthma prevalence among African Americans is 40% higher, rates of emergency department (ED) visits and hospitalizations are about 4 times higher, and death rates are about 2 times higher. California’s American Indian\Alaska Native, Pacific Islander, and Filipino populations also are more adversely affected by asthma compared to non-Hispanic Whites.

1. School-Based Health Centers. According to the California School-Based Health Alliance, SBHCs are uniquely situated to bring healthcare professionals and educators together to address the multifaceted needs of children, youth, and families. Some SBHCs serve only students, while others benefit family members or the school community. SBHCs offer a range of health services, with the most common being primary medical services. Many SBHCs play an essential role in managing students’ chronic illnesses, such as asthma and diabetes, and in responding to acute injuries or illnesses on campus. Some SBHCs in secondary schools offer reproductive health services, such as abstinence counseling, pregnancy prevention, and STD/HIV testing and treatment. Other services provided by SBHCs include dental care, mental health counseling, and youth development programs. Local school boards give final approval to the services provided by the SBHC. Standard services provided by SBHCs in California, and the percentage of SBHCs offering them, include:

• Medical services 85%;
• Mental health services 70%;
• Reproductive health 60%;
• Dental prevention 65%;
• Dental treatment 35%; and
• Youth engagement programs 51%

California SBHCs are funded through various sources that depend on their lead agencies, student populations, communities, and local resources. These funding sources include reimbursement from Medi-Cal and other third-party payers; local, state, and federal grants; private foundation or corporate grants; subsidies from their lead organizations; donations; and/or in-kind contributions from school districts and other partners.

In June 2021, the Legislature made an included unprecedented investments of $4.4 billion in the California Child and Youth Behavioral Health Initiative, with a special focus on school-based services and supports.

1. The Management Of Asthma In California Schools. CDPH “Guidelines for the Management of Asthma in California Schools" and "Asthma Action Plan for Schools and Families" assist schools in effectively managing this chronic disease. The "Guidelines for the Management of Asthma in California Schools" were developed jointly by health professionals in the CDE and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders. 

Further, the asthma program in the CDPH, California Breathing, works to improve the respiratory health of Californians and reduce asthma-related health disparities through education and environmental interventions where we live, work, learn, and play. Strategic Plan guides its work for Asthma in California, a document encompassing all aspects of asthma-related research, policy, and services.

1. Committee Amendment: The author has agreed to take the following amendments:
   1. Specify that LEAs may comply with this section if their current asthma management plan is consist with the requirements of this bill.
   2. Adds findings and declarations
2. Prior Legislation.

AB 743 (E. Garcia) Chapter 132, Statues of 2015, requires a school district to accept the written statement from a physician who is contracted with a binational health plan for the purposes of authorizing a pupil to carry and self-administer inhaled asthma medication that the pupil is required to administer during the regular schoolday.

AB 2132 (Reyes) Chapter 832, Statutes of 2004, authorizes a pupil to carry and self-administer medication, including inhaled asthma medication, or to receive assistance from school personnel, as specified, if the school district receives written statements, as specified.

AB 2185 (Frommer), Chapter 711, Statues of 2004, would have required specified health care service plans to provide coverage for equipment for the treatment of pediatric asthma and coverage for pediatric asthma outpatient self-management training and education.

AB 2367 (Chan), of the 2003-04 Session, would have required school districts that receives an asthma action plan to maintain the plan on file and provide it to teachers. This bill was held in Assembly Appropriations Committee.

SUPPORT

Los Angeles County Office of Education

OPPOSITION

None received

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