2020 Legislative Annual Report

2020 Annual Report of the Legislative Committee

According to Article V, Section 1. A. of the New Hampshire School Nurses’ Association (NHSNA) Constitution & By-Laws, the Legislative Committee aids in planning, drafting or presenting desired legislation to State Legislature; upgrades the standards of employment for school nurses; and, maintains an awareness of legislation and/or regulations pertinent to the practice of Nursing and School Nursing.

In fulfilling these duties, the NHSNA Legislative Committee is committed to working diligently on activities and initiatives that impact New Hampshire (NH) school children, their families and their school communities through the following:

  • ·         Participation on the NHNA’s Legislative Advisory Council with presentations at this year’s Legislative Town Hall Forum:
  • o   In support of HB 1489, Allowing RNs to certify walking disability plate eligibility. Fixes a problem with prior legislation by adding the RN to the list of health care providers that currently certify eligibility for walking disability plates and placards.
  • o   In support of HB 1662, Relative to purchase, use & possession of tobacco products. Raises the age for purchase, use and possession of tobacco products from 19 to 21 years.
  • o   In support of SB 609, Relative to passenger restraints. This bill aims to establish secondary seat belts requirements for all ages in the State of NH.
  • o   In support of SB 584, Relative to policies for students with head injuries. This bill requires the Department of Education to collaborate with the Brain Injury Association of NH to develop a return to learning policy and plan for students with concussions and brain injuries.
  • ·         Collaboration with the NH Department of Health and Human Services (DHHS)
  • o   During the rules writing process for R.S.A. 167:3-k, Medicaid to Schools for Medical Services. On February 21, 2020, the NH Joint Legislative Committee on Administrative Rules (JLCAR) voted unanimously to approve He-W 589, the new Medicaid to School rule. This rule describes Medicaid-reimbursable services, to include those provided by school nurses. (To view the rule, visit https://www.dhhs.nh.gov/ombp/medicaid/mts/documents/hew589adopted.pdf).
  • o   In support of SB 684, relative to Medicaid to Schools, signed by Governor Sununu on March 10, 2020. This law facilitates the provision of medical services in school settings to students by amending the Nurse Practice Act; Scope of Practice; Licensed Nursing Assistant [RSA 326-B:14, II-a(b)] to include public schools to the list of settings where a licensed nurse may delegate the task of medication administration.
  • o   Participation on the commission to develop and promote mental health programs and behavioral health and wellness programs in kindergarten through grade 12, subsequent to the passing of 2019 HB 131
  • o   Participation 10-Year Mental Health Plan
  • ·         Written and oral testimony based on robust discussions with elected officials and multi-disciplinary stakeholders
  • o   Regarding HB 1682, proposed legislation requiring a food allergy protocol with appropriate training for school staff in all schools, including charter and private schools
  • o   Supporting SB 599, requiring testing for lead in water in schools and child care facilities
  • o   Promoting HPV vaccination rates among NH adolescents
  • o   Advocating for SB 685-FN and making medication affordable through the lawful importation of prescription drugs from Canada

Due to the COVID-19 pandemic, the General Court has suspended all legislative activities through May 4, 2020. The Committee continues monitoring of a number of bills that have the potential to impact NH children, including:

  • o   SB 248, a bill increasing the age for sales and possession of tobacco products to 21 years of age
  • o   HB 1285, a bill prohibiting carrying a firearm on school property
  • o   SB 533, a bill establishing a committee to study the benefit of extended school recess
  • o   HB 1337, a bill permitting parents to opt their child out of armed assailant drills in school
  • o   HB 1459, a bill that would change the requirements for school district policies governing the administration of non-academic surveys or questionnaires
  • o   HB 1163, a bill requiring schools to update documents and software to include the option of identifying a student as non-binary
  • o   HB 1127 and 1512, bills that would require school boards providing free or reduced cost meals to refrain from actions that could stigmatize a child requesting such a meal, and addressing child hunger through freezing leftover school food to send home with children participating in free or reduced price meal programs, respectively
  • o   HB 1436-FN, a bill increasing insurance coverage for autism spectrum disorder
  • o   SB 665, a bill providing that as part of the system of care for children’s mental health under R.S.A. 135-F, the department of education shall assist school districts in using the multi-tiered system of supports for behavioral health and wellness or MTSS-B

It has been a rewarding challenge to represent the NH school nurses, school children and school communities through my work on the Legislative committee, and I would encourage anyone to consider joining us – your expertise and voice count!

Respectfully submitted,

Traci Fairbanks, RN

Legislative Committee Chair


2020 legislation

SB584
Session Year 2020
  Bill Docket
  Bill Status
  Bill Text[HTML] [PDF]   
Title: relative to policies for students with head injuries.
G-Status: SENATE
House Status:
Senate Status: IN COMMITTEE
Next/Last Comm: Senate Education and Workforce Development
Next/Last Hearing: 01/21/2020 at 09:45 AM    LOB Room 103


HB1682 -FN-L
Session Year 2020
  Bill Docket
  Bill Status
  Bill Text[HTML] [PDF]   
Title: requiring schools to maintain food allergy plans to address food allergy safety and training.
G-Status: HOUSE
House Status: IN COMMITTEE
Senate Status:
Next/Last Comm: House Education
Subcommittee Work Session Jan 28 @ 8:30 am in Legislative Office Building 207

SB 584: Relative to policies for students with head injuries

History:  This bill requires the Department of Education to collaborate with the Brain Injury Association of New Hampshire to develop a return to learning policy and plan for students with concussions and brain injuries.

Children between the ages 0-4 years and 15-19 years are among some of the most likely victims of Traumatic Brain Injury (TBI) related emergencies. In 2017, sports-related concussion affected nearly 2.5 million high school students.  Presently NH laws target head injury policies for student sports and focus only on returning to athletic activities.

  • Section 200:49 calls only for educating and informing players, parents and coaches of the risks for concussion and specifically directs school districts in the development of guidelines regarding a student’s continued play after sustaining a head injury.
  • Section 200:50 instructs school officials to immediately remove a student-athlete from play if they suspect the child has sustained a head injury during practice or a game.  This law requires clearance from a health care provider and written parental permission prior to returning to play.

The effects of pediatric TBI on cognition, behavior & adjustment often persist and can worsen over time. Children with TBI have been found to have significant academic difficulties characterized by school failure and deficits in academic achievement.  In addition, students who sustain less severe injuries often fail to receive school accommodations despite health care provider recommendations that they be made available for several weeks to months post-injury. 

Pros:

  • The bill would address the present need for policies and plans that support a student’s return to full academic participation.
  • The bill is a bipartisan effort from State Senators and Representatives.
  • All NH children stand to receive protection under this bill as the sponsors of the legislation hail from every corner of the State.
  • Future collaboration between the Brain Injury Association of New Hampshire and the New Hampshire Department of Education.

Cons:

  • Implementation of the law may increase the number of special services or accommodations school districts will need to provide.
  • Communication, written or otherwise between schools, parents and medical providers is beyond the oversight of this law.
  • Students may require additional medical visits to secure return-to-learn plans from their health care provider.

Committee:  Senate Education & Workforce Development

Sponsors:  Sen. David Watters; Rep. Rick Ladd; Rep. Glenn Cordelli; Rep. Chuck Grassie; Sen. Bob Giuda; Sen. Jay Kahn; and Sen. Cindy Rosenwald

Position:  Support

Action:

A public hearing is scheduled for Tuesday, January 21, 2020 at 9:45 am in LOB 103.


HB 1682-FN-L is AN ACT requiring schools to maintain food allergy plans to address food allergy safety and training.

Sponsors:  Rep. Janice Schmidt; Rep. Bruce Cohen; Rep. Skip Cleaver; Rep. Joseph Guthrie

History:  This bill requires every school in which a student with a life-threatening food allergy is enrolled to maintain a food allergy management and prevention plan.

Food allergies are a public health concern affecting an estimated 8% of children in the U.S., about 1 in 13, or 2 students per classroom. Most of these children attend federal- and state-supported schools or before and after care programs. Strict avoidance of the allergen is the only way to prevent a reaction. Because it is not always possible to avoid the allergen, it is important to develop and implement plans for preventing allergic reactions as well as responding to an allergy emergency, including anaphylaxis.

The following outlines NH laws already governing the use of epinephrine in schools and other public settings:

NH Public Health Title X Chapter 126-A Section 126-A:71governs the training requirements and administration of epinephrine by any employee or agent of an authorized entity, and defines “authorized entity" to include recreation camps and day care facilities, but excludes elementary, secondary & postsecondary educational institutions eligible to establish policies & guidelines under RSA 200

Pros: 

  • The bill underscores the need to legislate policies that recognize and support the needs of all students facing risks from food allergies
  • The bill recognizes the need to educate all service providers, not just teachers and para-professionals• The bill recognizes the importance of building principals working in consultation with school nurses
  • The bill allows the DOE to provide waivers to schools that show they have an existing food allergy management plan which substantially meet the requirements

Cons: 

  • The bill may exceed the scope of supervision school districts hold, as it requires bus drivers and food service works to be trained. In some districts, these individuals are not school employees.
  • The bill contradicts best practice in requiring updates at least biennially, and may put children at risk if not updated more frequently.
  • The bill itemizes each component of a food allergy management and prevention plan as well as the related areas of professional development, something that is best addressed by Rules committees with input from well-trained stakeholders, to include school nurses and administrators.
  • On its surface, the bill seems overly comprehensive, difficult to enforce and redundant in its nature, as epinephrine, its availability, its administration and the training for both are adequately governed in current NH law.

At the public hearing on January 21st,  the Chair decided to form a subcommittee to discuss the issues. Three Representatives, Cherie White from DOE, Representative Patty Cornell and Nancy Wells from NHSNA will meet on January 28th, 2020 to discuss. 

HB 131 - mental health education programs

Bill Title: Establishing a commission on mental health education programs.

Summary: This bill establishes a commission to develop and promote mental health programs in kindergarten through grade 12.  The bill has a list of professions that should be included on the commission.  Nurses are not listed.

Full Bill Text:  https://legiscan.com/NH/text/HB131/2019

Bill Sponsors:  Patricia Cornell, HIllsborough, District 18
Connie Van Houten  Hillsborough, District 45
Donovan Fenton  Cheshire, District 8
Joelle Martin  Hillsborough, Milford, District 23
Mary Heath  Hillsborough  District 14
Skip Berrien  Rockingham  District 18
Tamara Le  Rockingham  District 31
Timothy Smith  Hillsborough  District 17

Bill Status:  
1/02/2019:  Introduced in the House and assigned to House Education Committee
1/16/2019:  Public Hearing 10:15 am in LOB 207 - 
Laurie Fleming from NHSNA attended and testified to the importance of having a nurse, more specifically a school nurse, on the commission
2/14/2019: Passed the House with amendment.  Amendment included " One school nurse, appointed by the New Hampshire School Nurses' Association
7/19/2019 Passed and Signed by Governor Sununu 
7/24/2019  Legislative clerk has requested that NHSNA appoint someone to the task force
 

HB 719 - establishing the position of school nurse coordinator

Bill Title: establishing the position of school nurse coordinator in the department of education and making an appropriation therefor

FULL BILL TEXT

Summary:  To establish within the division of learner support the position of school nurse coordinator who shall be a classified employee qualified to hold such position by reason of education and experience. The school nurse coordinator shall coordinate and guide school nurses and other school personnel responsible for student health care in the areas of student health and wellness, safety, behavioral and mental health, and alcohol and substance misuse. The school nurse coordinator shall be a resource for administrators, professional development, parental education, and legislators.

This position currently is vacant.  This bill would fund the position withing the NHDOE.  NHSNA strongly supports this bill and helped craft it with Representative Polly Campion.

Sponsors:  Polly CampionLinda TannerMary HeathSkip BerrienJoelle MartinShannon Chandley

Bill Status:  1/03/2019  Introduced in the House
1/18/2019:  Referred to House Education Committee   
1/30/2019  Hearing before the House Education Committee,  Legislative Office Building   33 N State St, Concord, NH 03301 Room 207
Results of hearing: A public hearing before the Education Committee was held on 1/30/2019.  Several NHSNA members were in attendance and testified for the bill.  In addition NHSNA presented the committee with:

  • Copies of 27 letters of support from School Nurses and Stakeholders
  • A copy of the Online Petition. 164 people had responded, 100% supported the bill.  
  • Supporting documents of what a School Nurse Coordinator would do
  • Supporting documents of other states which have Coordinators / Consultants

2/27/2019 Passed the House, 198-146   Proceed to Senate
5/02/2019: The Senate supports the bill and felt it had a better chance of being signed by the Governor if it was added to the budget bill HB1
6/27/2019: HB1 passed the Senate and House with HB719 included
6/28/2019: Vetoed by Governor Sununu

As of 7/27/2019 There has been no action taken on the budget and negotiations with the Governor continue.

 

-- SB 137 -- To amend current school nurse certification

Senate Bill 137  Title: relative to the certification of school nurses   Full Bill Text

Current RSA 200:29     Current Rules on implementing RSA 200:29

Summary: This bill provides for the application of education and certification requirements for school nurses.  This bill would make changes to the current certification requirements in the following ways:

  • ADD a grandfathering clause to include school nurses hired before the effective date of the bill.    Note that the grandfathering clause was written into the rules, but the law should also include it.  This bill would also extend the number of nurses who quality for grandfathering
  • ADD:   All school nurses appointed after the effective date of this paragraph and before July 1, 2022 holding an associates' degree in nursing, and all nurses hired before the effective date of this paragraph who did not meet the application deadline in subparagraph (a), shall be enrolled in a registered nurse to bachelor of science in nursing program and shall complete such program within 6 years of the date of this paragraph.
  • ADD:  All school nurses appointed on or after July 1, 2022, shall meet the certification requirements in paragraph II, pursuant to rules adopted by the state board of education.

Bill Sponsors:  
Senator Jay Kahn  District 10
Senator Ruth Ward  District 8

Bill Status:  
This bill has been assigned to the Senate Education and Workforce Development Committee
3/12/2019:  Hearing March 12th Four people testified in favor, none against.
Executive session was held the same day.  VOTE:  4 to 1 in favor, 
3/21/2019: Senate Passed and it passed to the house
5/01/2019:  House Education Committed Passed with a vote of 12-7
5/08/2019 Passed the House on the Consent Agenda
2019-06-27 - Law Without Signature 06/26/2019; Chapter 0144

EFFECTIVE DATE OF LAW: 08/25/2019 

-- HB 275 -- to repeal school nurse certification

Bill Title: relative to repealing school nurse certification

Summary:  To amend RSA: 200:29 and repeal school nurse certification

Full Bill Text

Bill Sponsors:  Josh Yokela, Rockingham District 33
Dennis Acton, Rockingham  District 10
Timothy Lang  Belknap- District 04
Carol McGuire Merrimack- District 29
Sean Morrison Rockingham- District 09  
Max Abrahamson  Rockingham- District 20
Rick Ladd  Grafton- District 04
Ralph Boehm  Hillsborough- District 20
Russell Ober   Hillsborough- District 37
Chris True Rockingham- District 04

Bill Status: 

01/02/2019 Introduced and assigned to Education Committee

1/8/2019 Public Hearing Scheduled for 01/22/2019 01:00 pm LOB 207
NHSNA members will be present and testify to kill this bill.
NHNA members will be present and testify to kill this bill.
Kent Street Coalition will have parents testify to kill this bill.
Children's Behavioral Health Coalition and New Futures will submit written testimony to kill the bill.

2/5/19: Executive Session of the The Education Committee  Split vote 10 to 10

3/07/2019:   This bill was Tabled on the floor of the house.  This means that the bill will NOT move forward.

2018 Year: SB 322:  Bronchodilator/spacer/nebulizer

Asthma Action Plan Form          Fact Sheet on SB322          Download SB322 here

Senate Bill 322, passed in May 2016, allows school nurses to maintain a stock bronchodilator for the emergency treatment of asthma.  The use of the bronchodilator is limited to those students with a diagnosis of asthma, have a current Asthma Action Plan, and whose own inhaler is not available.  The inhaler can be used for multiple students but each student must be provided with a separate spacer.  The spacers cannot be shared.  The Office of Student Wellness website has is a powerpoint module that school nurses are welcome to use or adapt for staff training.  Each school year the use of the stock bronchodilator is to be reported; the form is also posted on the website.

The New Hampshire School Nurses Association has been collaborating with the New Hampshire Department of Education, the New Hampshire Public Health Association, the New Hampshire Asthma Collaborative, Acelleron and Convenient MD to find bronchodilator, spacer and nebulizer resources.

2018 Year: DOE School Nurse Certification

House Bill 1193 on School Nurse Certification

HISTORY:  The board of the New Hampshire School Nurses' Association is collaborating with the New Hampshire Department of Education to develop a certification process for School Nurses. It is the postion of NHSNA that  certification would establish a standard of practice to ensure that all children are receiving the highest level of health care that will allow them to reach their full educational potential.  This certification will be separate from teacher certification and school nurses will not be expected to teach.

NOTE:  It is not the position of the New Hampshire School Nurses' Association to interpret the rules.  Any questions on how the rules apply to you should be asked of the NH DOE Credentialing Office.

History/Context:
There are approximately 500 school nurses in New Hampshire, serving 618 public and private schools.  The role of the professional school nurse is currently defined by New Hampshire School Nurse Certification Law (RSA 200:29, II), with the current rules approved by JLCAR (Ed 306.12).  Certification ensures a professional level of qualification for the position of school nurse, which will support a minimal standard of care for students with acute and chronic health needs in school. 

New Hampshire school nurses are members of a unique discipline of professional nursing and are often the sole healthcare providers in their districts.  They are both an independent clinician and manager of school health services.  It is imperative that school nurses are prepared for and practice at the same level as their colleagues, such as teachers who are certified, as well as other adjunct therapists who are prepared with Masters Degrees, for example occupational therapists, physical therapists, and speech therapists.  


2016 Year: Senate Bill 25 FN-Relative to Epinephrine

HISTORY: This bill was introduced lin 2016 by Senator D’Alessandro of the Education Committee and was referred to committee.  This bill allows schools to acquire and maintain a supply of epinephrine auto-injectors with the intent of making them available to ANY student showing symptoms of anaphylaxis, and for the school nurse to train designated school personnel to receive training in the administration of an epinephrine auto-injector to any student with symptoms of anaphylaxis.
 FULL BILL FOUND HERE

CURRENT STATUS:  
Completed Legislative Action
Spectrum: Partisan Bill (Democrat 1-0)
Status: Passed on May 4 2016 - 100% progression
Action: 2016-05-04 - Signed by the Governor on 05/03/2016; Chapter 0039; 

Effective 07/02/2016
Text: Latest bill text (Chaptered) [HTML]

UNH STUDENT TRAINING RESOURCES     The school nurse has the authority to possess and administer epinephrine as a stock medication to use in the event of anaphylaxis, a severe and life threatening allergic reaction. There are students who experience their initial allergic episode during the school day and having access to epinephrine has prevented serious life threatening results. An EpiPen provides a safe and easy delivery system of epinephrine that can be used by an unlicensed person. This module has been developed as a training tool for school staff and includes essential information about anaphylaxis and the use of an EpiPen. Each school nurse maintains a list of those staff members trained. We would like to thank the senior nursing students from the University of New Hampshire for participating in this project.

Epinephrine Training Certificate

Epinephrine Auto Injector Training Evaluation Form

Epinephrine Auto Injector Training PPT

2015 Year: Glucagon injections
HISTORY: Sponsor: Senator Stiles District 4   This bill passed without input from NHSNA. This bill allows parents to train and delegate school staff on glucagon administration.  

CURRENT STATUS: Effective Date: July 4, 2015   FULL TEXT HERE

Glucagon Administration Training for Non-Medical School Personnel

A joint project project of NHSNA, Office of Student Wellness and Senior UNH Nursing Students

In an effort to provide the highest quality information and training in an accessible manner, the Office of Student Wellness is please to provide the following information on the administration of Glucagon to students by non-medical personnel. School nursing staff are encouraged to utilize the documents below and to contact our office with questions. We would like to thank the senior nursing students from the University of New Hampshire for participating in this project.

Glucagon Training PowerPoint       Please be aware that the slides will advance after one minute, your arrow buttons will work to advance or back up.

Glucagon Pre-Test and Answer Key
Post-Test and Answer Key
Glucagon Administration Checklist
Training Program Evaluation
Program Certificate of Completion

Naloxone

The New Hampshire School Nurses' Association formed a study committee in October 2015 to look at the issue of Naloxone in the schools.  Their work is now complete and the board of the NHSNA approved the a position statement for distribution.

Opioid related  overdose kills hundreds in New Hampshire every year. Many of these deaths are preventable with the timely use of an opioid antagonist (naloxone) as well as the quick summoning of EMS and the initiation of care. NH school nurses, as allowed by local administration and policy, are in the position to administer life-saving measures in the event of an opioid overdose. In addition, as an integral part of the interdisciplinary team, school nurses are also in the unique position to provide prevention awareness and support to students, family, faculty, and staff-- a critical step in the on-going management of substance abuse and misuse.

In response to the opioid crisis in New Hampshire, the state has created the campaign "Anyone. Anytime." to educate the public and professionals about addiction, emergency overdose medications, and support services for anyone experiencing opioid addiction. 

NH Naloxone laws and resources: 
NHSNA Position Statement
Anyone, Anytime  DrugfreeNH
House Bill 270 - Good Samaritan Law
House Bill 271 - Friends & Family Access to Naloxone

NH Board of Nursing Position Statement: RN Role in Off Label Medication UsePosted March 16th, 2016
The board determined that an off label medication can be administered or delegated with an appropriate provider order. The nurse should be familiar with the drug purpose and side effects in relation to the client that is receiving the medication.

FULL TEXT HERE

Vaccine Registry
HISTORY:  
New Hampshire is the only state without a centralized immunization registry. The NH Legislature in 1998 ordered the creation of a “single repository of accurate, complete and current immunization records to aid, coordinate and promote effective and cost-efficient disease prevention and control efforts.” But the initiative was never funded. 

The NH  Executive Council on in April 2014 approved a $1.3 million contract with an Arizona company to get a registry up and running. Everyone who administers vaccinations will enter information into the system, but only designated DHHS personnel would have the passwords needed to access the information on an aggregate or individual basis.
Massachusetts became the 49th state to adopt an online vaccination registry in 2011, leaving New Hampshire as the only state without one

CURRENT STATUS:
Years in the making, N.H. immunization registry hits snag during rulemaking
By CASEY McDERMOTT,   Concord Monitor Staff:  January 4, 2015


ENDS = Electronic Nicotine Delivery SystemsSince 2010, it has been illegal (RSA 126 K) for NH youth under 18 year of age to buy and/or use ENDS. ENDS are also included in the indoor clean air act (Indoor Smoking Act, RSA 155:64-77), making it illegal to use them in all the same places as combustible (tobacco) cigarettes. 

Download Flyer from Tobacco Free NH network

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