VISION SCREENINGS AND
COMPREHENSIVE EYE AND VISION EXAMS
House Bills 5307 & 5355 as introduced
Sponsor: Rep. Amanda Price
House Bill 5356 as introduced
Sponsor: Rep. Adam F. Zemke
Committee: Education
Complete to 3-2-16
SUMMARY:
House Bill 5307 would add a section to the Revised School Code providing a process for vision testing and screening of pupils both regularly and upon notification by the school.
House Bill 5355 would add a section to the Public Health Code clarifying that those vision tests and screenings are in addition to the pre-kindergarten screening currently required.
House Bill 5356 would add a section to the Social Welfare Act adding these vision screenings to the list of medical services which may be provided under the act.
The bills are explained in more detail below.
House Bill 5307 would provide for regular vision screenings, documented eye and vision examinations when school performance warrants, and additional steps by the Michigan Department of Education if the pupil's parent or guardian fails to comply with this requirement.
Specifically, the board of a school district or board of directors of a public school academy (charter school) must ensure that each enrolled pupil is provided with a vision screening before January 1 of that pupil's kindergarten, 3rd grade, 6th grade, and 8th grade year, the results of which will be provided to the school's principal or administrator.
If (1) the pupil's vision screening shows a vision deficiency, or (2) the pupil has been identified as a struggling reader, (3) has been recommended to be evaluated for possible reading difficulties, or (4) has not scored at least proficient on the state assessment for English Language Arts, then the following procedure will be followed:
· Within 10 days of any of these circumstances, the school district or charter school will notify the pupil's parent or guardian that the pupil is required to undergo a comprehensive eye and vision examination, described below.
· Within 60 days of the notice, the parent or guardian must ensure that the pupil has a comprehensive eye and vision exam conducted by a licensed physician specializing in ophthalmology or an optometrist.
· Within 30 days after the exam, the eye care professional must submit a signed certificate to the school or district that does all of the following:
o Acknowledges that the pupil has received the required exam;
o Indicates whether vision correction, vision therapy, or other treatment is recommended; and
o Confirms that, if treatment is recommended, the pupil's parent or guardian has complied with, or is in the process of complying with, the recommendation.
· If the school district or charter school does not receive the certificate in the time period allowed, it will submit a report to the MDE and take appropriate steps to encourage the pupil's parent or guardian to ensure the pupil receives the exam.
A vision screening is not required if the pupil's parent or guardian submits a statement that the pupil cannot participate in a vision screening due to religious convictions.
Proposed MCL 380.1176
House Bill 5355 would add a section to the Public Health Code to clarify that the hearing and vision screenings currently required in the Health Code are in addition to the regular screening requirements outlined for the Revised School Code in the proposed Section 1176 as well as the pre-kindergarten screening in the existing Section 1177.
Proposed MCL 333.9317
House Bill 5356 would add regular vision screenings, and irregular screenings when they are determined necessary, as introduced and described above in House Bill 5307, to the list of services provided under the Social Welfare Act. The act provides that these services may be provided to an eligible school-aged child.
As with other services provided under the act, if the statewide method or level of reimbursement service is proposed to change by a certain amount, the director of the Department of Health and Human Services will provide notice to the public, according to applicable federal regulations, as well as to the House and Senate Appropriations Committees. This notice is required if the proposed change would increase or decrease payments by 1% or more during the 12 months after the effective date of the change.
MCL 400.109
House Bills 5307, 5355 and 5356 are tie barred together, meaning none could take effect unless all are enacted. They would take effect 90 days after enactment.
BACKGROUND:
The introduction of a comprehensive eye and vision exam, when deemed necessary by a vision screening or academic performance, would ensure that a greater number of vision deficiencies are identified. According to a study from the National Eye Institute, vision screenings miss one-third of children with eye or vision disorders. It is hoped that a higher percentage of identified vision deficiencies would lead to fewer children experiencing developmental delays typically caused by vision deficiencies, less need for special education, and fewer ongoing vocational and social service needs into adulthood.
FISCAL IMPACT:
The bills could create short-term costs, but also the potential for long-term savings, for both the state and school districts.
Typically while adding services covered by Medicaid under the Social Welfare Act would increase state costs, House Bill 5356 is not likely to increase costs significantly because regular vision screenings and risk assessments are already covered by Medicaid and are required as part of well child visits with a child's primary care physician, along with medically appropriate referrals to an optometrist or ophthalmologist if necessary. However, the schedule for required vision screenings is based on the American Academy of Pediatrics recommendations, which are based on age, and may not line up completely with the grade level screening required under House Bill 5307.
Under House Bill 5355 the current vision screening services program provided by local public health departments under Part 93 of the Public Health Code becomes secondary to the new program. There is no direct fiscal impact to the current program; however, there is duplication between the current and proposed programs. Under the current vision screening program, pursuant to administrative rules, free vision screenings are provided for children preschool (age 3-5) and in grades 1, 3, 5, 7, and 9 (or in conjunction with driver training instead of grade 9). Currently, $5.15 million is included in the DHHS budget for vision and hearing screening of school children under Part 93. These funds are local school district funds that originate as a state appropriation in the School Aid budget, and they are included in the DHHS budget relative to its contractual relationship with local health departments for state-local cost shared public health services. Local public health departments are responsible under Part 93 for conducting current vision screening programs for school-age children and finance a share of the costs for the programs along with the state DHHS.
Under House Bill 5307, districts could incur additional costs in having to provide additional vision screenings in grades K, 3, 6, and 8 and creating the administrative process to follow up with parents for the children who need additional vision exams. Presumably districts already have the screening tools necessary and would simply redirect existing staff time to carry out the bill's added requirements.
Districts and the state could see long-term savings if additional screenings provide for early detection of vision issues, which could reduce future special education costs.
Legislative Analyst: Jennifer McInerney
Fiscal Analyst: Bethany Wicksall
Samuel Christensen
Susan Frey
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their deliberations, and does not constitute an official statement of legislative intent.