H.F. 2219 Section 1. NEW SECTION . 280.30 Diabetes care. 1 1. Definitions. For purposes of this section: 2 a. “Diabetes medical management plan” means a document 3 developed by a student’s personal health care team that sets 4 out the health services needed by the student at school and 5 that is signed by the student’s personal health care team and 6 parent or guardian. 7 b. “School employee” means a person employed by a public 8 or nonpublic school, any person employed by a local health 9 department who is assigned to a public or nonpublic school, or 10 a subcontractor designated for this function. 11 c. “Trained diabetes personnel” means a school employee who 12 volunteers to be trained in accordance with subsection 2. Such 13 an employee need not be a health care professional. 14 2. Training of designated school employees. 15 a. The department of education, in coordination with 16 the department of public health and the American diabetes 17 association, shall by January 1, 2013, develop guidelines 18 for the training of school employees in the care needed for 19 students with diabetes. Training shall be provided annually 20 and training guidelines shall include instruction in all of the 21 following: 22 (1) Recognition and treatment of hypoglycemia and 23 hyperglycemia. 24 (2) Understanding the appropriate actions to take when 25 blood glucose levels are outside of the target ranges indicated 26 by a student’s diabetes medical management plan. 27 (3) Understanding physician instructions concerning 28 diabetes medication dosage, frequency, and manner of 29 administration. 30 (4) Performance of finger-stick blood glucose checking, 31 ketone checking, and recording the results. 32 (5) The administration of glucagon and insulin and the 33 recording of results. 34 (6) Understanding how to perform basic insulin pump 35 -1- LSB 5762HH (8) 84 je/rj 1/ 8

H.F. 2219 functions. 1 (7) Recognizing complications that require emergency 2 assistance. 3 (8) Recommended schedules and food intake for meals and 4 snacks, the effect of physical activity upon blood glucose 5 levels, and actions to be implemented in the case of schedule 6 disruption. 7 b. The board of directors of a public school district and 8 the authorities in charge of a nonpublic school shall ensure 9 that the training outlined in paragraph “a” is provided to a 10 minimum of three school employees at a school attended by a 11 student with diabetes. The principal or school administrator 12 at such a school shall distribute written notice to recruit 13 employees to volunteer to be trained. 14 c. The board of directors of a public school district and 15 the authorities in charge of a nonpublic school shall not 16 subject a school employee to any penalty or disciplinary action 17 for refusing to serve as trained diabetes personnel or prohibit 18 or restrict a school employee from volunteering for training. 19 d. The training outlined in paragraph “a” shall be 20 coordinated by a school nurse and provided by a school nurse 21 or other health care professional with expertise in diabetes. 22 Such training shall take place prior to the commencement 23 of each school year, or as needed when a student is newly 24 diagnosed with diabetes or a student with diabetes is newly 25 enrolled at a school but in no event more than 30 days 26 following such diagnosis or enrollment. A school nurse or 27 other health care professional with expertise in diabetes shall 28 promptly provide follow-up training and supervision as needed. 29 e. A public and nonpublic school shall provide training 30 in the recognition of hypoglycemia and hyperglycemia and 31 actions to take in response to emergency situations related 32 to such conditions to all school personnel who have primary 33 responsibility for supervising a child with diabetes during 34 some portion of the school day and to all bus drivers 35 -2- LSB 5762HH (8) 84 je/rj 2/ 8

H.F. 2219 responsible for the transportation of a student with diabetes. 1 3. Diabetes medical management plan. The parent or guardian 2 of each student who seeks diabetes care while at school shall 3 submit to the student’s school a diabetes medical management 4 plan. The student’s school shall review and implement the 5 diabetes medical management plan upon receipt. 6 4. Required care. 7 a. In accordance with the request of a parent or guardian 8 of a student with diabetes and the student’s diabetes medical 9 management plan, a school nurse, or, in the absence of a school 10 nurse, trained diabetes personnel shall perform functions 11 including but not limited to responding to blood glucose levels 12 that are outside of the student’s target range; administering 13 glucagon; administering insulin or assisting a student in 14 administering insulin through the insulin delivery system the 15 student uses; providing oral diabetes medications; checking and 16 recording blood glucose levels and ketone levels or assisting 17 a student with such checking and recording; and following 18 instructions regarding meals, snacks, and physical activity. 19 b. A school nurse or at least one trained diabetes personnel 20 shall be on site and available to provide care to each student 21 with diabetes as set forth in paragraph “a” during regular 22 school hours, school-sponsored before school and after school 23 care programs, and on buses when the bus driver has not 24 completed the necessary training pursuant to subsection 2, 25 paragraph “e” . 26 c. A public and nonpublic school where a student with 27 diabetes is enrolled shall maintain trained diabetes personnel. 28 A student’s school choice shall not be restricted because the 29 student has diabetes. 30 d. The activities set forth in paragraph “a” shall not 31 constitute the practice of nursing and shall be exempt from all 32 applicable statutes or rules that restrict what activities can 33 be delegated by a nurse or performed by a person who is not a 34 licensed health care professional. 35 -3- LSB 5762HH (8) 84 je/rj 3/ 8

H.F. 2219 5. Independent monitoring and treatment. A student with 1 diabetes, upon written request of the student’s parent or 2 guardian and as authorized by the student’s diabetes medical 3 management plan, shall be permitted to perform blood glucose 4 checks, administer insulin through the insulin delivery system 5 the student uses, treat hypoglycemia and hyperglycemia, and 6 otherwise attend to the care and management of the student’s 7 diabetes in the classroom and in any area of the school or 8 school grounds, and to possess on the student’s person at all 9 times all necessary supplies and equipment to perform these 10 monitoring and treatment functions. 11 6. Immunity from civil liability. A physician, nurse, 12 school employee, school district, or nonpublic school shall not 13 be liable for civil damages or subject to disciplinary action 14 under professional licensing standards or school disciplinary 15 policies as a result of activities authorized by this section 16 when such acts are committed as an ordinarily prudent person in 17 a like position would have acted under similar circumstances. 18 7. Enforcement and recourse. 19 a. The board of directors of a public school district 20 and the authorities in charge of a nonpublic school shall 21 report to the department of education annually by September 22 15 the number of students with diabetes enrolled and shall 23 provide documentation showing compliance with this section and 24 guidelines developed in accordance with this section. 25 b. A parent or guardian of a student with diabetes may file 26 a complaint with the department of education or a civil action 27 for injunctive relief against a school district or nonpublic 28 school that fails to meet the requirements of this section. 29 The court shall award a parent or guardian who is a prevailing 30 party in such a civil action the reasonable costs of suit, 31 including but not limited to reasonable attorney fees. This 32 right of action shall not alter or limit the remedies available 33 under any other state or federal law. An individual school 34 employee shall not be liable under this paragraph. 35 -4- LSB 5762HH (8) 84 je/rj 4/ 8

H.F. 2219 Sec. 2. STATE MANDATE FUNDING SPECIFIED. In accordance 1 with section 25B.2, subsection 3, the state cost of requiring 2 compliance with any state mandate included in this Act shall 3 be paid by a school district from state school foundation aid 4 received by the school district under section 257.16. This 5 specification of the payment of the state cost shall be deemed 6 to meet all of the state funding-related requirements of 7 section 25B.2, subsection 3, and no additional state funding 8 shall be necessary for the full implementation of this Act 9 by and enforcement of this Act against all affected school 10 districts. 11 EXPLANATION 12 This bill directs the department of education, in 13 coordination with the department of public health and the 14 American diabetes association, to develop guidelines by January 15 1, 2013, for the training of school employees in the care 16 needed for students with diabetes. The bill provides that 17 training shall be provided annually and training guidelines 18 shall include instruction in a variety of functions necessary 19 for the monitoring and treatment of diabetes. 20 The bill directs the board of directors of a public 21 school district and the authorities in charge of a nonpublic 22 school to ensure that the required training is provided to a 23 minimum of three school employees at each school attended by 24 a student with diabetes. A school employee who has received 25 such training is defined as a “trained diabetes personnel”. 26 The principal or school administrator at such a school must 27 distribute written notice to recruit employees to volunteer to 28 be trained. The bill provides that the board of directors of 29 a public school district and the authorities in charge of a 30 nonpublic school cannot penalize an employee for refusing to 31 volunteer or restrict an employee from volunteering. The bill 32 provides that the training shall be coordinated by a school 33 nurse and provided by a school nurse or other health care 34 professional with expertise in diabetes. The training shall 35 -5- LSB 5762HH (8) 84 je/rj 5/ 8

H.F. 2219 take place prior to the commencement of each school year, or 1 as needed when a student is newly diagnosed with diabetes or 2 a student with diabetes is newly enrolled at a school, but 3 not more than 30 days after such diagnosis or enrollment. A 4 school nurse or other health care professional with expertise 5 in diabetes is to promptly provide follow-up training and 6 supervision as needed. The bill also provides that a public 7 and nonpublic school must provide training in the recognition 8 of hypoglycemia and hyperglycemia and actions to take in 9 response to emergency situations related to such conditions 10 to all school personnel who have primary responsibility for 11 supervising a child with diabetes during some portion of 12 the school day and to all bus drivers responsible for the 13 transportation of a student with diabetes. 14 The bill requires the parent or guardian of a student who 15 seeks diabetes care while at school to submit to the student’s 16 school a diabetes medical management plan. The student’s 17 school is required to review and implement the diabetes medical 18 management plan upon receipt. A “diabetes medical management 19 plan” means a document developed by a student’s personal health 20 care team that sets out the health services needed by the 21 student at school and that is signed by the student’s personal 22 health care team and parent or guardian. 23 The bill provides that in accordance with the request of a 24 parent or guardian of a student with diabetes and the student’s 25 diabetes medical management plan, a school nurse, or, in the 26 absence of a school nurse, trained diabetes personnel shall 27 perform various functions necessary for the monitoring and 28 treatment of diabetes. The bill provides that a school nurse 29 or at least one trained diabetes personnel shall be on site and 30 available to provide care to each student with diabetes during 31 regular school hours, school-sponsored before school and after 32 school care programs, and on buses when the bus driver has not 33 completed the necessary training. The bill requires a public 34 and nonpublic school where a student with diabetes is enrolled 35 -6- LSB 5762HH (8) 84 je/rj 6/ 8

H.F. 2219 to maintain trained diabetes personnel. The bill provides 1 that a student’s school choice shall not be restricted because 2 the student has diabetes. The bill provides that activities 3 involving diabetes care as set forth in the bill shall not 4 constitute the practice of nursing and shall be exempt from all 5 applicable statutes or rules that restrict what activities can 6 be delegated by a nurse or performed by a person who is not a 7 licensed health care professional. 8 The bill provides that upon written request of the student’s 9 parent or guardian and as authorized by the student’s diabetes 10 medical management plan, a student with diabetes shall be 11 permitted to perform various functions necessary for care and 12 management of the student’s diabetes in the classroom and in 13 any area of the school or school grounds, and to possess at 14 all times all necessary supplies and equipment to perform such 15 functions. 16 The bill provides that a physician, nurse, school employee, 17 school district, or nonpublic school shall not be liable 18 for civil damages or subject to disciplinary action under 19 professional licensing standards or school disciplinary 20 policies as a result of activities authorized by the bill when 21 such acts are committed as an ordinarily prudent person in a 22 like position would have acted under similar circumstances. 23 The bill provides that the board of directors of a public 24 school district and the authorities in charge of a nonpublic 25 school shall report to the department of education annually by 26 September 15 the number of students with diabetes enrolled and 27 shall provide documentation showing compliance with the bill 28 and guidelines developed in accordance with the bill. 29 The bill authorizes a parent or guardian of a student 30 with diabetes to file a complaint with the department of 31 education or a civil action for injunctive relief against a 32 school district or nonpublic school that fails to meet the 33 requirements of the bill. The bill provides that the court 34 shall award a parent or guardian who is a prevailing party in 35 -7- LSB 5762HH (8) 84 je/rj 7/ 8

H.F. 2219 such a civil action the reasonable costs of suit, including but 1 not limited to reasonable attorney fees. The bill provides 2 that such right of action shall not alter or limit the remedies 3 available under any other state or federal law. The bill 4 provides that an individual school employee shall not be liable 5 under such right of action. 6 The bill may include a state mandate as defined in Code 7 section 25B.3. The bill requires that the state cost of 8 any state mandate included in the bill be paid by a school 9 district from state school foundation aid received by the 10 school district under Code section 257.16. The specification 11 is deemed to constitute state compliance with any state mandate 12 funding-related requirements of Code section 25B.2. The 13 inclusion of this specification is intended to reinstate the 14 requirement of political subdivisions to comply with any state 15 mandates included in the bill. 16 -8- LSB 5762HH (8) 84 je/rj 8/ 8