Vision examinations for school children
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EXPLANATION--Matter enclosed in bold-faced brackets [thus] in this bill is not enacted and is
intended to be omitted in the law.
FIRST REGULAR SESSION
[TRULY AGREED TO AN D FINALLY PASSED]
SENATE COMMITTEE SUBSTITUTE FOR
SENATE BILL NO. 16
94TH GENERAL ASSEMBLY
2007
0236S.03T
AN ACT
To repeal section 192.935, RSMo, and to enact in lieu thereof three new sections
relating to vision examinations for school children.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 192.935, RSMo, is repealed and three new sections
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enacted in lieu thereof, to be known as sections 167.194, 167.195, and 192.935,
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to read as follows:
167.194. 1. Beginning July 1, 2008, every child enrolling in
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kindergarten or first grade in a public elem entary school in this state
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shall receive one com prehensive vision examination performed by a
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state licensed optom etrist or physician. Evidence of the examination
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shall be subm itted to the school no later than January first of the first
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year in which the student is enrolled at the school, provided that the
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evidence submitted in no way violates any provisions of Public Law
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104-191, 42 U.S.C. 201 et seq, Health Insurance Portability and
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Accountability Act of 1996.
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2. The state board of education, in conjunction with the
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departm ent of health a nd senior services, shall prom ulgate rules
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establishing the criteria for m eeting the requirements of subsection 1
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of this section, which m ay include, but are not limited to, forms or
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other proof of such exam ination, or other rules as are necessary for the
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enforcem ent of this section. The form o r other proof of such
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exam ination shall include but not be lim ited to identifying the result
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of the examinations performed under subsection 4 o f this section, the
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cost for the exam ination, the exam iner's qualifications, and method of
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paym ent through either:
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(1) Insurance;
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(2) The state Medicaid program ;
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(3) Com plim entary; or
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(4) Other form of paym ent.
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3. The departm ent of elem entary and second ary education, in
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conjunction with the department of health and senior services, shall
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compile and maintain a list of sources to which children who m ay need
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vision exam inations or children who have been found to need further
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examination or vision correction m ay be referred for treatm ent on a
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free or reduced cost basis. The sources may include individuals, and
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federal, state, local governm ent, and private programs. The department
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of elem entary and second ary education shall ensure that the
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superintendent of schools, the principal of each elem entary school, the
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school nurse or other person responsible for school health services, and
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the parent organization for each district elem entary school receives an
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updated copy of the list each year prior to school opening. Professional
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an d service organizations concerned with vision health m ay assist in
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gathering and dissem inating the information, at the direction of the
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departm ent of elem entary and secondary education.
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4. For purposes of this section, the following com prehensive
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vision exam inations shall include but not be lim ited to:
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(1) Com plete case history;
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(2) Visual acuity at distance (aided and unaided);
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( 3 ) E x t e r n a l e x a m i n a t i o n a n d i n t e r n a l e x a m i n a t i o n
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(ophthalm oscopic exam ination);
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(4) Subjective refraction to best visual acuity.
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5. Findings from the evidence of exam ination shall be provided
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to the d epartm ent of health and senior service and kept by the
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optom etrist or physician for a period of seven years.
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6. In the event that a parent or legal guardian of a child subje ct
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to this section shall submit to the appropriate school administrator a
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written request tha t the child be excused from taking a vision
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exam ination as provided in this section, that child shall be so excused.
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7. Pursuant to section 23.253, RSMo, of the Missouri sunset act:
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(1) The provisions of the new program authorized under this
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section shall automatically sunset on June 30, 2012, unless reauthorized
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by an act of the general assembly; and
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(2) If such program is reauthorized, the program authorized
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under this section shall autom atically sunset eight years after the
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effective date of the reauthorization of this section; and
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(3) This section shall terminate o n Septem ber first of the
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calendar year im m ediately following the calendar year in which the
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program authorized under this section is sunset.
167.195. 1. Beginning July 1, 2008, and continuing through the
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2010-2011 school y ear unless extended by act of the general assem bly,
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all public school districts shall conduct an e ye screening for each
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student o nce before the com pletion of first grade and again before the
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completion of third grade. The eye screening method utilized shall be
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one approved by the children's vision com m ission and shall be
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performed by an appropriately trained school nurse or other trained
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and qualified em ployee of the school district.
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2. Results of each eye screening shall be recorded on a form
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provided by the departm ent of health and senior services, developed
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and approved by the children's vision com m ission established under
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this section.
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(1) The screening results, with all individual identifying
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information removed, shall be sent to the state departm ent of health
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and senior services via electronic form and shall com pile the data
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contained in the reports for review and analysis by the com m ission or
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other interested parties;
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(2) When a student fails the eye screening, the school district
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shall send a notice developed by the com m ission to the parent or
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guardian notifying them of the results of the eye screening and propose
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that the student receive a com plete eye exam ination from an
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optom etrist or physician. Such notice shall have a place for the parent
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to acknowledge receipt along with an indication as to whether the
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student has received a com plete eye examination and the results of the
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exam ination. Evidence of an exam ination provided by an optom etrist
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or physician within the year preceding the school eye screening shall
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be sufficient for m eeting the requirements of this section. T he notice
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completed by the parent or guardian is to be returned to the school and
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sha ll be retained in the student's file and a copy shall be sent to the
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departm ent of health and senior services;
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(3) Notwithstanding any law to the contrary, nothing in this
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section shall violate any provisions of Public Law 104-191, 42 U.S.C. et
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seq, Health Insurance Portability and Accountability Act of 1996.
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3. The "Children's Vision Comm ission" is hereby established
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which shall cease to exist on June 30, 2012, unless renewed by act of the
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general assem bly.
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(1) The com m ission shall be com posed of seven m em bers
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appointed by the governor: two ophthalm ologists to be determ ined
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from a list of recom m ended ophthalm ologists by the Missouri society
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of eye physicians and surgeons; two optom etrists to be determ ined from
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a list of recom m ended optom etrists by the Missouri optometric
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association; one school nurse; one representative from the department
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of elem entary and secondary education; and one representative from
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the Missouri state school boards association. Each ophthalm ologist and
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o p to m e tr is t sh a ll se r v e a o n e -y e a r t e r m a s c h a i r o f th e
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com m ission. Mem bers of the com m ission shall serve w ith out
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com pensation, but may be reim bursed for reasonable and necessary
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expenses associated with carrying out their duties.
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(2) Duties of the com m ission shall be as follows:
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(a) Analyze and adopt one or more standardized e ye screening
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and eye exam ination tests to carry out the requirements of this section
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to be used in all schools begin ning with the 2008-2009 school year
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which, in the com m ission's estim ation, h av e a reasonable expectation
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of identifying vision problem s in children;
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(b) Develop, in conjunction with the departm ent of health and
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senior services, a standardized reporting form which shall be used by
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all school districts in carrying out the requirem ents of this section;
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(c) Design and coordinate a ppropriate training program s for
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school district staff who conduct the screening exams. Such training
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program s m ay utilize the volunteer services of nonprofit professional
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organizations which, in the opinion of the com m ission, are qualified to
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carry out those responsibilities associated with providing the training
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required;
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(d) Conduct a pilot project to track the results of the eye
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screenings v ersus eye exam inations conducted based on the reports
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subm itted by school districts to the departm ent of health and senior
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services;
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(e) Develop, in conjunction with the Missouri Optom etric
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Association (MOA) and the Missouri Society of Eye Physicians and
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Surgeons (MOSEPS), guidelines outlining the benefits and ongoing eye
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care for children and summ arizing the signs and sym ptom s of vision
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disorders in order for the guidelines to be made available on the MOA
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and MOSEPS website. The comm ission shall also consult with M OA and
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MOSEPS in the organizations' education and prom otion of the
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guidelines;
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(f) By Decem ber 31, 2011, the com m ission shall subm it a report
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to the general assem bly detailing the results and findings o f the study,
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including but not lim ited to the total num ber of eye screenings and eye
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examinations, the num ber of students who received a follow-up
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exam ination from an o ptom etrist, opthalm ologist, physician, or doctor
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of osteopathy and the results of those exam inations to determine the
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effectiveness of eye exam inations versus eye screenings.
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4. The departm ent of health and senior services shall make a
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reasonable accom m odation for public review and inspection of the data
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collected as part of the eye screening pilot project provided that no
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information is revealed that could identify any individual student who
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was screened or exam ined.
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5. In the event that a parent or legal guardian of a child objects
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to the child's participation in the eye screening program , the child shall
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be excused u pon receipt by the appropriate school administrator of a
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written request.
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6. The departm ent of health and senior services shall provide
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staff support to the com m ission.
192.935. 1. There is hereby created in the state treasury the "Blindness
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Education, Screening and Treatment Program Fund". The fund shall consist of
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moneys donated pursuant to subsection 7 of section 301.020, RSMo, and
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subsection 3 of section 302.171, RSMo. Unexpended balances in the fund at the
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end of any fiscal year shall not be transferred to the general revenue fund or any
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other fund, the provisions of section 33.080, RSMo, to the contrary
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notwithstanding.
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2. Subject to the availability of funds in the blindness education,
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screening and treatment program fund, the department shall develop a blindness
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education, screening and treatment program to provide blindness prevention
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education and to provide screening and treatment for persons who do not have
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adequate coverage for such services under a health benefit plan.
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3. The program shall provide for:
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(1) Public education about blindness and other eye conditions;
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(2) Screenings and eye examinations to identify conditions that may cause
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blindness; [and]
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(3) Treatment procedures necessary to prevent blindness; and
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(4) Any additional costs for vision examinations under section
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167.195, RSM o, that are not covered by existing public health
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insurance. Subject to appropriations, moneys from the fund sha ll be
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used to pay for those a dditional costs, provided that the costs do not
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exceed ninety-nine thousand dollars per year. P aym ent from the fund
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for vision exam inations under section 167.195, RSMo, shall not exceed
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the allowable state Medicaid reim bu rsem ent amount for vision
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examinations.
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4. The department may contract for program development with any
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department-approved nonprofit organization dealing with regional and community
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blindness education, eye donor and vision treatment services.
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5. The department may adopt rules to prescribe eligibility requirements
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for the program.
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6. No rule or portion of a rule promulgated pursuant to the authority of
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this section shall become effective unless it has been promulgated pursuant to the
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provisions of chapter 536, RSMo.
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