2025 SESSION

SENATE SUBSTITUTE

25106341D

SENATE BILL NO. 1320

AMENDMENT IN THE NATURE OF A SUBSTITUTE

(Proposed by the Senate Committee on Education and Health

on January 30, 2025)

(Patron Prior to Substitute—Senator Bagby)

A BILL to amend and reenact § 22.1-271.7 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 22.1-271.9 and by adding in Article 6 of Chapter 29 of Title 54.1 a section numbered 54.1-2973.2, relating to preparticipation physical evaluation; children's cardiac safety.

Be it enacted by the General Assembly of Virginia:

1. That § 22.1-271.7 of the Code of Virginia is amended and reenacted and the Code of Virginia is amended by adding a section numbered 22.1-271.9 and by adding in Article 6 of Chapter 29 of Title 54.1 a section numbered 54.1-2973.2 as follows:

§ 22.1-271.7. Public elementary and secondary school student-athletes; preparticipation physical examination.

No public middle elementary or secondary school student shall be a participant on or try out for any school athletic team or squad with a predetermined roster, regular practices, and scheduled competitions with other middle elementary or secondary schools unless such student has submitted to the school principal a signed report from a licensed physician, a licensed advanced practice registered nurse practicing in accordance with the provisions of § 54.1-2957, or a licensed physician assistant acting under the supervision of a licensed physician attesting that such student has been examined, within the preceding 12 months, received a physical examination and was found to be physically fit for athletic competition no more than 14 calendar months prior to the date on which such report was signed.

§ 22.1-271.9. Preparticipation Physical Evaluation form; module.

A. For the purposes of this section:

"Health care professional" means a physician, advanced practice registered nurse, or physician assistant.

"Preparticipation Physical Evaluation form" is a form developed jointly by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine and includes the American Heart Association's 14-point screening for heart disease in youth.

B. The Department and the Department of Health shall develop and make available to each public elementary and secondary school guidance relating to the purpose and use of the Preparticipation Physical Evaluation form established pursuant to this section for the purpose of satisfying the requirement set forth in § 22.1-271.7 that, in order to participate on or try out for any school athletic team or squad with a predetermined roster, regular practices, and scheduled competitions with other elementary or secondary schools, each elementary or secondary student shall submit to the school principal a signed report from a licensed physician, a licensed advanced practice registered nurse practicing in accordance with the provisions of § 54.1-2957, or a licensed physician assistant acting under the supervision of a licensed physician attesting that such student has received a physical examination and was found to be physically fit for athletic competition no more than 14 calendar months prior to the date of submission of such signed report. The Department and the Department of Health shall also make such guidance available to any private school with any school athletic team or squad that competes with any public elementary or secondary school's athletic team or squad.

C. The Department of Health shall develop a single Preparticipation Physical Evaluation Form to be used to satisfy the requirements set forth in § 22.1-271.7. The Preparticipation Physical Evaluation form shall include the history and physical education components and the additional questions required pursuant to subsection B of § 54.1-2973.2. The Preparticipation Physical Evaluation form shall also include a certification statement, to be signed by the registered, licensed, or certified health care professional who performed the physical examination, attesting to the completion of the current professional development module established pursuant to this section.

This physical examination shall be conducted and signed no more than 14 months prior to the date on which any public elementary or secondary school student is required to submit such signed report for the purposes of participating on or trying out for any school athletic team or squad pursuant to § 22.1-271.7. All preparticipation physical evaluations shall be updated in accordance with the Preparticipation Physical Evaluation Monograph developed jointly by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine and that includes the American Heart Association's 14-point screening for heart disease in youth and that asks if the student has (i) been advised by a licensed health care professional not to participate in a sport; (ii) sustained a concussion, been unconscious, or lost memory from a blow to the head; (iii) broken a bone or sprained, strained, or dislocated any muscles or joints; (iv) fainted or blacked out; (v) experienced chest pains, shortness of breath, or heart racing; (vi) had a recent history of fatigue and unusual tiredness; (vii) been hospitalized, visited an emergency room, or had a significant medical illness; (viii) started or stopped taking any over-the-counter or prescribed medications; (ix) had a sudden death in the family, or if any member of the student's family under the age of 50 has had a heart attack or heart trouble; and (x) been asked specifically the four questions listed in subdivision B 2 regarding heart health history during cardiac screening in a well-child visit or preparticipation physical evaluation.

D. No local school board or chief administrator shall permit a student enrolled in kindergarten through grade 12 to participate on a school-sponsored or community organization-sponsored interscholastic or intramural athletic team or squad unless the student has completed a Preparticipation Physical Evaluation form and, if applicable, a health history update questionnaire as required under this section, and submitted such signed and dated Preparticipation Physical Evaluation form to the school principal in accordance with § 22.1-271.7.

E. The Department and the Department of Health shall establish a childhood cardiac screening professional development module to increase the assessment skills of those health care professionals who perform well-child physical examinations and screenings. The Department of Education and the Department of Health shall either develop a module adhering to requirements in this section or adopt the module created by the New Jersey Commissioners of Education and Health in consultation with the New Jersey Chapter of the American Academy of Pediatrics, the New Jersey Academy of Family Physicians, the American Heart Association, and the New Jersey Chapter of the American College of Cardiology.

If the Department of Education and the Department of Health choose to develop a new module, they shall, in consultation with the Virginia chapter of the American Academy of Pediatrics, the Virginia Academy of Family Physicians, the American Heart Association Virginia, and the Virginia chapter of the American College of Cardiology, develop, for implementation by the 2026–2027 school year, a childhood cardiac screening professional development module to increase the assessment skills of those health care professionals who perform well-child physical examinations and screenings. The module shall include the following: (i) how to complete and review a detailed medical history with an emphasis on cardiovascular family history and personal reports of symptoms, (ii) how to identify symptoms of sudden cardiac arrest that may require follow up with a cardiologist, (iii) how to recognize normal structural changes of the athletic heart, (iv) how to recognize prodromal symptoms that precede sudden cardiac arrest, (v) how to perform the cardiovascular physical examination, (vi) how to review the major etiologies of sudden unexplained cardiac death with an emphasis on structural abnormalities and acquired conditions, and (vii) guidelines on when to refer a student to a cardiologist for further assessment.

The module shall be posted on the websites of the Departments of Education and Health and links shall be made available to relevant organizations upon request.

Providers completing the childhood cardiac screening professional development module will be registered in a database to ensure all providers have successfully completed the required modules. This data shall be held for 10 years by the Department of Health.

The Department of Health shall compile and publish on its website an annual report containing the total number of exams that were completed and the number of referrals that were made to cardiology. The report shall also analyze the outcomes of this legislation.

F. A licensed health care professional who performs annual physical examinations of children 19 years of age or younger, including examinations conducted prior to a student participating on or trying out for any school athletic team or squad with a predetermined roster, regular practices, and scheduled competitions with other elementary or secondary schools pursuant to § 22.1-271.7, shall complete the childhood cardiac screening professional development module established by the Department of Health under this section every four years.

A contract between a school division and a school nurse shall include a statement of assurance that the school nurse has completed the childhood cardiac screening professional development module under this section within the past four years.

A licensed health care professional who completes the childhood cardiac screening professional development module as required pursuant to this section shall retain on file at that person's professional office a hard copy of the certificate of completion of the module that shall be made available upon request.

Upon renewal of a license by a health care professional who performs annual physical examinations of children 19 years of age or younger, the health care professional shall attest to the completion of the module within the past four years to the Board of Medicine or the Board of Nursing, as appropriate. An application for renewal of a certification, biennial registration, or renewal of a license shall include a check box for attestation regarding the health care professional's compliance with this section.

Upon performing a preparticipation physical examination required pursuant to this section and in accordance with § 22.1-271.7, the health care professional shall sign the certification statement on the Preparticipation Physical Evaluation form required pursuant to this section attesting to the completion of the module. The school board shall retain the original signed statement to attest to the qualification of the health care professional to perform the physical examination required under this section.

G. The Department and the Department of Health shall encourage any private elementary or secondary school that is a member of any organization or entity whose purpose it is to regulate or govern interscholastic programs and that has any school athletic team or squad that competes with any public elementary or secondary school's athletic team or squad to comply with the requirements of this section relating to preparticipation physical examinations.

§ 54.1-2973.2. Preparticipation physical evaluation; children's cardiac safety.

A. For the purposes of this section:

"Health care professional" means a physician, advanced practice registered nurse, or physician assistant.

"Preparticipation Physical Evaluation form" is a form developed jointly by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine and includes the American Heart Association's 14-point screening for heart disease in youth.

B. A licensed health care professional who performs an annual physical examination of a child 19 years of age or younger shall include as part of that examination questions that evaluate a child's family history related to cardiac conditions contained in the Preparticipation Physical Evaluation form. Such evaluation shall include:

1. A question regarding the biologic heart health history of the child, including any history of sperm or egg donors and biological parents.

2. Four specific questions regarding biologic heart health history during cardiac screening in well-child visits and in preparticipation physical examinations, including:

a. Have you ever fainted, passed out, or had an unexplained seizure suddenly and without warning, especially during exercise or in response to sudden loud noises, such as doorbells, alarm clocks, and ringing telephones?

b. Have you ever had exercise-related chest pain or shortness of breath?

c. Has anyone in your immediate family (parents, grandparents, siblings) or other, more distant relatives (aunts, uncles, cousins) died of heart problems or had an unexpected sudden death before age 50? This would include unexpected drownings, unexplained auto crashes in which the relative was driving, or SIDS.

d. Are you related to anyone with hypertrophic cardiomyopathy or hypertrophic obstructive cardiomyopathy, Marfan syndrome, arrhythmogenic cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, or Wolff-Parkinson-White syndrome or anyone younger than 50 years old with a pacemaker or implantable defibrillator?

2. The Board of Medicine and the Board of Education, pursuant to the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia) and in consultation with the State Health Commissioner, shall adopt regulations to effectuate the purposes of this section.