GUIDELINES: FREQUENTLY ASKED QUESTIONS ABOUT QUALIFICATIONS REQUIRED OF PERSONNEL CONDUCTING MEDICAL REVIEWS

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1 GUIDELINES: FREQUENTLY ASKED QUESTIONS ABOUT QUALIFICATIONS REQUIRED OF PERSONNEL CONDUCTING MEDICAL REVIEWS What qualifications are required under the State Board of Education s rules? Section of rules governing Special Education (23 Ill. Adm ; see sets forth the qualifications of personnel who may conduct medical reviews, as follows: Until June 30, 2013, School Service Personnel Certificate endorsed for school nursing (23 Ill. Adm. Code ), or a license to practice medicine in all of its branches, or under Section 60 or 65 of the Nurse Practice Act [225 ILCS 65]. Beginning July 1, 2013, a School Service Personnel Certificate endorsed for school nursing (23 Ill. Adm. Code ); or a license to practice medicine in all of its branches; or a bachelor s degree or higher and a license issued under Article 60 or Article 65 of the Nurse Practice Act [225 ILCS 65/Art. 60 or Art. 65], provided that only a person holding a School Service Personnel Certificate endorsed for school nursing shall make recommendations regarding educational interventions, accommodations or modifications based on the findings of the student s medical review. How do the rules affect personnel who are currently employed by a cooperative or school district and assigned to conduct medical reviews? Beginning July 1, 2013, the medical review required for a student who is being evaluated or re-evaluated for special education services shall be conducted by one of these three qualified personnel: 1) School nurse (hereinafter defined as any registered professional nurse who holds a school service personnel certificate with an endorsement in school nursing, or any noncertificated registered professional nurse who was employed in the school district of current employment before July 1, 1976); or, 2) Physician licensed to practice medicine in all its branches (i.e., a medical doctor, an osteopathic doctor or a chiropractor who holds a license to practice medicine in all of its branches); or, 3) Registered Nurse with a bachelor s degree or higher, or Advanced Practice Nurse. Illinois State Board of Education - December 2012

2 In addition, the (1) school nurse (2) physician, or (3) RN (non-school nurse) with BA/BS or higher, may delegate portions of the medical review to other school staff, such as other nursing level staff, vision/hearing technicians, or assistants, as allowed by these other individual s education and training. As noted in the rules above, only a school nurse who holds a school service personnel certificate endorsed for school nursing (i.e., certified school nurse ) may make recommendations regarding educational interventions, accommodations or modifications to the student s individualized educational program (IEP) based on the findings of the medical review. Special education cooperatives and school districts that currently employ physicians licensed to practice medicine in all of its branches, registered nurses or advanced practice nurses to make these recommendations must use only certified school nurses for this purpose beginning July 1, 2013, although physicians licensed to practice medicine in all of its branches, registered nurses with a bachelor s degree or higher and advanced practice nurses may continue to conduct reviews relative to the student s medical and health status after that time. What exactly is a medical review? A medical review is not a single act but a process with a number of activities resulting in a complete review of the student s medical and health status that provides the answer to the question: Is a health condition adversely affecting a student s educational performance? Neither state nor federal law defines medical review. However, federal law requires that a student who is being evaluated or re-evaluated for special education services must be provided an assessment in all areas related to the suspected disability, including, if appropriate, health, vision, hearing. (U.S. Department of Education, 34 CFR , Evaluation procedures). The assessment must also be sufficiently comprehensive to identify all of the child's special education and related services needs, including related services such as school nursing services and school health services under 34 CFR (c)(13). This assessment has come to be commonly known as the medical review. How is a medical review conducted? A medical review begins with obtaining information in a process referred to by its acronym SOAP, or Subjective, Objective, Assessment, Plan. a. Subjective information is collected, such as the parent s concerns about the student s health, the student s own perception of his or her health, emotional feelings that are communicated, recollection of health history, teaching staff perceptions about how

3 student s health is affecting academic program requirements, other signs of health or illness that may or may not be able to be verified by lab tests or examination (such as pain, depression, etc.) b. Objective information is noted, such as information that is contained in the student s health records or can be obtained at school, including vital signs, hearing tests, vision tests, height/weight/bmi, heart and lung sounds, and other data collected in the past or present. Review of the student health record or potential health problems revealed by subjective information may lead to a need for additional records, possibly requiring a release from a parent for physician or hospital records. c. Assessment is first made of the quality of the data and a determination is made about whether more information or study is needed. That assessment is made by school nurse, advanced practice nurse, registered nurse with a bachelor s degree or higher, or a physician licensed to practice medicine in all of its branches. Assessment is then made by the individual conducting the medical review (school nurse, advanced practice nurse, registered nurse with a bachelor s degree or higher, or a physician licensed to practice medicine in all of its branches), about what, if any, appropriate nursing services are required to maintain the student during the school day, and reported to the certified school nurse. Assessment concludes when the certified school nurse, and only the certified school nurse, reviews the findings of the medical review and reports his or her educationally relevant medical findings to the IEP team (and others in attendance). This report should summarize the findings, including information about the educational significance of the student s medical status. This report takes the medical review to its conclusion, as required by IDEA, in the form of a statement or summary of the educationally relevant medical findings, if any. (34 CFR , Specific documentation for the eligibility determination). To arrive at findings, the certified school nurse is exercising instructional judgment or conducting an educational evaluation (105 ILCS 5/ ) when he or she makes any recommendations regarding educational interventions, accommodations or modifications (23 IAC ). In accordance with Section of the School Code, only a certified school nurse may conduct duties that require exercise of instructional judgment or education evaluation of pupils (105 ILCS 5/ ). d. Plan a) if there are no educationally relevant medical findings, a student may nonetheless have some medical issues that need to be addressed by the school. A plan that covers only the medical recommendations regarding nursing interventions needed at school may be developed by the school nurse, advanced practice nurse, registered nurse with bachelor s degree or higher, or physician licensed to practice medicine in all of its branches. b) If there are educationally relevant medical findings, a plan that provides for educational accommodations, educational modifications, annual goals, short-term objectives, and ongoing

4 evaluation related to the educationally relevant medical findings is developed by the certified school nurse (in collaboration with other members of the IEP team if relevant). The school nurse also makes recommendations regarding educational interventions related to the health condition(s) that are adversely impacting the student s educational performance. (Other personnel who are qualified to conduct the medical review may participate in the planning process, but they are not qualified to determine the specific educational-related provisions that may be needed in the student s IEP, including identification of student goals that may result from the provision of nursing interventions.) What is the role of the certified school nurse in the IEP goal-planning process for a student with educationally relevant medical findings? The certified school nurse: o assists with IEP development; o integrates any needed school nursing services, as defined in 34 CFR (c)(13), into the student s academic and/or functional goals; o makes recommendations regarding educational interventions, accommodations or modifications to instruction or in the learning environment; o provides or delegates (in accordance with provisions in the Illinois Nurse Practice Act) nursing interventions, which are the activities the nurse provides for the student (or patient) and may be direct interventions (direct nursing care, such as medications, tube feedings, dressing changes, skin care, respiratory care, etc., as well as teaching the client or other providers about the student s care, and indirect interventions, including case management activities, development of health component of the IEP, and in-service classes for staff and faculty); o make recommendations regarding student health-related goals, including frequency of evaluating student s progress; o make recommendations regarding specific school health services and school nursing services, 34 CFR (c)(13), to be documented in the IEP; and o writes progress reports relative to the established goals and evaluates the effectiveness of the interventions.

5 What can be done about shortages of certified school nurses available to conduct educationally evaluative provisions of the medical review? ISBE is working with a number of partners to identify quicker paths to school nurse certification. ISBE is working to identify retired or otherwise non-working certified school nurses who may be able to return to work at least part time. For a registered nurse who does not hold a bachelor s degree, avenues for accelerated bachelor degree programs in nursing are available at many of the state s colleges and universities. Small school districts may wish to enter into multi-district contracts for employment of one or more certified school nurses to carry out educational evaluations and medical reviews. Certified school nurses may delegate portions of the tasks in a medical review to other school staff, as allowed. School districts may wish to reorganize the school health services staff to best utilize existing personnel.

6 Appendix A Summary of Medical and Nursing Professionals and Qualifications to Conduct Medical Review Type of License issued by Illinois Dept. of Financial and Professional Regulation Licensed Practical Nurse (LPN) Registered Professional Nurse (RN) Registered Professional Nurse (RN) Registered Professional Nurse (RN) Registered Professional Nurse (RN) holding baccalaureate degree in another field besides nursing (either pre- or post-hospital training program or an associate s degree program) Educational Degrees, Diploma or Certificate One year in length; no academic degree Two years in length; associate degree in nursing (ADN) Hospital training program, 3 years in length; grants a diploma (no academic degree); one such program remains in Illinois Baccalaureate degree in nursing (BSN); four years in length Baccalaureate degree in any field other than nursing No Qualified to Conduct Medical Review No, unless practicing as school nurse prior to 1976 in the same district (grandfathered) No, unless grandfathered (see above) Qualified to make recommendations regarding educational interventions, accommodations or modifications based on the findings of the student s medical review No No, unless practicing as school nurse prior to 1976 in the same district (grandfathered) No, unless grandfathered (see above) Yes No, if not also holding Type 73 certificate issued by ISBE or grandfathered (see above) Yes, although a baccalaureate degree in nursing is preferred. No, if not also holding Type 73 certificate issued by ISBE or grandfathered

7 Type of License issued by Illinois Dept. of Financial and Professional Regulation Advanced Practice Nurse (APN) Certified School Nurse (RN license issued by IDFPR and Type 73 certificate issued by ISBE) Physician (licensed to practice medicine in all its branches) Educational Degrees, Diploma or Certificate Graduate degree or post-master s certificate (unless grandfathered prior to 2007) Post-baccalaureate minimum of one year to incorporate internship and related courses aligned to learning standards to address educational principles, special education, school law, and school and public health rules and regulations, among others. See 23 IAC for details. Qualified to Conduct Medical Review Qualified to make recommendations regarding educational interventions, accommodations or modifications based on the findings of the student s medical review Yes No, if not also holding Type 73 certified issued by ISBE or grandfathered (see above) Varies Yes No Yes Yes

8 Appendix B Components of Medical Review (including level of health care worker required) Components of a Medical Review; description; type of information Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. Vision Screening as directed by Subpart C of Illinois Department of Public Health (IDPH) rules governing Vision Screening (77 Ill. Reg. 685.Subpart C; ion/jcar/admincode/077/ sections.html) and Illinois law (objective data) CSN, MD, APN, RN/BSN who holds IDPH certificate as vision screening technician Yes Any person holding certificate issued by IDPH as vision screening technician Hearing screening -- as directed by IDPH rules governing Hearing Screening (77 Ill. Reg. 685.Subpart C; CSN, MD, APN, RN/BSN who holds IDPH certificate as hearing screening technician Yes Any person holding certificate issued by IDPH as hearing screening technician

9 Components of a Medical Review; description; type of information rules governing Vision Screening (77 Ill. Reg. 685.Subpart C; ion/jcar/admincode/077/ sections.html) and Illinois law (objective data) Health History Review of student health records (objective data, such as immunization record, health room visits, medications on record, health-related absences, etc.) Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. CSN, MD, APN, RN/BSN Yes By CSN, APN, RN/BSN to another RN By CSN, APN, RN/BSN to an LPN By MD to any licensed health worker as provided by Medical Practice Act of 1987 [225 ILCS 60] Health History Recall CSN, MD, APN, RN/BSN Yes By CSN, APN, RN/BSN to

10 Components of a Medical Review; description; type of information reported by parent and, if applicable, by student, and recorded by health care worker (subjective data) Health History Recall reported by student s other teachers and caregivers (subjective data) Physical Assessment (Head to toe ROS: Review of Systems) Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. another RN By CSN, APN, RN/BSN to an LPN By MD to any licensed health worker as provided by Medical Practice Act of 1987 CSN, MD, APN, RN/BSN Yes By CSN, APN, RN/BSN to another RN By CSN, APN, RN/BSN to an LPN By MD to any licensed health worker as provided by Medical Practice Act of 1987 CSN, MD, APN, RN/BSN Yes By CSN, APN, RN/BSN to another RN

11 Components of a Medical Review; description; type of information objective data obtained during physical examination Health Assessment (evaluate findings to determine whether a student has any health needs that the school must provide) Summary of Educationally Relevant Medical Findings and, for initial placement, determining whether the student s past or present health status is or is not adversely related to educational performance. May serve as the Statement Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. By MD to any licensed health worker as provided by Medical Practice Act of 1987 CSN, MD, APN, RN/BSN Yes By CSN, APN, RN/BSN to another RN CSN No, except to another CSN By MD to any licensed health worker as provided by Medical Practice Act 0f 1987

12 Components of a Medical Review; description; type of information Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. of Present Level of Educational Performance (as it relates to health) in the IEP. Educational Recommendations (Including Annual Goals and Short-Term Objectives) recommendations for educational interventions, accommodations and modifications (including but not limited to recommendations that would ameliorate the adverse impact of the health condition); report on how current conditions affect CSN No, except to another CSN

13 Components of a Medical Review; description; type of information Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. educational environment, including least restrictive environment; and recommendations on changes to educational interventions, methods or services that may improve student s ability to function within the regular classroom and/or least restrictive environment (Within the IEP) CSN No, except to another CSN Statement of Specific Nursing Related Services to be provided, duration, by whom, when and where Regular evaluation of the IEP student health goals, CSN No, except to another CSN

14 Components of a Medical Review; description; type of information Responsibility of which of the above professionals May this component be delegated by the professional who maintains the responsibility and accountability of the activity? (Illinois Nurse Practice Act: " 'Delegation' means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation. ") To whom Illinois Nurse Practice Act: "A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation. provided nursing interventions, and student progress