Consulting with Schools on Health Issues

B. LEGAL ISSUES IN SCHOOL HEALTH

Pediatricians who plan to spend any amount of time working within a school district must familiarize themselves with federal, state, and local laws affecting students' health and medical needs in schools.

1. Important Considerations

• Responsibility for school health policies and programs is often distributed among individual persons and groups, including school administrators, health care personnel, district personnel, and school boards. Lack of a central point of responsibility can result causes difficulties.
• Too often, school health is not "owned" by anyone. Legal mandates and traditional organizational patterns for human services affect local school health issues and programs.

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2. Federal Laws to Know

The pediatrician who intends to consult with schools should become familiar with the federal laws, regulations, and programs in this section. Note that most federal laws and services require periodic reauthorization and often change in the process, making education on these programs an ongoing effort.

Title XIX: The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

• In 1966, Medicaid provided health insurance coverage for poor children and specified that insured services should include EPSDT.
• Schools that provide some of these services either directly (screening of vision and hearing and/or scoliosis, or high blood pressure) or indirectly (by helping families access these services in the community) can draw from federal Medicaid dollars for these services through contracts with their state health departments.

Public Law 94-142: The Education for All Handicapped Children Act

• The law was passed in 1975 and mandated "equal education for all."
• The law provides a mandate for related services and sets standards.
• A focus of the law is school placement in the least restrictive environment for the student.
• Under the law, students with disabilities are required to have Individual Education Plans (IEPs).

Public Law 99-457: The Early Intervention Law

• Encourages early identification of children with special needs and initiation of the corresponding intervention.
• States have options in interpreting of eligibility and implementation.
• Requires family involvement in the intervention process.
• Requires the development of Individual Family Service Plans (IFSPs).

Public Law 101-476: The Individuals with Disabilities Education Act (IDEA)

• Details the identification and provision of "related services" for children with disabilities. Related services are those that may be required to assist a child with a disability to benefit from special education, including anything from transportation to medical services.
• Strengthens incentives for statewide coordinated programs that provide comprehensive early intervention services for all infants and toddlers with disabilities and their families.

Section 504 of the Rehabilitation Act of 1973

• Prohibits discrimination on the basis of disability within federal and federally assisted programs.
• Children with special needs are entitled to appropriate modifications within their educational programs to accommodate these needs, regardless of whether their classroom placement is considered regular education or special education.

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3. Implementation and Responsibility for Federal Programs

Who supports services under federal mandates?

• Court have generally mandated that therapies recommended in the IEP be reimbursed by the educational system.
• Occasionally, Medicaid or other public funding has been used to support medical service provisions for children with disabilities.
• In specific situations, private insurance carriers can be responsible for payment of such services. Parents, however, have the right to decline to make claims against their insurance if they would create a realistic threat of financial loss by, for example, lowering the child's available lifetime medical benefits.

Who takes responsibility for the services and medical care for the child?

• Because schools have been bearing the burden of implementing and funding most of the therapies in question, school authorities have become increasingly concerned about their responsibility for overseeing the delivery of medical care and health-related services.
• The supervision of medical care and health-related services for children with chronic or disabling conditions should be the responsibility of physicians and other members of the medical community, regardless of the location or source of payment.
• When considering services provided by the school system, clear and careful collaboration and coordination with the educational authorities are necessary. Issues such as the source of payment, liability, location of treatment, and the specific staff performing the treatment should be resolved with the responsible state and local agencies?

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4. State Laws

State regulations regarding school health vary significantly. Pediatricians interested in school health should seek information on the specific laws in the state before becoming formally involved.

• All states have legal requirements regulating age and medical requirements (eg, immunizations) at school entry, as well as requirements for periodic screening.
• Most states have a state agency office responsible for school health, either in the education department or shared by the health department and the education department.

5. Local Policies

• Policies for many important practices in school health, such as medication administration, dealing with head lice exclusion from school, and health education and life skills curricula, are defined at the district level and approved by the school board.
• Practices in many school districts may be regulated by specific school policies formulated years ago for reasons no longer valid. Pediatricians should be involved in reviewing and updating these policies.