1. www.msbanet.org Legal Issues in your Health Room and Beyond School Nurse Survival Conference July 27, 2016 Kelli Hopkins, MSBA

2. www.msbanet.org Family Educational Rights and Privacy Act FERPA is a federal statute. Protects personally identifiable information (PII) in or obtained from student education records. – Including health records – Records covered by FERPA are not subject to HIPAA. Gives parents certain rights.

3. www.msbanet.org FERPA Student records Directly related to student Maintained by district or a party acting for the district Does not include Personal notes or observations Records of students 18 or older Made by medical personnel Used only in connection with and disclosed only to those providing treatment Treatment does not include educational programs or instruction.

4. www.msbanet.org FERPA Exceptions most pertinent to health records: Other staff with a legitimate interest Health and safety Parents Directory information

5. www.msbanet.org FERPA (Parental Rights) Inspect and review education records – Sunshine Law is broader Seek amendment of records Consent before disclosure – Exceptions Annual notice – Rights – Procedures for exercising rights

6. www.msbanet.org IDEA IEP/504 – Should be part of the team – Share information (both ways) Activities – Nursing services – Medications Extended school day/year

7. www.msbanet.org ADA/504 Americans with Disabilities Act – Health information must be carefully protected. Discrimination based on disability – Knowing about a disability may create a presumption that actions taken were based on that disability. Employee accommodation requests – nurse may be asked to document Meal accommodations

8. www.msbanet.org IDEA/ADA/504 Frequently asked questions: Can a school nurse have a copy of a student’s IEP or 504 plan? What is the difference between an IEP and 504 plan? How does a health-related plan fit into the IDEA/504 piece?

9. www.msbanet.org IDEA/ADA/504 If a student requires medical care as a regular part of attending school, does that apply to: – Summer school (not just ESY)? – After-school program? – Trips? A student with a disability who requires medical care as an accommodation is entitled to that accommodation in all programs and activities of the district.

10. www.msbanet.org IDEA/ADA/504 Confidentiality is required. Because these laws cover children with disabilities and medical issues, discretion and confidentiality are crucial. – More sensitive than grades or other education information

11. www.msbanet.org Confidentiality Release student records in accordance with FERPA and state law. Do not promise a student you will keep something secret. A school is not a clinical setting. – Records are more easily obtained. – Your relationship is confidential but not privileged.

12. www.msbanet.org Immunizations There is a disconnect between medical and educational priorities that is reflected in law.

13. www.msbanet.org Immunizations Section 167.181, RSMo. “It is unlawful for any student to attend school unless he has been immunized as required under the rules and regulations of the department of health and senior services, and can provide satisfactory evidence of such immunization; except that if he produces satisfactory evidence of having begun the process of immunization, he may continue to attend school as long as the immunization process is being accomplished in the prescribed manner. It is unlawful for any parent or guardian to refuse or neglect to have his child immunized as required by this section, unless the child is properly exempted.”

14. www.msbanet.org Immunizations 19 C.S.R. 20-28.010 “Exclusion of students in noncompliance, section 167.181, RSMo. Students cannot attend school unless they are properly immunized and can provide satisfactory evidence of the immunization or unless they are exempted. The school administration shall exercise its power of pupil suspension or expulsion under section 167.161, RSMo, and possible summary suspension under section 167.171, RSMo, until the violation is removed.”

15. www.msbanet.org Immunizations Every Student Succeeds Act (ESSA) “If the [homeless] child or youth needs to obtain immunizations or other required health records, the enrolling school shall immediately refer the parent or guardian of the child or youth, or (in the case of an unaccompanied youth) the youth, to the local educational agency liaison who shall assist in obtaining necessary immunizations or screenings, or immunization or other required health records...”

16. www.msbanet.org Immunizations 19 C.S.R. 20-28.010 “[With respect to unimmunized students,]in the event of an outbreak or suspected outbreak of a vaccine-preventable disease within a particular facility, the administrator of the facility shall follow the control measures instituted by the local health authority or the Department of Health and Senior Services pursuant to 19 CSR 20-20.040.”

17. www.msbanet.org Immunizations Military Compact Section 160.2000, RSMo. “Immunizations - Compacting states shall give thirty (30) days from the date of enrollment or within such time as is reasonably determined under the rules promulgated by the Interstate Commission, for students to obtain any immunization(s) required by the receiving state. For a series of immunizations, initial vaccinations must be obtained within thirty (30) days or within such time as is reasonably determined under the rules promulgated by the Interstate Commission.”

18. www.msbanet.org Immunizations Section 167.183, RSMo. “Information and records pertaining to the immunization status of persons against childhood diseases as required by [law] may be disclosed... without a parent's or guardian's written release... to the following, who need... such information to assure compliance with [law] or to achieve... immunization status for children: Employees of public agencies, departments political subdivisions; Health records staff of school districts and child care facilities; Persons other than public employees who are entrusted with the... care of those under the care and custody of a state agency” Health care professionals.”

19. www.msbanet.org Immunizations Students in Foster Care Section 160.1990, RSMo. “In order to remove barriers to educational success imposed on foster care children because of frequent moves, the [DESE] shall ensure that the following criteria are implemented in every school district in this state regarding enrollment of foster care children: – Facilitate the timely enrollment of foster care children and ensure that they are not placed at a disadvantage due to difficulty in the transfer of education records from the previous school district...” Records include “health data.”

20. www.msbanet.org Immunizations Day Care Rule Requirements for immunization before enrollment is the same. Must notify parents that they have the right to know if any child enrolled in or attending in the facility where their child attends has an immunization exemption. – Not just day care students

21. www.msbanet.org Immunizations (Exemptions) Medical – Provided by MD, DO or designee – On original copy of form Imm.P12 created by DHSS – No renewal required Religious – Signed only by parent – Original form Imm.P11A – No renewal required Parental – Only preschool/daycare – Original form Imm.P11 – Annual renewal required

22. www.msbanet.org State Laws Administration of Medications – §167.627, RSMo. (Generally) – §167.630, RSMo. (Epinephrine) – §167.635, RSMo. (Asthma) – §167.621, RSMo. (Immunity) – §§167.800-824, RSMo.(Diabetes)

23. www.msbanet.org Administration of Medications Parent requests district administration of medication – Required? – Storage – safety and accessibility – Confidentiality Emergency medications – Optional

24. www.msbanet.org Administration of Medications Student possession and self-administration of medications – Sometimes required Extended trips and medications – Student administration – Staff administration – Types of medications

25. www.msbanet.org Upcoming Policy on bedbugs, fleas and any other critter we can think of. Policy for suicide prevention Mental health focus in ESSA Telehealth or telemedicine (SB 579 (2016)) Trauma-informed schools (SB 638 (2016))

26. www.msbanet.org KELLI HOPKINS HOPKINS@MSBANET.ORG (MO) 800-221-6722 EXT. 345 (TOLL) 573-445-9920 HOPKINS@MSBANET.ORG Contact Information