Self-administration of certain medications by students.
Purpose:
To establish standards for the self-administration by students of certain prescribed medications on school property and at school functions; and to establish standards for the training of unlicensed school personnel to administer prescribed epinephrine auto injectors and glucagon to specific students under specified conditions.
Substance of proposed rule (Full text is posted at the following State website:http://www.p12.nysed.gov/sss/schoolhealth/ schoolhealthservices/PROPOSED8NYCRRS136_7.html):
The Commissioner of Education proposes to add a new section 136.7 of the Regulations of the Commissioner to establish standards for the self-administration by students of certain prescribed medications on school property and at school functions; and establish standards for the training of unlicensed school personnel to administer prescribed epinephrine auto injectors and glucagon to specific students under specified conditions, consistent with Chapter 423 of the Laws of 2015. The following is a summary of the substance of the proposed rule.
Section 136.7(a) sets forth definitions of “inhaled rescue medications”, “epinephrine auto-injector”, “ketone test”, “blood glucose test”, “insulin”, “glucagon”, “duly authorized health care provider”, “cumulative health record”, “emergency action plan”, “diabetes management plan”, “school day”, “school property”, and “school function”.
Section 136.7(b) sets forth standards for the self-administration by students of prescribed inhaled rescue medications during the school day on school property or at a school function, including requirements for:
(1) written consent from the parent or person in parental relation; and
(2) written permission (also referred to as an order) and an attestation from a duly authorized health care provider of the following:
(i) that the student has a diagnosis of asthma or other respiratory disease for which inhaled rescue medications are prescribed;
(ii) that the student has demonstrated that he/she can self-administer the prescribed medication effectively; and
(iii) the expiration date of the order, name and dose of prescribed medication, times when medication is to be self-administered, and circumstances which may warrant the use of the medication.
A record of the written consents shall be maintained in the student’s cumulative health record.
Upon written request of a parent or person in parental relation, the school district or board of cooperative educational services (BOCES) shall allow the student to maintain an extra inhaled rescue medication in the care and custody of a licensed nurse, nurse practitioner, physician assistant, or physician employed by the district or BOCES.
Such medication provided by the parent or person in parental relation shall be made available to the student as needed in accordance with school policy and the written permission provided by the duly authorized health provider.
Each student who is permitted to self-administer medication should have an emergency action plan on file with the district or BOCES.
Section 136.7(c) sets forth standards for the self-administration by students of prescribed epinephrine auto-injectors during the school day on school property or at a school function, including requirements for:
(1) written consent of the parent or person in parental relation; and
(2) written permission (also referred to as an order) and an attestation from a duly authorized health care provider of the following:
(i) the student has a diagnosis of an allergy for which an epinephrine auto-injector is needed;
(ii) the student has demonstrated that he/she can self-administer the epinephrine auto-injector effectively; and
(iii) the expiration date of the order, name and dose of prescribed medication, times when medication is to be self-administered, and circumstances which may warrant the use of the medication.
A record of such written consents shall be maintained in the student’s cumulative health record.
Upon written request of a parent or person in parental relation, the school district or board of cooperative educational services (BOCES) shall allow the student to maintain an extra epinephrine auto-injector in the care and custody of a licensed nurse, nurse practitioner, physician assistant, or physician employed by the district or BOCES.
Such epinephrine auto-injector provided by the parent or person in parental relation shall be made available to the student as needed in accordance with school policy and the orders prescribed by the duly authorized health provider.
Each student who is permitted to self-administer an epinephrine auto-injector should have an emergency action plan on file with the district or BOCES.
Section 136.7(d) sets forth standards for allowing students to carry and self-administer prescribed insulin, carry glucagon, and carry and use equipment and supplies necessary to check blood glucose and/or ketone levels during the school day on school property or at a school function, including requirements for:
(1) written consent of the parent or person in parental relation; and
(2) written permission (also referred to as an order) and an attestation from a duly authorized health care provider of the following:
(i) that the student has a diagnosis of diabetes for which insulin and glucagon, and the use of equipment and supplies to check glucose and/or ketone levels are necessary;
(ii) that the student has demonstrated that he/she can self-administer the insulin effectively, can self-check glucose or ketone levels independently, and can independently follow prescribed treatment orders; and
(iii) the expiration date of the order, name of the prescribed insulin or glucagon, the type of insulin delivery system, the dose of insulin to be administered, the times when the insulin is to be self-administered, the dose of glucagon to be administered, and the circumstances which may warrant the administration of insulin or glucagon.
(iv) The written permission must also identify the prescribed blood glucose or ketone test, the times testing is to be done, and any circumstances which warrant testing.
A written diabetes management plan shall be provided. A record of the written consents shall be maintained in the student’s cumulative health record.
Upon written request of a parent or person in parental relation, the school district or board of cooperative educational services (BOCES) shall allow the student to maintain extra insulin, insulin delivery system, glucagon, blood glucose meter and related supplies in the care and custody of a licensed nurse, nurse practitioner, physician assistant, or physician employed by the district or BOCES.
Such insulin, insulin delivery system, glucagon, blood glucose meter and related supplies provided by the parent or person in parental relation shall be made available to the student as needed in accordance with school policy and the orders prescribed by the duly authorized health provider.
Students with diabetes may also carry food, oral glucose, or other similar substances necessary to treat hypoglycemia pursuant to district policy, provided such policy shall not unreasonably interfere with a student’s ability to treat hypoglycemia.
A record of such written consents shall be maintained in the student’s cumulative health record.
Each student who is permitted to self-administer and self-test should have an emergency action plan on file with the district or BOCES.
Licensed nurses, nurse practitioners, physician assistants, or physicians employed by school districts or BOCES are authorized to calculate prescribed insulin dosages, administer prescribe insulin, program the prescribed insulin pump, refill the reservoir in the insulin pump, change the infusion site, inject prescribed glucagon, teach an unlicensed person to administer glucagon, and perform other authorized services within their scope of practice to students diagnosed with diabetes and who are permitted to self-administer and self-test.
Section 136.7(f)(1) establishes standards for the training of unlicensed school personnel to administer prescribed epinephrine auto-injectors to a student. Such training must be provided and documented by an authorized licensed health professional and include, but not be limited to:
(i) identification of the specific allergen(s) of the student, review of each student’s emergency action plan if available;
(ii) signs and symptoms of a severe allergic reaction warranting administration of epinephrine;
(iii) how to access emergency services per school policy;
(iv) steps for administering the prescribed epinephrine auto-injector;
(v) observation of the trainee suing an auto-injector training device;
(vi) steps for providing ongoing care while waiting for emergency services;
(vii) notification of appropriate school personnel; and
(viii) methods of safely storing, handling and disposing of auto-injectors.
Section 136.7(2) establishes standards for the training of unlicensed school personnel to administer prescribed glucagon to a student. Such training must be provided and documented by an authorized licensed health professional and include, but not be limited to:
(i) overview of diabetes and hypoglycemia per Department of Health approved webinar;
(ii) review of student’s emergency action plan if available, including treatment of mild or moderate hypoglycemia;
(iii) signs and symptoms of a severe hypoglycemia warranting administration of glucagon;
(iv) how to access emergency services per school policy;
(v) steps for mixing and administering the prescribed glucagon;
(vi) observation of the trainee using a glucagon training device;
(vii) steps for providing ongoing care while waiting for emergency services;
(viii) notification of appropriate school personnel; and
(ix) methods of safely storing, handling, and disposing of glucagon and used needles and syringes.
Text of proposed rule and any required statements and analyses may be obtained from:
Kirti Goswami, State Education Department, Office of Counsel, State Education Building, Room 148, 89 Washington Ave., Albany, NY 12234, (518) 474-6400, email: legal@mail.nysed.gov
Data, views or arguments may be submitted to:
Cosimo Tangorra, Jr., Deputy Commissioner, State Education Department, Office of P-12 Education, State Education Building 2M West, 89 Washington Ave., Albany, NY 12234, (518) 474-5520, email: NYSEDP12@nysed.gov
Public comment will be received until:
45 days after publication of this notice.
This rule was not under consideration at the time this agency submitted its Regulatory Agenda for publication in the Register.
Regulatory Impact Statement
1. STATUTORY AUTHORITY:
Education Law section 207 empowers the Board of Regents and the Commissioner of Education to adopt rules and regulations to carry out the laws of the State regarding education and the functions and duties conferred on the State Education Department by law.
Education Law section 305(1) and (2) provide the Commissioner, as chief executive officer of the State's education system, with general supervision over all schools and institutions subject to the Education Law, or any statute relating to education, and responsibility for executing all educational policies of the Regents.
Chapter 423 of the Laws of 2014 amended section 916 of the Education Law and added new sections 916-a, 916-b, 902-a, and 902-b, effective July 1, 2015, to establish standards for the self-administration by students of certain prescribed medications on school property and at school functions. Additionally, Chapter 423 of the Laws of 2014 added a new section 921 to authorize, but not obligate, boards of education or trustees of each school district and boards of cooperative educational services (BOCES) and nonpublic schools to have certain specified licensed professionals to train unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. Training must be provided by a physician or other duly authorized licensed health care professional in a competent manner and must be completed in a form and manner prescribed by the Commissioner in regulation.
2. LEGISLATIVE OBJECTIVES:
The proposed rule is consistent with the above statutory authority and is necessary to implement Education Law sections 916, 916-a, 916-b, 902-a, 902-b and 921, as added and amended by by Chapter 423 of the Laws of 2014.
3. NEEDS AND BENEFITS:
The proposed rule is necessary to set forth standards for the self-administration by students of prescribed inhaled rescue medications and epinephrine auto-injectors, and standards for allowing students to carry and self-administer prescribed insulin, carry glucagon, and carry and use equipment and supplies necessary to check blood glucose and/or ketone levels, during the school day on school property and at a school function, including requirements for the written consent of the parent or person in parental relation and written permission (also referred to as an order) and an attestation from a duly authorized health care provider providing certain specified information including the expiration date of the order, name and dose of prescribed medication, times when medication is to be self-administered, and circumstances which may warrant the use of the medication.
The proposed rule is also necessary to establish standards for the training of unlicensed school personnel to administer prescribed epinephrine auto-injectors and glucagon to specific students under specified conditions, consistent with Chapter 423 of the Laws of 2014, for those school districts and BOCES that choose to provide such training.
4. COSTS:
(a) Costs to State: none.
(b) Costs to local governments: in general, the proposed rule does not impose any costs beyond those inherent in Chapter 423 of the Laws of 2014. Consistent with the statute, school districts, BOCES, and non-public schools may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. Furthermore, any costs associated with maintaining the written consents in the student’s cumulative health record are anticipated to be minimal and capable of being absorbed using existing district staff and resources.
(c) Costs to private regulated parties: there may be costs associated with the written permission/order and attestation of the authorized health care provider, and documentation of training by such health professional, but these costs are expected to be minimal and capable of being absorbed using existing staff and resources.
(d) Costs to regulating agency for implementation and continued administration of this rule: none.
5. LOCAL GOVERNMENT MANDATES:
The proposed rule does not impose any mandatory program, service, duty, or responsibility upon local government, including school districts or BOCES. Consistent with the statute, school districts, BOCES and non-public schools may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions.
6. PAPERWORK:
A record of the written consents shall be maintained in the student’s cumulative health record. Training of unlicensed school personnel under section 136.7(f) must be documented.
7. DUPLICATION:
The proposed rule does not duplicate any existing State or Federal requirements, and is necessary to implement Education Law sections 916, 916-a, 916-b, 902-a, 902-b and 921, as added and amended by by Chapter 423 of the Laws of 2014.
8. ALTERNATIVES:
The proposed rule is necessary to implement Education Law sections 916, 916-a, 916-b, 902-a, 902-b and 921, as added and amended by Chapter 423 of the Laws of 2014. There were no significant alternatives and none were considered.
9. FEDERAL STANDARDS:
There are no applicable Federal standards.
10. COMPLIANCE SCHEDULE:
It is anticipated that regulated parties can achieve compliance with the proposed rule by its effective date. Consistent with the statute, school districts, BOCES and non-public schools may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. The proposed rule also merely provides definitions and otherwise clarifies the circumstances regarding the proper self-administration by students of prescribed inhaled rescue medications and epinephrine auto-injectors, and the proper self-administration and self-testing by students with diabetes, during the school day on school property or at a school function.
Regulatory Flexibility Analysis
(a) Small businesses:
The purpose of the proposed rule is to establish standards for the self-administration by students of certain prescribed medications on school property and at school functions; and establish standards for the training of unlicensed school personnel to administer prescribed epinephrine auto injectors and glucagon to specific students under specified conditions, consistent with Chapter 423 of the Laws of 2015. The proposed rule does not impose any economic impact, or other compliance requirements on small businesses. Because it is evident from the nature of the proposed rule that it does not affect small businesses, no further measures were needed to ascertain that fact and none were taken. Accordingly, a regulatory flexibility analysis for small businesses is not required and one has not been prepared.
(b) Local governments:
1. EFFECT OF RULE:
The rule applies to each of the 695 school districts and 37 BOCES in the State.
2. COMPLIANCE REQUIREMENTS:
The proposed rule generally does not impose any compliance requirements upon local governments. Consistent with the statute, school districts and BOCES may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions.
The proposed rule also merely provides definitions and otherwise clarifies the circumstances regarding the proper self-administration by students of prescribed inhaled rescue medications and epinephrine auto-injectors, and the proper self-administration and self-testing by students with diabetes, during the school day on school property or at a school function. A record of the written consents obtained pursuant to the proposed rule shall be maintained in the student’s cumulative health record.
3. PROFESSIONAL SERVICES:
The proposed rule does not impose any additional professional services requirements on local governments.
4. COMPLIANCE COSTS:
In general, the proposed rule does not impose any costs beyond those inherent in Chapter 423 of the Laws of 2014. Consistent with the statute, school districts and BOCES may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. Furthermore, any costs associated with maintaining the written consents in the student’s cumulative health record are anticipated to be minimal and capable of being absorbed using existing district staff and resources.
5. ECONOMIC AND TECHNOLOGICAL FEASIBILITY:
The proposed rule does not impose any additional costs or technological requirements on local governments.
6. MINIMIZING ADVERSE IMPACT:
Consistent with the statute, school districts and BOCES may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. The proposed rule also merely provides definitions and otherwise clarifies the circumstances regarding the proper self-administration by students of prescribed inhaled rescue medications and epinephrine auto-injectors, and the proper self-administration and self-testing by students with diabetes, during the school day on school property or at a school function. Any costs associated with maintaining the written consents in the student’s cumulative health record are anticipated to be minimal and capable of being absorbed using existing district staff and resources.
7. LOCAL GOVERNMENT PARTICIPATION:
Comments on the proposed rule were solicited from school districts through the offices of the district superintendents of each supervisory district in the State, and from the chief school officers of the five big city school districts.
8. INITIAL REVIEW OF RULE (SAPA § 207):
Pursuant to State Administrative Procedure Act section 207(1)(b), the State Education Department proposes that the initial review of this rule shall occur in the fifth calendar year after the year in which the rule is adopted, instead of in the third calendar year. The justification for a five year review period is that the proposed rule is necessary to implement the statutory requirements of Chapter 423 of the Laws of 2014, and, therefore, the substantive provisions of the proposed rule cannot be repealed or modified unless there is a further statutory change. Accordingly, there is no need for a shorter review period. The Department invites public comment on the proposed five year review period for this rule. Comments should be sent to the agency contact listed in item 10 of the Notice of Proposed Rule Making published herewith, and must be received within 45 days of the State Register publication date of the Notice.
Rural Area Flexibility Analysis
1. TYPES AND ESTIMATED NUMBER OF RURAL AREAS:
The proposed rule applies to school districts, boards of cooperative educational services (BOCES), and nonpublic elementary and secondary schools, including those located in the 44 rural counties with fewer than 200,000 inhabitants and the 71 towns and urban counties with a population density of 150 square miles or less.
2. REPORTING, RECORDKEEPING, AND OTHER COMPLIANCE REQUIREMENTS; AND PROFESSIONAL SERVICES:
The proposed rule generally does not impose any compliance requirements upon local governments. Consistent with the statute, school districts, BOCES and nonpublic schools may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions.
The proposed rule also merely provides definitions and otherwise clarifies the circumstances regarding the proper self-administration by students of prescribed inhaled rescue medications and epinephrine auto-injectors, and the proper self-administration and self-testing by students with diabetes, during the school day on school property or at a school function. A record of the written consents obtained pursuant to the proposed rule shall be maintained in the student’s cumulative health record.
The proposed rule does not require any additional professional services upon entities in rural areas.
3. COSTS:
In general, the proposed rule does not impose any costs beyond those inherent in Chapter 423 of the Laws of 2014. Consistent with the statute, school districts, BOCES and nonpublic schools may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. Furthermore, any costs associated with maintaining the written consents in the student’s cumulative health record, or costs associated with the written permission/order and attestation of the authorized health care provider, and documentation of training by such health professional, are anticipated to be minimal and capable of being absorbed using existing district staff and resources.
4. MINIMIZING ADVERSE IMPACT:
Consistent with the statute, school districts, BOCES and nonpublic schools may, but are not required to, provide training to unlicensed school personnel to inject prescribed glucagon or epinephrine auto-injectors to specific students under specified conditions during the school day on school property or at school functions. The proposed rule also merely provides definitions and otherwise clarifies the circumstances regarding the proper self-administration by students of prescribed inhaled rescue medications and epinephrine auto-injectors, and the proper self-administration and self-testing by students with diabetes, during the school day on school property or at a school function. Any costs associated with maintaining the written consents in the student’s cumulative health record, or costs associated with the written permission/order and attestation of the authorized health care provider, and documentation of training by such health professional, are anticipated to be minimal and capable of being absorbed using existing district staff and resources.
Because the Regents policy and statute upon which the proposed amendment is based applies to all school districts and BOCES in the State, it is not possible to establish differing compliance or reporting requirements or timetables or to exempt schools in rural areas from coverage by the proposed amendment.
5. RURAL AREA PARTICIPATION:
The proposed amendment was submitted for review and comment to the Department’s Rural Education Advisory Committee, which includes representatives of school districts in rural areas.
6. INITIAL REVIEW OF RULE (SAPA § 207):
Pursuant to State Administrative Procedure Act section 207(1)(b), the State Education Department proposes that the initial review of this rule shall occur in the fifth calendar year after the year in which the rule is adopted, instead of in the third calendar year. The justification for a five year review period is that the proposed rule is necessary to implement the statutory requirements of Chapter 423 of the Laws of 2014, and, therefore, the substantive provisions of the proposed rule cannot be repealed or modified unless there is a further statutory change. Accordingly, there is no need for a shorter review period. The Department invites public comment on the proposed five year review period for this rule. Comments should be sent to the agency contact listed in item 10 of the Notice of Proposed Rule Making published herewith, and must be received within 45 days of the State Register publication date of the Notice.
Job Impact Statement
The purpose of the proposed rule is to establish standards for the self-administration by students of certain prescribed medications on school property and at school functions; and to establish standards for the training of unlicensed school personnel to administer prescribed epinephrine auto injectors and glucagon to specific students under specified conditions, consistent with Chapter 423 of the Laws of 2015. Because it is evident from the nature of the proposed rule that it will have no impact on the number of jobs or employment opportunities in New York State, no further steps were needed to ascertain that fact and none were taken. Accordingly, a job impact statement is not required and one has not been prepared.
