Nursing Services Updates

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9-2024

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Deitrich Drayton Medicaid and Health Administrator

Agenda

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• Purpose of the Training
• Nursing Services
• Review Staff Credentials, Requirements, and Verification Processes
• Health Services - Review Beginning of the Year
• Health Documentation
• Nursing Supervision
• Medical Clinical Records and Maintenance
• Medical Documents
• PCG Health Platform
• Health Updates
• Resources

Purpose of this Nursing Training

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• Provide training to promote a greater understanding of the Nursing policies and procedures for the nursing program.

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• This training provides a brief overview of policy requirements specific to Nursing Services.

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• Schools are responsible for ensuring that nursing procedures are followed according to

SCDE, DHEC, SCLLR guidelines, and the Nurse Practice ACT.

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Note: This is not a comprehensive nursing training session.

Nurse’s Role in the School

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The nurses play an important role in the school. When a new student is enrolled, a nursing packet should be included in the student enrollment packet.

The nurse should discuss with the parents the child’s medical care and prepare consent forms, an emergency care checklist, immunization checklist, and receive medical documents. This information is vital in preparing for the health care of the child.

At the beginning of the year, the nurse is responsible for checking all medications, medical orders, consent forms, and documenting services. The parent must sign new applicable medical consent documents.

Note: Ms. Ladd has forwarded a new nursing guidebook for setting up a Nurse’s office. The link is at New School Nurse Guide-Book - New School Nurse Guide 24 -copy.pdf - Google Drive

Nursing Services for Children Under 21 Year

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Nursing services for children under 21 years are those specialized health care

services including:

• nursing assessment and nursing diagnosis
• direct care and treatment
• administration of medication and treatment as authorized and prescribed by a

physician or dentist and/or other licensed/authorized healthcare provider

• nurse management
• health counseling and emergency care.

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An RN as allowed under state licensure and regulation must perform acts of nursing

diagnosis or prescription of therapeutic or corrective measures. The need for

services must be appropriately documented in an IEP, IFSP, IHP, or ITP or clinical service notes, when appropriate.

The LPN is only permitted to document medical encounters and do not need a co- signature.

Staff Credentials

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• Providers must maintain documentation that verifies that all staff is properly qualified, screened, trained, and supervised, including subcontractors, volunteers, students and/or interns, and other individuals under the provider’s authority.
• Providers must maintain a staff file, and make it available upon request, appropriate records, and documentation of such qualifications, training, and investigations.

• The staff’s credentials must be verified before rendering services.

The

staff’s credentials must be submitted to the district’s Medicaid office

for review before services are rendered.

• The school must notify the district of any staff changes and submit the new staff’s credentials.

Staff Credential Verification Process

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The verification process must include the following:

• A copy of the nurse license from the South Carolina Labor and Licensing Regulatory Authority can be located at https://llr.sc.gov.
• If a nurse is from another state, the license must be a multi-state license. A copy must be submitted with this information.
• Best Practice: A copy from the Office of Inspector General (OIG) must be documented and submitted to the district office. The link is Search the Exclusions Database | Office of Inspector General (hhs.gov).
• Note: Make sure the LLR license and OIG documents are dated, and time stamped. You can do this by checking the print settings on your computer. When the system lists more settings, click more settings and click header and footer before you print. This will allow the document to print the header and footer.

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Example of a Staff’s SCLLR

license with the date and time stamp.

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Example of an OIG Staff Report with the date and time stamp.

Staff Signature Page

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School Name

Medicaid Signature Page

Name of the Service School Year

Providers must maintain a signature sheet that identifies all staff names, signatures, initials, and licensure information. This document must be submitted to the Medicaid office at the beginning of the school year and when new staff are added.

Health Services - Review at the Beginning of the Year

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School-based health centers (SBHCs) provide a variety of health services

beyond the first aid treatment provided by a school nurse. Annual Documents and Processes:

• Check the student’s immunization record.
• Check Medication, Emergency Permission and Contact forms
• Check Medical Orders
• Emergency Plan of Action for students with health issues
• Check the IHP, or ITP for students with medicals order for medical services
• Medical/Safety/Emergency procedure or protocol book available in the

nursing office. Check to update the nursing procedures for specialized

health care including, but not limited to, feeding, catheterization,

respiratory care, ostomies, medical support systems, collecting, and/or

performance of tests, other nursing procedures, and development of health care and emergency protocols.

Medical Clinical Records and Maintenance

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Requirements for Clinical Records and Maintenance

• Each clinical entry must be typed or legibly handwritten in dark ink,
• Clinical records must be arranged logically,
• All clinical entries must be filed in the student’s clinical records, and
• Each entry must stand on its own and not include arrows, ditto marks, etc.
• Schools are required to maintain a clinical record on every student that is rendered services.
• Clinical records must be current, meet documentation requirements and provide a clear descriptive narrative of the services provided.
• It is essential that an internal records review be conducted to ensure that the services are medically necessary and appropriate both in quality and quantity, and that services are documented.

Family Educational Rights and Privacy ACT (FERPA)/Healthcare Insurance Portability and Accountability Act (HIPAA) of Medical Records

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• All records must follow the HIPAA/FERPA security measures.
• All clinical records must be secured under lock and key and in a secured locked cabinet.
• Signature logs of people who have accessed health records.
• All providers must grant access to SCPCSD, or its designees for the purpose to review and/or investigate and allow for copying and reproducing documents.

Medical Documentation

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Medical documents must be completed annually and for new students.

• Medicaid Student Eligibility form – Medicaid Webportal (only for Medicaid students)
• Consent and Permission to Provide Medication or Medical Services
• Permission to Provide Medication (IDEA requirement).
• Medical Orders (For all students with a medical prescription or order).
• Treatment Plans: Individual Health Plan (IHP), or Individual Treatment Plan (ITP) – (For students with a medical prescription or medical orders) and include medical assessment of the student’s medical condition.
• Clinical Service Notes (CSN) (Documentation for all students receiving medical care) and include the medical assessment.
• Staff Credentials – (For all Nursing staff providing medical care).

Consent to Render, Release Information, and Bill for Nursing Services

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• Consent is the act of providing express permission, in writing, for some particular action to take place.
• To comply with legal requirements and the guidelines established by Health Insurance Portability and Accountability Act (HIPAA), Individuals with Disabilities Education Act (IDEA), and the Family Educational Rights and Privacy Act (FERPA), the person providing written consent must be fully informed of all information, in his or her native language, relevant to the activity for which consent is sought and understand the activity for which consent is sought.

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• The next pages will display copies of the consent forms. The school may add its logo on the front of the document with the school logo.

Medical Permission and Medical Emergency Contact

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A copy of the Medicaid General Consent to render All services. (Medicaid only students.)

What are Medical Orders?

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A medical order is a written order by an authorized licensed prescriber for the following services:

• given for medications,
• written for medical treatments, and
• written for medical procedures.

Note: Medicaid does not require medical orders for over-the-counter (OTC) medications. A parental medical permission form for all OTCs must be signed.

Who Can Prescriber Medical Orders?

• Medical Doctor (M.D.),
• Doctor of Osteopathy (D.O.),
• Dentist (D.M.D., D.D.S),
• Advanced Practice Registered Nurse (APRN), and
• Physician Assistant (PA).

What mut be included in the Medical Order?

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The documentation must include the following:

• Student name,
• Date,
• Addresses the frequency and duration of the order (i.e., 1 x PRN, or 1 TID)
• Reason for the Medical Orders, and
• Description of services to be rendered.
• Signed by the prescribing provider, and
• Parent must sign.

A copy of a Medical Order

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Over the Counter Medications

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The Over-the-Counter Medication Process:

• The parent must sign an over-the-counter non-prescription consent form.
• The Medication must be submitted in the original unopened container with the manufacturer's label intact .
• The parent must sign a consent to provide the medication.
• The nurse must follow the directions on the package.
• The student is not allowed to self carry this medication.
• The student cannot give the medication to the nurse and request the nurse to provide the medication.
• The nurse will document the medication as a general medical encounter.
• The school is not required to replace the medication

�Authorization for Non-Prescription �and Over the Counter Medication �form

Treatment Plan Components

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The treatment plan must include the following components:

• Individualization – must be individualized with the student’s name included in the treatment

plan

• Specific problems to be addressed – The assessment section is where the student’s medical

condition is described and explained in detail. Write a brief summary of the student’s health—

including, for example, the length of time the student has had the disease/condition/illness,

description of symptoms and frequency, the impact of the disease/condition/illness on the

student’s ability to function in a school setting, and the student’s needs for assistance and level

of independence. Specify the Medical care the child will receive according to the medical

order, list allergies and list the diagnoses of the medical condition

• Goals of treatment - Nurses’ goals on how to care for the medical condition.
• Types of interventions to be utilized – list types of interventions to be used in caring for the student’s medical condition.
• Planned frequency of service delivery and duration – frequency of the medication or

medical service – example: 2 x a day

• Criteria for achievement – list in the nursing goals or student goals what the student should

learn or accomplish in understanding or caring for the medical condition

• Beneficiary’s strengths and weaknesses – list in the student’s goals

• Signature of the RN, printed name of the RN, date, and title of the nurse. The LPN

cannot sign the IHP.

Medical Criteria to Develop a Treatment Plan

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Students with special health care needs are defined as students with health conditions

requiring treatments, medical procedures, medications, and/or monitoring that must be

performed by school personnel and meet one or more of the criteria below.

1. are complicated and/or lengthy,
2. require several contacts with the nurse or health assistant during the school day,
3. are needed to prevent death or disability on an emergent basis,
4. are needed for students who have medically fragile health conditions, and/or
5. are prescribed for treatment, medical procedures, medications, and/or monitoring Administered at school for more than fourteen consecutive days.

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Additionally, students who have been granted permission to self-medicate and/or self-

monitor in accordance with the school district’s policy are also considered to have special healthcare needs an IHP or ITP must be established in order for a student to be allowed to

self-medicate and/or self-monitor. The

RN must sign the treatment plan.

Copy of a PCG IHP

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A copy of an ITP or IHP.

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Copy of the IHP/ITP – Last Page

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*EAP will be developed, if applicable.

IHP/ITP Approvals (if applicable)

This IHP/ITP for

was prepared by the following nurse:

RN’s signature: Date:

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RN’s name (print/type): RN’s initials:

Additional school staff signature (if applicable): Review plan: ◻ beginning of next school year ◻ upon parent/health care practitioner/school request ◻other:

Student’s last name and first initial: RN’s initials: Date: (page of )

Emergency Action Plan must be filed for all students with a Health Alert (PRN meds and other emergency meds.

CSN Requirements

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Clinical Service Notes must include a narrative summary of the medical encounter. Clinical Service Note requirements:

pertinent clinical description

• Provide a of the activities that took place during

the medical encounter and a diagnosis code.

▪

Student’s level of participation/response to treatment

as it reflects the student’s

behavior/response during the medical encounter.

• Reflect the delivery of a specific billable service as identified in the physician’s order (Procedure code and description of the service rendered),
• Document the services rendered corresponding to the billing

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Date of service, Type of service rendered, and number of units billed,

Start and stop times

of the medical encounter, and

• Individualized and student-specific with the student’s response to treatment

▪

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Date, Provider’s printed name, signature, and professional title of the provider

delivering the service.

Health CSN – General Services

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Health

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– CSN

General

Medical

Note

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Health CSN

–

Daily Medication Note

Nursing Supervision

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• The RN supervisor must provide the initial assessment of the child’s condition as appropriate and establish a plan of care based on the child’s medical condition in accordance with state licensure and regulation. The RN must write the treatment plans.
• If the LPN receives additional information regarding the child’s health condition after the initial assessment, the LPN will consult with the RN.

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Supervision by the RN of the LPN must be performed at a minimum of every 60

days via direct observation or review of clinical service notes.

It is best practice to

have written or electronic documentation of the RN’s supervision of the LPN. Nurses billing Medicaid must show proof of supervision.

Nursing Supervision - Requirements

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• Nursing Supervision requirements
• An LPN must always be supervised by an RN.
• RN must be physically present or accessible by phone/pager, and
• RN must be readily available (i.e., physically accessible to the individual being supervised within a certain response time based upon the medical history and condition of the beneficiary and competency of personnel).
• Note: Recommend schools using an LPN, partner with another school with an RN or contract RN services. The LPN must follow supervisory guidelines set by SC LLR.

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LPN

Supervision

Log

Medicaid Eligibility Form

• The Medicaid eligibility status must be checked annually and as needed.
• The District office will provide information for the staff to have access to the Medicaid Webportal to review the student’s elgibility.
• The staff must check the student’s Medicaid eligibility status at the beginning of the year or before services are rendered.
• A copy must be kept in the student’s file.

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Example of the Medicaid Eligibility Form – with the date and time stamp.

Nursing Services Fee Schedule

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PowerSchool and PCG Compliance

PowerSchool student data uploads into the PCG platform nightly.

The school’s PowerSchool staff must place the student’s Medicaid ID number in PowerSchool, and this information will upload into the PCG Platform.

What is needed?

Medicaid Eligibility Date: This is the most current eligibility date. Districts should be

reviewing these each year and reinitializing (blanks-out and/or updates) this field (if the

student leaves the system and/or returns to the system). If the child never leaves the system,

the eligibility date will not change. Often, the Medicaid consent date and the Medicaid eligibility date will be the same.

What happens if the student’s information doesn’t rollover?

Check the student’s profile in PowerSchool. Select Data Exchange>Publishing. You will see

green checks by the student’s Ed-FI profile. If there are no green checks beside the student’s

data, this means there are missing scheduling and information. Select Courses &

Programs>Bell Schedule and add core content courses to the schedule or the information

needed to complete the student’s profile. The student’s information will not roll over until

the information is coded correctly in PowerSchool.

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PCG Health Platform

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• Every school has access to the PCG Health Platform.
• Receive training on the platform.
• The school is responsible for placing the student’s identifying information into PowerSchool and it must be coded correctly. If you are having issues with information not being uploaded, you will need to check with the school’s PowerSchool contact. They will need to contact the district office IT staff, and we can assist with technical issues only.
• PCG provides videos and the staff can request technical assistance on the Health platform. A help ticket can be sent using this link  2024-2025 EDPlan SC Assistance Request (google.com).

PCG-Related Services-Medicaid Services

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Charter School Compliance and Responsibility with PCG

• The School is responsible for maintaining all documentation.
• The School is responsible for the accuracy of the data it enters in EDPlan,
• The School District is responsible for controlling user access to the PCG System, which may include managing single sign on access or managing individual access through passwords and activating users and removing user access when an individual no longer has a need to access the PCG system or is violating the terms of the parties’ Medicaid billing services contract.
• The School is responsible for the accuracy of the consolidated record.

PCG – Non-Billing and Billing Services

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PCG will provide Medicaid billing services, and pre-billing checks, for services

allowable within the South Carolina Medicaid school-based billing program and, if applicable, as outlined in the Medicaid billing services contract.

PCG covers many standard Medicaid documentation requirements for school-based

Medicaid direct services billing programs. Services will be subject to the following

pre-billing checks. These checks do not relieve School District of its responsibility

to provide accurate data and to maintain the necessary documentation. If any of the following are not present, the document will not be billed.

• Medicaid ID: Every student for whom a service is claimed must have.
• Each service submitted to Medicaid must be age appropriate (3-21). (Check age according to

the birthday listed.)

• Each service submitted to Medicaid must include a diagnosis code.
• PCG will check that service delivery dates are within the date span of the Treatment Plan, based on School District data.
• PCG will check the date of the physician or licensed practitioner medical order, referral, or authorization prior to billing, based on School District data.
• PCG will check for Supervisor Sign-Off prior to billing, based on School District data.
• PCG will check that date of service was a date on which provider met Medicaid and State license/certification requirements, based on School District data.
• PCG will check for parental consent to access public benefits, based on School District data.

PCG Resources – PCG Resources

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• EDPlan
• EDPlan

Provider Electronic Signature Certification Form Health Quick Reference Guide

• EDPlan Quick Reference Guide – Set Up Caseloads
• EDPlan Health User Manual
• EDPlan Quick Reference Guide – Basic Quick Reference Guide

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• Note: PCG Resource Data Tile listed on the Health Platform. You can find resources that will provide reference guides on how to navigate the Health Platform.

PCG – Medicaid Forms and Nursing Videos

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• General Medicaid Consent Form - Consent to Bill Private Insurance and Medicaid
• Annual Notification of Benefits - Notification of Use of Public Benefits (Medicaid) or Private Insurance to Pay for Services Under the IDEA

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PCG Nursing Videos

• 2023-2024 EDPlan Health Training Webinar on Vimeo

SNPAC and Charter/PIPSN - Newsletter

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Victoria Ladd, MSN, RN - State School Nurse Consultant

• School Nurses & Childcare Centers- School Health – Helpful Links - S.C. Dept. of Public Health - School Health - Helpful Links | South Carolina Department of Public Health
• Office: (803) 898-2347 Cell: (803) 429-9078 (preferred)
• Email: laddvj@dph.sc.gov
• SCAN link: Home - South Carolina Association of School Nurses (scasn.org)
• SCDPH- Immunizations link: Vaccinations | South Carolina Department of Public Health (sc.gov)
• Sends out health alerts monthly.
• AAP Purple Book
• Measles preparedness for school nurse awareness - https://downloads.aap.org/AAP/PDF/ThinkMeasles-final.pdf
• Medical Encounter Monthly Data
• Brittney White, MPH, CHES® - Education Associate, School Nursing Program
• Phone 803-391-5460 - Web www.ed.sc.gov
• 428 Wholesale Lane
• West Columbia, SC 29172

Health - Updates

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SMART Asthma Treatment (Single Maintenance And Reliever Therapy;

• Here is a free training. There is also a new variation of asthma action plan for a student on SMART treatment. Link: https://allergyasthmanetwork.org/?s=smart

2023-2024 Bill 3309: Seizure Safe Schools Act references mandatory seizure training programs

in schools.

This act takes effect July 1, 2025.

• The act will amend the South Carolina code of laws by enacting the "Seizure Safe Schools Act" by

adding section 59-10-215 so as to provide each school district and charter school shall adopt a

seizure training program and to provide the purposes and requirements of the programs; and by

amending section 59-63-80, relating to individual health care plans for students with special health

care needs, so as to make conforming changes.

• The program requires each school district and charter school to adopt a seizure training program

and provide instructions in understanding the basics about epilepsy and administration of seizure

medications. Each school must provide training to the staff, and the school must adopt an

emergency policy that addresses seizure health care, medication or health device. The health device

must be appropriately identified at school and prescribed by a health care provider, the student

must receive an individual health care plan (IHP) and/or a Seizure actin plan to address the specific

health needs. A emergency action plan must be developed, schools must adopt a policy for students

with special health care needs to have an IHP, and policies to address the needs of students that self-administer their medication.

Health Reminders

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COVID-19

• CDC is providing actionable steps that people can take to reduce the number of small

respiratory virus particles that circulate in indoor air. On March 1, 2024, CDC

released updated guidance for respiratory viruses, which recommended taking steps for

cleaner air, along with staying up to date on vaccines for respiratory illnesses such as

COVID-19 and flu, as core prevention strategies to lower risk. Some of these

recommended actions to improve ventilation may require systems-level changes, but

individuals can still take steps to reduce exposure to virus particles in buildings, especially in their homes.

• Read more at: Ventilation Can Reduce Exposure to Respiratory Viruses in Indoor Spaces
• https://covid.cdc.gov/covid-data-tracker/#datatracker-home
• https://www.cdc.gov/vaccines/imz- managers/coverage/covidvaxview/interactive/vaccination-dashboard.html

COLLECTING SCHOOL NURSE ENCOUNTER DATA

• Contact: Victoria Ladd, RN, MSN at VLADD@ed.sc.gov at 803.429.9078, and Brittney

White, MPH, CHES at bawhite@ed.sc.gov at 803.391.5460

Resources

• SCPCSD Webpage for School Nurses – School Resources - Nursing (google.com)
• SCPCSD Webpage for Medicaid School Nurses - School Resources - Medicaid Nursing (google.com)
• Local Education Agencies Provider Manual - Report (Vertical) (scdhhs.gov).
• SCDE Role of the School Nurse Webpage – Role of a School Nurse - South Carolina Department of Education - 09/16/2024 4:35 PM

Victoria Ladd, MSN, RN – Office of Health and Nutrition - School Nurse Consultant - Phone: (803)734-0753 - Fax: 803-737-4188 - Email: VLADD@ed.sc.gov

• S.C. Department of Public Health – State School Nurse Consultant : (803) 898-2347 or : (803) 429-9078 (preferred) - Email: laddvj@dph.sc.gov

Laws, Recommendations and Guidelines | South Carolina Department of Public Health (sc.gov)

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Contact Information

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Deitrich (Dee) Drayton Medicaid and Health Administrator

ddrayton@sccharter.org

(803) 212-5482