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���Nursing Services Updates��3-28-2024��

Deitrich Drayton

Medicaid and Nursing Administrator

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Agenda

  • Purpose of the Training
  • Review Staff Credentials, Requirements, and Verification Processes
  • Nursing Services
  • Nursing Services to Review at the End of the Year
  • Nursing Documentation
  • Nursing Supervision
  • Clinical Records and Maintenance
  • Medicaid Documents
  • SNPAC and Charter/PIPSN
  • COVID Updates
  • Resources

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Purpose of this Nursing Training

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

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

  • Schools are responsible for ensuring that nursing procedures are followed according to SCDE, DHEC, SCLLR guidelines, and the Nurse Practice ACT.

Note: This is not a comprehensive nursing training session.

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Staff Credential Verification Process

  • Schools are required to check the credentials of all licensed staff through SCLLR to verify their license, which may exclude them from providing services. A copy of the nurse’s license must be submitted to the district office. An updated copy must be kept on file.
  • The school must notify the district of any staff changes.
  • A copy of the South Carolina nurse license can be found at the South Carolina Labor and Licensing Regulatory Authority at https://llr.sc.gov.
  • 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 date and time stamp is documented on the top of the forms.

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Example of a Staff’s SCLLR license

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Example of an OIG �Staff Report

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Nursing Services for Children Under 21 Year

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.

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.

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Nurse’s Role in the School

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 from the previous school. This information is vital in preparing for the health care of the child.

At the end of the year, the nurse is responsible for checking all medications and documenting services. If school is not held during the summer, all medication should be sent home with the child in the original container. The parent should sign to document that they have received the medication.

Note: Ms. Ladd developed a nursing guidebook for setting up a Nurse’s office. The link is at New School Nurse Guide-Book - SCDE Nurse's Guidebook 2023-24

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Nursing Services to Review at the End of the Year

School-based health centers (SBHCs) provide a variety of health services beyond the first aid treatment provided by a school nurse;

    • Check and finalize the student’s immunization record.
    • Check the student’s Medication file to make sure the medical encounters have been documented.
    • Check the IHP, or ITP for students with a prescribed medication.
    • Make sure there is a 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.
    • Update the nurse’s LLR license and OIG reports.

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Medicaid End-of-the-Year Check List

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

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

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Medical Documentation

Medical documents must be completed annually for new students entering school.

  • Medical Student Eligibility form – Medicaid Webportal
  • 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).

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Consent to Render and Bill for Nursing Services

  • 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.

  • 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.

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Medical Permission and Medical Contact Documents

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A copy of the Medicaid General Consent to render All services.

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What are Medical Orders

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 of 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).

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What must be included in the Medical Order?

The documentation must include:

    • 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.

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A copy of Medical Orders

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Treatment Plan Components

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. Specify the Medical care the child will receive according to the medical order 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 only, date signed, and title of the nurse. It must be completed.

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Medical Criteria to Develop a Treatment Plan

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.

(a) are complicated and/or lengthy,

(b) require several contacts with the nurse or health assistant during the school day,

(c) are needed to prevent death or disability on an emergent basis,

(d) are needed for students who have medically fragile health conditions, and/or

(e) are prescribed for treatment, medical procedures, medications, and/or monitoring

Administered at school for more than fourteen consecutive days.

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. Only an RN can write the treatment plan.

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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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CSN Requirements

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

Clinical Service Note requirements:

    • Provide a pertinent clinical description 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
      • Date of service, Type of service rendered, and number of units billed,
    • Individualized and student-specific with the student’s response to treatment
    • Start and stop times of the medical encounter, and
    • Date signature and professional title of the provider delivering the service.

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A Copy of a CSN from SNAP – with Medical Order

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A copy of a CSN from �SNAP – General Medical Encounter

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A copy of the Nursing CGM CSN.

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Nursing Supervision - Updates

  • Nursing Supervision requirements
    • An LPN must be always 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).

  • On October 21, SCDE and DHHS sent an email to update the nursing supervision. Medicaid will not require the RN to co-sign the LPN’s clinical service notes.

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Supervision (Cont.)

  • 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.
  • 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.

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Medicaid Signature Page

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

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LPN Supervision Log

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Medicaid Clinical Records and Maintenance

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.

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

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Nursing Services Fee Schedule

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SNPAC and Charter/PIPSN - Newsletter

Victoria Ladd, MSN, RN - State School Nurse Consultant

    • Division of Children's Health and Perinatal Services - S.C. Dept. of Health & Environmental Control - State School Nurse Consultant | SCDHEC
    • Office: (803) 898-2347 Cell: (803) 429-9078 (preferred)
    • Email: laddvj@dhec.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
    • Address 1429 Senate St, Columbia, SC 29201

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COVID - Updates

Information from the CDC. March 22, 2024, 4:30 PM EDT

What CDC knows

Improving ventilation, whether natural or mechanical (air flow, filtration, and air treatment), reduces the number of small respiratory virus particles in indoor air, helping lower the risk of transmission. Ventilation is one of many tools available to help protect people from respiratory viruses.

What the CDC is doing:

  • 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

COVID-19

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Resources

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Contact InformationDeitrich (Dee) Drayton�ddrayton@sccharter.org�(803) 212-5482

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