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IEP Paperwork

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					                           Special Health Services and the IEP

IEP Paperwork

1. Why do special health services need to be listed on the IEP and coded as a service in
IMS?
If the special health service is required for the student to attend and/or benefit from their
educational program, it should be listed in the IEP regardless of whether or not Medicaid
is billed. The requirement to document health services on IEPs as a “related service” is
written in IDEA 2004. The federal definition of related service is “…such developmental,
corrective, and other supportive services…as may be required to assist a child with a
disability to benefit from special education…” The latest language to be added to this
federal definition is “ the term related service means… school nurse services designed to
enable a child with a disability to receive a free appropriate public education as described
in the individualized education program of the child…”

2. How should nursing services be coded on the IEP?
Services provided by a registered school nurse should be coded NR.

3. How should paraprofessional health services be coded on the IEP?
Most paraprofessionals assist with both health and educational tasks. However the
professional providing the instruction and supervision differs. It is best practice to
separate the functions, and code these duties differently. Tasks such as assistance with
eating, personal hygiene, mobility, safety, bowel and bladder requirements, and
medication administration must be included in a treatment plan developed by a licensed
health care professional. These services are coded HL and must be written in exact
minutes. Use a one box to record health services and a separate box to list educational TA
services. The total number of minutes must not exceed the student’s day unless two
individuals are needed for a task. All students with the HL code for health must also have
the NR code to describe the interrelationships between the professional and para. A new
code added this year is the PP code. This is used to describe Medicaid health or behavior
services. It is an ideal code to use for students with an associate who provides services
under both the individual health plan and the behavior intervention plan.

4. When deciding how to label special health services, what are the differences between
related service, supplementary aids and services, and support for school personnel?
Related service: Provided by the registered nurse and may include assessment and
evaluation; diagnosis and planning; administering treatments and procedures,
consultation with parents, health system personnel, and staff; instruction; emergency
intervention; and screening.

Supplementary aids and services: Tasks performed by a paraprofessional under the
direction of the registered nurse that enable the student to be educated with nondisabled
peers to the maximum extent appropriate.

Supports for school personnel: Training for staff to allow them to understand the child’s
condition or to perform delegated tasks under the supervision of the registered nurse.



Strawhacker AEA 11 2009”                                                                    1
                           Special Health Services and the IEP

5. Can the team add health information to the IEP without doing a full and individual
evaluation for health?
No: Not for an initial evaluation but health information may be included in Section B that
is important for the team to consider but does not require service at school.

Yes: Under new guidance from the Federal Government, a service may be added to the
IEP of a student already identified as special education. Adequate information is needed
to determine the scope of these special health services but parental consent for evaluation
is no longer needed. A word of caution: if the student has an IHP, they are most likely
receiving services so check both boxes under health considerations and describe the
services received on page F.

Full and Individual Evaluation for Health

6. When should the school nurse request an evaluation for health to determine if the
addition of special health services?
Prior to the student’s initial eligibility determination, is the time to request an evaluation.

In the event the student’s health status dramatically changes between these routine
meetings, this may be a reason to request a parental signature on an evaluation plan. This
would be needed to determine the educational implications of this change in status. This
would be used only in rare circumstances. An example might be that the student sustains
a traumatic brain injury or is diagnosed with leukemia and has endured extensive
chemotherapy and radiation.

7. Whose role is it to complete the paperwork for a full and individual health evaluation
and obtain the parent’s signature?
LEA or AEA staff will complete this form with input from the school nurse.

8. How does a traditional nursing health history differ from a health evaluation for
special education?
A health history is a narrative detailing the child’s past and present developmental and
medical history. This includes birth, accidents, injuries, surgeries, illnesses, and current
medical treatments/ procedures. The purpose is to record this information and to
determine the need for nursing intervention. Parental consent is implied if they answer
questions or provide written information.

 A Full and Individual Initial Evaluation serves the function of providing the parents
written prior notice, secures their written consent for a health evaluation, and documents
that they were offered a copy of the Procedural Safeguards Manual. Each of theses
functions is related to the special education process. After the Full and Individual
Evaluation form and process is complete, the school nurse should receive notification of a
pending evaluation. By law, the evaluation must be completed and the team reconvened
within 60 days to act on the information contained within the report. The report itself
must be written in complete sentences and address the student’s past developmental and



Strawhacker AEA 11 2009”                                                                       2
                           Special Health Services and the IEP

medical history, current health status, and needs at school. The history should be focused
on educationally relevant information only such as pregnancy or birth insult, delayed
developmental milestones, potential brain injury, and periods of absences due to illness or
injury. The nurse should provide the team with enough information about current
services the student requires to allow them to determine eligibility for related services.



9. Why should the nurse request to add health services to an IEP if the student has always
received the service anyway?

Not all health services provided by the school nurse to or on behalf of students qualify as
related service. General first aid, short-term administration of antibiotics, reassurance,
and routine health education are all examples of services that may not be considered
“related services”. The IEP should reflect those related services the student needs to
access and/or to benefit from their educational program.

10. Since health services may be variable, how should school nurses determine the
number of minutes to allocate on the IEP for their services?
Part of the health evaluation should focus on determining the amount of service required.
Review of health records to determine past service provided is the best way to determine
the amount of time to allocate. A time study may also be helpful to collect this
information if review of records is inadequate. The time allocated should be specific to
student need not a routine number listed for all students.

11. If the nurse writes a health evaluation report isn’t she obligated to attend the
student’s IEP meeting?
The nurse is required to attend the IEP meeting if health services are being discussed or
modified. The only way the nurse can be excused is if the AEA, school, and parent agree
and the nurse submits input in writing. An agreement to Excuse Attendance at IEP
meeting form must be completed prior to the meeting.

12. Once the student is entitled to special health services, how often should these services
be reviewed?
Services should be reviewed annually or more often if there are significant changes in
health status.

Individual Health Plans and Special Health Services on the IEP

13. Does the school nurse need to bring a draft of the student’s individual health plan
(IHP) to his/her IEP meeting? Does the team need to review the draft line by line at the
meeting?
Once the student is entitled to special health services (related service), the IHP details
how services will be provided at school. It should not contain accommodations or
service provided by other team members. These should be written directly into the IEP
once the team determines necessity. It is acceptable to include interventions for



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                           Special Health Services and the IEP

collaboration or consultation with other team members in the IHP. The team should be
aware of the IHP’s general content to help understand what services are provided and
how those services fit into the educational program. It is helpful for the school nurse to
bring a draft copy of the IHP to the meeting to help answer questions and provide an
overview. It is not necessary to review the IHP line by line unless there are areas of
disagreement between team members as to how or when services should be provided.

14. Can the school nurse modify the IHP or does the IEP team need to reconvene?
The school nurse modifies the document as needed.


15. Does the team need to attach a copy of the IHP to the IEP?
No. They must note on the IEP page F where it is located.

16. If the IHP is located in the nurse’s office do IEP team members need to record on a
“record of access” if they review the document?
Team members would qualify as “authorized employees” under the 2007 Iowa Rules of
Special Education and would be exempt from signing a record of access. Review your
district policies to determine any additional guidance.


Relationship between Section 504 and Special Education for Students with Health
Impairments

17.Do special education students need to have both a Section 504 plan and an IEP?
No. According to the Office of Civil Rights, an IEP is required if a student is eligible for
special education. Complying with IDEA requirements is one way to meet Section 504
requirements.

18. What criteria does the team use to determine whether or not to include
accommodations in the IEP for a health condition that does not directly impact learning?
The IEP team uses the same criteria as a Section 504 team. The student must have a
physical or mental impairment that substantially limits a major life activity. If the health
condition substantially limits any major life activity then the student may be eligible for
health related accommodations in addition to their specialized instruction. One way the
team determines substantial limitation is to make a comparison to typical age peers in the
condition, manner, or duration under which the student can perform a major life activity.
The purpose is to provide equal access through accommodations within the school
setting.

19. Why can’t health accommodations be listed only on the IHP and not the IEP?
An IHP is written by the registered school nurse and directs special health services. It
does not meet Section 504 evaluation criteria. Section 504 mandates that a “group of
individuals” make decisions, that information must be drawn from a variety of sources,
and that procedures exist to document and consider all sources of information.




Strawhacker AEA 11 2009”                                                                       4

				
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