MA School Health Law & Regulation

MGL c112 s80B – Nurse Practice Act

• RNs
• LPN
• Advanced Practice Nurses

Advisory Rulings
AR 9324: Accepting, Verifying, Transcribing and Implementing Medication Orders:

• To guide the practice of Registered Nurses and Licensed Practical Nurses when accepting, verifying, transcribing, and implementing patient care orders from a duly authorized prescriber

• The Board of Registration in Nursing issues this Advisory Ruling in response to questions regarding licensed nurses’ responsibilities when delegating selected nursing activities to unlicensed assistive personnel.

• To guide the practice of the Registered Nurse (RN) who is employed in the role of School Nurse in MA public and private schools in developing over-the-counter (OTC) medication administration protocols and to define the scope of practice for OTC medication administration by RNs and LPNs.

• To clarify that an individual may not accept a paid or voluntary nursing position in Massachusetts (MA) that requires the performance of nursing activities prior to obtaining a current MA license

• Nurses licensed by the Board will engage in the practice of nursing in accordance with the regulations found in 244 CMR 3.001 and accepted professional standards.
• Licensed nurses must acquire and maintain necessary knowledge, skills, and abilities before assuming responsibility and accountability for performing nursing activities.
• RNs and LPNs are individually responsible and accountable for their nursing actions, judgments and competencies and practicing within their scope. There is no regulatory requirement for RNs to supervise LPNs.

AR 2401: The Role of Nursing in Harm Reduction

• DPH recommends that prescribers issue standing orders for opioid antagonist dispensing within their healthcare facility or practice setting (such as a clinic, acute care hospital, or emergency department) for individuals with opioid use disorder and those presenting after an overdose.

The following information is for medication administration in all schools (public and non-public)

105 CMR 200 - Physical Examination of School Children

The purpose of 105 CMR 200.000 is to identify and take appropriate actions with respect to disabilities and medical conditions of school children in public schools as soon as possible so as to enable all children to obtain the fullest benefit of their educational opportunities and to identify and take appropriate action with respect to contagious or communicable diseases among students. School screenings under 105 CMR 200.000 are intended to supplement, not supplant, oversight of care by the student's primary care provider.

105 CMR 220 - Immunization of Students Before Admission to School

105 CMR 220.000 applies to all students attending public or private elementary schools, secondary schools, postsecondary institutions of higher education, and certain pre-schools in the Commonwealth, including students from other states and countries.

For the most up-to-date immunization requirements by year and age/grade of school, please visit the MA DPH School Immunization website here: School Immunization Requirements and Data

Having a hard time getting immunization list from PCPs? Here's a helpful resource.

105 CMR 460 - Lead Poisoning Prevention and Control

105 CMR 460.050 (E)"If children between one and six years of age have never been screened for lead poisoning, they must be screened at entry to daycare including group or family day care, or kindergarten or pre-kindergarten, and present evidence of such screening. If they have previously been screened for lead poisoning, they need not be screened again to fulfill daycare, pre-kindergarten, or kindergarten entry requirements, but must present evidence of previous screening."

105 CMR 215: Standards for School Wellness Advisory Committees

The purpose of 105 CMR 215.000 is to set standards for the establishment and operation of School Wellness Advisory Committees. These committees are intended to ensure that each public school district has an established group of school staff and concerned community representatives to recommend, review and help implement school district policies addressing school nutrition, nutrition education, physical activity and related issues that affect student health.

603 CMR 23 - Student Records

• 603 CMR 23.00 is promulgated by the Board of Education pursuant to its powers under M.G.L. c.71, § 34D which directs that "the board of education shall adopt regulations relative to the maintenance of student records by the public elementary and secondary schools of the commonwealth," and under M.G.L. c. 71, § 34F which directs that "the board of education shall adopt regulations relative to the retention, duplication and storage of records under the control of school committees, and except as otherwise required by law may authorize the periodic destruction of any such records at reasonable times."

Family Education Rights and Privacy Act (FERPA)

• (a) Except as otherwise noted in §99.10, this part applies to an educational agency or institution to which funds have been made available under any program administered by the Secretary, if...
• Non-Public Schools: Unsure if your school receives these funds?...check with your school administration and business office. FERPA might apply to you!

Health Insurance Portability and Accountability Act (HIPAA)

• The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes federal standards protecting sensitive health information from disclosure without patient's consent. The US Department of Health and Human Services issued the HIPAA Privacy Rule to implement HIPAA requirements. The HIPAA Security Rule protects specific information cover the Privacy Rule.

MGL. c71, s53 - Appointment of one or more school physicians and registered nurses

• The school committee shall appoint one or more school physicians and registered nurses, shall assign them to the public schools within its jurisdiction, shall provide them with all proper facilities for the performance of their duties and shall assign one or more physicians to the examination of children who apply for health certificates required by section eighty-seven of chapter one hundred and forty-nine, but in cities where the medical inspection hereinafter prescribed is substantially provided by the board of health, said board shall appoint and assign the school physicians and registered nurses.

MGL c71 s54C – AEDs in Schools

Each school district, vocational district, charter school, approved private day or residential school and collaborative school shall provide and maintain at least 1 automated external defibrillator, AED, on site at each school facility where instruction is provided. Each school shall have on staff a person who is an AED provider having current certification in a training course in cardiopulmonary resuscitation and in the use of an AED in accordance with the standards established by the American Heart Association or the American National Red Cross. The school administration shall ensure that an AED and AED provider is readily available at any school-sponsored athletic event.

603 CMR 50 - Educational Collaboratives (Requirements for School Nurses)

• The collaborative board of directors shall appoint one or more registered nurse(s) as a school nurse and shall provide such nurse with all proper facilities for the performance of the school nurse's duties. Collaboratives with programs housed in an operating public school may enter into an agreement with the host school district whereby the school nurse of the host school or district provides school nursing services to the students served by the collaborative. No person shall be employed by a collaborative as a school nurse unless such nurse is either licensed as a school nurse under 603 CMR 7.00: Educator Licensure and Preparation Program Approval, or was employed as a school nurse by the collaborative on or before February 1, 2012.

MGL c71 s96 - School Policies Regarding Substance Use Prevention

• Each public school shall have a policy regarding substance use prevention and the education of its students about the dangers of substance abuse.

MGL c71 s97 - SBIRT

• Subject to appropriation, each city, town, regional school district, charter school or vocational school district shall utilize a verbal screening tool to screen pupils for substance use disorders. Screenings shall occur on an annual basis and occur at 2 different grade levels as recommended by the department of elementary and secondary education, in consultation with the department of public health.

603 CMR 46 - Prevention of Physical Restraint and Requirements If Used

• Purpose. The purpose of 603 CMR 46.00 is to ensure that every student participating in a Massachusetts public education program is free from the use of physical restraint that is inconsistent with 603 CMR 46.00. Physical restraint shall be used only in emergency situations of last resort, after other lawful and less intrusive alternatives have failed or been deemed inappropriate, and with extreme caution.

Individuals with Disabilities Act (IDEA)

• The Individuals with Disabilities Education Act (IDEA) is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.

Americans with Disabilities Act (ADA)

• The Americans with Disabilities Act (ADA) protects people with disabilities from discrimination.

The term “homeless children and youth”—

A. means individuals who lack a fixed, regular, and adequate nighttime residence…; and

B. includes —

i. children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or are abandoned in hospitals;

ii. children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings…;

iii. children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and

iv. migratory children…who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in clauses (i) through (iii).

105 CMR 225.000 establishes nutrition standards for competitive foods and beverages sold or provided in public schools, in order to ensure that students are offered nutritious food and beverage choices that will enhance learning, contribute to healthy growth and development, and cultivate lifelong healthy eating behaviors.

DESE School Nurse licensure is required for all public school nurses. Non-public school nurses may be required to obtain DESE licensure depending on their contractual requirements.