Ed_banner_left Ed_banner_right
U.S. Department of Education: Promoting Educational Excellence for all Americans

School health services and school nurse services (proposed School nurse services) (Sec. 300.34(c)(13))

Comment: Some commenters noted that while "school health services" is included in the list of related services in Sec. 300.34(a), it is not defined, which will result in confusion about the relationship between "school health services" and "school nurse services."

Some commenters stated that adding the definition of school nurse services and eliminating the definition of school health services must not narrow the range of related services available to children. One commenter recommended that the definition of school nurse services allow school nurse services to be provided by other qualified persons, as well as a qualified school nurse, because the majority of schools do not have a school nurse on staff. One commenter requested that the regulations clarify that schools can continue to use registered nurses or other personnel to provide school nurse services, consistent with State law. Another commenter stated that there is well-established case law upholding the obligation of an SEA and LEA to provide health-related services necessary for a child to benefit from special education.

Discussion: School health services was retained in the definition of related services in Sec. 300.34(a). However, the definition of school health services was inadvertently removed in the NPRM. To correct this error, we will add school health services to the definition of school nurse services and clarify that school health services and school nurse services means health services that are designed to enable a child with a disability to receive FAPE. We will also add language to clarify that school nurse services are provided by a qualified school nurse and that school health services are provided by either a qualified school nurse or other qualified person. We recognize that most schools do not have a qualified school nurse on a full-time basis (i.e., a nurse that meets the State standards for a qualified school nurse), and that many schools rely on other qualified school personnel to provide school health services under the direction of a school nurse. Therefore, we believe it is important to retain the definition of school health services and school nurse services in these regulations.

With the changes made in Sec. 300.34(c), it is not necessary for the reference to "school nurse services" in Sec. 300.34(a) to include the phrase, "designed to enable a child with a disability to receive a free appropriate public education as described in the IEP of the child." We will, therefore, remove this phrase in Sec. 300.34(a). Changes: Section 300.34(c)(13) has been revised to include a definition of school health services and school nurse services. Additional language has been added to clarify who provides school health services and school nurse services. We have also modified Sec. 300.34(a) by deleting the redundant phrase, "designed to enable a child with a disability to receive a free appropriate public education as described in the IEP of the child."

Comment: One commenter stated that adding school nurse services to the definition of related services makes it more burdensome for the delivery of services to children who are medically-fragile.

Discussion: It is unclear how adding school nurse services to the definition of related services affects services to children who are medically fragile. As defined in Sec. 300.34(c)(13), school health services and school nurse services are designed to enable a child with a disability to receive FAPE as described in the child's IEP. A child who is medically fragile and needs school health services or school nurse services in order to receive FAPE must be provided such services, as indicated in the child's IEP.

Changes: None.

Comment: One commenter stated that the definition of school nurse services should include services that enable a child with a disability to receive FAPE in the LRE. Another commenter stated that school nurses can be extremely supportive of children with disabilities receiving FAPE in the LRE and recommended changing the regulations to ensure that parents understand that the definition of related services includes school nurse services.

Discussion: The LRE requirements in Sec. Sec. 300.114 through 300.120 provide, that to the maximum extent appropriate, children with disabilities are to be educated with children who are not disabled. It is not necessary to repeat this requirement in the definition of school health services and school nurse services.

We agree that school health services and school nurse services are important related services. Section 300.34(a) and section 602(26)(A) of the Act are clear that the definition of related services includes school health services and school nurse services. The IEP Team, of which the parent is an integral member, is responsible for determining the services that are necessary for the child to receive FAPE. We, therefore, do not believe that it is necessary to add a regulation requiring public agencies to ensure that parents understand that related services include school health services and school nurse services.

Changes: None.

Comment: One commenter stated that including the phrase, "designed to enable a child with a disability to receive a free appropriate public education" in Sec. 300.34(c)(13) in relation to school nurse services, is unnecessary and confusing.

Discussion: As stated in Sec. 300.34(a), the purpose of related services is to assist a child with a disability to benefit from special education. We believe it is necessary to specify that school health services and school nurse services are related services only to the extent that the services allow a child to benefit from special education and enable a child with a disability to receive FAPE.

Changes: None.