STATE BOARD OF EDUCATION

ADMINISTRATIVE CODE

COMMENT/RESPONSE FORM

This comment and response form contains comments from the February 4, 2015, State Board meeting when the draft regulations were considered at Proposal Level.

Topic: Programs to Support Student Development Meeting Date: September 2, 2015

Code Citation: N.J.A.C. 6A:16 Level: Adoption Level

Division: Learning Supports and Specialized Services Completed by: Office of Student Support Services

Summary of Public Comments and Agency Responses:

The following is a summary of comments received from the public and the Department’s responses. Each commenter is identified at the end of the comment by a number that corresponds to the following list:

1. Tim Conway, President

N. J. School Counselors Association

2. Bianca Aniski, MEd, RN, CNM, FN-CSA

Long Beach Island Consolidated School District

3. Gina Emge

N. J. State School Nurses Association

4. MaryAnn Bacon, President

N. J. State School Nurses Association

5. Claudine M. Leone, Director of Government Affairs

N. J. Academy of Family Physicians

6. Diana MTK Autin, Executive Co-Director

Lauren Agoratus, NJ Coordinator- Family Voices

Elizabeth Athos, Esq.

Statewide Parent Advocacy Network

7. Melinda Martinson, General Counsel

Medical Society of New Jersey

8. Michael A. Vrancik, Director Governmental Relations

N. J. School Boards Association

1.  COMMENT: The commenters disagreed with the Department’s proposed definition of “physician assistant” at N.J.A.C. 6A:16-1.3 and its use at N.J.A.C. 6A:16-2.2(h)1i and at proposed N.J.A.C. 6A:16-2.2(h)1ii(2). The commenters disagreed with the proposed use of the definition provided by a professional society rather than referencing the definitions already adopted in New Jersey statute and Administrative Code. N.J.S.A. 45:9-27.11 states a “physician assistant” means a person who holds a current, valid license issued pursuant to N.J.S.A. 45:9-27. At N.J.A.C. 13:35-2B.2, a “physician assistant” is defined as a person who holds a current, valid license to practice as a physician assistant in this State. (5, 7)

RESPONSE: The Department disagrees. The Department does not want to limit the student’s medical home to physician assistants licensed in New Jersey when the student’s medical home could be in another state. Physician assistants licensed in New Jersey are subject to the requirements at N.J.S.A. 45:9-27 and, therefore the definition at N.J.A.C. 13:35-2B.2 excludes out-of-state physician assistants who may be performing the preparticipation physical examinations for students attending school in New Jersey. The proposed definition is inclusive of any licensed physician assistant.

2.  COMMENT: The commenter agreed with the amendments proposed at N.J.A.C. 6A:16-2.1(a)2vi that allow employees to volunteer to be trained and designated by a nurse for epinephrine administration; however, the commenter expressed concern there could be instances when there are no or an insufficient number of volunteers, or a volunteer could be absent to administer epinephrine. The commenter also stated there must be a guaranteed back up plan and all school employees who interact with a child directly must have the minimum amount of training around medication administration. (6)

RESPONSE: The Department thanks the commenter for the support of the proposed amendment at N.J.A.C. 6A:16-2.1(a)2vi; and the Department agrees that district boards of education should have a plan to provide the needed delegates. N.J.S.A. 18A:40-12.6 requires the school nurse to designate, in consultation with the district board of education or chief school administrator of a nonpublic school, additional school district or nonpublic school employees who volunteer to administer epinephrine via a pre-filled auto-injector mechanism to a pupil for anaphylaxis when the school nurse is not physically present at the scene. It is the responsibility of the district board of education or the chief school administrator of a nonpublic school to assist the school nurse in recruiting and training designees who are determined acceptable candidates to administer epinephrine, as deemed necessary by the nursing services plan, pursuant to N.J.S.A. 18A:40-12.6c.a and b. It is the district board of education’s or nonpublic school’s decision to determine the number of additional employees necessary to administer epinephrine in an emergency situation to maintain compliance with the law. Current statute does not require school employees to have medication administration training; therefore, the Department declines to propose minimum training requirements for school employees who interact directly with students.

3.  COMMENT: The commenter expressed support for the proposed N.J.A.C. 6A:16-2.1(a)4vi, which would require the establishment and implementation of an emergency action plan for responding to a sudden cardiac event, including the use of an automated external defibrillator (AED), in compliance with Janet’s Law (N.J.S.A. 18A:40-41a through c). The commenter also expressed support for N.J.A.C. 6A:16-2.2(i), which specifies the requirements to have available and maintain an AED in each public and nonpublic school, pursuant to N.J.S.A. 18A:40-41a.a(1) and (3) which states, the AED must be made available in an unlocked location on school property with an appropriate identifying sign. The AED must be accessible during the school day and any other time when a school-sponsored athletic event or team practice is taking place in which pupils of the district or nonpublic school are participating. The AED must also be within reasonable proximity of the school athletic field or gymnasium, as applicable. (6)

RESPONSE: The Department thanks the commenter for the support. N.J.S.A. 18A:40-41b.b(1) requires the emergency action plan to include a list of no less than five school employees, team coaches, or licensed athletic trainers who hold current certifications from the American Red Cross, American Heart Association, or other training program recognized by the State Department of Health, in cardiopulmonary resuscitation and the use of a defibrillator. A district board of education is required to update the list, as necessary, but at least once each semester, which ensures employees on the list are trained and have current certifications.

4.  COMMENT: The commenter expressed support for the amendment at N.J.A.C. 6A:16-2.2(h)1i which specifies the number of days the preparticipation examination of students in grades six to 12 must be completed prior to the first practice session of a school-sponsored interscholastic or intramural athletic team or squad, to state the examination must be conducted within 365 days prior to the first official day of practice in an athletic season. The Department proposes to amend the rule to require the examination to be conducted by a licensed physician, advanced practice nurse (APN), or a physician assistant (PA). Both proposed amendments will bring the rule into compliance with the Scholastic Student-Athlete Safety Act (N.J.S.A. 18A:40-41.7.b). The commenter suggested adding the requirement of an additional examination prior to participation if there has been a change in the student’s health within the past year. (6)

RESPONSE: The Department thanks the commenter for the support of the proposed amendment; and the Department agrees a requirement for an additional examination is necessary and is currently regulated at N.J.A.C. 6A:16-2.2(h)1iii. The proposed amendment at N.J.A.C. 6A:16-2.2(h)1iii requires that a health history update questionnaire be completed and signed by the student-athlete’s parent or guardian if the student-athlete’s preparticipation athletic physical examination was completed 90 days prior to the first day of official practice in an athletic season pursuant to N.J.S.A. 18A:40-41.7b.

5.  COMMENT: The commenter suggested amending N.J.A.C. 6A:16-2.2(f), which states that each student medical examination must be conducted at the medical home of the student. If a student does not have a medical home, the school district must provide the examination at the school physician’s office or other comparably equipped facility, pursuant to N.J.S.A. 18A:40-4, to replace “the school district shall provide the examination at the school physician’s office or other comparably equipped facility” with “a school nurse or the district board of education may facilitate the procurement of a medical home.” The commenter stated it is important for students to have a medical home and regular source of care and suggested replacing the language. (5)

RESPONSE: The Department agrees it is important for students to have a relationship with a medical home that provides continuous medical care. However, the Department disagrees with removal of the provision permitting the school physician to perform an examination as it might not be in a student’s best interest. Additionally, N.J.S.A. 18A:40-4 does not require a district board of education to facilitate the procurement of a medical home. If a student does not have medical coverage or a medical home, the district board of education must make accessible information regarding the NJ FamilyCare Program to students who are knowingly without medical coverage, pursuant to N.J.S.A. 18A:40-34.

6.  COMMENT: The commenters suggested proposed N.J.A.C. 6A:16-2.2(h)1ii(1)(A), which would allow a parent to request the school physician complete the student’s Preparticipation Physical Examination (PPE) when the form is submitted without the signed certification statement, is unnecessary. The commenters expressed concern the proposed rule disrupts efforts in maintaining the student's medical home and the school system should foster the student’s relationship with his/her personal physician who is responsible for providing continuous and comprehensive care. In addition, the commenters stated the physical examination is a critical pillar in this effort, providing essential data for the physician to determine the student’s medical needs. The commenters stated the annual physical examination is the opportune time for student, family, and physician interaction and collaboration to address the student’s medical needs during the school day. (3, 4, 5)

RESPONSE: The Department agrees it is important for students to have a relationship with a medical home that provides continuous medical care; however, there are instances when this may not be feasible. The Department has made every effort to publicize the importance of the medical home. However, the Department does not want to exclude students from participation in school-sponsored activities that require a physical examination if the health care provider did not complete the PD module or other unforeseen circumstances arise that would lead to the PPE form being submitted without being signed by the medical home.

Proposed N.J.A.C. 6A:16-2.2(h)1ii(1)(A) allows the student-athlete’s parent to obtain a physical examination from a physician who can certify completion of the PD module or to request the school physician to complete the preparticipation physical examination, if the student-athlete’s PPE is submitted without the signed certification statement and the school district has confirmed the licensed physician, APN, or PA from the medical home did not complete the PD module. The Department does not want a parent to suffer a financial burden if a subsequent medical appointment is necessary to obtain the health care provider’s signature who previously viewed the PD module, but did not sign the certification statement. Additionally, the Department does not want a parent to suffer further financial burden due to a repeated examination once the physician completes the module, or when an examination is completed by a new physician who has completed the PD module. Therefore, the Department proposes that the parent have the option the school physician complete the medical examination which is provided at no cost.

7.  COMMENT: The commenter stated the proposed rule at N.J.A.C. 6A:16-2.2(h)1ii(1)(A) is unnecessary because P.L. 2015, c.37 requires all physicians, PAs, and APNs who perform annual physical examinations of children 19 years of age or younger to complete the Student-Athlete Cardiac Screening professional development module (PD module) developed pursuant to subsection a of section 3 of P.L.2013, c.71 (C.18A:40-41d). Therefore, the school physician should not have to perform the medical examination as all practitioners are required to complete the module. (5)

RESPONSE: The Department is aware of the requirements at P.L. 2015, c.37 that take effect on October 1, 2015. The Department is hopeful that all practitioners will comply with the law; however, the Department does not want to exclude students from participation in school-sponsored activities that require a physical examination due to unforeseen circumstances.

8.  COMMENT: The commenter expressed support for the amendment proposed at N.J.A.C. 6A:16-2.3(a)4iii which requires the school physician to provide physical examinations in the school physician’s office or other comparably equipped facility for students without a medical home. The commenter stated that deleting the provision allowing a parent to identify the school as the medical home for the purpose of the sports physical examination is not necessary since there no longer is a distinction between the sports physical examination and other medical exams when the school is the medical home. (6)

RESPONSE: The Department thanks the commenter.

9.  COMMENT: The commenter stated the amendment proposed at N.J.A.C. 6A:16-2.5(a)4 which requires school districts to make every attempt to provide nursing services for nonpublic school students at the beginning of the school year and continuing throughout the year to ensure nonpublic students have access to medical care every day school is in session is duplicative of a district board of education’s responsibilities under N.J.S.A. 18A:40-25 and, therefore, is unnecessary. The commenters stated the proposed regulation at N.J.A.C. 6A:16-2.5(a)4 is vague because “make every attempt” to provide nursing services at the start of the school year does not provide enough specificity. The commenter suggested amending the language to: “The district board of education must provide nursing services … .” The commenter suggested adding further specificity to the proposed amendment to clarify nursing services are required throughout the “school” year. (6, 8)

RESPONSE: Proposed N.J.A.C. 6A:16-2.5(a)4 ensures nonpublic students receive nursing services at the start of the school year. N.J.S.A. 18A:40-25 describes the services that school districts must provide to eligible nonpublic school students, but the requirement for the services to begin at the start of the school year is not explicit. The proposed rule will require district boards of education to “make every attempt” to provide nursing services at the start of the school year, while recognizing there may be circumstances beyond the district board of education’s control that could result in the services being provided after the start of the school year. The Department agrees with the need to add greater specificity to the proposed amendment as follows:

4. The district board should make every attempt to provide nursing services for students in nonpublic schools beginning at the start of the school year and continuingthroughout the school year.

Note: The rule text provided above reflects the progression of the rule proposal. The rule text included in the Administrative Code portion of this document reflects the rule as it is being put forth at Adoption Level.