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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJune 2017

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16 DE Admin. Code 4102
On January 1, 2017 (Volume 20, Issue 7), DHSS published in the Delaware Register of Regulations its notice of proposed regulations, pursuant to 29 Del.C. §10115. It requested that written materials and suggestions from the public concerning the proposed regulations be delivered to DHSS by February 10, 2017, after which time the DHSS would review information, factual evidence and public comment to the said proposed regulations.
In accordance with Delaware Law, public notices regarding proposed Department of Health and Social Services (DHSS) Regulations Governing School-Based Health Centers were published in the Delaware State News, the News Journal and the Delaware Register of Regulations. Written comments were received on the proposed regulations during the public comment period (January 1, 2017 through February 10, 2017).
DPH Response:
The Agency appreciates and acknowledges these comments.
DPH Response:
The Agency appreciates and acknowledges these comments.
Health care providers in Delaware are permitted to accept the consent of minors for reproductive health under 13 Del. Code, Section 710 and they may choose to provide such services without notifying the parent or they may choose to notify the parent. However, pursuant to 16 Del. C. 710, a provider may not notify the parents of the consultation, examination or treatment of a minor in connection with a sexually transmitted infection without the minor’s consent. There is no requirement that a health care provider provide such treatment to a minor without parental involvement.
Section 6.0 Billing and Reimbursement
Second, the Legislature enacted H.B. 234 in 2016 with the understanding that “(u)nder DPH regulations students under 18 must enroll for services by having a parent or guardian sign a consent form”. See synopsis. There was no evidence of a legislative intent to eliminate a consent requirement. In contrast, DPH is striking the operative §4.1 which addresses who can consent to services. This makes little sense. Moreover, DPH is retaining a revised definition of “parent” in §2.0. There is no reason to have a definition of “parent” if §4.1 is stricken. The only residual reference to “parent” in the entire regulation is a passing reference to satisfaction surveys within §8.1.2.
Third, the amended definition of “parent” in §2.0 merits reconsideration.For example, it would not cover a court-appointed guardian of a student ages 18 and up. It would also not cover a relative caregiver who is not “charged with caring” but is voluntarily caring for a child. The reference to 13 Del.C. §8-201 is odd. That Code section is from the chapter on establishing paternity and maternity. DPH could consider a cross reference to the Code section specifically addressing consent to health care (Title 13 Del.C. §707) which includes relative caregivers, parents, and guardians.
DPH Response:
The Agency appreciates and acknowledges these comments.
Sixth, revised §4.2 limits persons serving students to “licensed professionals”. See also revised §5.1. This would exclude a host of professionals and paraprofessionals, including certified school psychologists [14 DE Admin Code §1583]; unlicensed autism services providers [18 Del.C. §3570A(e)(2) and (f)]; physical therapist assistants [24 Del.C. §2602(9)]; occupational therapy assistants [24 Del.C. §2002(5)]; psychological assistants [24 Del.C. §3507]; and speech pathology aides [24 Del.C. §3702(12)]. DPH should consider retaining the current language, “health professionals” (§5.1). Section 5.2 already limits provision of services to that within a staff member’s “education and experience and legally within their scope of practice”.
Seventh, the enabling legislation for SBHCs explicitly requires insurers to cover some costs of care. See 18 Del.C. §3571G(c). DPH proposes to eliminate the only regulation contemplating insurer billing: “6.1 SBHCs are required to implement and maintain a third party insurance billing process for services provided.” There is some “tension” between the statutory requirement and elimination of this regulation.
Per Delaware law, From Title 13 § 1043 Authority, “school board which shall have the authority to administer and to supervise the free public schools of the reorganized school district and which shall have the authority to determine policy and adopt rules and regulations for the general administration and supervision of the free public schools”.
These regulations are intended to implement the provisions of 18 Del.C. §3365 and 3517G 3571G, school-based health centers. These regulations apply to medical vendors who provide services at school-based health centers and health insurance plans who reimburse for covered medical services. These regulations define: (1) services offered in a school-based health center; (2) criteria for recognition as a school-based health center; (3) interactions with primary care providers; and (4) criteria for health promotion.
Agency means the Division of Public Health, Bureau of Adolescent and Reproductive Health, school-based health center program.
[Parent” means the parent or legal guardian authorized to enroll a student in the school-based health center a parent as defined by 13 Del.C. §8-201 or a nonparent or agency charged with caring for a child during the child's minority].
School-based health center means a health care clinic located in or near a school facility that is organized through school and health provider relationships that provides services designated in section Section 4.0 of this regulation.
Student means a child or adolescent who is enrolled in school.
3.1 School-based health centers (SBHC) are designed to reduce risk behaviors and improve health among children and adolescents through health promotion and education, early intervention, and preventive care. These services include physical examinations, treatment of minor acute medical conditions, counseling and community referrals. SBHCs do not supplant the primary care provider, but rather serve to coordinate care between students and their primary care provider, as well as increase access to services.
3.2 A health care clinic may be designated as a school-based health center (SBHC) by the Agency if it has demonstrated that it meets the criteria provided in paragraphs Sections 4.0-8.0 in these regulations. The Agency shall be the sole arbiter of the satisfaction of these criteria.
4.1 In order to obtain services at the SBHC, a minor student must be enrolled in the SBHC by his or her parent/guardian or relative caregiver acting pursuant to an Affidavit of Establishment of Power to Consent to Medical Treatment of Minors in accordance with Title 13 Del.C. §708. A student of the age of 18 years or more may consent for himself or herself.
[Nothing in the regulations limits the ability of a SBHC to require student or parental consent, as applicable, for particular services in accordance with applicable state and federal laws and regulations, and in accordance with the contractual guidance issued by DPH to Medical Sponsors of SBHCs.]
4.2[4.2] A SBHC shall be open during hours accessible to students. Information on hours of operation must be posted in areas frequented by students.
[4.324.3] A SBHC is required to make services available under the categories of physical health, mental health, health education, and nutrition consultation/education, as outlined in this section All SBHCs shall provide through licensed professionals, primary health services to children, including comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions, [nutrition consultation/education,] referrals to and follow-up for specialty care and oral and vision health services, mental health and substance use disorder assessments, crisis intervention, counseling, treatment, and referral to a continuum of mental health and substance abuse services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs.
[ 4.3.1] Diagnosis and treatment of sexually transmitted diseases, reproductive health, provision of contraceptives, and HIV testing and counseling. Provision of these services by SBHCs is may be provided by a SBHC subject to the approval of the school board governing the SBHC [locale].
4.3.64 Promotion of vaccination among [enrolled] students SBHCs must promote provision of all vaccinations required or recommended by the Division of Public Health to [enrolled] students either on site or through referral to a primary care provider. SBHCs shall promote vaccination among students through education and awareness activities.
5.1 A SBHC shall provide services through health professionals who: maintain up to date Delaware licensure, training and proper certification in their individual discipline for the population to be served.
6.1 SBHCs are required to implement and maintain a third-party insurance billing process for services provided.
6.2 A SBHC shall not charge co-pays or any other out-of-pocket fees for use of SBHC services.
6.32 The following services shall be exempt from third-party billing:
6.32.1 Any services provided to a student related to an evaluation or assessment of eligibility under the Individuals with Disabilities Education Act, 20 U.S.C. §1400 et seq, or Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. §701 et seq.; and
6.32.2 Any services provided to a student implementing an Individualized Education Program (IEP) or Section 504 Plan developed in conformity with either of the above federal laws.
6.43 Insurance information on each student [enrolled] in the SBHC must be updated annually at minimum.
Last Updated: December 31 1969 19:00:00.
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