Medication Management Under California’s New “IDEA” Regime
By Roger Greenbaum
October 30, 2011
www.RogerGreenbaum.com
The shift from California AB 3632 "mental health services" to federal IDEAdefined "related services" works a change that could modify the scope of available
services from a psychiatrist for medication management under approved individualized
education plans (IEP’s).
School districts and other local education agencies may perceive in the
“realigned” new rules a footing on which to more narrowly define now, than they have in
the past, the scope of their mental health responsibilities relating to special education.
The new rules provide wording that may assist the parties, to some degree, in sorting
what is covered from what is excluded.
However, in some (not a few) instances, a so-called “bright line” to distinguish
psychiatric services which are covered from those which are not, could prove elusive.
This is due to ambiguities which are simply built into the situation of many students
whose special education status stems from emotional disability. Brief discussion of this
is included below.
One key to persuasive interpretation and advocacy around this question probably
will be found in keeping three related concepts in mind:
(1) while the services of a psychiatrist will unquestionably continue to
be a part of a school district’s financial responsibilities to some of its
special needs students, the only services a district is required to obtain
from a licensed M.D. who is a psychiatrist are those services that are
demonstrably “supportive” and necessary for the student to be able to
gain the benefits of special education;
(2) the only broad mandate flowing from special education law is one
for education; and
(3) special education law has not in the past, and does not now,
provide a governmental mandate or entitlement for “health care” per se.
The now-cancelled state regulations under AB 3632, by their terms, provided a
basis to deem the "prescribing" and "monitoring" of medications which were "necessary
to alleviate the symptoms of mental illness", to be among the several kinds of
educationally related "mental health services" which California did indeed cover and
authorize. With the repeal of AB 3632 earlier this year, those California regulations are
regarded now as no longer in effect.
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By contrast, under IDEA (the federal Individuals with Disabilities Education
Act), which now governs in California, the words defining the scope of school district
obligations relating to mental health are a bit different. There is a so-called "bright line"
rule that the only "medical" services (that is, services capable of being performed only by
a licensed physician such as a psychiatrist) which are included as "related services" are
those which are necessary for purposes of diagnosis or evaluation to enable the child to
benefit from special education. (This brings them into the category of services which are
“supportive” of the special education.) Such covered psychiatric services would continue
to be provided at no cost to parents/guardians.
On its face this would appear to be a narrower coverage, in that the words
“prescribing” and “monitoring” of medications are no longer in the list of psychiatric
services expressly to be covered through special education. As a result, in some instances
(varying with circumstances), the new regime may tend to exclude from school district
responsibility the prescribing and monitoring of medications by a psychiatrist for special
ed students with emotional disability.
NOTE: The shift to IDEA does not disturb or change the coverage which
prevailed under AB 3632, for the services of a school nurse or other school employee to
administer or dispense medications which have been duly prescribed by a psychiatrist.
These would still also be covered, at no cost to parents/guardians.
“Monitoring” of psychiatric medications is not expressly excluded, however, from
the types of psychiatric services which local educational agencies must cover in special
ed. Indeed, a range of situations can be imagined in which a reasonable good-faith
argument for coverage of medication monitoring as a “supportive service” intended for
coverage by the law, would exist. One example might be where the child’s condition is
sufficiently complex, or sufficiently changeable, that the psychiatrist appointments are a
continuing part of diagnosis confirmation and re-evaluation for purposes of special
education placement, and not pure-and-simple monitoring of the pharmaceutical effects
of the medication.
This is not to suggest that the above example is exclusive. And, to be sure,
“prescribing” and “monitoring” by a psychiatrist are not among the types of services
benefited by blanket coverage for special education students. But fundamentally, the
question of how to classify a medication prescribing or monitoring appointment with a
psychiatrist should receive consideration on an individualized basis to reflect its context
in regard to the district’s and the family’s ongoing effort to meet the educational needs of
the child.
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© 2011, 2012 Roger A. Greenbaum.
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