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Expanded Spectrum of Health Care Providers for Students with Chronic or Acute Health Conditions

Minnesota Statutes, section 125A.08 was amended in 2016 to expand the spectrum of licensed health care providers who could provide written documentation of a student’s medically diagnosed chronic or acute health condition required for potential eligibility under the Other Health Disabilities category. This expanded spectrum now includes licensed health care providers whose scope of practice includes diagnosing patients. Two examples include advanced practice registered nurses (APRNs) and physician assistants (PAs). When considering other health care providers, districts should inquire whether the provider’s professional scope of practice includes the ability to provide documentation of a medically diagnosed chronic or acute health condition.

Authority: MN Rule 3525.1335, Subpart 2; Minn. Stat. § 125A.

(Updated 4/4/2017)

Minnesota Rule 3525.1335

Minnesota Rule 3525.1335, Other Health Disabilities does not require that a local education agency (LEA) use or send a specific form for medical documentation of a chronic or acute health condition, including AD/HD. Districts must ensure that a diagnosis includes written and signed documentation of a medically diagnosed chronic or acute health condition or AD/HD from a health care provider operating within their professional scope of practice. If an LEA decides to develop or use a form for the purpose of obtaining required medical documentation, consider including the following topics.

  • Activity limitations or restrictions
  • Implications for school attendance (e.g., projected absences due to hospitalizations, surgeries, etc.)
  • Medications or specialized health care procedures necessary during the school day
  • Medications that may adversely affect school performance

(MDE) (Updated 4/4/2017)

Eligibility & Medical Documentation: Students with Attention Deficit/Hyperactivity Disorder

The expanded spectrum of health care providers referenced in Minn. Stat. § 125A.08 does not apply to the eligibility process for students with a diagnosis of Attention Deficit/Hyperactivity Disorder (AD/HD). As before, there must be signed documentation of a medical diagnosis by a physician, advanced practice registered nurse (APRN), or licensed psychologist (LP). The diagnosis of AD/HD must include appropriate documentation using DSM criteria that items A to E have been met. DSM criteria documentation must be provided by either a licensed physician or mental health or medical professional licensed to diagnose the condition. Some examples of health care providers whose professional scope of practice may include the provision of DSM documentation are licensed psychologists (LP) and licensed independent clinical social workers (LICSW).

DSM Documentation Requirements for AD/HD

MN Rule 3525.1335 Other Health Disabilities refers to the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria as opposed to a specific DSM version as the required documentation source for AD/HD. Although DSM-IV documentation is sufficient in determining continued eligibility for students with ADHD who were previously qualified under the OHD category using DSM-IV criteria, schools should only accept diagnostic documentation based on current DSM-5 criteria for newly referred students.

The diagnosis of Attention Deficit/Hyperactivity Disorder must include “appropriate documentation using DSM criteria that items A to E have been met” (MN Rule 3525.1335). However, MN Rule 3525.1335 does not explicitly require the provider to identify the items and accompanying symptoms for items A (1) or A (2) in the DSM that have been met. The only requirement is that ‘appropriate documentation’ must be provided.

DSM Documentation Guidelines

  • The health care provider states as part of the written documentation that items A-E in the current DSM have been met, either in narrative form or a checklist from the provider’s office; or
  • The health care provider completes a checklist that the district has provided, which indicates that items A-E in the current DSM have been met.

In the event that the health care provider does not specify which DSM items under A (1) or A (2) have been met, the school district may ask the provider to include this information, indicating that this would be helpful in planning for the student’s educational needs in the school setting. However, providing this level of detail is not required of the provider.

DSM- Type of Presentation

The type of presentation (combined, predominantly inattentive, predominantly hyperactive/impulsive) is a required component of an AD/HD diagnosis and should be listed as such, since, as part of DSM diagnostic requirements and coding purposes, the provider must specify the type of presentation, as well as current severity and remission status. The presentation type also has significant implications for educational programming, and should always be part of the provider’s written documentation.

Required Components of a Student Evaluation

Documented, systematic interviews and student observations are a required and significant part of an initial student evaluation when the Other Health Disabilities (OHD) categorical area is being considered. Interviews and at least one observation must be conducted by a licensed special education teacher. Other required initial evaluation activities include a review of the student’s health history and school records, and an individually administered, nationally normed standardized evaluation of the student’s academic performance.

When conducting a reevaluation to determine continuing eligibility, some procedures and requirements vary from the initial evaluation process. For more information, refer to the document entitled, Q & A: Reevaluations under Part B of the Individuals with Disabilities Education Act (IDEA), found on the MN Department of Education website at: http://education.state.mn.us/MDE/dse/sped/caqa/IEP/ (external site)

For more information and guidance in the areas of student evaluation, eligibility requirements, educational supports, and resources in the categorical area of OHD, refer to the State Other Health Disabilities Manual.

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Tami Childs, Ph.D., Statewide ASD & OHD Specialist

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