As students returned to school in fall 2021, school nurses played a critical role in ensuring the ongoing health and safety of students. Though school nurses have historically led efforts to mitigate the spread of communicable diseases, their role has shifted significantly over time, and new COVID-19 responsibilities only added to school nurses’ already full plates. Even before the pandemic, school nurses were responsible for a wide range of tasks, including managing chronic disease, creating and coordinating individual student health plans, administering and storing medications, training school staff in emergency procedures and medication administration, and keeping and reporting records and health information. School nurses typically performed these services for multiple school buildings (as of 2017, only 39.3 percent of schools had a full time school nurse). Now, school nurses have become responsible for administering COVID-19 tests; helping with vaccination clinics; facilitating immunizations and health screenings that had been disrupted during remote learning; conducting contact tracing; enforcing general COVID protocols; and providing COVID-19 education to students, staff, and families—all in addition to their regular duties.

State statutes and regulations dictate not only whether schools are required to employ a school nurse, but also what qualifications they must have and what they must do once they arrive in school buildings. Moreover, state policies highlight whether and how the role of a school nurse is valued, particularly as an expert in the wake of public health crises like COVID-19. Understanding the current landscape of state statutes and regulations that govern school nursing is critical to identifying opportunities to better support and elevate school nurses’ role as longstanding pillars of public health.

Child Trends, in partnership with EMT Associates, analyzed the landscape of state statutes and regulations as of October 2021 to better understand how such policies define the role of school nurses (see Methodology). This brief presents our findings.


Findings

State policies on whether districts must employ school nurses

Thirty-five states and the District of Columbia (DC) have policies requiring (“must,” “shall”) the employment of school nurses, while another seven states authorize (“may”), encourage (“should”), or address making school nurses available to students (Appendix A). However, even among states that require making school nurses available, those requirements range from full-time nurses in each school to part-time nurses providing services to several schools to nurses employed at the LEA level. For example, two states (Delaware and Vermont) require full-time nurses in every school, and an additional twelve states (Alabama, Arkansas, Georgia, Indiana, Iowa, Oregon, Pennsylvania, Tennessee, Utah, Vermont, Virginia, and West Virginia) set recommended or required nurse-to-student ratios, though these ratios go unheeded by many districts. Notably, those ratios range from 1:500 (Alabama, Vermont) to 1:3,000 (Tennessee), while the Centers for Disease Control and Prevention recommends a ratio of one school nurse for every 750 students. Eight states (Alaska, Arizona, Idaho, Maryland, Montana, Nevada, New Mexico, and North Dakota) do not address requirements for school districts to employ school nurses.


State policies on whether districts must employ school nurses

CDC map1 must employ nurses 150-01

State policies on school nurses’ qualifications

CDC map 2 nurse qualifications 150-01

State policies on school nurses’ role in managing chronic conditions

Forty-eight states have policies that describe school nurses’ role in managing chronic conditions, including allergies, diabetes, and seizures (Appendix C). Responsibilities include storing and administering medication; developing and implementing student health plans related to these conditions; and training other school personnel on chronic disease care (e.g., recognizing symptoms, emergency administration of medication). Of these, 39 states require (“must,” “shall”) a registered (or otherwise properly licensed or certified) nurse to perform these services, while eight states authorize (“may”) but do not require school nurses to fill these roles, giving some flexibility to who performs these duties. Oregon addresses the non-liability of school nurses, school administrators, teachers, or other school staff related to administering medication or supervising student self-administration of medication. Notably, there is a nationwide school nurse shortage, which may mean that schools are asking staff without proper medical training to perform these duties, even when the state requires proper licensure or certification. Schools may put students at risk when non-nurses perform duties that should be performed by qualified individuals.


State policies on school nurses’ role in managing chronic conditions

cdc map3 chronic conditions 150-01

State policies on school nurses’ role in administering medication

Twenty-five states have policies that describe school nurses’ role in administering medication beyond what is specifically required for managing chronic conditions (Appendix D). These responsibilities include storing and administering students’ prescription medicine, managing students’ health records and parental consents, training other school personnel to administer prescription medication as permitted by parents or guardians, and assessing students’ ability to self-administer medication. Of states with policies addressing medication administration, 18 specifically require (“must,” “shall”) school nurses to perform these duties, while five states authorize (“may”) but do not require school nurses to fill these roles, which allows unlicensed assistive personnel, school administrators, teachers, or other school staff to perform these duties.


State policies on school nurses’ role in administering medication


State policies on school nurses’ role in developing and managing student health plans

Twenty-one states have policies that describe school nurses’ role in developing and managing student health plans for chronic conditions such as allergies, asthma, diabetes, and seizures as well as other individualized health care needs (Appendix E). Responsibilities addressed include training other school personnel and volunteer health aides on proper procedures of care; collaborating with students, parents or guardians, and primary care physicians; developing protocol for emergency response; and storing emergency stock medication. Of the states that govern school nurses’ role in student health plans, 17 require (“must,” “shall”) a registered nurse to be involved in creating individualized student health and emergency action plans, while two states authorize (“may”) but do not require school nurses to assist students who require individualized health care services. Importantly, the assessment and care planning can be done only by an RN—assessment is not in the scope of practice for LPNs. In cases where an RN is not present, student care plans may not exist or are provided from outside healthcare providers, often without proper adaption to the school setting or school-specific needs.


State policies on school nurses’ role in developing and managing student health plans

cdc map 5 managing health plans 150-01

State policies on school nurses’ role in student health screenings

Twenty-five states have policies that describe school nurses’ roles in health screenings—including vision, hearing, dental, BMI, scoliosis, dyslexia, lead exposure, and general physical health (Appendix F). Their responsibilities range from scheduling, facilitating, documenting results, and/or referring students for follow-up care. Nineteen states require (“must,” “shall”) school nurses to conduct or oversee these screenings, receive training on specific screenings or examinations, or train other personnel to conduct the screenings, while six states authorize (“may”) or encourage (“recommend,” “should”) but do not require school nurses to fill these roles.


State policies on school nurses’ role in student health screenings

cdc map 6 health screenings 150-01

State policies on school nurses’ role in student immunizations

Twelve states have policies that describe school nurses’ role in facilitating and/or keeping records of student immunizations (Appendix G). Of these, ten states detail requirements for school nurses to administer immunizations, facilitate immunization programs or clinics, or keep or access records of student immunizations. New Mexico authorizes school nurses to access the immunization registry, while Texas authorizes school nurses to submit a written statement of a student’s immunity or disease history in lieu of a vaccine record for varicella.


State policies on school nurses’ role in student immunizations


State policies on school nurses’ role in infectious disease control

Eighteen states and DC have policies that describe school nurses’ role in mitigating the spread of contagious diseases (Appendix H). Of these, five states (Maine, New York, Oregon, Pennsylvania, West Virginia) and DC require schools to exclude students from school who have been exposed to a communicable disease or who are showing signs of illness as reported to them by school nurses, while four states (Massachusetts, New Jersey, Oklahoma, Wisconsin) authorize but do not require schools to do so. Oregon and Pennsylvania’s policies require nurses to determine when excluded students are no longer communicable and may be readmitted, while Idaho, Oklahoma, and New York authorize but do not require school nurses to perform this duty. Three states (Georgia, Maine, Pennsylvania) and DC require school personnel to consult with the school nurse when a student is suspected of having a communicable disease, while nine states (Idaho, Iowa, Maryland, Massachusetts, Nebraska, New Mexico, Oregon, West Virginia, Wisconsin) and DC require school nurses to report suspected cases of communicable diseases to state and local public health agencies.


State policies on school nurses’ role in infectious disease control


State policies on school nurses’ role in COVID-19

As of October 2021, policies in three states explicitly addressed school nurses’ role in COVID-19. New Mexico requires school nurses to use the Centers for Disease Control and Prevention (CDC) recommended transmission-based precautions when caring for sick people. New York allowed health examinations, including hearing, vision, and scoliosis screenings to be waived during the 2020-2021 school year due to COVID-19. Maine also updated an existing regulation on comprehensive health and safety and emergency management plans to require involving school nurses, physicians, and public health staff in developing and annually updating those plans. Four additional states (Delaware, Maryland, Vermont, and West Virginia) updated policies referencing either immunization or communicable disease between March 2020 and October 2021; however, these policies do not specifically mention COVID-19. Delaware also passed emergency legislation on COVID-19 Mitigation and Prevention requiring mask use by all students, faculty, staff, and visitors inside school buildings; however, the policy does not delegate a person responsible for ensuring that the policy is implemented or enforced.


State policies on school nurses’ role in COVID-19


Discussion and Conclusion

Our analysis examined how states govern the roles, responsibilities, and requirements for school nurses through policy. These policies often determine the availability of nurses in school buildings, the daily responsibilities they perform in service to their students, and expectations for how they will contribute to public health. The COVID-19 pandemic added significantly to existing responsibilities as school nurses stepped in to administer COVID-19 tests; conduct contact tracing; educate staff, students, and families on COVID-19 precautions, such as proper mask wearing, hand washing and hygiene, and physical distancing; update school-based health protocols and safety plans; and support decision making for school closing/reopening plans. The pandemic has increased the need for school nurses—who address and support efforts related to chronic absenteeism and the impact of health conditions on academic outcomes—and added to school nurses’ direct care responsibilities as students return to school demonstrating worsened physical and mental health.

Our analysis was necessarily limited: although we examined the landscape of state policies, we did not evaluate their effect in practice. The presence or absence of state-level policy pertaining to school nurses does not preclude the existence of non-codified guidance, nor does it indicate whether or how well policies are being implemented. However, from what is codified, we can assess the baseline expectations of school nurses. School nurses are required to fulfill numerous codified responsibilities around coordinating care or providing direct health services in all 50 states and DC and have been asked to take on even more during the COVID-19 pandemic. Despite these copious and ever-increasing demands, few states have policies that set a strong floor for school nurse capacity in schools—just twelve states have policies addressing recommended or required nurse-to-student ratios and only two require a full-time nurse in every school. By establishing policies that improve school nurses’ capacity, states can vest power in nurses’ deep expertise to lead their school communities’ health and wellness efforts on behalf of students and staff.


Methodology

To analyze the current landscape of state statutes and regulations related to school nursing practice, Child Trends and EMT Associates identified codified policies using a series of keyword Boolean searches in LexisNexis and Westlaw that reference school nursing. Policies repealed before October 2021 were not included in the search, nor were policies passed after this date or pending legislative action. Based on the content of each identified policy, researchers at EMT Associates conducted memoing to describe unique categories of policies. They then coded each identified policy based on its degree of prescriptiveness (addressed, encouraged, authorized, or required). Our analysis focused on the following research questions:

  • How do states govern the availability of school nurses?
  • How do states govern certifications or qualifications for school nurses?
  • What are school nurses authorized to do?
  • What are school nurses required to do?
  • How are school nurses engaged in public health efforts?
  • What specific responsibilities do school nurses have with respect to the COVID-19 pandemic?

Suggested Citation

Steed, H., O’Toole, D., Lao, K., Nuñez, B., Surani, K., & Stuart-Cassel, V. (2022). State laws on school nursing outline copious responsibilities for nurses. Child Trends. https://doi.org/10.56417/2161j1674h


This publication is supported by cooperative agreement NU87PS004367-01-01 funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views or endorsement of the CDC or the Department of Health and Human Services.


Appendices

Appendix A - Availability

State Code Citation(s)
Alabama Required Ala. Code § 16-22-16
Alaska Not Addressed
Arizona Not Addressed
Arkansas Required Ark. Code Ann. § 6-18-706 ; Ark. Code Ann. § 6-20-2517
California Required Cal. Educ. Code § 49426
Colorado Authorized Colo. Rev. Stat. Ann. § 25-1.5-406
Connecticut Required Conn. Gen. Stat. Ann. § 10-212
Delaware Required Del. Code Ann. tit. 14, § 1310
District of Columbia Required D.C. Code Ann. § 38-621
Florida Addressed Fla. Stat. § 381.0057
Georgia Required Ga. Code Ann. § 20-2-771.2; Ga. Code Ann. § 20-2-186
Hawaii Addressed HAR 11-146-2
Idaho Not Addressed
Illinois Required 105 ILCS 5/10-22.23; Ill. Admin. Code tit. 23, § 1.760
Indiana Required; Authorized; Encouraged; Addressed 511 Ind. Admin. Code 4-1.5-2; 511 Ind. Admin. Code 4-1.5-6; Burns Ind. Code Ann. § 16-22-8-34; Burns Ind. Code Ann. § 16-46-3-2; Burns Ind. Code Ann. § 20-34-3-6; Burns Ind. Code Ann. § 20-34-3-7; Burns Ind. Code Ann. § 20-34-4.5-4
Iowa Required; Authorized 281 IAC 12.4; Iowa Code § 249A.32B; Iowa Code § 256.11
Kansas Required Kan. Admin. Regs. 60-15-101
Kentucky Required KRS § 156.501
Louisiana Required LAC 28:CXV.503; La. Stat. Ann. § 17:28
Maine Required Me. Rev. Stat. tit. 20-A, § 6403-A; CMR 05-071-125
Maryland Not Addressed
Massachusetts Required; Authorized Mass. Gen. Laws Ann. ch. 71, § 53; Mass. Gen. Laws Ann. ch. 71, § 53A ; 105 CMR 201.015; 603 CMR 18.05; 603 CMR 50.06
Michigan Required; Authorized Mich. Admin. Code R 340.1163; Mich. Comp. Laws Ann. § 380.1252
Minnesota Required Minn. R. 8710.6100; Minn. Stat. § 121A.21; Minn. Stat. § 125A.29
Mississippi Required Miss. Code Ann. § 37-14-1; Miss. Code Ann. § 37-14-3; Miss. Code Ann. § 41-79-5; Miss. Code Ann. § 41-79-53
Missouri Authorized Mo. Ann. Stat. § 168.171
Montana Not Addressed
Nebraska Required Nebraska Admin. Code Title 471, Ch. 25
Nevada Not Addressed
New Hampshire Required; Encouraged; Addressed RSA 21-N:6-a; RSA 186:13; RSA 189:49; RSA 200:27; RSA 200:29; RSA 200:31
New Jersey Required; Encouraged; Addressed N.J. Stat. § 18A:40-1; N.J. Stat. § 18A:40-3.1; N.J. Stat. § 18A:40-3.2; N.J. Stat. § 18A:40-3.3; N.J. Stat. § 18A:40-3.4; N.J.A.C. 6A:16-2.3
New Mexico Not Addressed
New York Required; Encouraged NY CLS Educ § 901; NY CLS Educ § 902; NY CLS Educ § 912; NY CLS Educ § 1950; NY CLS Educ § 2503; NY CLS Pub Health § 356; 8 NYCRR § 136.2
North Carolina Required 16 N.C.A.C. 6D.0402
North Dakota Not Addressed
Ohio Encouraged ORC Ann. 3313.68; ORC Ann. 3313.72
Oklahoma Required O.A.C. § 210:35-3-107; 70 Okl. St. § 3-129.11
Oregon Required; Authorized OAR 581-022-2220; ORS § 336.201; ORS § 678.038
Pennsylvania Required; Encouraged; Addressed 24 P.S. § 14-1402; 24 P.S. § 14-1405; 24 P.S. § 14-1410; 28 Pa. Code § 23.51; 28 Pa. Code § 23.52; 28 Pa. Code § 23.53; 28 Pa. Code § 23.62
Rhode Island Required R.I. Gen. Laws § 16-21-7; R.I. Gen. Laws § 16-21-8; R.I. Gen. Laws § 23-17-4.1
South Carolina Required; Addressed S.C. Code Ann. § 43-5-1235; S.C. Code Ann. § 59-10-210
South Dakota Required S.D. Codified Laws § 13-33A-1
Tennessee Required; Authorized; Encouraged; Addressed Tenn. Comp. R. & Regs. R. 1200-11-05-.02; Tenn. Comp. R. & Regs. R. 1200-11-05-.05; Tenn. Code Ann. § 49-3-359; Tenn. Code Ann. § 68-1-1201; Tenn. Code Ann. § 68-1-1203
Texas Required; Authorized Tex. Educ. Code § 21.002; Tex. Health & Safety Code § 281.0465
Utah Required; Encouraged Utah Code Ann. § 53F-2-415; Utah Code Ann. § 53G-9-204
Vermont Required CVR 22-000-003
Virginia Required; Encouraged Va. Code Ann. § 22.1-253.13:2; Va. Code Ann. § 22.1-274
Washington Authorized; Encouraged Rev. Code Wash. (ARCW) § 28A.210.300; Rev. Code Wash. (ARCW) § 28A.210.305
West Virginia Required W. Va. Code § 18-5-22; W. Va. CSR § 126-25A-7; W. Va. CSR § 126-25A-9
Wisconsin Required; Encouraged Wis. Adm. Code PI 8.01; Wis. Stat. § 120.13
Wyoming Encouraged Wyo. Stat. § 21-2-202

Appendix B - Certification

State Code Citation(s)
Alabama Required Ala. Code § 16-22-16
Alaska Not Addressed
Arizona Not Addressed
Arkansas Not Addressed
California Required Cal. Educ. Code § 44267.5; Cal. Educ. Code § 44877; Cal. Code Regs. tit. 5, § 80050
Colorado Required 1 Colo. Code Regs. § 301-101:7.05
Connecticut Required; Encouraged Conn. Agencies Regs. 10-212-2; Conn. Agencies Regs. 10-212-4; Conn. Agencies Regs. 10-212-5; Conn. Agencies Regs. 10-212-6
Delaware Required Code Del. Regs. 1582
District of Columbia Required D.C. Code Ann. § 38-621
Florida Required Fla. Stat. § 1012.55
Georgia Not Addressed
Hawaii Addressed HAR 11-146-2
Idaho Required Idaho Code § 33-1201
Illinois Required Ill. Admin. Code tit. 23, § 23.120
Indiana Required 511 Ind. Admin. Code 15-6-35
Iowa Required 281 IAC 12.4
Kansas Required K.S.A. § 72-255
Kentucky Required KRS § 156.501
Louisiana Required LAC 28:CXXXI.411
Maine Required CMR 05-071-125
Maryland Required COMAR 13A.05.05.13
Massachusetts Required; Authorized Mass. Gen. Laws Ann. ch. 71, § 53; Mass. Gen. Laws Ann. ch. 71, § 53A
Michigan Required; Addressed Mich. Admin. Code R 340.1161; Mich. Admin. Code R 340.1164; Mich. Admin. Code R 340.1166; Mich. Admin. Code R 340.1167; Mich. Admin. Code R 340.1168; Mich. Admin. Code R 340.1169
Minnesota Required Minn. Stat. § 121A.21
Mississippi Addressed CMSR 07-000-003
Missouri Not Addressed
Montana Not Addressed
Nebraska Not Addressed
Nevada Required Nev. Admin. Code 391.305; Nev. Admin. Code 391.310
New Hampshire Required; Encouraged N.H. Admin. Rules, Ed 306.12; RSA 200:29
New Jersey Required; Addressed N.J. Stat. § 18A:40-3.3; N.J. Stat. § 18A:40-3.7; N.J. Stat. § 18A:40-3.8
New Mexico Addressed N.M. Admin. Code 6.63.2; N.M. Stat. Ann. § 22-34-2
New York Required 8 NYCRR § 136.2
North Carolina Required 16 N.C.A.C. 6D.0402
North Dakota Not Addressed
Ohio Addressed OAC Ann. 3301-24-05
Oklahoma Addressed 70 Okl. St. § 1-116
Oregon Required; Encouraged; Addressed ORS § 342.455; ORS § 342.465; ORS § 342.475; ORS § 342.485; ORS § 342.495; OAR 584-021-0110
Pennsylvania Required 28 Pa. Code § 23.54
Rhode Island Required 216 RICR 020-10-4
South Carolina Required S.C. Code Regs. 43-205
South Dakota Required S.D. Codified Laws § 13-33A-1
Tennessee Required; Encouraged Tenn. Comp. R. & Regs. R. 1200-11-05-.05; Tenn. Code Ann. § 49-3-359
Texas Not Addressed
Utah Encouraged Utah Code Ann. § 53G-9-204
Vermont Addressed 7-1 Vt. Code R. § 13
Virginia Encouraged Va. Code Ann. § 22.1-274
Washington Encouraged Rev. Code Wash. (ARCW) § 28A.210.300
West Virginia Required W. Va. Code § 18-5-22; W. Va. CSR § 126-25A-9
Wisconsin Required; Encouraged Wis. Adm. Code PI 8.01; Wis. Stat. § 120.13
Wyoming Not Addressed

Appendix C - Services - Chronic

State Code Citation(s)
Alabama Required; Authorized; Addressed Ala. Code § 16-1-48; Ala. Code § 16-30A-3; Ala. Code § 16-30A-5; Ala. Code § 16-30C-2; Ala. Code § 16-30C-4; Ala. Admin. Code 610-X-7-.10
Alaska Authorized Alaska Stat. Ann. § 14.30.141
Arizona Required; Authorized Ariz. Admin. Code R7-2-809; Ariz. Admin. Code R7-2-810; Ariz. Rev. Stat. Ann. § 15-157; Ariz. Rev. Stat. Ann. § 15-158; Ariz. Rev. Stat. Ann. § 15-342; Ariz. Rev. Stat. Ann. § 15-344.01
Arkansas Required Code Ark. R. 005.28.42-4.00; Code Ark. R. 005.28.42-7.00; 067 00 CARR 009; Ark. Code Ann. § 6-18-707
California Required; Authorized Cal. Educ. Code § 49414; Cal. Educ. Code § 49414.5; Cal. Educ. Code § 49423.1
Colorado Required Colo. Rev. Stat. Ann. § 22-1-119.5; Colo. Rev. Stat. Ann. § 22-1-132; Colo. Rev. Stat. Ann. § 22-2-135; 1 Colo. Code Regs. § 301-68:2.00; 1 Colo. Code Regs. § 301-68:3.00; 1 Colo. Code Regs. § 301-68:4.00; 1 Colo. Code Regs. § 301-68:5.00
Connecticut Required Conn. Agencies Regs. 10-212a-2
Delaware Required; Addressed Code Del. Regs. 612; Del. Code Ann. tit. 16, § 3003E; Del. Code Ann. tit. 16, § 3007E
District of Columbia Not Addressed
Florida Required Fla. Admin. Code Ann. r. 6A-6.0251; Fla. Admin. Code Ann. r. 6A-6.0253
Georgia Required Ga. Code Ann. § 20-2-776; Ga. Code Ann. § 20-2-779
Hawaii Not Addressed
Idaho Required; Addressed Idaho Code § 33-520; Idaho Code § 33-520A
Illinois Required 105 ILCS 5/2-3.182; 105 ILCS 145/15; 105 ILCS 145/27; Ill. Admin. Code tit. 23, § 1.540
Indiana Required; Authorized Burns Ind. Code Ann. § 20-34-3-26; Burns Ind. Code Ann. § 20-34-5-12; Burns Ind. Code Ann. § 20-34-5-13; Burns Ind. Code Ann. § 20-34-5-14; Burns Ind. Code Ann. § 20-34-5-15; Burns Ind. Code Ann. § 20-34-5-17
Iowa Required; Authorized 281 IAC 14.3(256); Iowa Code § 280.16; Iowa Code § 280.16A
Kansas Required K.S.A. § 72-6282
Kentucky Required KRS § 158.834; KRS § 158.836
Louisiana Required LAC 28:CLVII.307; La. Stat. Ann. § 17:436.1; La. Stat. Ann. § 17:436.3
Maine Required; Authorized Me. Rev. Stat. tit. 20-A, § 254; 20-A M.R.S. § 6305
Maryland Required Md. Code Ann., Educ. § 7-426.2; Md. Code Ann., Educ. § 7-426.4
Massachusetts Required; Addressed Mass. Gen. Laws Ann. ch. 71, § 54B; 105 CMR 210.100
Michigan Authorized Mich. Comp. Laws Ann. § 333.17744a
Minnesota Required Minn. Stat. § 121A.24; Minn. Stat. § 121A.221
Mississippi Required Miss. Code Ann. § 37-11-71; Miss. Code Ann. § 41-79-1; Miss. Code Ann. § 41-79-3
Missouri Required; Authorized Mo. Code Regs. Ann. tit. 5, § 20-200.300; Mo. Ann. Stat. § 167.630; Mo. Ann. Stat. § 167.635; Mo. Ann. Stat. § 167.803; Mo. Ann. Stat. § 167.809
Montana Required; Authorized Mont. Code Ann. § 20-5-420; Mont. Code Ann. § 20-5-421
Nebraska Required Neb. Rev. Stat. Ann. § 79-224; Neb. Rev. Stat. Ann. § 79-3203
Nevada Authorized Nev. Rev. Stat. Ann. § 386.870; Nev. Rev. Stat. Ann. § 392.425
New Hampshire Required; Encouraged; Authorized; Addressed RSA 200:42; RSA 200:43; RSA 200:44; RSA 200:44-a; RSA 200:45; RSA 200:46; RSA 200:54; RSA 200:55; RSA 200:57
New Jersey Required; Authorized; Addressed N.J. Stat. § 18A:40-12.5; N.J. Stat. § 18A:40-12.6; N.J. Stat. § 18A:40-12.6c; N.J. Stat. § 18A:40-12.6d; N.J. Stat. § 18A:40-12.7; N.J. Stat. § 18A:40-12.8; N.J. Stat. § 18A:40-12.11; N.J. Stat. § 18A:40-12.13; N.J. Stat. § 18A:40-12.14; N.J. Stat. § 18A:40-12.35; N.J.A.C. 6A:16-2.1; N.J.A.C. 6A:16-2.2
New Mexico Required; Authorized 6.12.2.9 NMAC; 6.12.8.8 NMAC; 6.12.11.10 NMAC; 7.30.12.10 NMAC; N.M. Stat. Ann. § 22-5-4.3; N.M. Stat. Ann. § 22-33-3; N.M. Stat. Ann. § 22-33-4; N.M. Stat. Ann. § 22-34-5
New York Required; Authorized NY CLS Educ § 902-a; NY CLS Educ § 902-b; NY CLS Educ § 916; NY CLS Educ § 916-a; NY CLS Educ § 916-b; NY CLS Educ § 921; NY CLS Pub Health § 2500-h; 8 NYCRR § 136.7
North Carolina Required N.C. Gen. Stat. § 115C-12; N.C. Gen. Stat. § 115C-375.2; N.C. Gen. Stat. § 115C-375.2A
North Dakota Not Addressed
Ohio Required; Authorized ORC Ann. 3313.718; ORC Ann. 3313.719; ORC Ann. 3313.7110; ORC Ann. 3313.7112; ORC Ann. 3313.7113; ORC Ann. 3313.7115
Oklahoma Required; Authorized 70 Okl. St. § 1-116.3; 70 Okl. St. § 1210.196.3; 70 Okl. St. § 1210.196.4; 70 Okl. St. § 1210.196.5
Oregon Addressed ORS § 339.871
Pennsylvania Required; Authorized 24 P.S. § 14-1414.1; 24 P.S. § 14-1414.2; 24 Pa. Stat. Ann. § 14-1414.3
Rhode Island Required; Authorized R.I. Gen. Laws Ann. § 16-21-22; R.I. Gen. Laws § 16-21-32; 216 RICR 020-10-4
South Carolina Authorized S.C. Code Ann. § 59-63-95
South Dakota Authorized S.D. Codified Laws § 13-33A-6
Tennessee Required Tenn. Code Ann. § 49-50-1602; Tenn. Comp. R. & Regs. R. 0520-01-13-.03
Texas Required; Authorized Tex. Educ. Code § 38.015; Tex. Educ. Code § 38.208; Tex. Health & Safety Code § 168.003; Tex. Health & Safety Code § 168.005; Tex. Health & Safety Code § 168.007; 25 TAC § 40.44; 25 TAC § 40.46; 25 TAC § 40.47
Utah Required; Authorized Utah Code Ann. § 26-41-104; Utah Code Ann. § 26-41-105; Utah Code Ann. § 53G-9-504; Utah Code Ann. § 53G-9-505
Vermont Authorized 16 V.S.A. § 1388
Virginia Required; Authorized 8 VAC 20-131-260; Va. Code Ann. § 22.1-274.01:1; Va. Code Ann. § 22.1-274.2; Va. Code Ann. § 22.1-274.6; Va. Code Ann. § 54.1-3408
Washington Required; Encouraged Wash. Rev. Code Ann. § 28A.210.355; Rev. Code Wash. (ARCW) § 28A.210.370; Rev. Code Wash. (ARCW) § 28A.210.380; Rev. Code Wash. (ARCW) § 28A.210.383
West Virginia Required; Authorized W. Va. Code § 18-2K-2; W. Va. Code § 18-5-22b; W. Va. Code § 18-5-22c; W. Va. CSR § 126-25A-11; W. Va. CSR § 126-25A-12; W. Va. CSR § 126-27-9; W. Va. CSR § 126-27-10
Wisconsin Authorized Wis. Stat. § 118.2925
Wyoming Authorized Wyo. Stat. § 21-4-316

Appendix D - Services - MA

State Code Citation(s)
Alabama Not Addressed
Alaska Not Addressed
Arizona Not Addressed
Arkansas Required Ark. Code Ann. § 6-18-718
California Required; Authorized Cal. Educ. Code § 49423; Cal. Code Regs. tit. 5, § 600; Cal. Code Regs. tit. 5, § 604
Colorado Addressed Colo. Rev. Stat. Ann. § 12-255-132
Connecticut Required Conn. Gen. Stat. Ann. § 10-212a ; Conn. Agencies Regs. 10-212a-3; Conn. Agencies Regs. 10-212a-4; Conn. Agencies Regs. 10-212a-5; Conn. Agencies Regs. 10-212a-7; Conn. Agencies Regs. 10-212a-8; Conn. Agencies Regs. 10-212a-9
Delaware Required Del. Code Ann. tit. 16, § 3004E; Del. Code Ann. tit. 16, § 3006E; Code Del. Regs. 817
District of Columbia Not Addressed
Florida Not Addressed
Georgia Not Addressed
Hawaii Not Addressed
Idaho Not Addressed
Illinois Required 105 ILCS 5/10-22.21b; 105 ILCS 5/22-30; 105 ILCS 5/34-18.61
Indiana Authorized; Addressed Burns Ind. Code Ann. § 20-34-4.5-2; Burns Ind. Code Ann. § 20-34-4.5-4
Iowa Not Addressed
Kansas Required Kan. Admin. Regs. 60-15-104; K.S.A. § 72-6282
Kentucky Not Addressed
Louisiana Required LAC 28:CLVII.305
Maine Required Code Me. R. tit. 05-071 Ch. 40, § 2; Code Me. R. tit. 05-071 Ch. 40, § 3
Maryland Required Md. Code Ann., Educ. § 7-421
Massachusetts Required; Addressed 105 CMR 210.001; 105 CMR 210.003; 105 CMR 210.004; 105 CMR 210.005; 105 CMR 210.006; 105 CMR 210.007; 105 CMR 210.008; 105 CMR 210.009; 603 CMR 18.05
Michigan Addressed Mich. Comp. Laws Ann. § 380.1178
Minnesota Not Addressed
Mississippi Not Addressed
Missouri Required Mo. Ann. Stat. § 167.627
Montana Not Addressed
Nebraska Not Addressed
Nevada Required Nev. Admin. Code 632.226
New Hampshire Required N.H. Admin. Rules, Ed 311.02
New Jersey Required N.J. Stat. § 18A:40-12.30; N.J. Stat. § 18A:40-12.32
New Mexico Not Addressed
New York Authorized NY CLS Educ § 919
North Carolina Not Addressed
North Dakota Authorized; Encouraged; Addressed N.D. Cent. Code, § 15.1-19-23; N.D. Cent. Code, § 23-44-03; N.D. Cent. Code, § 43-12.1-04; N.D. Cent. Code, § 43-12.1-16; N.D. Cent. Code, § 43-12.1-16.1
Ohio Not Addressed
Oklahoma Authorized 70 Okl. St. § 1-116.2
Oregon Required; Addressed OAR 581-021-0037; ORS § 339.873
Pennsylvania Not Addressed
Rhode Island Not Addressed
South Carolina Not Addressed
South Dakota Required S.D. Codified Laws § 13-33A-1
Tennessee Not Addressed
Texas Not Addressed
Utah Required Utah Code Ann. § 53G-9-502
Vermont Not Addressed
Virginia Not Addressed
Washington Authorized Rev. Code Wash. (ARCW) § 28A.210.305
West Virginia Required; Addressed W. Va. CSR § 126-25A-10; W. Va. CSR § 126-27-3; W. Va. CSR § 126-27-6; W. Va. CSR § 126-27-7; W. Va. CSR § 126-27-8
Wisconsin Not Addressed
Wyoming Not Addressed

Appendix E - Services - SHP

State Code Citation(s)
Alabama Addressed Ala. Code § 16-30A-2
Alaska Not Addressed
Arizona Authorized Ariz. Rev. Stat. Ann. § 15-344.01
Arkansas Required Ark. Code Ann. § 6-18-718
California Not Addressed
Colorado Required 1 Colo. Code Regs. § 301-68:2.00
Connecticut Not Addressed
Delaware Not Addressed
District of Columbia Not Addressed
Florida Required; Addressed Fla. Admin. Code Ann. r. 6A-6.0251; Fla. Admin. Code Ann. r. 6A-6.0252
Georgia Required Ga. Comp. R. & Regs. 160-4-8-.18
Hawaii Authorized HAR 11-146-6
Idaho Not Addressed
Illinois Required 105 ILCS 145/15
Indiana Required Burns Ind. Code Ann. § 20-34-5-12; Burns Ind. Code Ann. § 20-34-5-13; Burns Ind. Code Ann. § 20-34-5-16; Burns Ind. Code Ann. § 20-34-5-17
Iowa Not Addressed
Kansas Not Addressed
Kentucky Not Addressed
Louisiana Required LAC 28:CLVII.307; La. Stat. Ann. § 17:436.3
Maine Not Addressed
Maryland Not Addressed
Massachusetts Not Addressed
Michigan Not Addressed
Minnesota Not Addressed
Mississippi Not Addressed
Missouri Not Addressed
Montana Not Addressed
Nebraska Required Neb. Rev. Stat. Ann. § 79-3203
Nevada Not Addressed
New Hampshire Not Addressed
New Jersey Addressed N.J. Stat. Ann. § 18A:40-12.34
New Mexico Required 6.12.2.9 NMAC
New York Not Addressed
North Carolina Required N.C. Gen. Stat. § 115C-12; 16 N.C.A.C. 6D.0402
North Dakota Not Addressed
Ohio Not Addressed
Oklahoma Required 70 Okl. St. § 1210.196.3
Oregon Not Addressed
Pennsylvania Not Addressed
Rhode Island Required R.I. Gen. Laws § 16-21-32; 216 RICR 020-10-4
South Carolina Required S.C. Code Ann. § 59-63-80
South Dakota Not Addressed
Tennessee Required Tenn. Code Ann. § 49-50-1601; Tenn. Code Ann. § 49-50-1602; Tenn. Comp. R. & Regs. R. 0520-01-13-.03
Texas Required Tex. Health & Safety Code § 168.003; Tex. Health & Safety Code § 168.007
Utah Not Addressed
Vermont Not Addressed
Virginia Not Addressed
Washington Required Wash. Rev. Code Ann. § 28A.210.355
West Virginia Required W. Va. Code § 18-2K-2; W. Va. CSR § 126-25A-6
Wisconsin Not Addressed
Wyoming Not Addressed

Appendix F - Services - Screenings

State Code Citation(s)
Alabama Not Addressed
Alaska Required Alaska Stat. Ann. § 14.30.127
Arizona Required Ariz. Rev. Stat. Ann. § 36-899.10
Arkansas Required; Authorized Code Ark. R. 005.28.18-8.0; Code Ark. R. 005.28.43-12.00; Ark. Code Ann. § 6-18-701; Ark. Code Ann. § 6-18-1501
California Required; Authorized Cal. Educ. Code § 33319; Cal. Educ. Code § 49452.5; Cal. Educ. Code § 49455; Cal. Code Regs. tit. 5, § 591; Cal. Code Regs. tit. 5, § 596
Colorado Not Addressed
Connecticut Required Conn. Agencies Regs. 10-214-2; Conn. Agencies Regs. 10-214-3; Conn. Agencies Regs. 10-214-4; Conn. Gen. Stat. Ann. § 10-206
Delaware Required Code Del. Regs. 815
District of Columbia Not Addressed
Florida Not Addressed
Georgia Authorized Ga. Comp. R. & Regs. r. 511-5-6-.04
Hawaii Not Addressed
Idaho Not Addressed
Illinois Required Ill. Admin. Code tit. 23, § 1.760
Indiana Not Addressed
Iowa Not Addressed
Kansas Not Addressed
Kentucky Not Addressed
Louisiana Authorized LAC 28:CLVII.301; LAC 48:V.2103; La. Stat. Ann. § 17:2112
Maine Required; Authorized CMR 10-144-281; Code Me. R. tit. 05-071 Ch. 45, § 2; Code Me. R. tit. 05-071 Ch. 45, § 4
Maryland Not Addressed
Massachusetts Required 105 CMR 200.400
Michigan Not Addressed
Minnesota Authorized Minn. Stat. § 121A.17
Mississippi Encouraged; Addressed Miss. Code Ann. § 37-23-15; CMSR 07-000-007
Missouri Not Addressed
Montana Not Addressed
Nebraska Not Addressed
Nevada Required Nev. Admin. Code 385B.336; Nev. Rev. Stat. Ann. § 392.420
New Hampshire Not Addressed
New Jersey Required N.J.A.C. 6A:16-2.2; N.J. Stat. § 18A:40-4.3; N.J. Stat. § 18A:40A-23; N.J. Stat. § 18A:40-41.7
New Mexico Required; Authorized N.M. Code R. § 7.30.11.8; N.M. Stat. Ann. § 22-13-30
New York Required NY CLS Educ § 903; NY CLS Educ § 904; 8 NYCRR § 136.3
North Carolina Not Addressed
North Dakota Not Addressed
Ohio Not Addressed
Oklahoma Not Addressed
Oregon Required; Authorized ORS § 336.211; OAR 581-021-0031
Pennsylvania Required 28 Pa. Code § 23.11; 28 Pa. Code § 23.71; 28 Pa. Code § 23.73; 28 Pa. Code § 23.78
Rhode Island Required R.I. Gen. Laws § 16-21-10; 216 RICR 020-10-4
South Carolina Required S.C. Code Ann. § 44-29-195
South Dakota Not Addressed
Tennessee Not Addressed
Texas Not Addressed
Utah Required; Authorized Utah Code Ann. § 53G-9-403; Utah Code Ann. § 53G-9-404; U.A.C. R384-201-8; U.A.C. R384-201-9; U.A.C. R384-201-10
Vermont Not Addressed
Virginia Not Addressed
Washington Authorized WAC § 246-760-080; WAC § 246-760-100
West Virginia Required W. Va. CSR § 126-51-5
Wisconsin Authorized Wis. Stat. Ann. § 118.25
Wyoming Not Addressed

Appendix G - Immunization

State Code Citation(s)
Alabama Not Addressed
Alaska Not Addressed
Arizona Required Ariz. Rev. Stat. Ann. § 36-673; Ariz. Rev. Stat. Ann. § 36-674
Arkansas Not Addressed
California* Required Cal. Educ. Code § 49426
Colorado Not Addressed
Connecticut Not Addressed
Delaware Required Code Del. Regs. 804
District of Columbia Not Addressed
Florida Required Fla. Stat. § 1003.22
Georgia Not Addressed
Hawaii Not Addressed
Idaho Not Addressed
Illinois Not Addressed
Indiana Not Addressed
Iowa Not Addressed
Kansas Not Addressed
Kentucky Not Addressed
Louisiana Not Addressed
Maine* Required Code Me. R. tit. 05-071 Ch. 126, § 7; Code Me. R. tit. 10-144 Ch. 261, § 7; Code Me. R. tit. 10-144-261
Maryland Not Addressed
Massachusetts* Required; Authorized 105 CMR 300.191; Mass. Gen. Laws Ann. ch. 76, § 15
Michigan Not Addressed
Minnesota Not Addressed
Mississippi Not Addressed
Missouri Required Mo. Ann. Stat. § 167.181
Montana Not Addressed
Nebraska Not Addressed
Nevada Required Nev. Rev. Stat. Ann. § 391.292
New Hampshire Required RSA 200:38
New Jersey Not Addressed
New Mexico Authorized N.M. Stat. Ann. § 24-5-9
New York Not Addressed
North Carolina Not Addressed
North Dakota Not Addressed
Ohio Not Addressed
Oklahoma Not Addressed
Oregon Not Addressed
Pennsylvania Not Addressed
Rhode Island Not Addressed
South Carolina Not Addressed
South Dakota Not Addressed
Tennessee Not Addressed
Texas Authorized 25 Tex. Admin. Code § 97.65
Utah Not Addressed
Vermont Required; Authorized 18 V.S.A. § 1124; 18 V.S.A. § 1129; 12-5 Vt. Code R. § 5; CVR 13-140-021
Virginia Not Addressed
Washington Not Addressed
West Virginia Not Addressed
Wisconsin Not Addressed
Wyoming Not Addressed

Appendix H - Communicable

State Code Citation(s)
Connecticut Required Conn. Agencies Regs. 19a-36-A8 Rcol-N
District of Columbia Required D.C. Mun. Regs. tit. 22-B, § 209 RC-N; REx-N; RR-N
Georgia Required Ga. Comp. R. & Regs. 160-1-3-.03 RC-N
Idaho Required Idaho Admin. Code r. 16.02.10.020; Idaho Admin. Code r. 16.02.10.090 RR-N; A-RA-N
Illinois Required Ill. Admin. Code tit. 23, § 1.760 Rcol-N
Iowa Required 641 IAC 1.4; 641 IAC 1.6 RR-N
Maine* Required Me. Rev. Stat. tit. 20-A, § 6301; Me. Rev. Stat. tit. 20-A, § 6402-A; Code Me. R. tit. 05-071 Ch. 126, § 6; Code Me. R. tit. 10-144 Ch. 261, § 6 RC-N; REx-S; AEx-N
Maryland Required COMAR 10.06.01.04 RR-N
Massachusetts* Required Mass. Gen. Laws Ann. ch. 71, § 55A AEx-N; RR-N
Nebraska Required 173 Neb. Admin. Code Ch. 1, 1-007; 173 Neb. Admin. Code Ch. 3, 3-004 RR-N
New Mexico Required 6.12.14.8 NMAC; 7.4.3.8 NMAC RR-N
New York Required 8 NYCRR § 136.3 REx-S
Oregon Required; Addressed OAR 581-022-2220; ORS § 433.260 R-RA-N; REd-N; RR-N; REx-S
Pennsylvania Required 28 Pa. Code § 27.71; 28 Pa. Code § 27.72; 28 Pa. Code § 27.73 REx-S; R-RA-N; RC-N
West Virginia Required; Addressed W. VA. CSR § 126-42-7; W. Va. CSR § 126-51-3; W. Va. CSR § 126-51-9 REx-N; RR-N; REd-BoE
Wisconsin Required Wis. Stat. § 252.21 AEx-N; RR-N

Appendix I - COVID

State Code Citation(s)
Alabama Not Addressed
Alaska Not Addressed
Arizona Not Addressed
Arkansas Not Addressed
California Not Addressed
Colorado Not Addressed
Connecticut Not Addressed
Delaware Updated Code Del. Regs. 804; Code Del. Regs. 815
District of Columbia Not Addressed
Florida Not Addressed
Georgia Not Addressed
Hawaii Not Addressed
Idaho Not Addressed
Illinois Not Addressed
Indiana Not Addressed
Iowa Not Addressed
Kansas Not Addressed
Kentucky Not Addressed
Louisiana Not Addressed
Maine Addressed Me. Rev. Stat. tit. 20-A, § 1001
Maryland Updated COMAR 10.06.01.04
Massachusetts Not Addressed
Michigan Not Addressed
Minnesota Not Addressed
Mississippi Not Addressed
Missouri Not Addressed
Montana Not Addressed
Nebraska Not Addressed
Nevada Not Addressed
New Hampshire Not Addressed
New Jersey Not Addressed
New Mexico Addressed 6.12.14.8 NMAC
New York Addressed 8 NYCRR § 136.3
North Carolina Not Addressed
North Dakota Not Addressed
Ohio Not Addressed
Oklahoma Not Addressed
Oregon Not Addressed
Pennsylvania Not Addressed
Rhode Island Not Addressed
South Carolina Not Addressed
South Dakota Not Addressed
Tennessee Not Addressed
Texas Not Addressed
Utah Not Addressed
Vermont Updated 18 V.S.A. § 1129
Virginia Not Addressed
Washington Not Addressed
West Virginia Updated W. VA. CSR § 126-42-7
Wisconsin Not Addressed
Wyoming Not Addressed