Massachusetts - Chronic Conditions: Policy requirement

Area: 
Policy Or Plan Requirements
Policy Type: 
regulation; statute
Summary: 

State law addresses plans for managing chronic conditions.

Code of Massachusetts Regulations 105 CMR 210.100: Administration of Epinephrine

(A) A public school district or non-public school, as defined by the Massachusetts Department of Education, may register with the Department for the limited purpose of permitting properly trained school personnel to administer epinephrine by auto injector in a life-threatening situation during the school day when a school nurse is not immediately available, including field trips, provided that the following conditions are met:

  • (1) the school committee or, in the case of a non-public school, the chief administrative officer, approves policies developed by the designated school nurse leader or, in the absence of a school nurse leader, a school nurse with designated responsibility for management of the program (“responsible school nurse”) governing administration of epinephrine by auto injector. This approval must be renewed every two years;

  • (2) the school committee or chief administrative officer provides an assurance to the Department that the requirements of 105 CMR 210.000 will be met;

  • (3) in consultation with the school physician, the designated school nurse leader or responsible school nurse manages and has final decision making authority about the program. This person, or school nurses designated by this person, shall select the individuals authorized to administer epinephrine by auto injector. Persons authorized to administer epinephrine shall meet the requirements of 105 CMR 210.004(B)(2);

  • (4) the school personnel authorized to administer epinephrine by auto injector are trained and tested for competency by the designated school nurse leader or responsible school nurse, or school nurses designated by this person, in accordance with standards and a curriculum established by the Department.

    • (a) The designated school nurse leader or responsible school nurse, or school nurses designated by this person, shall document the training and testing of competency.

    • (b) The designated school nurse leader or responsible school nurse, or a designee, shall provide a training review and informational update at least twice a year.

    • (c) The training, at a minimum, shall include:

        1. procedures for risk reduction

Code of Massachusetts Regulations 105 CMR 210.100: Administration of Epinephrine

(5) epinephrine shall be administered only in accordance with an individualized medication administration plan satisfying the applicable requirements of 105 CMR 210.005(E) and 210.009(A)(6), updated every year, which includes the following:

  • (a) a diagnosis by a physician that the child is at risk of a life threatening allergic reaction and a medication order containing proper dosage and indications for administration of epinephrine;

  • (b) written authorization by a parent or legal guardian;

  • (c) home and emergency number for the parent(s) or legal guardian(s), as well as the names(s) and phone number(s) of any other person(s) to be notified if the parent(s) or guardian(s) are unavailable;


Code of Massachusetts Regulations 105 CMR 210.006: Self Administration of Prescription Medications

(A) Consistent with school policy, students may self administer prescription medication provided that certain conditions are met. For the purposes of 105 CMR 210.000, "self administration" shall mean that the student is able to consume or apply prescription medication in the manner directed by the licensed prescriber, without additional assistance or direction.

(B) The school nurse may permit self medication of prescription medication by a student provided that the following requirements are met:

  • (1) the student, school nurse and parent/guardian, where appropriate, enter into an agreement which specifies the conditions under which prescription medication may be self administered;

  • (2) the school nurse, as appropriate, develops a medication administration plan ( 105 CMR 210.005(E) which contains only those elements necessary to ensure safe self administration of prescription medication;

  • (3) the school nurse evaluates the student's health status and abilities and deems self administration safe and appropriate. As necessary, the school nurse shall observe initial self-administration of the prescription medication;

  • (4) the school nurse is reasonably assured that the student is able to identify the appropriate prescription medication, knows the frequency and time of day for which the prescription medication is ordered, and follows the school self administration protocols;

  • (5) there is written authorization from the student's parent or guardian that the student may self medicate, unless the student has consented to treatment under M.G.L. c. 112, § 12F or other authority permitting the student to consent to medical treatment without parental permission;

  • (6) if requested by the school nurse, the licensed prescriber provides a written order for self administration;

  • (7) the student follows a procedure for documentation of self-administration of prescription medication;

  • (8) the school nurse establishes a policy for the safe storage of self-administered prescription medication and, as necessary, consults with teachers, the student and parent/guardian, if appropriate, to determine a safe place for storing the prescription medication for the individual student, while providing for accessibility if the student's health needs require it. This information shall be included in the medication administration plan. In the case of an inhaler or other preventive or emergency medication, whenever possible, a backup supply of the prescription medication shall be kept in the health room or a second readily available location;

  • (9) the school nurse develops and implements a plan to monitor the student's self administration, based on the student's abilities and health status. Monitoring may include teaching the student the correct way of taking the prescription medication, reminding the student to take the prescription medication


Massachusetts General Laws Annotated. Part I. Title XII. Chapter 71. Section 54B.

Notwithstanding any general or special law or regulation to the contrary, no school district shall prohibit students with asthma or other respiratory diseases from possessing and administering prescription inhalers or students with life-threatening allergies from possessing and administering epinephrine in accordance with department of public health regulations concerning students’ self-administration of prescription medications. Each school shall allow storage of epinephrine in a secure but unlocked place, as determined by the school nurse, accessible only to authorized persons, located in every part of the school grounds where an allergic student is most at risk, including, but not limited to, classrooms and lunchrooms.
General Court of the Commonwealth of Massachusetts


Massachusetts General Laws Annotated. Part I. Title XII. Chapter 71. Section 54B.

Notwithstanding any general or special law or regulation to the contrary, a school district shall not prohibit a student with diabetes from possessing and administering a glucose monitoring test and insulin delivery system, in accordance with department of public health regulations concerning a student’s self-administration of a prescription medication.
General Court of the Commonwealth of Massachusetts


Code of Massachusetts Regulations 105 CMR 210.004: Policies Regarding Delegation of Prescription Medication Administration

(A) The School Committee or Board of Trustees, consulting with the Board of Health where appropriate, may approve a proposal, developed by the school nurse and school physician, to permit the administration of prescription medications to be delegated by the school nurse to unlicensed school personnel. Such delegation may occur only if the school district registers with the Department of Public Health pursuant to the applicable provisions of 105 CMR 700.000 and complies with the requirements of 105 CMR 210.000.

(B) In accordance with the proposal of the school nurse and school physician, the School Committee or Board of Trustees may approve categories of unlicensed school personnel to whom the school nurse may delegate responsibility for prescription medication administration.

  • (1) Said categories of personnel may include administrative and teaching staff, licensed health personnel, health aides and secretaries.

    • (a) For the purposes of 105 CMR 210.000, health aide shall mean an unlicensed employee of the school district who is generally supervised by the school nurse and performs those health-related duties defined by the school nurse, the School Committee, Board of Health or Board of Trustees.

    • (b) For the purpose of administering emergency prescription medication to an individual child, including parenteral administration of medication pursuant to 105 CMR 210.004(B)(4), the school nurse may identify individual school personnel or additional categories. Said school personnel shall be listed on the medication administration plan developed in accordance with 105 CMR 210.005(E) and receive training in the administration of emergency medication to a specific child.

  • (2) An individual in an approved category may be authorized to administer prescription medication if he/she meets the following criteria:

    • (a) is a high school graduate or its equivalent;

    • (b) demonstrates sound judgment;

    • (c) is able to read and write English;

    • (d) is able to communicate with the student receiving the prescription medication or has ready access to an interpreter when needed;

    • (e) is able to meet the requirements of 105 CMR 210.000 and follow nursing supervision;

    • (f) is able to respect and protect the student's confidentiality; and

    • (g) has completed an approved training program pursuant to 105 CMR 210.007.

  • (3) A school nurse shall be on duty in the school system while prescription medications are being administered by designated unlicensed school personnel, and available by telephone should consultation be required.

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