Oregon Standards for Certification

SECTION C: OPERATIONS/STAFFING

Operations

C.1   Hours of Operation Requirements: (Core SBHC)

  1. Center must be open a minimum of 3 days/week when school is in session.

  2. Center must be open for at least 15 hours/week and may include before or after school hours as necessary.

  3. Both walk-in and scheduled appointments shall be available for center services.

  4. Center must have in place a system to instruct patients where they may seek care after hours (e.g. primary care physician, emergency room, urgent care center or mental health crisis line). These instructions shall be posted outside the main entrance to the SBHC as well as available on a telephone answering system or voice mail system that can be accessed 24 hours per day on a direct phone line.

C.2   Hours of Operation Requirements: (Expanded SBHC)

  1. Center must be open each day school is in session, except for a maximum 10 closures per school year.

  2. Center should be open for at least (6) hours/day and may include before or after school hours as necessary.

  3. .Both walk-in and scheduled appointments shall be available for center services.

  4. Center must have in place a system to instruct patients where they may seek care after hours (e.g. primary care physician, emergency room, urgent care center or mental health crisis line). These instructions shall be posted outside the main entrance to the SBHC as well as available on a telephone answering system or voice mail system that can be accessed 24 hours per day on a direct phone line.

C.3   Eligibility for Services Requirements: (Core and Expanded SBHC)

  1. All students in the school are eligible for services if they have obtained the necessary consent as determined by local policy.

  2. Students 15 years of age or older are eligible for physical health services (14 years of age or older for mental health services) (OR Rev. St. 109.640, OR Rev. St. 109.675). If needed services are not available on site, appropriate referral is required (see Definition H.1.a).

  3. Students of any age are eligible for reproductive health and family planning services and for diagnosis and treatment of STDs (OR Rev. St. 109.640, OR Rev. St. 109.610). If needed services are not available on site due to local policy restrictions, appropriate referral is required (see Definition H.1.a).

  4. Students shall not be denied access or services based on insurance status or ability to pay.

  5. Students shall not be denied access to services based on race, color, national origin, religion, immigration status, sexual orientation, handicap or gender.

  6. Reasonable accommodation shall be made to provide confidential services to non-English speaking students.

C.4   Policies and Procedures Requirements: (Core and Expanded SBHC)

  1. Center must have written policies set forth and in place for:
    • non-discrimination
    • confidentiality of client services, medical records & data
    • consent for medical, mental health and AOD services (parent and/or client)
    • student rights and responsibilities
    • release of information and access to medical records
    • data management
    • schedule of standard charges (if any) for services rendered
    • method of transmitting billing and other fiscal information to agencies as appropriate, including the handling of explanation of benefits (EOB) statements for confidential patient visits
    • emergency procedures (disaster/fire/school violence)
    • reporting of child abuse and maltreatment
    • SBHC staff job descriptions with qualifications, responsibilities, supervision, evaluation
    • staff vacation and sick leave policies
    • quality assurance process
    • complaint and incident review

  2. The written policies and procedures shall be reviewed and updated every 2 years. The review shall be documented in writing.

C.5   Eligibility for Services Recommendations: (Core and Expanded SBHC)

  1. It is encouraged that Oregon State Statutes define access to services within a SBHC (e.g. students 15 years or older should be able to obtain SBHC services with self-consent and without parental consent).

C.6   Staffing Requirements: (Core SBHC)

  1. SBHC Staff shall include at a minimum:
    • Support staff (office assistant) - 15 hours/week
    • Primary care provider (NP, PA, MD, DO) - 10 hours/week, at least 2 days/week
    • Registered nurse (RN) or Mental health provider (QMHP)- 10 hours/week

    Note: At least one licensed medical professional (e.g. RN, NP, PA) or one qualified mental health professional must be available each day the center is open for clinical services.

    Note: The primary care provider may assume (but not replace) any or all of the registered nurse or mental health provider time to meet the combined professional time requirement (20 hours).

  2. A mental health provider (QMHP) and AOD assessment capacity shall be available either on site or through referral. If not available on site, a written agreement with the outside provider(s) must be in place to provide services and for sharing information between the provider and SBHC.

  3. Each SBHC shall have a designated site coordinator, with administrative duties outlined in a job description. The site coordinator shall be employed by the sponsoring agency (or one of the sponsoring agencies) and may be one of the staff listed above.

  4. Each SBHC shall have a designated medical director who is available to provide on-site clinical assistance at least monthly and who will be accessible to staff by phone to discuss clinical issues as needed (see also B.2.a).

  5. All SBHC program staff shall have the appropriate training, experience and qualifications to work with the SBHC population (children and adolescents), including basic first aid and lifesaving certification.

  6. All staff shall maintain their licensure through appropriate professional standards.

  7. To assure ability to bill for services, the primary care provider (NP, PA, MD, DO) must be eligible for reimbursement from Medicaid and/or Medicare programs and should be enrolled in the Vaccines for Children (VFC) program.

C.7   Staffing Requirements: (Expanded SBHC)

  1. SBHC Staff shall include at a minimum:
    • Support staff (office/health assistant) - 30 hours/week
    • Primary care provider (NP, PA, MD, DO) - 20 hours/week
    • Registered nurse (RN) - 20 hours/week
    • Mental health provider (QMHP) - 20 hours/week

    Note: At least one licensed medical professional (primary care provider or registered nurse) and one support staff must be available each day the SBHC is open for clinical services.

    Note: The primary care provider may assume (but not replace) any or all of the RN time to meet the combined professional time requirement (40 hours).

  2. The mental health provider shall:
    • Be a qualified mental health professional (QMHP)
    • Be trained at the Master's degree level in a mental health field
    • Be eligible for reimbursement for services rendered
    • Be able or have an agreement with a licensed professional to prescribe medications for mental health conditions as clinically indicated
    • Provide alcohol and other drug (AOD) assessment. If such capacity is not available through the mental health provider, this must be available by referral to an outside provider. A written agreement with the outside provider or agency must be in place to provide services and for sharing of information necessary to provide coordinated care.

  3. Site Coordinator: See Core SBHC (C.6.c)

  4. Medical Director: See Core SBHC (C.6.d)

  5. Training: See Core SBHC (C.6.e)

  6. Licensure: See Core SBHC (C.6.f)

  7. Reimbursement Potential: See Core SBHC (C.6.g)

C.8   Staffing Recommendations: (Core and Expanded SBHC)

  1. It is recommended that the SBHC nurse (RN) have public health training and background, given the community outreach and public health functions of this position.

  2. In sites where school nurse services are available in addition to SBHC services, it is advised that there be a clear delineation of roles and responsibilities. A written policy to address sharing of medical information (e.g. immunization records, serious medical conditions) between school nurse and SBHC staff is recommended. Where possible, it is recommended that the school nurse be co-housed with the SBHC facility to further strengthen this relationship.

  3. While the main duties of the support staff may be clerical, it is preferable to have a support staff with additional health training (e.g. health assistant, nursing aide, medical assistant, LPN) to assist with triage.

  4. The special needs of a school should be taken into account when planning the need for additional staff, such as:
    • Health educator
    • Dental hygienist/ dentist
    • Nutritionist

  5. Bilingual staff are recommended if the composition of the student population being served suggests such a need.
SECTION D: LABORATORY

Laboratory/ Diagnostic Services

D.1   Laboratory Space Requirements:

  1. Center must have a clearly designated lab space, which includes a sink and separate clean and dirty lab areas (see Facilities B.3.d and B.4.b)

D.2   Lab Certification Requirements:

  1. Center must meet OHD requirements for initial laboratory licensure for school health clinics and/or as a participant in a multiple site laboratory license.1

D.3   Laboratory Reporting Requirements:

  1. Center must have written protocols which assure timely review of lab results, documentation and follow-up of abnormal labs.
  2. Center must have a written policy in place that assures confidential handling of lab results.

D.4   Relationship with CLIA Certified Lab Requirement:

  1. Center must have a written agreement with a fully licensed (CLIA certified) lab that can provide lab services not available on site or restricted by the site license.

1 As of January 1, 2000, it is anticipated that the OHD will no longer perform the certification of lab sites for CLIA. Consequently new requirements and procedures may be necessary for lab licensing. Further guidance to follow at a later date.

D.5   Laboratory/ Diagnostic Services Requirements:

  1. The following includes services that must be available either:
    • On-site at the school-based health center (On)
    • By direct referral (Ref) from the center (see definition H.1.a)
    • Some services are considered recommended (Rec) either on-site or by referral but are not mandatory

      Elem (K-5) Middle(6-8) High 9-12
      Core EXP Core EXP Core EXP
    Urinalysis(dip) On On On On On On
    Hgb &/or Hct Ref On Ref On On On
    Blood glucose Ref On Ref On On On
    Strep Throat1 Ref On Ref On Ref On
    Venipuncture Ref On Ref On Ref On
    PPD2 Ref2 On Ref2 On Ref2 On
    Pregnancy Test3 Ref Ref On On On On
    STD/ STI4 Ref Ref On On On On
    Pap Smear Ref Ref On On On On
    HIV test Ref On Ref On Ref On
    Wet mount/KOH Rec Rec Rec Rec Rec Rec
    Blood lead level Ref Ref Ref Ref Ref Ref
    Sickle cell test Ref Ref Ref Ref Ref Ref
    Imaging (X-ray, etc.) Ref Ref Ref Ref Ref Ref

    1 rapid or culture
    2 unless significant high-risk population is present
    3 UHCG
    4 Chlamydia, GC, Syphilis

D.6   Equipment Requirements:

  1. Center must have the equipment necessary to provide all required labs and screening tests.

  2. Equipment must be maintained and calibrated regularly in compliance with all state licensing requirements.

D.7   Laboratory Recommendations:

  1. Center is encouraged to initiate regular on-site consultation with the state lab.
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