Having to have the Nursing Plan of Care signed by the physician will cause extra work and loss of revenue for school divisions and the State.  The signing of the plan of care by the physician unfortunately will not be a top priority for the physician will result in services being given and not billed for in turn affecting cost report, interim billing, billing compliance review, and administrative activity claiming. Doctors generally charge for filling out forms. Who will be responsible for these changes?  This could result in the parent revoking permission for billing of Medicaid.  One student multiple doctors with multiple orders could result in excessive paperwork in tracking the time of administering medication/nursing services per each doctor. How do we know that the ordering physician is a registered ORP especially with the urgent care facilities?   Potentional financial obligations for the school division when doctor signs order for personal care and communicates with the parent and parent expects for the school to have it implemented in the IEP (one on one) The concerns in regards to the nursing plan of care will have the same effect on personal care as well. 

Time and services used to track all the paperwork will affect the money used to benefit students that could ultimately result in numerous school divisions discontinuing the billing of nursing and personal care.