Disability Modifications Including Food Allergies

Background

Federal and state laws contain provisions to require reasonable modifications be made to school meals to accommodate children with disabilities, including food allergies on a case-by-case basis. Below are summaries on current policy guidance, which reinforces these laws that provide equal access to participate and benefit from school nutrition programs, and state laws relevant to the issue of pupils with food allergies in schools.

Federal Policy Guidance and Laws
State Laws

Federal Policy Guidance and Laws

Title 7, Code of Federal Regulations and Section 504 of the Rehabilitation Act

The USDA regulations under Title 7, Code of Federal Regulations (7 CFR), sections 15b and 15b.26(d), implements Section 504 of the Rehabilitation Act. Section 504 of the Rehabilitation Act as amended prohibits discrimination on the basis of disability in programs and activities that receive federal financial assistance.

In addition, 7 CFR, sections 210.10(m) and 220.8(m), require SFAs to make substitutions or modifications in the NSLP and SBP for students who are considered to have a disability under 7 CFR Section 15b.3 and whose disabilities restrict their diets.

The Americans with Disabilities Act (ADA) Amendments Act

The ADA Amendments Act of 2008 simplified what determines a disability and it no longer requires extensive analysis. SFAs should not be involved in analyzing documentation to determine whether a particular physical or mental impairment is severe enough to qualify as a disability. The ADA Amendments Act amended the definition of disability, broadening it to cover most physical and mental impairments, and the goal is to ensure equal opportunity to participate in or benefit from the SNPs.

The Individuals with Disabilities Education Act

The Individuals with Disabilities Education Act of 1990 (IDEA) requires an Individualized Education Program (IEP) which is defined as a plan or program developed in accordance with the IDEA to ensure that a child who has a disability receives specialized instruction and related services.  The IDEA affects the modifications required to accommodate disabilities in the SNPs. It should be noted, if a child’s IEP or 504 Plan includes the same information required in the medical statement, or if the required information is obtained by the school during the development or review of the IEP or 504 Plan, it is not necessary for the SFA to obtain a separate medical statement for a meal modification.

The U.S. Department of Education (USDE) is responsible for the administration and enforcement of the IDEA. SFAs should direct inquiries regarding IDEA requirements to the USDE IDEA web page.

State Laws

California Education Code (EC) Section 49414.2

EC Section 49414.2 requires the CDE to compile state and federal policy guidance, food allergy protocol, resources, strategies, and best-practices to minimize the risk of food allergy anaphylaxis in schools. The web page is available to SFAs, students, parents, guardians, and general public.

EC Section 49414 - Providing Emergency Epinephrine Auto-Injectors To School Nurses Or Trained Personnel; Use Of Injectors; School Procedures

School districts, county offices of education, and charter schools shall provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered pursuant to EC Section 49414 subdivision (d), and school nurses or trained personnel may use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

Health and Safety Code Section 110673 - Food Allergen Labeling Not In Conformity With Federal Requirements

Any food is misbranded if its labeling does not conform with the requirements for food allergen labeling as set forth in Section 403(w) of the federal act [21 USC Sec. 343(w)] and the regulations adopted pursuant thereto. Any food exempted from those requirements under the federal act, shall also be exempt under this section.

Definitions

The Americans with Disabilities (ADA) Amendments Act of 2008 included changes to the meaning and interpretation of the term “disability” and other terms, as set forth below. The changes demonstrated Congress’s intent to restore the broad scope of the ADA by making it easier for an individual to establish that they have a disability. After the passage of the ADA Amendments Act, most physical and mental impairments constitute a disability.

Disability
Physical or Mental Impairment
Major Life Activities
Major Bodily Functions

Disability

Disability, with respect to an individual, means: (1) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment.

Physical or Mental Impairment

Physical or mental impairment means, any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more body systems, such as: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, immune, circulatory, hemic, lymphatic, skin, and endocrine; or any mental or psychological disorder such as intellectual disability, organic brain syndrome, emotional or mental illness, and specific learning disability.

Physical or mental impairment includes but is not limited to, contagious and noncontagious diseases and conditions such as the following: orthopedic, visual, speech, hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, intellectual disability, emotional illness, dyslexia, other specific learning disabilities, Attention Deficit Hyperactivity Disorder, Human Immunodeficiency Virus infection (whether symptomatic or asymptomatic), tuberculosis, drug addiction, and alcoholism.

Major Life Activities

Major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working; and the operation of a major bodily functions.

Major Bodily Functions

Major bodily functions include the operation and functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive systems.

Meal Modification Information

The Individuals with Disabilities Education Act (IDEA) requires that any instruction or services included in a child’s individualized education plan (IEP) related to a child’s nutritional needs that are deemed necessary for the child to receive a free and appropriate public education must be provided at public expense and at no cost to the parents and guardians. Accordingly, SFAs are required to make modifications to accommodate children with disabilities at no extra charge. (Title 7, Code of Federal Regulations [7 CFR], Section 15b.26[d]). Regardless of the meal accommodation, reimbursement for modified meals served to children with disabilities is based on the child’s eligibility for free, reduced-price, or paid meals for the applicable program. SFAs must notify families of the process for requesting meal modifications and the individual responsible for coordinating modifications (7 CFR 15b.7[a]). SFAs are encouraged to use the team approach to address meal modifications, as described in further detail below. In many cases, reasonable dietary modifications for a child with a disability can be managed within the meal pattern requirements specified in 7 CFR, sections 210.10(m) and 220.8(m). In other cases, the needs of a child with a disability may involve requests for accommodations that do not meet the meal requirements, but are still reimbursable if documented with a medical statement. SFAs should direct specific inquiries regarding funding and requirements pertaining to Part B of IDEA to the U.S. Department of Education's IDEA web page .

Medical Statement
Food Allergies Guidance
Meal Service
Accessibility
Recommended Team Approach
Procedural Safeguards

Medical Statement

If a request for a meal modification for a child’s disability can be made within the USDA’s meal pattern, for example by substituting one fruit or vegetable for an another to avoid an allergy, a medical statement is optional and not necessary for reimbursement.

A disability that requires modifications outside the meal pattern is still reimbursable, provided that the request is supported by a medical statement or contained in the child’s IEP or 504 Plan. 

Consistent with USDA guidance, California allows a medical statement to be signed by a licensed physician, a physician assistant or nurse practitioner. (USDA Memo S-32 CACFP-13 SFSP-15-2015)

Medical statements should:

• Describe the physical or mental impairment sufficiently in order for the SFA to understand how it restricts a child’s diet
  
  
• Explain what must be done to accommodate a child’s disability
  
  
• Identify food or foods to be omitted from a child’s diet
  
  
• Recommend food or choice of foods that must be substituted in a child’s meals

If a written medical statement is unclear or lacks sufficient detail, the SFA must provide the accommodation to the extent it is clear and safe while obtaining appropriate clarification to ensure a proper and safe meal is provided to the child. The SFA may consider the services of a registered dietitian, when available, to assist in implementing meal modifications. SFAs may also contact the CDE for guidance. (USDA Memo SP-59-2016)

Food Allergies Guidance

Food allergies can be life threatening. School officials should be attentive to children’s complaints of physical discomfort, faintness, or other symptoms which may signal an allergic reaction. The CDC lists several phrases children may use to communicate these symptoms on their website. Examples include “my tongue itches,” “there’s a frog in my throat,” and “my mouth feels funny.” School officials should share this information widely throughout the school and develop a comprehensive emergency plan for situations where children experience an allergic reaction.

When accommodating a child’s food allergy, the SFA should ensure that no food item offered to the child contains traces of substances that may trigger an allergic reaction. For example, if a child has a peanut allergy, no foods served to the child should contain peanuts, include peanuts as an ingredient or be processed on equipment that also processes peanut products. This means food labels or specifications on food items children with allergies will consume should be checked for allergens.

The USDA Food and Nutrition Services (FNS) recommends providing the child’s parents or guardians advance copies of lunch menus so they can ask questions and raise any potential concerns. FNS advises that if a food label for a product served in the programs does not provide adequate information, it is the responsibility of the school food service to obtain the information necessary to ensure no allergic substances are present. This may require contacting the supplier or manufacturer or other reliable parties and checking with the parents or guardians. The SFA should also ensure the proper storage, preparation, and cleaning techniques are used to prevent exposure to allergens through cross contamination. Avoiding allergens may require preparing a separate meal “from scratch” using ingredients allowed on the modified diet rather than serving a meal using processed foods. In general, school food professionals should exercise caution at all times, and should not serve foods to children with severe food allergies if the full ingredient list of a food product is not available.

Meal Service

SFAs are required to provide all meal services in the most integrated setting appropriate to meet the needs of the child. Exclusion of any child from the environment is not considered an appropriate or reasonable modification, in most cases. For instance, a child may not be excluded from the classroom and required to sit in the hallway during the service of breakfast in the classroom. The IDEA requires that a child’s disability be accommodated in the least restrictive environment. This means that students are entitled to be located with their nondisabled peers to the maximum extent appropriate. However, a separate, specially-cleaned table, may be medically necessary to control exposure to a severe food allergy. Prior to developing such a special seating arrangement, the school should determine, with input from the child’s parents or guardians and the licensed professional who signed the medical statement, if this type of seating arrangement is medically necessary (20 USC Section 1412[a][5] ; 34 CFR Section 300.114[a] ; 7 CFR Section15b.4[b][2] )

Accessibility

SFAs are responsible for the accessibility of food service areas and for ensuring the provision of food service aides, where needed, to assist in preparing and serving meal accommodations. (7 CFR Section 15b.13; 7 CFR sections 15.b18-23, 26; 34 CFR Section 300.704(c)(4)(ii) )

Recommended Team Approach

In the 2017 USDA Guidance Manual entitled Accommodating Children with Disabilities in School Meal Programs (Guidance Manual), the USDA recommends the “team approach” described below to handle modification requests. SFAs are encouraged to make the process of requesting a meal modification as simple and straightforward as possible.

LEAs that employ 15 or more individuals must designate at least one person to coordinate compliance with disability requirements. [7 CFR 15b.6 ]This position is often referred to as the Section 504 coordinator.

In many cases, the Section 504 coordinator leads the team and is responsible for addressing requests for accommodations in the school. As part of their general responsibilities, this individual also may be responsible for ensuring compliance with disability requirements related to meal modifications and the meal service. Regardless of whether the coordinator works in the school food service, the coordinator must ensure school food service professionals understand the procedures for handling meal modification requests.

The Section 504 team should discuss best practices and develop a holistic plan to create a safe learning environment for children. This team approach encourages information sharing throughout the school, and may help protect children in situations where food is served outside the cafeteria, such as during classroom parties. Team members may include, but are not limited to:

• School food service staff
  
  
• Principal or program director
  
  
• School nurse
  
  
• School nutritionist

Any request for a modification related to the meal or meal service should be forwarded to the Section 504 coordinator and reviewed by the Section 504 team.

The Section 504 team should work with the child’s parents and guardians to review the request, the medical statement, and any IEP or 504 plans in order to develop a solution as quickly as possible.

If a medical statement does not fully explain the modification needed, the SFA should immediately contact the child’s parent or guardian for guidance and ask the family to provide an amended medical statement as soon as possible. However, clarification of the medical statement should not delay the SFA from providing a meal modification. SFAs should follow the portion of the medical statement that is clear and unambiguous to the greatest extent possible, while obtaining the additional information.

When making meal modifications, SFAs should also consider the age and maturity of the child. For instance, younger children may need more assistance with selecting and eating their meals while older children may be able to take more responsibility for some of their dietary decisions. The Section 504 team can also ensure schools make sure allergic children understand the importance of not sharing food with their peers. This will help children better understand their role in preventing food allergy emergencies. Schools may even consider integrating allergy education into other coursework. The Section 504 team is also encouraged to develop policies and practices that address the disabilities they most commonly encounter so that these disabilities can be quickly and consistently addressed in a proper manner.

The Section 504 team should be advised that any personal information obtained must be kept confidential and not used or disclosed except as allowed by applicable law. The Family Educational Rights Privacy Act (FERPA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and various state laws safeguard the release and use of personal information obtained by schools, including medical statements.

SFAs are encouraged to consider children’s cultural, religious, and ethical preferences when planning and preparing meals. Accommodating children’s preferences helps to maintain participation in the NSLP and SBP. Variations, whether on an experimental or continuing basis, must be consistent with the food and nutrition requirements specified in Program regulations in order for children’s meals to be eligible for reimbursement

In some situations, a medial statement may require a particular brand of product as a substitute, rather than specifying a generic alternative. The SFA should provide the brand required in the medical statement, unless a generic or alternative brand is authorized by the family through the Section 504 team process. 

Generally, the SFA must provide the modification required by the medical statement. In very rare cases, the modification request could be denied because the cost of the modification would fundamentally alter the nature of the SFA’s program, but only if the SFA can prove that the LEA cannot afford to make the modification, based on all of the resources that are available. If an SFA declines a request, the SFA is required to ensure that the child’s parents and guardians understands their rights under the procedural safeguards process.

Procedural Safeguards

LEAs should work with the school food service staff to implement procedures for parents and guardians to request modifications to meal service for children with disabilities and to resolve grievances. LEAs may use their existing procedures to address requests to accommodate students with disabilities in the classroom in compliance with Section 504 of the Rehabilitation Act or the IDEA to receive requests and resolve grievances for food service modifications.  

Under the procedures, the LEA must, as a minimum:

• Notify parents and guardians of the process for requesting meal modifications to accommodate a child’s disability

• Arrange for an impartial hearing process to resolve grievances related to requests for modifications based on a disability

• Include the opportunity for the child’s parents and guardians to participate, be represented by counsel, and examine the record

• Provide notice of the final decision and a procedure for review

For more information on the LEA’s role in providing parents and guardians with guidance on the civil rights and complaint process, visit the CDE's USDA Civil Rights and Complaints web page.

 

Compliance

SFAs are required to comply with legal requirements for meal accommodations. The CDE monitors SFA legal compliance during the Administrative Review (AR). The CDE provides technical assistance when the standards are not met. There will be an off-site assessment (OAT) and an on-site review. Please see the following AR guidance:

• Administrative Review Off-site Assessment Tool (OAT) Guidance

  SFAs are required to fill out the OAT prior to the on-site review. To download the OAT guidance in Child Nutrition Information and Payment System (CNIPS), select SNP, Applications, Download Forms, and select Form ID SNP 58 AR. For accommodating disabilities in the SNPs information, search question 805.

• Administrative Review Guidance Chart

  Once the OAT is completed, the AR reviewer conducts an on-site review to validate the information submitted in the OAT and to observe the operation of programs at the SFA and in selected schools. Prior to the on-site review, the state reviewer sends the SFA the Administrative Review Guidance Chart, so the SFA can prepare all required documents for the on-site review. To download the guidance chart in CNIPS, select SNP, Applications, Download Forms, and select Form ID SNP 42. For accommodating disabilities in the SNPs information, search disability.

• USDA Administrative Review Manual 2018–19

  USDA FNS provides general guidance to state agencies on the areas of review. To download the AR Manual in CNIPS, select SNP, Applications, Download Forms, and select Form ID MANUAL AR. For meal modifications for children with disabilities,search meal modifications.

For more information regarding Administrative Reviews, you can visit the CDE’s School Nutrition Programs Administrative Review web page

Trainings

This section provides online nutrition and operation training information to assist sponsors of the School Nutrition Programs (SNP) to better understand the expectations for accommodating children with disabilities.

Online Courses

 

Resources

For more information on accommodating disabilities in the school setting, refer to the following reliable resources.

General Resources
Forms

General Resources

 

Forms

 

Policy

The following policy memoranda and supporting guidance manual are related to modifications to accommodate disabilities in the School Nutrition Programs (SNP). When merited, the CDE released a subsequent management bulletin to include state specific policy guidance and/or further explain or clarify the topic.

Policy Guidance
Guidance Manual

Policy Guidance

Guidance Manual

FAQs

The CDE is providing frequently asked questions (FAQ) to help clarify common questions regarding Modifications to Accommodate Children with Disabilities in the SNPs. For more questions and answers, refer to USDA Accommodating Disabilities in the School Meal Programs: Guidance and Q&As.

Question: If the child no longer needs a meal modification, can the SFA stop providing the amended diet without the state licensed healthcare professional's approval?

Yes. The USDA does not require SFAs to obtain written documentation from a state licensed healthcare professional rescinding the original diet prescription to end the amended diet. However, it is a best practice to get the child’s parents and guardians to sign a statement indicating their child no longer needs a meal modification before ending the accommodation.

Question: Does the SFA need to receive a completed written medical statement prior to implementing the dietary restrictions?

No. Per USDA Guidance Manual, the SFA should begin providing a reasonable modification to keep the child safe, and request the family provide a medical statement completed and signed by a state licensed healthcare professional to support the meal modification as soon as possible.

Question: Is a food allergy considered a disability?

A food allergy will generally be considered a disability. Per the definition of disability in the ADA, a food allergy does not need to be life-threatening or cause anaphylaxis in order to be considered a disability. A non-life-threatening allergy may be considered a disability and require a meal modification, if it impacts a major bodily function or other major life activity (such as digestion, respiration, immune response, skin rash, etc.).

Question: How often must the medical statement be updated?

The USDA does not require SFAs to obtain updated medical statements on a regular basis. When SFAs receive updated medical information, they must ensure that medical statements on file reflect the current dietary needs of participating children. SFAs may require updates as necessary to meet their responsibilities, but should carefully consider the burden obtaining additional medical statements could create for parents and guardians when establishing such requirements.

Contacts

If you have any questions, please contact the School Nutrition Program Unit by email at SNPInfo@cde.ca.gov.

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