Modifications to Accommodate Disabilities

This management bulletin provides information and policy that supersedes management bulletin SNP-07-2024 Modifications to Accommodate Disabilities in the School Meal Programs. This management bulletin provides information on the requirements related to accommodating children with disabilities for school food authorities (SFA) participating in the National School Lunch Program (NSLP), School Breakfast Program (SBP), Special Milk Program, and Fresh Fruit and Vegetable Program and regulatory updates regarding the allowability of accepting medical statements from Registered Dietitians (RD). These policy memos are available on the U.S. Department of Agriculture (USDA) Food Nutrition Service (FNS) Modifications to Accommodate Disabilities in the School Meal Programs web page at https://www.fns.usda.gov/cn/modifications-accommodate-disabilities-school-meal-programs and the Requirement to Accept Medical Statements from Registered Dietitians for Schools and Child and Adult Care Institutions and Facilities web page at https://www.fns.usda.gov/cn/requirement-accept-medical-statements-registered-dietitians.

It is also important that SFAs continue to have the option to accommodate children with special dietary needs that are not considered a disability. This includes those accommodations related to religious or moral convictions or personal preferences.

Individualized Education Program

The two federal acts that require modifications be made to accommodate disabilities in the School Nutrition Programs (SNP) are the Individuals with Disabilities Education Act of 1990 (IDEA) and Section 504 of the Rehabilitation Act of 1973 (Section 504).

IDEA requires an Individualized Education Program (IEP) for students with disabilities. An IEP, is defined as a program developed in accordance with IDEA to ensure that a child who has a disability receives specialized instruction and related services.

Section 504 requires a 504 Plan for students with disabilities. A 504 Plan is defined as a plan developed in accordance with Section 504 of the Rehabilitation Act to ensure that a child who has a disability has equitable access to the learning environment.

If the 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.

FNS guidance does not require the SFA to provide meals to children with disabilities beyond the meals provided to other children. However, schools may have additional obligations to students with disabilities under the Americans with Disabilities Act (ADA), IDEA, and Section 504 beyond the scope of FNS guidance.

SFAs may use the same food service facilities or food service management company to provide the meals required under an IEP as it uses to provide SNP meals. The U.S. Department of Education (DOE) is responsible for the administration and enforcement of the IDEA. SFAs should direct inquiries regarding IDEA requirements to the DOE IDEA web page at https://sites.ed.gov/idea/.

School Nutrition Program Regulations

Title 7, Code of Federal Regulations (7 CFR), Section 15b, specifically 15b.26(d), implements Section 504 nondiscrimination requirements. Recipients of federal financial assistance, such as SFAs, are required to serve special meals at no extra charge to children with disabilities that restrict their diet. 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 children whose disabilities restrict their diets. These regulations require SFAs to ensure that breakfast, lunch, snacks, or milk (meals) offered through the SNPs meet the respective meal pattern requirements established in the program regulations. Meeting the meal pattern requirements is necessary to obtain meal reimbursement, unless the student provides a written and signed medical statement (more information below under Requiring a Medical Statement).

Children with Disabilities

The ADA Amendments Act has simplified what constitutes a disability and it should not require extensive analysis. SFAs and local educational agencies (LEA) should not analyze 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, with respect to the SNPs, is to ensure equal opportunity to participate in or benefit from these meal programs.

Section 504, the ADA, and 7 CFR, Section 15b, define a person with a disability as any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment. Major life activities are broadly defined and include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working. Major life activities also include the operation of a major bodily function, including but not limited to, functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.

A physical or mental impairment does not need to result in a severe, life-threatening reaction to be considered a disability. It is sufficient that the impairment limits a major life activity. For instance:

• Digestion is an example of a bodily function that is a major life activity. A child whose digestion is impaired by an intolerance to lactose may have a disability regardless of whether or not consuming milk causes the child severe distress. A modification in this case is appropriate.
• An allergic reaction that is controlled by taking medication should still be considered a disability. A modification in this case is appropriate.
• A dietary preference that a child eat a gluten-free diet because a parent believes it is better for the child does not constitute a disability and does not require accommodation.

A physical or mental impairment that constitutes a disability must be on a case-by-case basis. The determination must be made without regard to whether mitigating measures may reduce the impact of the impairment.

Substitutions and other Reasonable Modifications

In many cases, reasonable dietary modifications for a child with a disability are managed within the meal pattern requirements when a well-planned variety of nutritious foods are available. However, the needs of a child with a disability may involve requests for accommodations that do not meet the meal pattern requirements.

Requiring a Medical Statement

SFAs are required to make substitutions to meals for children with a disability that restricts the child’s diet on a case-by-case basis and only when supported by a written medical statement from a state licensed healthcare professional. In California, effective April 1, 2025, RDs are permitted to complete and sign a written medical statement for school meal modifications due to a disability. The California Department of Education (CDE) continues to permit the following state licensed healthcare professionals to complete and sign a written medical statement for a disability: licensed physicians, physician assistants, and nurse practitioners. The CDE does not recognize any other medical authorities as authorized to sign a written medical statement to substantiate modifications to a student’s diet.

California allows verified electronic signatures. A written medical statement that is e-signed by the designated state licensed healthcare professional or RD can also be considered an acceptable signature.

Medical statements must:

• 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 obtain appropriate clarification to ensure a proper and safe meal is provided to the child. SFAs may consider the services of a registered dietitian to assist in implementing meal modifications. These activities are allowable program costs. SFAs may also contact the CDE for guidance.

The CDE developed a Medical Statement to Request Special Meals and/or Accommodations form (CNP-925) to identify the information required to implement a sound nutrition plan for children with dietary restrictions. The CNP-925 is located in the Download Forms Section of the Child Nutrition Information and Payment System, commonly known as CNIPS.

SFAs may choose to accommodate requests related to a disability that are not supported by a written medical statement if the requested modifications meet the meal pattern requirements.

Assessing Requests for Substitutions and other Modifications

SFAs may consider expense and efficiency in choosing an appropriate approach to accommodate a child’s disability. SFAs are not required to provide the specific substitution or other modification requested, but must offer a reasonable modification that effectively accommodates the child’s disability and provides equal opportunity to participate in or benefit from the program.

SFAs are not required to provide a specific brand name food item that may be requested or identified on the written medical statement. Instead, the child affected by an allergy must be offered the appropriate food substitution which does not contain the allergen that adversely affects the child.

SFAs should consider the age and maturity of the child when determining what is appropriate during the decision-making process. 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.

SFAs are not required to provide modifications that would fundamentally alter the nature of the program; however, instances of this are rare. Instead, the goal is to work with the parents and guardians to develop an approach that will meet the child’s needs.

Serving Meals in an Integrated Setting

Per 7 CFR, Section 15b.26(d), SFAs must 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. 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. A separate table available for children to control exposure to a severe food allergy may be an appropriate safeguard, but it cannot simultaneously be used to segregate children as punishment for misconduct.

Reimbursement

Regardless of the meal accommodation, reimbursement for modified meals served to children with disabilities is based on the child’s eligibility rate for the applicable program. These meal modifications do not have to meet the program meal pattern requirements in order to be claimed for reimbursement if they are supported by a signed written medical statement; however, SFAs should ensure that the meal modifications meet the nutritional needs of the child.

Any instruction or services included in a child’s 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 or guardians. SFAs should direct inquiries regarding funding and requirements pertaining to Part B of IDEA to the DOE IDEA web page at https://sites.ed.gov/idea/.

Accessibility

SFAs and LEAs 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 meals with accommodations.

SNPs will not receive additional reimbursement for these types of accommodations; however, costs for adaptive feeding equipment are considered allowable uses of the nonprofit school food service account. Special education funds could also be a source of supplemental funding if specified in the child’s IEP or the LEA’s general fund could supplement as well.

Procedural Safeguards

LEAs must work with school food service staff to implement procedures for parents or guardians to request meal service modifications for children with disabilities and to resolve grievances. Procedures already in place to address requests to accommodate students with disabilities in the classroom in compliance with Section 504 or the IDEA may be used to fulfill this requirement. At minimum, the LEA must:

• 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 parent or guardian to participate, be represented by counsel, and examine the record.
• Provide notice of the final decision and a procedure for review.

LEAs that employ 15 or more individuals must designate at least one person to coordinate compliance with disability requirements. This position is often referred to as the Section 504 coordinator. The Section 504 coordinator is responsible for addressing requests for accommodations in the classroom which may also include ensuring compliance with disability requirements related to meals and meal service. It is not required to designate a separate Section 504 coordinator responsible only for meal modifications. LEAs should ensure that school food service staff understand the procedures for handling requests for meal modifications and know how to contact the Section 504 coordinator.

Team Approach

A team approach to providing modifications for children with disabilities is strongly encouraged. When developing a team, ensure that the Section 504 coordinator is included. The most effective team will include:

• School food service staff
• Principal or program director
• School nurse
• School nutritionist
• Section 504 coordinator

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 will work with the child’s parents or guardian to review the request and develop a solution as quickly as possible. The Section 504 team is encouraged to develop policies and practices that allow for the disabilities they most commonly encounter to be quickly and consistently addressed. The team should be advised that any medical information obtained must be kept confidential.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Family Educational Rights and Privacy Act of 1974 (FERPA) safeguard the release of personal health information and requires medical information to be kept confidential. SFAs will need to consult with an appropriate school official or seek legal counsel around HIPAA and FERPA requirements. The CDE’s FERPA web page can be accessed at https://www.cde.ca.gov/ds/ed/dataprivacyferpa.asp.

Contact Information

If you have any questions regarding this subject, please contact the SNP Unit at SNPInfo@cde.ca.gov.