The proposed changes to the policy manual for nurses, personal care assistants and psychological services will significantly affect the funding our school division receives from DMAS for services provided.  These changes would impact funding to school divisions due to loss of billable time waiting for the physician to sign and return the Plan of Care, potential doctor fees for completing additional paperwork, and loss of funding for transportation for these lost billable services.  These changes would also result in increased staff time in following up on the new required information and tracking data for students who have multiple physicians that would result in a Plan of Care for each physician. School divisions would also have to submit a claim per physician which would be an additional cost to school divisions.