Good afternoon.  I am writing to express concern about the added layer of red tape proposed in this notice - a step that requires a doctor signature on a Plan of Care prior to our school division being able to seek reimbursement for nursing services through Medicaid.  This unnecessary and cumbersome step will likely result in significant loss in revenue and will do nothing to improve the care students receive.

Nurses author a Plan of Care based upon Doctor's orders to begin with, so I do not believe that that collaborative step needs to be replicated. 

Please consider addressing whatever the catalyst was for this change in a way that doesn't result in such potential cost to the schools and students we serve.