- What is the new rule about sports physicals?
Starting with the 2008-2009 school year, the State Board of Education requires that every athlete in the 7th and 9th grade receive a complete well child checkup (also known as an EPSDT screen) prior to participation in sports.
This rule change does not alter the way in which forms are collected or processed; it only changes: 1) the type of exam required for these two grade levels, and 2) the form that is used to report that an athlete has been cleared.
- Athletes are some of the healthiest students. Why are they being required to have an extra physical?
This is not an extra physical. The well child checkup is a broad exam that includes a thorough history, a physical exam, screening for hearing and vision, laboratory tests, immunizations, and age-appropriate education. The well child checkup also covers all the items needed so that athletes can be cleared for participation in sports, so athletes will only need this exam and not an extra sports physical.
- Does this mean that sports physicals aren't good enough for our athletes?
Sports physicals are good exams for clearing students to participate in sports. But this represents only a part of a student's total health. It is important to also address the physical, social, and emotional well-being of children. This can only be accomplished through the full well child checkup.
- What forms have to be filled out?
The only form required by the school for 7th & 9th graders is the one page "Interscholastic Sports Examination Form," available on the Department of Health website (http://health.state.tn.us/sportsphysical/). This form can be copied, distributed and linked to other websites as needed.
***The approved clearance form has a specific checkbox which states: "This athlete has completed well child exam/EPSDT screen." This box must be checked in order for all 7th and 9th grade athletes to participate in sports. This form provides the appropriate emergency information (medications, medical problems, allergies, etc) and does not violate HIPAA privacy requirements.
- When can the sports clearance form be filled out?
The clearance form can be filled out anytime after May 1.
- What happens with the forms once they are filled out?
The process for what schools do with the clearance forms is not impacted by this rule change. Unless you have been told otherwise, these forms will be processed the same way they have been in the past at your school.
- Which sports are required to have a sports clearance form?
The rule change did not impact this. For information regarding which sports require a sports clearance, check with your school. Sports that required a sports clearance form last year will still require one this year. Sports that did not require a sports clearance form this year do not require one this year. If you are asking about this, it wouldn't hurt to have one—if in doubt, get one of these exams from your health care provider.
- What about children in the 8th grade? Or 6th grade? Or 10th grade? Or any grade other than the 7th or 9th grade?
Beginning with the 2008-2009 school year, only athletes in the 7th and 9th grade will be required to have a well child checkup prior to playing sports. Athletes in all other grades will be required to turn in the same sports clearance forms as in previous years.
- What if a student was held back in either the 7th or 9th grade? Will they have to get the full exam two years in a row?
No. It is not the intent of the rule to have students have two full exams in consecutive years. The full well child checkup is only required the first time a student is classified as a 7th or 9th grader. Otherwise, the student may have the traditional pre-participation exam required in the other grades.
- What if a student had their yearly well child checkup before May 1? Will he or she have to have another exam before playing sports?
Usually not. This depends on how long it has been since the student's exam. If it has only been a few months, and their health care provider feels comfortable filling out the sports clearance form, then the student will probably not need another complete exam. However, the health care provider may want the student to come back in or talk with the family by phone to check on those health aspects related directly to sports participation. The sports clearance form must be filled out in order for the student to be eligible to participate in sports.
- What is the process for the 7th & 9th graders?
- Go to your doctor.
- If you have insurance (private or commercial insurance, TennCare, or CoverKids), then you should have an assigned doctor. If you do not do know who this doctor is, then call your insurance company.
- If you do not have insurance, then you should see if you are eligible for TennCare or CoverKids. Information about these programs is available at:
http://www.tennessee.gov/tenncare/ or 1-866-311-4287 and
http://www.covertn.gov/web/cover_kids.html or 1-866-Cover-TN.
- If you do not have insurance and you do not qualify for TennCare or CoverKids, then you can check with your local health department. Many local health departments offer these services on a sliding scale fee basis.
- What if I have a student who doesn't have health insurance? What about families who can't afford these exams?
Many children in Tennessee are eligible for TennCare (http://www.state.tn.us/tenncare) 1-866-311-4287 or Cover Kids (http://www.covertn.gov) 1-866-CoverTN. If a student does not qualify for either of these programs and does not have health insurance, they can check to see if the local health department offers the well child checkup—many offer the exam on a sliding fee scale. A list of local health departments can be found at: (http://health.state.tn.us/localdepartments.htm)
- Who can perform the well child checkup? Can nurses perform this exam?
According to the State Board of Education (SBE) Rule, the yearly well child checkup can be provided by a "physician, a nurse practitioner, or a specially trained public health nurse or registered nurse." Currently the TSSAA and SBE rules are not in sync. Some properly trained public health nurses can provide this screening and sign the form; however, they will need to have the form cosigned by a nurse practitioner or a physician (until the TSSAA bylaws are changed).
- Our school already has the mass screenings scheduled for athletes. Should my 7th & 9th graders go through that, too?
The mass screening will still be accepted for everyone except 7th and 9th graders. If a 7th or 9th grader goes through the mass screening process, they will still be required to have the separate full well-child checkup/EPSDT by their primary health care provider. The best course would be to have 7th and 9th graders just see their primary health care provider, so that they don't have to get two exams. The only required exam for 7th & 9th graders is the well-child checkup/EPSDT.
- Why is a full well child checkup being required?
Yearly well child checkups for children and adolescents are recommended by a number of professional health groups, including the American Academy of Pediatrics. These exams are important for the early diagnosis and treatment of medical problems. The yearly exam is also a good time to provide education on important health topics—nutrition, exercise, alcohol and drug use, and safety issues such as seatbelt/helmet use. Given the large number of chronic medical problems that start in childhood, it is important to tackle these problems at an early age, and to foster healthy lifestyle choices that may prevent medical problems in adulthood.
- What is the purpose of this new rule?
The ultimate goal is to improve children's health and well being through consistent care provided by a medical home. Ideally this could be expanded to cover more students (not just athletes) as a requirement for school entry. Of note, this is not planned for any particular school year; this is just a long-term thought.
This new process (for the 7th and 9th graders) is a pilot to test the capacity of the system in the event that the requirement is broadened to include more students.
This will be a new process for our students, our school officials, and our health care providers. By beginning with a small set of students (athletes in 7th and 9th grades), we will be able to understand the challenges that may arise when a large number of students need to have well child checkups
Additional Common Questions from Health Care Providers:
- What does this rule change mean to our office? How will this impact us?
Older students often do not seek annual health maintenance exams. For those who participate in sports, their yearly sports physical may serve as their only encounter with the medical system. Many of these sports physicals are done by someone other than the primary care provider. We anticipate that this rule change will result in patients coming back to you for their follow up care.
- How is my office going to accommodate all the extra students who now need a well child check/EPSDT screen?
Based on available data, it is estimated that the new rule will result in an average of 2-5 additional visits to providers per week during the months of May-July. This minimal additional volume should not pose a major burden to any practice.
- What forms will I have to fill out? Will this result in more paperwork for me or my office staff?
The State Board of Education now requires that sports clearance for 7th & 9th grade athletes be documented on the "Interscholastic Sports Examination Form," developed by the Department of Health. That form is available on the websites of the Department of Health (http://health.state.tn.us/), TN AAP (http://www.tnaap.org/), TN AFP (http://www.tnafp.org), TN Primary Care Association (http://www.tnpca.org/) and the Tennessee Medical Association (http://www.medwire.org/). Sample health maintenance exam forms that include pertinent sports pre-participation questions are available at the TN AAP website.
- My office uses an electronic medical record or already has a standard form for the health maintenance exam. So am I still required to use the forms listed above?
This will not change the provider's process if they already have a form for EPSDT or well child checks. If they have existing forms or templates built into your EMR, they can continue to use those forms. Example forms for well child checks (including the sports-related physical exam) and the preparticipation history are available on the TN AAP website (http://www.tnaap.org/). These are only examples of comprehensive forms that include all elements of the health maintenance exam (including relevant questions and exam components for patients who wish to be cleared for sports).
- What if my patient had their yearly health maintenance exam before May 1? Will he or she have to have another exam before playing sports?
Usually not. This depends on how long it has been since your patient's exam. If it has only been a few months, and you feel comfortable filling out the sports clearance form, then your patient will probably not need another complete exam. However, you may want the patient to come back in or talk with the family by phone to check on those health aspects related directly to sports participation.
