In its 7-2 ruling in Cedar Rapids Community School District v. Garret F., the court held that the Individuals With Disabilities Education Act required the district to provide Garret Frey, a medically fragile high school sophomore, with the nursing services he needed during school hours. The youth was left a quadriplegic following a motorcycle accident at age 4 and now requires continuous nursing care.

The dispute involves the Supreme Court’s interpretation of "related services" for students with disabilities under the IDEA. The court determined that the related services definition broadly encompasses those supportive services that "may be required to assist a child with a disability to benefit from special education."

In an earlier case, Irving Independent School District v. Tatro, the Supreme Court concluded that the U.S. Department of Education had reasonably determined that medical services referred to services that must be performed by a physician, not school health services.

The Tatro decision, issued by the Supreme Court in 1984, provided a two-step analysis of the related services definition--asking first whether the services requested by a parent or guardian are included within the phrase "supportive services," and second whether the services are excluded as medical services.

In addition, Tatro established a "brightline" test to gauge whether services can be classified as medical in nature and thus be excluded. The court held that the services of a physician (other than for diagnostic and evaluation purposes) are subject to the medical services exclusion, but services that can be provided in the school setting by a nurse or qualified layperson are not.

While acknowledging the district might have legitimate financial concerns, the court pointed out that its role in this dispute was to interpret existing law. The court stated that the definition in the statute does not employ cost in its definition of related services or excluded medical services. Therefore, the justices indicated that if they accepted the district’s cost-based standard as the sole test for determining the scope of the provision, it would be engaging in "judicial lawmaking without any guidance from Congress."

The court concluded that because Garret Frey must receive the services at issue to remain in school, the district must fund such related services to integrate him and other students who are medically fragile or technology dependent into the public schools.

Justice Clarence Thomas’ dissenting opinion attacked the majority’s position, arguing it ignored the fact IDEA was adopted in connection with Congress’ spending power and therefore was meant only to impose conditions on the states’ receipt of federal funding. Funding statutes are construed narrowly to avoid burdening states with obligations they could not reasonably have anticipated at the time they accepted federal funds. "Congress enacted IDEA to increase the educational opportunities available to disabled children, not to provide medical care for them," wrote Thomas.

In this case, the states could not have anticipated this extraordinary burden on school districts. As such, Thomas argued, districts should not be forced to accept this mandate of paying for related services. Schools should not be forced to bear the brunt of the costs alone.

The Cedar Rapids case involved some distinctions that result in the decision having a greater fiscal impact in the state of Iowa. Iowa has a nurse practice act that required the district to hire a registered nurse to deliver services to Garret. According to Iowa state licensure rules, school nurses must hold a license as a registered nurse issued by the board of nursing. As a result, the district faces higher costs because an R.N. must provide the related services to the special needs student. In addition, Garret did not qualify for Medicaid because he had a trust fund related to his injury.

With its decision in the Cedar Rapids case, the Supreme Court is sending a message to Congress to clarify the IDEA. As the legislative branch, Congress is the only body that can provide a more specific definition of the medical services that are excepted from the required coverage under Sec. 1401(a)(17) of the IDEA.

In addition, Congress could change administrative procedures within Medicaid to ensure reimbursements are issued to schools, amend Title 19 of the Social Security Act to ensure state plans for medical assistance provide for financial participation by the state or encourage an extension of Medicaid waivers, such as the Katie Beckett waiver, to special-needs children in schools. AASA and its members must demand that Congress clarify or change existing law.

If Congress decides not to effectuate such changes and determines that services provided by nurses are to be paid for by schools, then schools will need more funding from the federal government. Before this decision, the cost of IDEA nationwide was $60 billion per year.

In 1975, the federal government promised to fund up to 40 percent of the IDEA mandate on local communities. The federal government now funds 10.7 percent of that mandate. It is unlikely that Congress will fully fund IDEA and increase funding beyond the promised 40 percent to help defray the costs of related services.

Mandating schools to pay for the services at issue in the Cedar Rapids case will cause special education costs to rise drastically, and school budgets are already stretched too thin. Congress must act swiftly to address the issue of paying for related services so that the quality and availability of care provided to special-needs students does not suffer.

Julie Lewis is legal counsel and legislative specialist at AASA.