An Act To Establish Guidelines for the Stocking and Administration of Epinephrine Autoinjectors in Schools
Maine Legislature, Session 126, LD 1727
Committee Amendment CA_A_H779 (House)
Amends: 20-A MRSA §6305

COMMITTEE AMENDMENT "A" to H.P. 1235, L.D. 1727, Bill, "An Act To 
Establish Guidelines for the Stocking and Administration of Epinephrine Autoinjectors in 
Schools" 
Amend the bill by inserting after the title and before the enacting clause the 
following: 
'Mandate preamble. This measure requires one or more local units of government 
to expand or modify activities so as to necessitate additional expenditures from local 
revenues but does not provide funding for at least 90% of those expenditures. Pursuant to 
the Constitution of Maine, Article IX, Section 21, 2/3 of all of the members elected to 
each House have determined it necessary to enact this measure.' 
Amend the bill by striking out all of section 1 and inserting the following: 
'Sec. 1. 20-A MRSA §6305 is enacted to read: 
§630S. Epinephrine autoinjectors; guidelines; emergency administration 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. 
"Collaborative practice agreement" means a written and signed agreement 
between a physician licensed in this State or a school health advisor under section 
6402-A and a school nurse under section 6403-A that provides for the prescription of 
epinephrine autoinjectors by the physician or school health advisor and 
administration of epinephrine autoinjectors by a school nurse or designated school 
personnel to students during school or a school-sponsored activity under emergency 
circumstances involving anaphylaxis. 
B. "Designated school personnel" means those employees, agents or volunteers of a 
school administrative unit or an approved private school designated by a 
collaborative practice agreement between a physician licensed in this State or a 
school health advisor under section 6402-A and a school nurse under section 6403-A 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT 11" to H.P. 1235, L.D. 1727 
who have completed the training required by rule to provide or administer an 
epinephrine autoinjector to a student. 
C. 
"Epinephrine autoinjector" means a device that automatically injects a 
premeasured dose of epinephrine. 
D. "School" means a public or approved private school. 
2. 
Collaborative practice agreement; adoption authorized. 
A school 
administrative unit or an approved private school may authorize adoption of a 
collaborative practice agreement for the purposes of stocking and administering 
epinephrine autoinjectors as provided under this section. 
The administration of an 
epinephrine autoinjector in accordance with this section is not the practice of medicine. 
3. 
Collaborative practice agreement; authority. 
A collaborative practice 
agreement permits a physician licensed in this State or school health advisor under 
section 6402-A to prescribe an epinephrine autoinjector and direct a school nurse under 
section 6403-A to administer an epinephrine autoiniector in good faith to any student 
experiencing anaphylaxis during school or a school-sponsored activity. Pursuant to a 
collaborative practice agreement, a physician licensed in this State or school health 
advisor under section 6402-A may authorize the school nurse under section 6403-A 
during school or a school-sponsored activity to designate other school personnel with 
training required by rule to administer an epinephrine autoinjector if the school nurse is 
not present when a student experiences anaphylaxis. 
4. Collaborative practice agreement; terms and provisions. A collaborative 
practice agreement must include the following information: 
A. Name and physical address of the school; 
B. 
Identification and signatures of the physician or school health advisor under 
section 6402-A and school nurse under section 6403-A who are parties to the 
collaborative practice agreement, the dates the agreement is signed by each party and 
the beginning and end dates of the period of time within which the agreement is in 
effect; and 
C. Any other information considered appropriate by the physician or school health 
advisor under section 6402-A and school nurse under section 6403-A. 
5. Use of epinephrine autoinjectors without a collaborative practice agreement. 
The governing body of a school administrative unit or an approved private school may 
authorize a school nurse under section 6403-A and designated school personnel to 
administer an epinephrine autoinjector to a student in accordance with a prescription 
specific to the student on file with the school nurse and in accordance with section 254, 
subsection 5. The administration of an epinephrine autoinjector in accordance with this 
subsection is not the practice of medicine. 
6. Manufacturer or supplier arrangement. A school administrative unit or an 
approved private school may enter into an arrangement with a manufacturer of 
epinephrine autoinjectors or a 3rd-party supplier of epinephrine autoinjectors to obtain 
epinephrine autoinjectors at fair market prices or reduced prices or for free. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 1235, L.D. 1727 
7. Purchase from licensed pharmacies. A collaborative practice agreement under 
this section may provide that a school administrative unit or an approved private school 
may purchase epinephrine autoinjectors from a pharmacy licensed in this State. 
8. Guidelines. By December 1, 2015 and as needed after that date, the department 
in consultation with the Department of Health and Human Services shall develop and 
make available to all schools guidelines for the management of students with life-
threatening allergies. The guidelines must include, but are not limited to: 
A. 
Guidelines regarding education and training for school personnel on the 
management of students with life-threatening allergies, including training related to 
the administration of an epinephrine autoinjector; 
B. Procedures for responding to life-threatening allergic reactions; 
C. A process for the development of individualized health care and allergy action 
plans for students with known life-threatening allergies; and 
D. Protocols to prevent exposure to allergens. 
9. Plan. By September 1, 2016 and as needed after that date, the governing body of 
a school administrative unit or an approved private school shall: 
A. Implement a protocol based on the guidelines developed pursuant to subsection 8 
for the management of students with life-threatening allergies enrolled in the schools 
under its jurisdiction; and 
B. Make the protocol under paragraph A available on the governing body's publicly 
accessible website or the publicly accessible website of each school under the 
governing body's jurisdiction or, if those websites do not exist, make the protocol 
publicly available through other means as determined by the governing body. 
The governing body of the school administrative unit or the approved private school shall 
annually attest to the department that the schools under its jurisdiction are implementing 
the protocol in accordance with the provisions of this subsection.' 
Amend the bill in section 2 by striking out the first paragraph (page 2, lines 38 to 40 
and page 3, lines 1 to 2 in L.D.) and inserting the following: 
'Sec. 2. Rules. By December 1, 2015, the Department of Education, in consultation 
with the Department of Health and Human Services, shall amend their rules relating to 
medication administration in schools in the State to carry out the provisions of the Maine 
Revised Statutes, Title 20-A, section 6305. Rules adopted pursuant to this section are 
major substantive rules as defined in Title 5, chapter 375, subchapter 2-A. The rules 
must' 
Amend the bill in section 2 in subsection 1 in the first line (page 3, line 3 in L.D.) by 
striking out the following: "Require each school" and inserting the following: 'Encourage 
each school administrative unit and approved private school' 
Amend the bill in section 2 in subsection 1 in the 2nd line (page 3, line 4 in L.D.) by 
striking out the following: "at the school or" and inserting the following: 'in the school 
administrative unit or the approved private school or at' 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to H.P. 1235, L.D. 1727 
Amend the bill in section 2 in subsection 3 in the first line (page 3, line lOin L.D.) by 
inserting after the following: "programs" the following: 'overseen by school nurses' 
SUMMARY 
This amendment provides for the prOVISIOn and administration of epinephrine 
autoinjectors through collaborative practice agreements between physicians licensed in 
this State or school health advisors and school nurses. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 03128/14 
~ac.. 
LD 1727 
LR 2221(02) 
An Act To Establish Guidelines for the Stocking and Administration of Epinephrine in Schools 
Fiscal Note for Bill as Amended by Committee Amendment 'fi,{j/ -77ciJ 
Committee: Education and Cultural Affairs 
State Mandates 
Required Activity 
Fiscal Note Required: Yes 
Fiscal Note 
State Mandate - Exempted 
Requires the governing body of a school administrative unit or an approved private 
school to implement a protocol based on guidelines developed by the Department of 
Education for the management of students with life-threatening allergies and to 
make the protocol available on its publicly accessible website or through other 
means. 
Unit Affected 
School 
Local Cost 
Moderate 
statewide 
Pursuant to the Mandate Preamble, the two-thirds vote of all members elected to each House exempts the state from 
the constitutional requirement to fund 90% of the additional costs. 
Fiscal Detail and Notes 
Any additional costs to the Department of Health and Human Services and the Department of Education to develop 
the required guidelines and amend certain rules related to medication administration in Maine schools can be absorbed 
within existing budgeted resources. 
LR2221 (02) - Fiscal Note - Page 1 of 1