HOME/HOSPITAL (H/H)
SERVICES GUIDELINES
2022
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HOME/HOSPITAL (H/H)
SERVICES GUIDELINES
2022
Anna Marie Dufault
Assistant Superintendent Student
Engagement and Support
Prepared by:
• Annie Hetzel, MSN, RN, NCSN School Health Services Consultant Student Support
[email protected] | 360-725-6049
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TABLE OF CONTENTS
Background ............................................................................................................................................................................. 4
Submitting a Request for H/H Services ........................................................................................................................ 4
Eligibility ................................................................................................................................................................................... 5
Students Hospitalized Outside of Resident District Boundaries .................................................................... 5
Students Hospitalized at Seattle Children’s Hospital ......................................................................................... 5
Private School and Home-Schooled Students ...................................................................................................... 6
Alternative Learning Experience (ALE) Program ................................................................................................... 6
Early Learning .................................................................................................................................................................... 6
Expelled Students ............................................................................................................................................................. 6
Summer Enrollment ........................................................................................................................................................ 6
Post-Partum Students .................................................................................................................................................... 6
Students with Anxiety and School Refusal ............................................................................................................. 7
Tutor Requirements ............................................................................................................................................................. 7
Tutor Qualifications ......................................................................................................................................................... 7
H/H Tutor Administration of State Assessments ................................................................................................. 7
Duration of Services ............................................................................................................................................................. 7
Extensions ........................................................................................................................................................................... 8
Intermittent Absences .................................................................................................................................................... 8
18-week Limitation for Students who receive Services at Seattle Children’s ............................................ 8
New School Year Eligibility ........................................................................................................................................... 9
Special Education and Section 504 ................................................................................................................................ 9
Section 504 Plans ............................................................................................................................................................. 9
Special Education Services............................................................................................................................................ 9
Homebound Placement .............................................................................................................................................. 10
Reporting Students Receiving H/H Services for State Funding ....................................................................... 10
Reporting H/H Services for H/H Reimbursement on the E-525 Form ...................................................... 10
Counting Students Receiving H/H Services on the P-223 Form for Basic Education Funding ........ 10
Counting Students Receiving H/H Services on the P-223H Form for Special Education Funding 11
Reporting Absent Students Receiving H/H Services for CEDARS ............................................................... 11
H/H Services Reimbursement........................................................................................................................................ 11
Legal Notice ......................................................................................................................................................................... 12
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BACKGROUND
Home Hospital (H/H) services are in-person tutoring for students who are temporarily unable to
attend school for academic instruction due to a sickness or injury. The intent of H/H services is to
keep students current in their regular academic classes while they are temporarily absent from
school. These services are provided at a student’s home or hospital room. Virtual or remote
instructional support is not considered H/H services.
H/H services can be claimed for reimbursement by the Local Educational Agencies (LEAs). The
reimbursement amount is intended to cover the cost for the tutor and the commuting expense.
H/H determinations are strictly for reimbursement and are not prescriptive. LEAs that have
available funding to provide tutoring at a student’s home that may not qualify as H/H may do so
within their policy and as capacity allows.
For questions regarding whether an LEA is obligated to provide H/H services, LEAs should check
their policies and with their legal counsel. Additionally, when, how often, and who will provide the
H/H services should be based on the LEA’s policy.
Separately, for students eligible for special education services, the Individualized Education
Program (IEP) team determines when, how, and where the special education services will be
provided while the student is temporarily unable to attend school. See WAC 392-172A-02100
. Note
that special education services provided at a student’s home or hospital is instead homebound
special education services, not H/H services.
SUBMITTING A REQUEST FOR H/H SERVICES
Student’s parents or guardians can request H/H services by completing a LEA form or letter that
must contain the following information:
• Student’s name
• Diagnosis
• Qualified medical practitioner’s signature, date, and anticipated weeks of absences
• Beginning date that H/H services would begin
• Whether or not the IEP team needs to meet
A qualified medical practitioner is a:
• Doctor of Medicine (M.D.)
• Doctor of Osteopathy (D.O.)
• Doctor of Naturopathy (N.D.)
• Doctor of Dentistry (D.M.D.)
• Doctor of Chiropractic (D.C.)
• Physician Assistant (P.A.)
• Advanced Registered Nurse Practitioner (A.R.N.P.)
• Certified Nurse Midwife (C.N.M.)
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ELIGIBILITY
Eligibility for H/H is limited to public school students who are enrolled in a public school for basic
education instruction but are expected to be temporarily absent from in-person instruction.
H/H services are limited to a maximum of 18 weeks per school year per student. Weeks of absences
may be consecutive or intermittent but may not exceed the 18-week limit. To qualify for H/H
services on an intermittent basis, the total expected school days of absences must be at least four
weeks, but the time between the beginning and end of the H/H services can be no more than 18
weeks.
Students caring for an infant or relative who is ill are not eligible for H/H services.
H/H services for summer is limited to students who are enrolled in a summer school program that
is designed to earn credit and is not enrichment, eligible to be claimed for state funding for the
summer months but are unable to attend due to a temporary illness or injury.
H/H services cannot begin for a student if less than four weeks of school remain.
Students Hospitalized Outside of Resident District
Boundaries
A student’s resident district is responsible to provide H/H services. If a student is hospitalized for an
extended period in a hospital located in a different school district within Washington, the student’s
resident district will change. Students hospitalized in another state would no longer be considered
a resident of Washington state and the student’s original resident district is not responsible for the
student’s education until they return to the state. A resident district is one in which a student is
expected to reside for at least 20 consecutive days (See WAC 392-121-115
).
However, even if a student’s resident district changes, the student’s original school district may
continue to provide the H/H services since the student will be returning to the original district.
Ideally, the district where the hospital is located and the student’s original resident district work
together to best accommodate the student’s H/H service needs.
Students Hospitalized at Seattle Children’s Hospital
Students hospitalized at Seattle Children’s Hospital are not eligible to receive H/H services. Seattle
Children’s Hospital is provided direct funding from OSPI to offer tutoring for hospitalized students.
More information can be found at their website: Seattle Children's Hospital, School Services
, or by
phone at 206-987-6534.
While a student is hospitalized at Seattle Children’s Hospital, H/H services cannot be claimed.
Additionally, students may not be claimed for state funding on the monthly P-223 or P-223H form.
Note: The student’s time at this hospital does not count towards the 18 weeks limitation for H/H
services once the student is discharged and returns to their home.
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Private School and Home-Schooled Students
Students enrolled full time in private or home school are not eligible for H/H services. A student
must be first a public-school student prior to becoming absent and cannot enroll in public school
for the purposes of receiving H/H services.
A student who is enrolled part-time in a public school including a charter or tribal compact school
prior to their absence is eligible for H/H services. However, the H/H services are limited to the
classes that the student is enrolled in at the public school and cannot include the student’s private
or home school classes.
Alternative Learning Experience (ALE) Program
Eligibility is dependent on the attendance requirement of the ALE program. H/H services are
available to students who are temporarily unable to attend in-person school. If the ALE course does
not require attendance in a classroom and daily absences are not recorded, the student’s ALE
enrollment is not eligible for H/H services. If there is any seat-time in a classroom required by the
ALE course and if the student is expected to be absent for at least four weeks from the classroom,
then the student’s ALE enrollment is eligible for H/H services.
Early Learning
Eligibility for H/H services is limited to grades K–12 and instruction that generates K–12 basic
education funding. Preschool students are not eligible for H/H services. Transitional Kindergarten
(TK) is considered a kindergarten program and generates basic education funding. Accordingly, TK
students qualify for H/H services.
Expelled Students
LEAs remain responsible to provide education services to expelled students. Expelled students do
not qualify for H/H services unless they are subsequently reenrolled in an alternative in-person
instructional delivery model. If at that time, they become temporarily unable to attend due to
temporary illness or injury, they would qualify for H/H services.
Additionally, LEAs remain responsible to provide special education services to expelled students.
These services would be considered homebound services – not H/H services.
Summer Enrollment
H/H services for summer is limited to students who are enrolled in a summer school program that
is designed to earn credit and is not enrichment. The students must be eligible to be claimed for
state funding for the summer months but are unable to attend due to a temporary illness or injury.
Post-Partum Students
A student is eligible for H/H services during their postpartum recovery, provided a qualified
medical practitioner certifies that the student is expected to be absent for at least four weeks. H/H
services are not available for students caring for an infant.
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Students with Anxiety and School Refusal
Students with anxiety who meet the requirements of H/H may qualify for H/H services. It should be
noted that anxiety related to school attendance or school avoidance behaviors may be worsened
by prolonged absences from school. The school should work closely with the student’s family and
provider to ensure students with anxiety are receiving appropriate treatment and have a plan for
returning to school. H/H services may not be appropriate for these students as a typical treatment
plan includes gradual return to school and prolonged absences may worsen their anxiety. Please
see your district policy and the following section on duration of services for more information on
planning for re-entry to in-school instruction for students without a clear trajectory for recovery.
TUTOR REQUIREMENTS
An LEA determines who will function as H/H tutor and how many hours per week of H/H services
will be provided. H/H tutors must be employed or contracted by the LEA. Volunteers, parents, and
students who are not employed or contracted with the LEA are not eligible to provide H/H services.
Tutor Qualifications
If a student’s H/H services will include direct teaching instruction, the tutor must be a certificated
instructional staff member. If the H/H services will only include assistance to help a student to
remain current with his/her school assignments, then the tutor does not need to be certificated.
However, if the student is eligible to receive Title I, additional requirements apply. See the following
links for additional information:
• Paraeducators Guidelines
• Special Educator, Paraeducator
H/H Tutor Administration of State Assessments
H/H tutor must be trained as a proctor as described in the directions for administering the
assessment in order to administer them at the student’s home or hospital.
DURATION OF SERVICES
To qualify for H/H services, a student must be expected to be absent from school for a minimum of
4 weeks as certified by a qualified medical practitioner. However, if a student is absent for a longer
amount of time than what the qualified medical practitioner estimated, the student can continue to
qualify for H/H services for up to 18 weeks.
If the student returns to school earlier than the expected four weeks of absence, the LEA can
request H/H reimbursement for the time the student received H/H services.
Do not wait until the end of the student’s eligibility period to check in on student’s status.
Students whose temporary disability does not have a clear trajectory for recovery and return to
school should have a plan in place for regular check-ins and a timeline for when to explore other
options such as a Section 504 plan or enrollment in remote instruction. This should be discussed
early in the student’s eligibility period so the student and family can prepare for such an
eventuality.
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A temporary disability is defined as one that affects an individual for a short period of time and
usually results in recovery. The Centers for Disease Control and Prevention (CDC) defines conditions
that last a year or more and that require ongoing medical attention or limit activities of daily living
or both as chronic conditions. For the purposes of H/H, the definition of temporary disability is 18
weeks. This is generally the equivalent of half a school year.
Extensions
H/H services are intended to support students with temporary disability and are limited to 18
weeks total per school year. Any condition expected to be ongoing (past 18 weeks) does not meet
the temporary condition requirements for H/H services. Alternative options for student access to a
public education should be considered, including Section 504, remote learning options, or special
education services for conditions expected to exceed 18 weeks.
Short-term extensions of 1–2 weeks may be granted based upon individual, extenuating
circumstances such as a new diagnosis or unforeseen complication of the initial qualifying
condition or treatment. Extensions are exceedingly rare and usually only apply if the student is
expected to return within 1–2 additional weeks. There are no extensions that will allow another 18
weeks as the disability is no longer considered temporary. Students whose health condition
causing a disability has not improved enough for school re-entry after 18 weeks should be
referred to the school 504 or special education teams for an evaluation of an on-going
disability.
Factors that are considered in determining extensions:
• The nature of the health condition, whether it is projected to be resolved soon or if it is
ongoing.
• Whether there are less than four weeks left in the school year.
• Whether the student is scheduled to graduate that school year.
• Whether or not the student is expected to be well enough to attend school the following year.
Intermittent Absences
H/H services can be intermittent. The intent of H/H services to provide in-person tutoring for
student whose illness or recovery is expected to cause the student to be absent from school for at
least 4 weeks. However, if the student is well enough to attend school, they should be encouraged
to attend without terminating H/H. This does not apply to students with a chronic health condition
except when a new or secondary injury, illness, or treatment which is expected to be temporary
occurs. Any day a student was able to come to school cannot be claimed for H/H reimbursement,
but H/H services can continue.
18-week Limitation for Students who receive Services at
Seattle Children’s
The program at Seattle Children’s Hospital is a separate program. The student’s time at this
hospital does not count towards the 18 weeks limitation for H/H services.
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New School Year Eligibility
H/H services provided in one school year does not limit eligibility for the next school year. The
student must meet the eligibility requirements independent of the previous year’s request and a
new request for H/H services is required. Consideration should be taken to ensure that the
student’s health condition is not chronic and H/H services remain the best option to serve their
needs. It may be appropriate to consider the student’s needs through a Section 504 plan, remote
learning option, or special education services.
SPECIAL EDUCATION AND SECTION 504
H/H services are for temporary disabilities and in most cases are limited to 18 weeks. If a student is
expected to be absent for longer than 18 weeks due to an ongoing medical condition, an LEA must
take steps to determine if the student requires a Section 504 plan or should be referred for a
special education evaluation. Under federal and state Child Find requirements, the LEA must take
steps to conduct child find activities calculated to locate, evaluate, and identify all students who
need a Section 504 plan or special education and related services, regardless of the severity of their
disability. H/H services should not be used to delay a referral for a Section 504 or special education
evaluation.
Section 504 Plans
Most students with a health condition that requires a student to be homebound qualify as students
with a disability under Section 504 and may require a 504 plan and related accommodations.
Accommodations may include providing home tutoring beyond the time available under the H/H
program. A student’s 504 team determines how to provide a student who cannot attend school a
free appropriate education (FAPE).
It should be noted that an impairment that is episodic or in remission constitutes a disability under
Section 504 for purposes of FAPE if it would substantially limit a major life activity for the student
when active. If it is foreseeable that a student’s illness would require H/H services on an
intermittent basis, the student should be evaluated, and a Section 504 plan developed that could
include H/H services depending on the student’s needs. For more information, see:
• A Parent & Educator Guide to Free Appropriate Public Education
• OSPI Equity & Civil Rights Website
Special Education Services
Students receiving special education services may qualify for H/H services for their general
education academic classes.
A student with a health condition which requires them to be absent from school may be eligible to
receive special education services. An LEA who suspects a student may have a disability and may be
in need of special education services must follow special education referral procedures as stated in
WAC 392-172A-03005. See also
OSPI Special Education, Technical Assistance Paper No. 1 (TAP 1)
Revised.
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Homebound Placement
If a student becomes hospitalized or homebound due to a medical condition, and is eligible to
receive special education services, then the student’s IEP team determines if the student’s
placement should be homebound placement and what services the student will receive. If a student
usually attends both academic and special education classes, they may qualify to receive both
homebound services for their special education classes and H/H services for their general
education classes.
Homebound services are one of a continuum of placement options that IEP teams must
consider when determining a student with a disability’s least restrictive environment (LRE).
Homebound services are provided in the student’s home or other setting (such as a hospital)
when an IEP team determines the student needs services provided in the home due to the
student’s individual health and/or academic needs. IEP teams consider homebound instruction to
be a very restrictive environment. For example, an IEP team may determine a student who is
severely
immunocompromised requires homebound instruction. A student in a homebound placement is
entitled to FAPE that is provided in the LRE.
REPORTING STUDENTS RECEIVING H/H
SERVICES FOR STATE FUNDING
Reporting H/H Services for H/H Reimbursement on the
E-525 Form
LEAs report H/H services on the E-525 form. The link to the 2022–23 form is here. The form is an
annual one, completed at the end of the school year. The 2022–23 E-525 form is due to OSPI by
July 14, 2023.
Instructions on how to complete the E-525 form is provided on the back of the form. LEAs report
the number of weeks of H/H services provided for all their students. To calculate the weeks, count
each missed school day from the first until the last day of H/H services and divide the total number
of days by 5.
Counting Students Receiving H/H Services on the P-223
Form for Basic Education Funding
In most cases, students who are absent for more than 20 consecutive school days are excluded
from being counted on the monthly P-223 from for basic education funding. However, if the
student participated in a course of study during the current school year, prior to their extended
absence, and the parent/guardian and the LEA create a written agreement that states the student’s
academic progress will continue while absent and the student will return to school by the end of
the school year, the student’s enrollment can be counted on the next two months P-223 form. If
the student does not return to school, the enrollment must be removed from the two months they
claimed while absent.
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Students who do not attend school at the beginning of a school year due to a temporary absence
requiring H/H services cannot be claimed on the monthly P-223 form until they attend school.
Counting Students Receiving H/H Services on the P-
223H Form for Special Education Funding
A student who has an active IEP and current evaluation in place on the monthly count day, and
who received special education services in the prior month, can be claimed for special education
funding on the P-223H form. The special education services can be provided at the student’s home
or hospital.
Reporting Absent Students Receiving H/H Services for
CEDARS
If the student is actively participating in educational services, they should not be reported as
absent in Comprehensive Education Data and Research System (CEDARS). If the student is not
participating, the school days they are absent should be reported in CEDARS as excused absences.
H/H SERVICES REIMBURSEMENT
Reimbursement of H/H services will be provided by OSPI based on the number of weeks the
student was absent from school and received H/H services. Weeks for H/H reimbursement are not
calendar weeks. Every five missed school days count as one week of H/H services.
H/H funding for the months of September through June is paid based upon the projected amount
reported to OSPI by the LEA on their F-203 (State Revenue Forecast). H/H funding is adjusted in
July based upon the actual weeks of H/H services reported to OSPI on E-525 form. H/H
reimbursement is $55 for each week of tutoring for a student who is hospitalized or in a treatment
center and $60 for each week of home tutoring.
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LEGAL NOTICE
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Instruction. Original materials may be accessed at Home/Hospital Instruction | OSPI (www.k12.wa.us)
.
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Chris Reykdal | State Superintendent
Office of Superintendent of Public Instruction
Old Capitol Building | P.O. Box 47200
Olympia, WA 98504-7200
All students prepared for post-secondary pathways,
careers, and civic engagement.
