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Hospital Homebound
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Hospital/Homebound (HHB) services are designed to provide continuity of educational services between the classroom and home or hospital for students in Georgia public schools whose medical needs, either physical or psychiatric, do not allow them to attend school for a limited period of time. HHB instruction may be used to supplement the classroom program for students with health impairments whose conditions may interfere with regular school attendance (e.g., students receiving dialysis or radiation/chemotherapy or students with other serious health conditions). Students must be enrolled in a public school in Georgia in order to receive HHB services.

HHB services are not intended to supplant regular school services and are by design temporary. The student must anticipate being absent from school for a minimum of ten consecutive or intermittent school days due to a medical or psychiatric condition. The student’s inability to attend school for medical or psychiatric reasons must be certified by the licensed physician or licensed psychiatrist who is currently treating the student for the diagnosis presented.

 

 

 

Overview of Services

 

Georgia State Board of Education Rule 160-4-2-.31 Hospital/Homebound (HHB) Services

 

Hospital/Homebound (HHB) services are designed to provide continuity of educational services between the classroom and home or hospital for students in Georgia public schools whose medical needs, either physical or psychiatric, do not allow them to attend school for a limited period of time. HHB instruction may be used to supplement the classroom program for students with health impairments whose conditions may interfere with regular school attendance (e.g., students receiving dialysis or radiation/chemotherapy or students with other serious health conditions). Students must be enrolled in a public school in Georgia in order to receive HHB services.

 

HHB services are not intended to supplant regular school services and are by design temporary. The student must anticipate being absent from school for a minimum of ten consecutive or intermittent school days due to a medical or psychiatric condition. The student’s inability to attend school for medical or psychiatric reasons must be certified by the licensed physician or licensed psychiatrist who is currently treating the student for the diagnosis presented.

 

Student Eligibility

 

Eligibility for HHB service is based on the following criteria:

 

1. The student must be enrolled in the public school system in which he or she is requesting this service. Private or home school students are NOT eligible for HHB services from a Georgia public school.

 

2. The student must have a medical and/or psychiatric condition that is documented by a licensed physician. Only a psychiatrist can submit a medical request form for an emotional or psychiatric disorder. The psychiatric condition presented must be listed in the latest edition of the Diagnostic and Statistical Manual (DSM). The referring licensed physician and/or licensed psychiatrist must be the treating physician or psychiatrist for the medical and/or psychiatric condition for which the student is requesting HHB services. Examples include the following:

 

·  A student with leukemia may not request HHB services with a medical statement from a pediatrician. A statement from the oncologist currently treating the student is required.

 

·  A student with paranoid delusions may not request HHB services with a medical statement from a psychologist or pediatrician. The medical request must be from the licensed psychiatrist currently treating the student.

 

3. The student must be anticipated to be absent from school for a minimum of ten consecutive school days or for intermittent periods of time anticipated to exceed ten school days during the school year.

 

4. If the school is on an approved block schedule, then the ten day minimum requirement is reduced to five consecutive or five intermittent days during the school year.

 

5. Students who have been declared emancipated by a court or are 18 years of age or older are eligible to sign the Hospital/Homebound (HHB) Services Request Form and the Compliant Authorization for Exchange of Health and Education Information (The Health Insurance Portability and Accountability Act - HIPAA).

6. Students who have any form of influenza or other airborne contagious diseases will not be provided services until the licensed physician certifies that the student is no longer infectious.

7. The local education agency (LEA) may require the parent, guardian, emancipated minor, or student 18 years of age or older to sign the HIPAA form relating to the reason for the request for HHB services. If the LEA requires the HIPAA form, it must be submitted before services can be provided.

8. Students approved for intermittent HHB services must be absent for three consecutive school days on each occurrence before HHB services will be proved.

Note: Chronic illnesses that require long term intermittent absences may require students missing many days, but possibly not three consecutive days. Systems are encouraged to use their discretion and evaluate these cases on an individual basis.

Application Process

Each LEA should outline a procedure for HHB services identifying initial contact either at the school level or system level. It is recommended that the student’s school counselor, graduation coach, or school social worker be the initial contact for parents/guardians to provide information regarding the policies, procedures, and the application process.

1.  The parent/guardian, emancipated minor, or student18 years of age or older should contact the school’s HHB contact to discuss HHB services and to obtain an application for these services.

2.  The parent/guardian, emancipated minor, or student 18 years of age or older should read and sign a document to certify his or her understanding of the HHB policies, procedures and application process.

3.  The parent/guardian, emancipated minor, or student 18 years of age or older should take the HHB application to the licensed physician or licensed psychiatrist treating the student for the medical condition. The completed application must be returned to the school HHB contact. An incomplete application may cause a delay in services. Only the original paperwork will be accepted as application for hospital/homebound services.

4. The appropriate designee will review the application to ensure that the student meets the minimal eligibility requirements and submit the application to the appropriate school or system personnel for action.

5. The application will be forwarded to the appropriate school team for regular education students or Individualized Education Program (IEP) team for special education students.

6. Within five school days of receiving the completed Licensed Physician/Psychiatrist Statement and Medical Referral Form, the appropriate HHB personnel shall notify the parent, guardian, emancipated minor or student 18 years of age or older of the time and place of the school team or IEP meeting to discuss HHB services. A telephone conference call or other electronic communication may be considered a meeting.

7. The school team or IEP team will develop an Educational Service Plan (ESP) for each designated HHB student. This plan must address the disabling condition, anticipated length of absence, accommodations and modifications recommended by the licensed physician or licensed psychiatrist, instructional delivery method, place of instruction, adult parent designee if the student is under 18 years of age, team members participating, and strategies for the student’s reentry to school upon his or her return.

8. The plan does not need to be lengthy, but it must give all parties enough information to adequately serve the student’s needs.

9. If the doctor does not address reentry on the medical referral form, the LEA may want to contact the doctor directly. If such information is not provided, the school team can develop the reentry plan without doctor input.

10. The ESP shall identify the number of hours necessary to meet the instructional needs of the student. To comply with the Georgia State Board of Education Rule 160-4-2-.31 Hospital/Homebound (HHB) Services and meet attendance requirements, a minimum of three hours of instruction per week must be provided. If the LEA wishes to provide additional instructional hours, that is a local option on behalf of the district.

11. The ESP shall identify the appropriate course load for the student during the approved period of HHB instruction. It is noted that HHB instruction is not structured to supplant the regular school day and may, therefore limit the number and type of classes offered.

12. Parents/guardians of students, emancipated minors, or students 18 years of age or older who are hospitalized must follow the application process in order for the LEA to provide HHB services in the hospital setting.

13. A contractual agreement between the LEA and hospital that stipulates the services to be provided shall be entered into prior to the hospital providing HHB services.

Attendance

1.The student shall be counted present for the entire week when he or she is provided instruction on an individual basis or as part of a group by the HHB teacher for a minimum of three hours per week.

Note: The HHB code should be used to record attendance which is not the FTE code used for a student being “present”.

2. A student shall be counted absent for the week when the HHB teacher’s visit is cancelled by the parent/guardian, emancipated minor or student 18 years of age or older. The LEA may, at its discretion, reschedule the cancelled session. Once the schedule is completed, the student is counted in accordance with the Georgia State Board of Education Rule 160-5-1-.10 Student Attendance.

3. If the student is unable to receive HHB instruction during the school week due to his or her medical condition, the school may, at the school’s discretion, schedule a make-up session. Once the session is completed, the student is counted in accordance with the Georgia State Board of Education Rule 160-5-1-.10 Student Attendance.

4.Make-up sessions must have documentation that identifies the date of the absence that is being made-up, the number of hours of instruction, the type of instruction provided, and the content area(s) taught.

5. The health care facility providing approved HHB services to a student confined in the facility must submit verification of the number of instructional hours the student received to the appropriate HHB contact at the LEA for the student to be counted present during this time.

 

Scheduling

 

1.      Within five school days of receiving the completed medical referral form, the HHB services initial contact shall notify parent of the time and place of the school team for regular education students or the IEP meeting for special education students regarding HHB services and the development of the ESP. It is recommended that the team meeting be held as quickly as possible in order to assure continuity of instruction for the approved HHB student.

 

2.  The time of the instructional session shall be arranged by the HHB teacher in cooperation with the parent, guardian, emancipated minor, or student 18 years of age or older. The time of the instructional session will typically occur during the school day.

3. The parent, guardian, or approved adult parent designee as identified in the ESP must be present at the student’s home during the entire instructional period. If an adult is not present at the time of the scheduled sessions or leaves the home at any time during the scheduled session, that session shall be considered cancelled without notice and shall not be rescheduled. The student shall be counted absent for that school week.

 

4. A parent, guardian, or approved adult parent designee is not required to be in attendance during the session with students 18 years of age or older.

Instructional Delivery

1. An individual employed as an HHB teacher must hold Georgia teacher’s certification. The HHB teacher must be employed and supervised by a designated official of the LEA. The HHB teacher should have a broad background of professional training and experience so that he or she will be able to adapt instruction to each student’s needs. The HHB teacher must also be able to adjust to a variety of home situations and be knowledgeable of cultural diversity existing within his or her community.

2. HHB teachers providing educational services in a hospital must hold Georgia teacher’s certification and possess similar characteristics as teachers in an LEA.

3. HHB instruction can be offered on a one-on-one basis, or in a small group, at the home of the student, at the health care facility where the student is confined, or through online learning courses, such as the Georgia Virtual School or other approved online courses or other locations as identified by the ESP. The type of instruction offered is based on the agreement as set forth in the ESP which shall take into consideration the cognitive ability and medical condition of the student.

4. Other locations that may be considered are the public libraries, community centers, Boys and Girls Clubs, etc.

5. If instruction is provided in the student’s home a table, desk in a work space that is well ventilated, smoke-free, clean, and quiet (e.g., free of radio, TV, pets, and visitors) must be provided. A schedule for student study time between teacher visits should be established and the student should be prepared for each session with the teacher.

6. For students participating in online learning courses such as the Georgia Virtual School or other approved courses, the HHB teacher may facilitate the learning process, monitor assignments and provide tutoring assistance as defined in the ESP. Participation in an online course will meet the requirement of the minimum of three hours of HHB instruction per school week for the HHB student to be considered present by the school. For more information regarding the use of Georgia Virtual School for HHB instructional delivery, contact the Georgia Virtual School program at GaDOE: www.gadoe.org (Take Classes Online ).

7. HHB teachers shall provide direct delivery of the course materials provided by the student’s classroom teacher. The classroom teacher is required to provide to the HHB teacher a course syllabus, assignments, and tests and any supplementary materials

(i.e., study guides for quizzes/tests, chapter notes, etc.) in a timely manner.

8. All state mandated tests shall be administered unless the student is approved to take an alternate assessment as stipulated in the ESP. The decision to administer final examinations shall be included in the ESP.

9. Full credit shall be given for work completed as stipulated in the ESP.

10.  HHB instructional delivery shall focus on the core subjects, i.e., reading, language arts, mathematics, science, and social studies. However, elective courses may, at the discretion of the LEA, be included in HHB instruction for graduating seniors.

 

Safety tips for HHB Visits

·  Inform the school administrator or other responsible school employee of the destination of the HHB instructor and the expected start and end time.

·  The HHB instructor should leave a contact number for emergencies.

·  Be actively aware of surroundings inside and outside of the student’s home.

·  Carry keys and money in a pocket rather than in a purse or wallet.

·  If the instructor feels unsafe during the visit, and think there might be the threat of danger, immediately end the session and leave.

·  Do not allow parents or students to play on your sympathy and good nature to get what they want. Stay firm and stick to the curriculum.

·  Conduct a first time drive by to observe the home, the atmosphere, and the surrounding area.

Instructional Materials

1. The HHB student shall use instructional materials issued by the student’s classroom teachers. The student’s parents or guardians shall be responsible for obtaining all of the student’s books from the school prior to the first session of HHB instruction.

2. High school students approved for HHB services may receive instruction through Georgia Virtual School (GAVS) or approved online courses. Instructional resources associated with online courses shall be provided by the LEA.

3. The LEA should ensure that the HHB student is complying with the legislative requirements of HB 400 (BRIDGE) (passed during the 2010 General Assembly), HB 713 (passed during the 2012 General Assembly), and HB 186, (K-12 Career Development) (passed during the 2011 General Assembly) are being met. Communication guidelines should be established between the counselor and the HHB instructor.

4. It is the student’s and parent’s responsibility to stay current with homework and class projects and make appropriate arrangements for delivery and submission of such.

Termination of Services

1. A student is released from the HHB program:

a. As of the projected return date on the Application for Hospital/Homebound Services Medical Referral or if the licensed physician or licensed psychiatrist indicates that the medical condition has changed or as defined in the ESP.

b. When the student is employed in any capacity, goes on vacation, regularly participates in extracurricular activities, or is no longer confined to home.

c. On the last day of school of the regular school year.

d. When the student returns to school or is able to return to school for any portion of the school day other than to participate in state-mandated standardized testing.

e. When the parent/guardian cancels three HHB instructional sessions without providing 24 hours notice.

f.  When the conditions of the location where HHB services are provided, are not conducive for instruction, or threaten the health and welfare of the HHB teacher.

Eligibility Policies

1)   Eligibility for services is based on the Georgia State Board of Education Rule 160-4-2-.31 Hospital/Homebound (HHB) Services, and that a medical referral form issued from a licensed physician or licensed psychiatrist is required to determine eligibility.

2)   The Local Education Agency (LEA) HHB services personnel may contact the licensed physician or licensed psychiatrist to obtain information needed to determine if my child will be eligible for HHB services and provide appropriate instructional delivery.

3)   A child must be enrolled in a public school prior to the referral for HHB services.

4)   HHB services are for students confined to the home or hospital due to a medical or psychological condition, which is acute, catastrophic, chronic, or repeated intermittent.

5)   Parents will be required to sign an agreement regarding HHB services policies and procedures.

6)   A child eligible for HHB services, my child may be dismissed from the HHB program and may be required to return to school if his or her medical or psychological condition(s) improve as documented by a licensed physician or licensed psychiatrist.

7)   A child who is eligible for HHB services, he or she is subject to the same mandatory attendance requirements as other students.

Policies and Procedures

1)   A parent, guardian, or an approved adult parent designee as identified in the Educational Service Plan (ESP) shall be present during each entire home instructional period.

2)   A table or a desk in a workspace that is well ventilated, smoke-free, clean, and quiet (i.e., free of radio, TV, pets, and visitors) must be provided.

3)   A schedule for student study time between teacher visits will be established and the student will be prepared for each session with the teacher.

4)   Instructional materials must be obtained from the school, and assignments completed and submitted on time.

5)   Assignments will be returned to the regular school teacher for grading if the student is on HHB services for a short period of time.

6)   A parent, guardian, emancipated minor, student 18 years of age or older, or an approved adult parent designee as identified in the ESP must notify the HHB teacher at least 24 hours in advance if an instructional session must be cancelled. The LEA may, at its discretion, reschedule the cancelled session. The HHB teacher will notify the parent, guardian, or approved adult parent designee if they need to cancel a session and the session may be rescheduled.

7)   For long-term or intermittent HHB students, the HHB teacher, in collaboration with the regular school teacher, shall assign grades for the work completed.

8)   The parent/guardian, emancipated minor, or student 18 years of age or older must submit a release form from the licensed physician or licensed psychiatrist upon the student’s return to school.

9)   To extend HHB services beyond the originally identified return to school date, the licensed 
physician or licensed psychiatrist must submit an updated medical referral request form.

Cause for Dismissal

1)      If the licensed physician or licensed psychiatrist recommends that the student is able to attend school or can no longer participate or benefit from HHB services, the student will be removed from the program.

2)      If the student is employed in any capacity, goes on vacation, regularly participates in

extracurricular activities, or is no longer confined at home, the student will be removed from the program.

3)      If the parent, guardian, emancipated minor, student 18 years of age or older or adult parent designee cancels three sessions without 24 hours notice, the student will be removed from the program.

4)      If the conditions of the location where HHB services are provided are not conducive for instruction or threaten the health and welfare of the HHB teacher, the student will be removed from the program.

Frequently Asked Questions

The following Frequently Asked Questions (FAQs) are provided to assist schools, local education agencies (LEAs), parent, guardians, and others regarding Hospital/Homebound (HHB) services. The answers supplied are general in nature and may vary depending upon other facts involved in an individual case.

1.      What is the purpose of Hospital/Homebound (HHB) instruction?

The purpose of Hospital/Homebound (HHB) instruction is to sustain continuity of instruction for students who will be absent from school for medical or psychiatric reasons for a minimum of ten consecutive school days per year (five school days on an approved block schedule) or intermittent periods of time for a minimum of ten days per year (five school days on an approved block schedule), and to facilitate the student’s return to school.

2.      Can I request homebound services for a child having mental health issues?

Yes. Students with absences due to psychiatric and/or emotional disorders as defined in the latest edition of the Diagnostic and Statistical Manual (DSM) are eligible for HHB services for a length of time as determined by the Educational Service Plan (ESP)provided that they satisfy the eligibility requirements as set forth in the Georgia State Board of Education Rule 160-4-2-.31 Hospital/Homebound (HHB) Services.

3.      How do parents request HHB services?

The actual procedure for requesting homebound services is not determined by the state, but by each

education agency (LEA).

4.      Who provides HHB instruction?

Instruction is provided by a Georgia certified teacher.

5.      Is homebound instruction the same as home schooling?

No. In home schooling parents are responsible for their child’s education. The local education agency (LEA) provides HHB services to enrolled students with medical or psychiatric conditions that prevent them from attending school for a minimum of ten consecutive days per school year.

6.      Can private school or home school students receive HHB services?

No. The student must be enrolled in the public school system in which he or she is requesting this

service.

7.      If a student lives in one LEA in Georgia and attends school in another LEA, which LEA has the

responsibility for providing HHB services?

The LEA in which the student is enrolled must provide HHB services.

8.      Is a pregnant student eligible for HHB services?

Students with absences due to pregnancy, related medical conditions, services or treatment; childbirth; and recovery are eligible for HHB services provided that they satisfy the eligibility requirement for HHB service. [The Georgia State Board of Education Rule 160-4-2-.31 Hospital/Homebound (HHB) Services reflects the following Title IX, statement: Pregnancy, childbirth, false pregnancy, termination of pregnancy and recovery shall be treated as any other temporary medical condition/disability. If the school does not have a leave policy for students, or in the case of a student who does not otherwise qualify for leave under the policy, the school shall treat pregnancy, childbirth, false pregnancy, termination of pregnancy and recovery as a justification for a leave of absence for so long a period of time as is deemed medically necessary by the student’s licensed physician, at the conclusion of which the student shall be reinstated to the status which she held when leave began. Regulations implementing Title IX, 34 C.F.R. § 106.40(b) (4).]

9.      How much instructional time is provided for a student eligible for HHB services?

Although the local school team or IEP team determines the number of hours necessary to meet the instructional needs of the student, the student must receive a minimum of three hours of HHB instruction per school week to be considered present by the school system. This requirement does NOT apply to students receiving instruction via the Georgia Virtual School or other online/telecommunication courses.

10.  When students enrolled in a public school are hospitalized in health care or psychiatric facilities that do not provide education services, is the LEA obligated to provide HHB instruction in the health care facility?

Yes. Each LEA must provide academic instruction to students who are confined in a health care facility for periods that would prevent them from attending school based upon certification of need by the licensed physician or licensed psychiatrist who is treating the student for the condition for which the student is requesting HHB services.

11.  When students are hospitalized in out-of-state health care or psychiatric facilities, is the LEA obligated to provide HHB services in the out-of-state facilities?

Yes. The LEA is obligated to provide services even if the student is hospitalized out-of-state. The LEA must arrange with or contract directly with the health care facility, the LEA in which the health care facility is located, or the appropriately certified teachers in the geographic area in which the health care facility is located.

12.  What courses are available for students approved for HHB services?

Core subjects (reading, language arts, mathematics, science, and social studies) are the focus of instructional delivery with students’ receiving hospital/homebound services; however, elective courses may be included for graduating seniors.

13.  Who will provide the grades for HHB students?

The classroom teacher (in collaboration with the HHB teacher) is responsible for assigning grades.

14.  Is it permissible to use medical information/referral submitted by a nurse, dentist, chiropractor, social worker, licensed professional counselor, or psychologist to determine eligibility for HHB services?

No. Only the licensed physician (or Advanced Nurse Practitioner) or licensed psychiatrist treating the child for the presenting diagnosis can provide the certification of need (medical referral form) for students to receive HHB.

15.     Does the LEA have to provide services if a pregnant student submits a referral from a psychiatrist 
stating that the student should be placed on HHB services due to emotional issues related to the 
pregnancy, but the OB-GYN indicates that the student can attend school?

Yes, the LEA must provide services because the psychiatrist is licensed to treat mental disease and to assess the student’s psychiatric and/or emotional condition.

16.     Can HHB services be denied if there is reason to believe the medical condition identified for the student to miss school is not legitimate?

Only a person licensed to practice medicine under state law can determine if a student is unable to attend school because of illness. School personnel can discuss the situation with the doctor if the parent or guardian has signed the medical release. The school may also request a second medical opinion. It is best for the LEA in this situation to consult its local board attorney for advice.

17.  Can the LEA provide more than three hours of instruction?

The number of hours of instruction is determined by the local school team or IEP to meet the specific

needs of the individual student as identified in the ESP.

18.  Does the LEA have to provide HHB services during the summer?

Services do not have to be provided during the summer unless the student is in the special education

program and the IEP requires it.

19.  Are LEAs required to make-up sessions?

Make-up sessions are provided at the discretion of the LEA.

20.  It is difficult to get doctor’s input into the medical referral plan, it will be impossible to get input into a reentry plan.

The input of the licensed physician or psychiatrist regarding the student’s current physical or psychological condition is important and is part of the medical referral plan; if the attending physician or psychiatrist fails to provide such information, the school team can proceed to develop a reentry plan without the input.

21.  How are students counted for attendance purposes?

A student is counted present for the week if he or she receive three hours of instruction. If the student is unable to receive a scheduled HHB instructional session during the school week due to his or her medical condition as documented by the licensed physician or licensed psychiatrist who is treating the student a make-up instructional session may be provided. Once the student completes the instructional session the student shall be counted in accordance with the attendance rule.

22.  Is there ever a time when a child is counted present but no HHB service is provided?

No. The student must receive a minimum of three hours of instruction to be counted present for that

week.

23.  Can students participate in extra-curricular activities while on HHB?

The decision should be based on the student’s ESP, the physician’s statement, and the LEA if there is

not a stated policy.

 

 


Miller County Schools