The Massachusetts regulation requiring educational services in the home or hospital is 603 CMR 28.03(3)(c): Upon receipt of a physician's written order verifying that any student enrolled in a public school or placed by the public school in a private setting must remain at home or in a hospital on a day or overnight basis, or any combination of both, for medical reasons and for a period of not less than fourteen school days in any school year, the principal shall arrange for provision of educational services in the home or hospital. Such services shall be provided with sufficient frequency to allow the student to continue his or her educational program, as long as such services do not interfere with the medical needs of the student. The principal shall coordinate such services with the Administrator for Special Education for eligible students. Such educational services shall not be considered special education unless the student has been determined eligible for such services, and the services include services on the student's IEP.

Students must be enrolled in the district or be a special education student attending private school or be a student attending a private school who may be eligible for special education services if the medical condition is determined to be a health impairment that adversely affects educational performance.

Upon receiving documentation on the Department of Elementary and Secondary Education form 28/r (physicians’ statement) form that a student is confined to home (physically unable to attend school) or hospital for not less than 14 school days during the school year due to a medical reason, the principal shall arrange to provide the student with the amount of instruction necessary to enable the student to keep up in his/her courses of study and minimize the educational loss that might occur during the period the student is confined at home or in a hospital. There is no required 14-day waiting period before home or hospital services can commence if it is likely that the student will be absent from the school-based program for 14 school days or more in the school year. In this case, tutoring should be provided and funded from the start of the confinement.

A physician can submit other signed documentation other than the 28/r form; however it must include the date the student was admitted to the hospital or confined to home, the medical reasons for the confinement, the expected duration of the confinement and what medical needs of the student should be considered in planning home/hospital services. The request must come from a student’s personal physician (i.e. pediatrician, medical specialist, psychiatrist), not a nurse practitioner, physician’s assistant, social worker, etc.

If the school district receives a form with insufficient form, they should ask the physician to provide the required information. The district then makes a determination of whether or not the student is eligible for home/hospital services.

Services may be provided directly to the student using district employees, contracting with the hospital, another school district, or another agency to provide the needed services. Any invoices/contracts from hospitals are authorized by the principal of the school the student attends, or in the case of an out of district student, the principal of the school that the student would have attended if in-district. If the hourly rate is more than the going district tutor rate, the principal will indicate on the contract that the district will only authorize payment of the district tutor rate.

If services are provided within the home by a district employee, the district requires an adult to be present during the homebound instruction.

The school district may not preset the number of instructional hours per week provided to students. The decision must be individualized and instruction must include the same academic content as that provided in the school setting.

If a student attends an out of district placement, and the district continues to pay the costs of the placement in order to hold the enrollment status of the student while they are confined to home or a hospital, the respective collaborative or public or private school must provide, at no additional cost to the school district, appropriate educational and special educational services.

If a special education student is likely to remain at home or in a hospital for more than 60 school days in any school year, the Administrator of Special Education will convene a Team meeting without undue delay to consider evaluation needs and make changes to the IEP if needed.

LEGAL REF.: 603 CMR 28.03(3)(c)
ADOPTED: February 10, 2015