What is Home and Hospital Instruction?
California state law affords all students enrolled in a public school the right to access the Home and Hospital Instruction ("HHI") Program. The HHI Program serves students with temporary disabilities [1] for whom it is impossible or unadvisable to attend regular classes, regardless of their disability status. HHI is an instructional model within the scope of general education regardless of whether a student is already eligible for special education services. Examples of when HHI may be appropriate for a student include when the student is in the home or hospital setting for a temporary period due to pneumonia, a communicable disease, a broken limb significantly impacting mobility, or is unable to attend school due to the death of a loved one and subsequent emotional impact. The goal of HHI is to maintain the student’s prior level of performance and support a successful transition back to the student’s regular educational program.
Responsibility To Provide Home and Hospital Instruction
California Education Code section § 48206.3 places the obligation to provide Home and Hospital Instruction (HHI) on the student’s district of residence or, when applicable, the school district in which the hospital or qualifying health facility is located.
When an enrolled student is eligible for HHI, the charter school should make every reasonable effort to provide the necessary instructional support. Responsibility should not automatically be referred to the student’s district of residence or the district in which the hospital or qualifying health facility is located. Per the California Department of Education (CDE), a student with an IEP does not participate in the statutory HHI program under EC § 48206.3. CDE states that students with IEPs do not generate HHI attendance and must instead be educated consistent with their IEP. If instruction at home or in a hospital is necessary, the IEP must provide for that instruction. Therefore, for an IEP student enrolled in a charter school, the charter school remains responsible for implementing the student's IEP, including providing whatever home-based/hospital instruction the IEP team determines is necessary to provide FAPE (see Home Hospital Instruction for Students with IEPs).
Enrollment and Right to Return to School of Origin
Assembly Bill 2109 (effective January 1, 2019) clarified several provisions related to HHI for students with temporary disabilities. The legislation authorizes, but does not require, an LEA/district to maintain enrollment for a student receiving individual instruction in a hospital, regardless of district boundaries, in order to support a student’s timely transition back to school and reduce barriers to reentry. If a student receiving HHI through another District/LEA becomes well enough to return to school during the same school year, the student has the right to return to their school of origin.
AB 2109 also allows for flexibility when a student receives individual instruction in a hospital for fewer than five days per week. For example, a student receiving medical treatment in a hospital on designated days may receive instruction from the LEA serving the hospital location while continuing to receive instruction from their school of origin on other days. Instructional arrangements may occur in the school setting or at home, depending on the student’s individual circumstances and educational needs.
Eligibility for Home Hospital Instruction
If an LEA has established HHI policies and procedures, those procedures should be followed when determining eligibility and implementing HHI. In the absence of LEA-specific policies and procedures, the guidance outlined in this section provides a framework for determining eligibility and implementing HHI in accordance with the requirements of CA EDC §§ 48206.3–48208. This includes applying the applicable eligibility criteria, documenting the basis for the HHI request, determining the appropriate instructional program, and ensuring that the student’s educational needs are addressed throughout the period of HHI.
It is the primary responsibility of the parent/guardian to notify the LEA/district of the request for Home and Hospital Instruction, or of their child’'s presence in a qualifying hospital (Education Code §48208).
A student is eligible for HHI when all of the following conditions are met:
- The condition is verified by medical documentation (e.g., a physician’s letter) from a licensed healthcare professional [2] that states the diagnosed condition and a projected date of return, and;
- The student has a temporary physical, mental, or emotional disability,
- The temporary disability was incurred while the student was enrolled in regular day classes or an alternative education program,
- The temporary disability makes it impossible or unadvisable for the student to attend regular day classes,
- The request for HHI is not based on the student’s identified disability-related needs under IDEA. For purposes of HHI eligibility, the need for instruction must arise from a temporary disability rather than the student’s ongoing disability-related educational needs. (EC § 56026)
Required Timelines
Upon receiving notification of an HHI request, the LEA/District must determine the appropriateness of HHI services within five working days of the request, based on the licensed healthcare professional's written description of the disabling condition (EC §48208). HHI shall commence no later than five working days after the LEA/District has determined that the student is eligible to receive HHI (Education Code §48207.5).
Duration, Attendance, and Return to School
A student eligible for HHI may receive one hour of individual instruction per school day, up to five hours per week, through the HHI program. For purposes of computing Average Daily Attendance (ADA), each clock hour of individual instruction counts as one day of attendance, with no more than five days of attendance credited per calendar week (EC § 48206.3). The initial HHI request should include a projected conclusion date identified by the licensed healthcare professional. LEAs/districts may use a Release from Home and Hospital Instruction form (located in the SEIS Document Library), completed by the licensed healthcare professional, to document the student’s readiness to return to school. Use of the form is recommended, but not required, and a student’s return to school should not be delayed or denied because the form has not been completed.
The LEA may consider automatically concluding HHI services for current placements at the end of the school year. If a student requires continued HHI services into a subsequent academic year, the HHI process should be reinitiated at the beginning of the new school year.
Requirements for Home Hospital Instruction Teachers
Under Education Code Section 44865, teachers assigned to home or hospital positions must hold valid teaching credentials issued by the State Board of the Commission on Teacher Credentialing and explicitly consent to the assignment.
Ultimately, the LEA/district is responsible for defining the respective roles and responsibilities of the student’s regularly assigned teacher(s) and the HHI teacher.
Regularly assigned teacher(s) may be responsible for:
- Providing instructional materials that provide a program, as consistent as possible, with the program available in the school setting.
- Maintaining an effective and ongoing working relationship with the HHI teacher.
- Grading completed work turned in via the HHI teacher.
- Responding to specific parent/student questions regarding assignments, assessment, and grades.
The HHI Teacher Responsibilities may include:
- Develop and coordinate an instructional program that provides up to five hours of instruction per week based on the student’s assigned work.
- Maintain effective and ongoing communication with the student’s assigned teachers.
- Maintain weekly attendance forms of meeting dates and total hours per week.
- Consultation with Special Education Case Manager, if applicable.
Home Hospital Instructions for Students with IEPs
Requests for Home Hospital Instruction
For students with IEPs, when a request for HHI is received, the LEA/district should convene an IEP team meeting within five days of the request.
The IEP team should review the request and determine eligibility using the criteria outlined in the Home Hospital Instruction General Information section above during an IEP team meeting. If the student is eligible for HHI, the IEP team will determine how the student’s educational program, including special education and related services, will be provided during the period of HHI based on the student’s individual needs. Services must begin within five days of the date the IEP team determines that the student is eligible for HHI. If the student’s need for instruction is related to their disability and eligibility under IDEA, the IEP team should address those needs through the typical IEP process, including any necessary changes to the student’s FAPE.
Updating the IEP for Home Hospital Instruction
Home Hospital Instruction is a temporary change in placement. When a student with an IEP is determined eligible for HHI, the IEP team must clearly document the temporary offer during the HHI period by amending the Offer of FAPE Services page and the Offer of FAPE Educational Setting page. IEP meeting notes and a Prior Written Notice (PWN) may explain and support the temporary offer, but they do not replace amendments to the offer pages.
The IEP team should determine the appropriate instruction and related services based on the student’s individual needs. In doing so, the team should consider that the goal of HHI is to maintain the student’s current level of performance and facilitate a successful transition back to the student’s regular educational setting. A student with an IEP is not automatically required to receive both general education instruction and special education services during HHI. The instructional delivery model, including the type, frequency, duration, location, and provider of services, must be individualized. Although a student may receive up to five hours per week of general HHI instruction, there is no corresponding minimum or maximum frequency or duration for SAI or related services. The frequency and duration of those services must be individualized based on the student’s unique needs, current medical circumstances, and the services necessary to provide FAPE during the HHI period.
General Instruction for a Student with an IEP
A general education teacher or a special education teacher may be identified to provide general instruction, depending on the student’s individual needs and the teacher’s credential and assignment. General instruction refers to instruction aligned with the general education curriculum and does not constitute Specialized Academic Instruction (SAI). The IEP notes should identify the general HHI instructional hours and describe how that instruction relates to the temporary offer documented on the Offer of FAPE pages.
Special Education, Related Services, and Educational Setting
The IEP team must determine which special education and related services the student requires during HHI. Services must be provided by appropriately credentialed or authorized personnel. The Offer of FAPE Services page should clearly distinguish the temporary HHI offer from the student’s pre-HHI offer by:
- Amending each current service to include a comment stating that it will not be provided as written during the HHI period. The comment should identify the temporary HHI start and end dates and state that the pre-HHI service will automatically resume when HHI concludes. Use the “Do Not Report” field as appropriate and consistent with current SEIS procedures.
- Adding each service that will be offered during HHI. Identify the appropriate frequency and duration, align the service start and end dates with the physician’s certification or documented anticipated HHI period, and identify the location as (210) Home or (220) Hospital, as applicable. The service comments should state that the service is part of the temporary HHI offer.
The Offer of FAPE Services page should expressly state that the HHI offer is temporary, identify the anticipated end date, and state that the student’s pre-HHI services will resume when HHI concludes. The end date should correspond to the physician’s certification rather than remain open-ended.
The temporary change in placement must also be reflected on the Offer of FAPE Educational Setting page. The educational setting should be updated to (401) Homebound/Hospital for the documented HHI period.
After the IEP is amended, the LEA/district should provide a PWN documenting the action, the medical basis for the temporary change, the duration of HHI, the services and placement offered during HHI, and the resumption of the student’s pre-HHI services when HHI concludes. The PWN supports the amended offer; it does not substitute for updating the Offer of FAPE pages.
If the anticipated HHI period is lengthy or the return date is genuinely uncertain, the IEP team should set a review date (no more than 8 weeks) and reconvene before the physician’s certification lapses so the temporary placement does not continue without review.
Return from Home Hospital
Before the student returns to school, the LEA/district should confirm that the physician or other authorized medical provider has cleared the student to return. If the IEP clearly states that the temporary HHI offer ends on the documented end date and that the student’s pre-HHI services and placement will resume when HHI concludes, the IEP team does not need to reconvene solely to restore the prior offer. Whether through an IEP team amendment meeting or written amendment, the Offer of FAPE must be updated to reflect the student’s return to the pre-HHI services and educational setting. Specifically:
- On the Offer of FAPE Services page, the HHI services should be identified as “Do Not Report” in SEIS, allowing the pre-HHI services to resume (remove “Do Not Report” from the student’s pre-HHI services).
- On the Offer of FAPE Educational Setting page, the pre-HHI program setting should return to the pre-HHI program setting.
Note: An IEP team meeting must be convened when there is new information to review, a change in the anticipated return date, a need to revise the student’s program, a need to plan supports for the student’s transition back to school, or a need to determine whether compensatory education is warranted. Document any determination regarding compensatory education in the IEP and address it in a subsequent PWN, as appropriate.
Home Instruction
What is Home Instruction?
Home Instruction, also referred to as Homebound Instruction or Instruction in the Home, is a placement on the continuum of services for students receiving special education services. It provides special education and related services to students with IEPs who are unable to access their regular educational setting due to disability-related needs. The need for Home Instruction may be temporary or ongoing and may include circumstances in which a student is hospitalized for medical or psychiatric purposes or cannot be educated in the public school setting due to significant health or behavioral needs.
How is Home Instruction Different from Home Hospital Instruction?
The key distinction between Home Instruction and Home and Hospital Instruction (HHI) is the basis for the student’s need for instruction. HHI serves students with a temporary disability that makes it impossible or unadvisable for them to attend regular classes, regardless of whether they are receiving special education services. In contrast, Home Instruction is provided through the student’s IEP when the student’s inability to access school relates to disability-related educational needs that do not have to be temporary.
Eligibility, Services, and Teacher Requirements for Home Instruction
To qualify for Home Instruction, a student must have an Individualized Education Program (IEP). Home Instruction may only be provided under the following circumstances (5 CCR §3051.4):
- The student has been identified as having exceptional needs (has an IEP);
- The IEP team has recommended home instruction; and
- The IEP team recommendation is based on a medical report which:
- Is from the student's attending physician, surgeon, or psychologist;
- States the diagnosed condition;
- Certifies that the student's condition prevents attendance in a less restrictive setting; and
- Contains a projected calendar date for the student's return to school.
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Note: The procedures the IEP team follows in developing an IEP for a student receiving Home Instruction are the same as those followed for any other student with special education services. The IEP team must decide whether individualized instruction is appropriate for a student with an IEP. This is not part of the general education HHI protocols.
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Determination of Services
The IEP team will determine the duration and type of instruction required to address the student's unique needs (which may be more or less than five hours per week and likely requires special education and related services). If Home Instruction is intended to be temporary, the IEP should include an end date.
Any Home Instruction program must be individually designed to ensure the student continues to make progress on goals and objectives and has access to, and can make progress in, the general education curriculum. Unlike HHI, Home Instruction may be provided over the summer if required to provide FAPE, and may exceed five hours per week if required for the student to continue progressing. Equipment or technology necessary to enable the student to benefit from Home Instruction, access the general curriculum, or make progress on IEP goals must be provided as part of FAPE.
Credentialing
Home Instruction services may include individual, small-group, or virtual instruction. A regular education teacher or specialist with the appropriate teaching or related-services credential must provide them. California law does not require a parent to be present in the home during instruction; however, when possible, it may be in the best interest of the educator and student to schedule instruction while a parent/guardian is home.
At-A-Glance: Home Hospital Instruction and Home Instruction
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Primary Purpose
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Home and Hospital
Instruction (HHI)
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HHI for Students with IEPs
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Home Instruction
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A general education instructional model for students with temporary disabilities.
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A general education model adapted for students with IEPs through the team process, allowing the student to continue receiving special education and related services, if appropriate.
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A specific placement on the continuum of special education services, based on the student's individualized needs.
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Eligibility Basis
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Temporary physical, mental, or emotional disability making attendance "impossible or unadvisable."
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A temporary disability not arising from the student’s needs related to their IDEA disability.
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Inability to access school due to ongoing or temporary disability-related needs.
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Medical Verification
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Written note from a licensed healthcare professional (Civil Code §56.05(h)).
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Written note from a licensed healthcare professional stating the condition and return date.
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Report from an attending physician, surgeon, or psychologist certifying the condition "prevents attendance in a less restrictive setting."
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Decision
Makers
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LEA/District Administration (based on medical note).
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LEA/District Administration in conjunction with the IEP Team.
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The IEP Team (sole arbiter of the placement on the continuum).
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Instructional Hours & ADA
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Max 5 hours/week. 1 hour of instruction = 1 day of attendance (EC §48206.3).
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General Instruction (max 5 hours), SAI, and related services as determined by the IEP.
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Determined by the IEP team to provide FAPE; general instruction can exceed 5 hours/week.
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Staffing Requirements
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Validly credentialed teacher who explicitly consents to the assignment (EC 44865).
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Credentialed teacher; SAI and related services must be provided by a teacher with appropriate SPED credentials.
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Specialist or regular teacher holding appropriate teaching or related-services credentials.
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Setting Duration
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Temporary, approved for a specified duration with consideration for documented timeframe requested by healthcare professional.
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Temporary, approved for a specified duration with consideration for documented timeframe requested by healthcare professional.
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Can be temporary or ongoing; not limited to the academic calendar (includes ESY).
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Citations and References
Education Code §48206.3 — Pupils with Temporary Disabilities — individual instruction; setting; ADA computation.
Education Code §48207 — Pupils with Temporary Disabilities in Hospitals Outside of the School District of Residence.
Education Code §48207.3 — Return to School of Pupil Receiving Individual Instruction.
Education Code §48207.5 — Starting Date for In-Home Individual Instruction (no later than five working days).
Education Code §48208 — Presence of Pupils with Temporary Disabilities in Qualifying Hospitals; parent notification and district timelines.
Education Code §56026 — Definition of “individual with exceptional needs” (HHI does not apply to such students).
5 CCR §3051.4 — Individual instruction in the home or hospital for students with an IEP (Home Instruction).
Civil Code §56.05(h) / 29 CFR §825.125 — Definition of a licensed “health care provider.”
Assembly Bill 2109 (2019) — Reentry, continued enrollment, partial-week instruction/ADA, and honorary diplomas.
For additional information, please contact your Charter SELPA Program Specialist. Verify all Education Code and CCR citations against current statute before adoption.
