School Counseling Services - Homebound Services

Statutory Basis for Medical Homebound Instruction - South Carolina Law

South Carolina’s mandates regarding medical homebound instruction appear in State Board of Education Regulation 43-241. Put in the simplest terms, R 43-241 defines “homebound instruction” as teaching that is offered to the student who has an acute or chronic medical condition that prevents him or her from attending classes at school, takes place “in a room especially set aside for the period of instruction,” and is conducted by an individual who holds a South Carolina teacher’s certificate.

Specifically, Regulation 43-241 says that students who cannot attend public school because of illness, accident, or pregnancy, even with the aid of transportation, are eligible for medical homebound instruction. A physician, nurse practitioner, or physician's assistant must certify that the student is unable to attend school but may profit from instruction given in the home or hospital. Any student participating in a program of medical homebound instruction or hospitalized instruction must be approved by the district superintendent or his or her designee on standardized forms provided by the State Department of Education. All approved forms must be maintained by the district for documentation.

Regulations Update


How does a parent arrange for his or her child to receive medical homebound instruction?

The procedure for requesting medical homebound instruction is established by the school district. Therefore, a parent should start by contacting the school counselor or a school administrator. State Board of Education Regulation 43-241 requires that a licensed physician, nurse practitioner, or physician's assistant certify that the student cannot attend school as a result of an accident, illness, or pregnancy, despite the aid of transportation, and that he or she may profit from instruction given in the home or hospital.

In addition, the physician must complete the state’s medical homebound instruction form that the school district provides. The district superintendent, or his or her designee, may or may not then approve the student’s participation in a program for medical homebound instruction.

When can medical homebound instruction begin?

State Board of Education Regulation 43-241 stipulates that a student is eligible for medical homebound instruction on the day following the last day of his or her school attendance or on the first day of the regular nine-month academic year in which the student would otherwise be enrolled if he or she were able to begin the school year. The student remains eligible until the day before he or she returns to school or until the last day of the regular academic year in the school year he or she would normally be enrolled, whichever occurs first.

Who teaches the student receiving medical homebound instruction?

Medical homebound instruction is provided either by a teacher who is regularly employed in the school district or by a teacher whom the district contracts to perform the service. State Board of Education Regulation 43-241 specifies that any teacher providing medical homebound instruction to students residing in South Carolina must hold a valid South Carolina teacher’s certificate. In most instances, the teacher providing medical homebound instruction will not be the student’s current classroom teacher. A South Carolina school district may count in membership a student who is compelled to reside outside the state to receive medical services, provided the student’s teacher is certificated by the Department of Education in the state where services are rendered.

Teachers providing medical homebound instruction are encouraged to use audiotapes, videotapes, computer software, Internet resources, and other alternative methods of instructional delivery when appropriate.

Can a parent request medical homebound instruction for a child because of a mental health problem?

Yes. A mental health problem may be a legitimate reason to request medical homebound instruction. However, a licensed physician must certify that the state of the child’s mental health is the cause of his or her inability to attend school. If the mental health diagnosis indicates that long-term medical homebound instruction will be necessary, the parent(s) will need to make arrangements for a licensed mental health professional to develop a treatment plan and strategy for reentry into the school environment.

If a physician completes a medical homebound application, isn’t the school district required to provide medical homebound instruction?

No. The superintendent of the school district, or his or her designee, must approve any medical homebound instruction request. Upon the signed authorization of the parent, the district’s medical representative may ask the physician to supply additional documentation in order to determine if medical homebound instruction is appropriate. The absence of this authorization could effect the approval process. School districts are encouraged to discuss with physicians the accommodations and modifications that can be made to keep students in the least restrictive environment.

Can the superintendent request a second medical opinion if he or she disagrees with the first physician or feels that inadequate information has been provided?

There is no regulation in federal or state law that prohibits a superintendent from doing so. If the superintendent feels that additional information is needed, then he or she may request a second medical opinion in order to gain the necessary information to approve medical homebound instruction, deny medical homebound instruction, or determine possible accommodations or modifications to allow the student to continue in his or her regular school program.

What are the student’s responsibilities in the medical homebound instruction process?

The student must realize that medical homebound instruction is an extension of regular school and all classroom rules and regulations, as well as school district policies, apply.

In addition, the student should

  • be available for all scheduled instruction;
  • be dressed appropriately;
  • have all books and materials needed for instruction;
  • complete all homework assignments;
  • remain courteous, comply with teacher requests, and use appropriate language; and
  • dedicate instruction time to instruction only (no phone calls, visiting, radio, television, and so on).

Failure to fulfill these responsibilities could result in the early termination of a student’s homebound period and/or loss of credit.

What are the parents’ responsibilities in the medical homebound instruction process?

The parents should

  • realize that before instruction can begin, all necessary paperwork must be completed;
  • ensure that the child is prepared for the arrival of the medical homebound teacher;
  • understand that during the course of medical homebound instruction, adult supervision in the home may be required in order to ensure a healthy and safe environment for both the student and the teacher;
  • make certain that the student is available for all scheduled instruction;
  • contact the homebound teacher to cancel the scheduled period of instruction in cases of emergency;
  • inform the homebound teacher of the child’s future medical appointments as early as possible if such appointments will interfere with instruction time;
  • understand that if the student is absent for his or her scheduled period of instruction, he or she is considered absent from school on that day;
  • understand that the state’s compulsory attendance laws fully apply to medically homebound students;
  • communicate with the district’s medical homebound instruction coordinator or the school’s contact person about changes in the child’s health and return-to-school plans;
  • understand that although medical homebound instruction usually takes place at home, an alternative site may be designated if circumstances warrant.