CurrentHealth NetPolicy N/A

Asthma Remediation Community Support — Authorization and Coverage Criteria

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Governs authorization and provision of in‑home asthma remediation supplies and physical modifications for Medi‑Cal members in California, describing eligibility, required documentation, limits, and provider requirements for Health Net‑managed services.

Policy Summary

PayerHealth Net

PolicyAsthma Remediation Community Support — Authorization and Coverage Criteria

Policy CodePolicy N/A

Change TypeAdministrative update (no material clinical changes)

Effective DateDec 16, 2025

Last ReviewDec 16, 2025

Next Review DateN/A

Key ActionSubmit the Asthma Remediation Authorization Form with a completed in‑home environmental trigger assessment (within 12 months) and required documents to request authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$7,500lifetime max

12 monthsassessment window

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CurrentHealth NetPolicy N/A

Asthma Remediation Community Support — Authorization and Coverage Criteria

Customize your policy alerts

Sign up for all Health Net policy alerts

Know when Health Net releases new policies or updates existing guidance.

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Policy Summary

PayerHealth Net

PolicyAsthma Remediation Community Support — Authorization and Coverage Criteria

Policy CodePolicy N/A

Change TypeAdministrative update (no material clinical changes)

Effective DateDec 16, 2025

Last ReviewDec 16, 2025

Next Review DateN/A

Key ActionSubmit the Asthma Remediation Authorization Form with a completed in‑home environmental trigger assessment (within 12 months) and required documents to request authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$7,500lifetime max

12 monthsassessment window

Mechanical onlyair cleaners allowed

Californiajurisdiction

Coverage and Exclusions

Initial Authorization Criteria

Covered when ALL of the following are met

Assessment requirement: Member has a completed in-home environmental trigger assessment through the Asthma Preventive Services (APS) benefit within the past 12 months that identifies which asthma remediation interventions are medically appropriate and explains how they address the member's specific needs.assessment within 12 months

MCPs must confirm and document the assessment.

Service location: Services are provided in a home owned, rented, leased or occupied by the member or their caregiver.residence of member/caregiver

Services may be provided over time and need not be performed all at once.

Provider and workmanship: Physical adaptations must be performed by an individual holding a California contractor's license and providers must be approved by the Managed Care Plan; providers must enroll in Medi-Cal for APS-related services.licensed contractor for adaptations

MCPs shall monitor quality and experience standards.

Asthma Remediation expressly excludes adaptations or improvements that are of general utility to the household or any aesthetic embellishments. Remediations must provide a direct medical or remedial benefit to the member — for example, finishing (drywall and painting) only as necessary to return the home to a habitable condition when required for the remediation. Projects or upgrades that primarily benefit the property rather than addressing the member's specific health needs are not covered.

Only mechanical air cleaners are permitted for Asthma Remediation. Mechanical units use physical filtration (for example, pleated or HEPA filters) and do not generate ozone or ions. Electronic or ozone‑generating/ionizing air cleaners are not allowed because they produce reactive compounds that can harm health; therefore electronic cleaners must not be provided under this benefit.

Services that duplicate an available state plan service should not be provided through Asthma Remediation. If an equivalent state plan service (for example, durable medical equipment) exists and would accomplish the same goals of preventing asthma emergencies or hospitalizations, that state plan service must be accessed first and Asthma Remediation should not be used to duplicate those services.

Assessment Recency and Financial Limits

Assessment recency — in‑home environmental trigger assessment

Required assessment recencyCompleted in‑home environmental trigger assessment through the APS benefit within the past 12 months.

Assessment contentAssessment must identify which asthma remediation interventions are medically appropriate and explain how they address the member's specific needs.

MCP confirmationManaged Care Plans must confirm and document that the assessment was completed as outlined.

Residency unchangedIf the member's residence has not changed, an assessment within the last 12 months is sufficient and no additional documentation is required.

Lifetime maximum — total lifetime maximum payable

Total lifetime maximumAsthma Remediation is payable up to a total lifetime maximum of $7,500.

Authorization, Documentation, and Provider Responsibilities

Prior Authorization

Authorization form and required assessment — submit Asthma Remediation Authorization Form with required documents, including a completed APS in‑home assessment

Submit the Asthma Remediation Authorization Form with all required supporting documents. Include a completed in‑home environmental trigger assessment (APS) performed within the last 12 months that identifies which asthma remediation interventions are medically appropriate and explains how those interventions address the member's specific needs.

Required: Asthma Remediation Authorization Form
Required: Completed APS in‑home environmental trigger assessment (<= 12 months)
Include assessment details that justify each requested intervention

Denial Risk

Access existing state plan service first — if equivalent state plan service exists (e.g., DME), it must be accessed before Asthma Remediation

Key Terms

Asthma Remediation Community Support — definition

DefinitionNecessary supplies and/or physical modifications to a home environment to ensure the health, welfare, and safety of a member or to reduce the likelihood of acute asthma episodes.

Service locationServices are available in a home owned, rented, leased, or occupied by the member or their caregiver.

Scope of interventionsMay include supplies (e.g., allergen‑impermeable mattress and pillow covers, HEPA‑filtered vacuums, dehumidifiers, asthma‑friendly cleaning supplies) and physical modifications (e.g., ventilation improvements, minor mold removal/remediation) identified as medically appropriate.

Timing and deliveryServices may be provided over time and are subject to the program's lifetime maximums.

Workmanship and codesPhysical adaptations must comply with applicable state and local building codes and be performed by an individual holding a California contractor's license.

Policy Background

Asthma Remediation provides in‑home supplies and physical modifications intended to reduce environmental triggers and prevent acute asthma episodes that could lead to emergency services or hospitalization. The program funds medically appropriate interventions identified by an in‑home environmental trigger assessment and delivered in a home occupied by the member or caregiver. Physical adaptations must be performed in compliance with applicable building codes and by a contractor holding a California license; non‑permanent supplies (for example, allergen‑impermeable covers, HEPA vacuums, dehumidifiers, and portable air filters) are also included when clinically indicated. Services are subject to program limits and a total lifetime maximum of $7,500, unless a substantial change in the member's condition justifies additional modifications.

Policy Summary

PayerHealth Net

PolicyAsthma Remediation Community Support — Authorization and Coverage Criteria

Policy CodePolicy N/A

Change TypeAdministrative update (no material clinical changes)

Effective DateDec 16, 2025

Last ReviewDec 16, 2025

Next Review DateN/A

Key ActionSubmit the Asthma Remediation Authorization Form with a completed in‑home environmental trigger assessment (within 12 months) and required documents to request authorization.

SourceLink

On This Page

Exception to maximumException allowed if the member's condition has changed significantly and additional modifications are necessary to ensure health, welfare, safety, or avoid institutionalization/hospitalization.

Services may be spread over timeServices provided to a member need not be carried out at the same time but may be spread over time, subject to the lifetime maximums.

If an equivalent state plan service (for example, durable medical equipment or another covered benefit) is available and would accomplish the same clinical goals of preventing asthma emergencies or hospitalizations, the state plan service must be accessed before authorizing Asthma Remediation.

Check for existing State Plan services (e.g., DME) that meet needs before approving Asthma Remediation
Document rationale if Asthma Remediation is approved instead of an available State Plan service

Documentation Required

Required assessment — completed in‑home environmental trigger assessment within the last 12 months through the APS benefit required and must identify medically appropriate interventions

A completed in‑home environmental trigger assessment through the APS benefit within the last 12 months is required to establish medical appropriateness. The assessment must identify which remediation interventions are medically appropriate and explain how they address the member’s specific needs. If the member’s residence has not changed, an APS assessment performed within the last 12 months is sufficient and no additional documentation is required.

Assessment timeframe: within the last 12 months via APS benefit
Assessment must identify medically appropriate interventions and how they meet member needs
If residence unchanged, a prior APS assessment (<=12 months) suffices

Documentation Required

Owner/member notification for permanent modifications — provide written documentation to owner and member that permanent modifications are the responsibility of the owner and State is not responsible for maintenance/repair/removal

Before beginning any permanent physical adaptation or installation (for example, installing an exhaust fan or replacing moldy drywall), provide written documentation to both the property owner and the member that the modifications are permanent and that the State is not responsible for maintenance, repair, or removal if the member ceases to reside at the residence. This written notice is not required for non‑permanent supplies (e.g., mattress and pillow dustcovers, HEPA vacuums, dehumidifiers, portable air filters, asthma‑friendly cleaning products).

Written notification to owner and member that modifications are permanent and State not responsible for maintenance/repair/removal
Applies to permanent adaptations/installations (not to non‑permanent supplies)
Provider must attest/sign that notice was provided

Billing Rule

Duplicate state plan service handling — If another state plan service (e.g., DME) is available and would accomplish the same goals, that service must be used first

If another State Plan service beyond APS (e.g., DME) is available and would accomplish the same goals, that service must be used first. Ensure remediations comply with applicable state and local building codes and are limited to direct medical or remedial benefit (not general household improvements).

Verify and document lack of an applicable State Plan service before approving remediation
Asthma Remediation payable up to $7,500 lifetime maximum (exceptions only for significant clinical change)
Permanent home modifications must be performed by a licensed California contractor

Mechanical air cleaners — definition and permitted features

DefinitionAir cleaners that use only physical filtration (for example, pleated or HEPA filters) and do not generate ozone or ions.

Permitted typeOnly mechanical (physical filtration) air cleaners are permitted for Asthma Remediation.

Prohibited featuresElectronic air cleaners that generate ozone or ions are not permitted, and devices classified as 'electronic' that can produce reactive compounds that harm health are excluded.

Reference listCalifornia Air Resources Board maintains a list of certified air cleaning devices that includes mechanical and electronic units; for Asthma Remediation only mechanical options are allowable.