CurrentmhnPolicy N/A

Asthma remediation community supports (home modifications and supplies)

Authorization form and program requirements for providing asthma remediation community supports (supplies and physical home modifications) for Medi‑Cal members in California, including eligibility, required documentation, limits, and provider requirements.

Policy Summary

Payermhn

PolicyAsthma remediation community supports (home modifications and supplies)

Policy CodePolicy N/A

Change TypeRevised program responsibilitiesAPS assessment requirement

Effective DateDec 16, 2025

Next Review DateN/A

Key ActionUpload a completed in‑home environmental trigger assessment (APS) performed within the last 12 months with the Asthma Remediation authorization.

SourceLink

POLICY UPDATE CHANGES

Effective January 1, 2026 DHCS removed in-home environmental trigger assessments and asthma self-management education from the Asthma Remediation Community Support program and shifted them to the Asthma Preventive Services (APS) program.

$7,500lifetime maximum ($)

12 moAPS assessment max age

Californiageography

Coverage criteria for asthma remediation supports

Authorized Asthma Remediation

Covered when ALL of the following are met

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

MCPs must confirm and document completion of the APS assessment; upload the APS with the authorization form.

Service location and scope: Services are provided in a home owned, rented, leased, or occupied by the member or caregiver and are limited to interventions that provide a direct medical or remedial benefit to the member (not general household utility or aesthetic embellishments).

Finishing work (e.g., drywall and painting) may be included only to return the home to a habitable condition; aesthetic embellishments are excluded.

Policy Summary

Payermhn

PolicyAsthma remediation community supports (home modifications and supplies)

Policy CodePolicy N/A

Change TypeRevised program responsibilitiesAPS assessment requirement

Effective DateDec 16, 2025

Next Review DateN/A

Key ActionUpload a completed in‑home environmental trigger assessment (APS) performed within the last 12 months with the Asthma Remediation authorization.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider and work standards: Permanent physical adaptations must be performed by an individual holding a California contractor's license and must comply with applicable state and local building codes.California contractor license for permanent work

MCPs must apply minimum standards, monitor quality, and provide written notice to owner and member that modifications are permanent and the state is not responsible for maintenance or removal if the member ceases residence (not required for non-permanent supplies).

Financial limits: Asthma remediation is payable up to a total lifetime maximum of $7,500 unless the member's condition has changed significantly and additional modifications are necessary to ensure health, safety, or to avoid institutionalization/hospitalization.$7,500 lifetime; exception if significant condition change

MCPs may authorize services spread over time subject to the lifetime maximum.

Alternative services and denial risk: Authorization is appropriate only when no alternative state plan service (e.g., durable medical equipment) that would accomplish the same clinical goals is available; if such a service is available, it should be accessed first and requests may be denied until that service is used.

MCPs must verify alternatives before authorizing Asthma Remediation.

Asthma Remediation excludes adaptations or improvements that are primarily of general utility to the household or are purely decorative. Remediations must be limited to interventions that provide a direct medical or remedial benefit to the member; finishing work to restore habitability (for example, drywall and painting) may be included when necessary, but aesthetic embellishments are not covered.

Only mechanical air cleaners are permitted for Asthma Remediation. Mechanical devices are those that use physical filtration (for example, pleated or HEPA filters) and do not generate ozone or ions. Electronic air cleaners that generate ozone or ions are not allowed under this program.

If an alternate state plan service (for example, durable medical equipment) can achieve the same clinical goals of preventing asthma emergencies or hospitalizations, that state plan service should be accessed first and requests for Asthma Remediation should not be authorized until the alternate service has been pursued. Authorization decisions should consider availability and appropriateness of those other services.

Age limits and payment limits

In‑home environmental trigger assessment age

Maximum age for required APS assessmentCompleted within the past 12 months (≤ 12 months)

Purpose of assessmentIdentify which asthma remediation interventions are medically appropriate and explain how they address the member's specific needs

Who must confirm the assessmentManaged Care Plans (MCPs) must confirm and document the APS assessment was completed as outlined

Lifetime maximum payment

Total lifetime maximum payable$7,500

Exception to lifetime maximumAdditional modifications may be authorized if the member's condition has changed significantly and further work is necessary to ensure health, welfare, safety, or to avoid institutionalization/hospitalization

Payable scopeRemediations limited to interventions of direct medical or remedial benefit; general household improvements and aesthetic embellishments excluded

Compliance requirementRemediations must follow applicable state and local building codes

Provider requirements and authorization steps

Prior Authorization

Authorization form + APS assessment required

Prior authorization required. Initial and extension requests must include a completed Asthma Remediation Authorization Form and an uploaded APS in‑home environmental trigger assessment performed within the last 12 months identifying medically appropriate remediation and explaining how interventions meet the member's specific needs.

Asthma Remediation Authorization Form must be submitted for initial and extension requests.
Upload a completed in‑home environmental trigger assessment from the Asthma Preventive Services (APS) benefit dated within the last 12 months.

Denial Risk

Alternate State Plan service may preclude approval

Requests may be denied if another State Plan service is available and would accomplish the same goals. If an alternate State Plan service (for example, durable medical equipment) can prevent asthma emergencies or hospitalizations and meets the member’s needs, that service should be used first.

MCPs should verify whether an existing State Plan service can meet the clinical goals before authorizing Asthma Remediation.
Denials may be issued when an alternative State Plan benefit is appropriate and sufficient.

Documentation Required

Must upload completed APS in‑home environmental trigger assessment

Upload requirement: the provider must upload a completed in‑home environmental trigger assessment (APS) within the last 12 months that identifies which Asthma Remediation interventions are medically appropriate and documents how the interventions address the member’s specific needs.

Assessment must be through the APS benefit and uploaded with the authorization form.
If the member’s residence has not changed and an APS assessment within 12 months exists, no additional assessment is required.

Documentation Required

Attestation required for permanent physical adaptations

For permanent physical adaptations or installations (for example, exhaust fan installation or replacement of mold‑damaged drywall), the provider must attest that the owner and member received written documentation stating 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 attestation is not required for non‑permanent supplies (e.g., mattress covers, HEPA vacuum, dehumidifiers, portable air filters, cleaning supplies).

Provider attestation required on the authorization form before starting permanent adaptations or installations.
Permanent adaptations must comply with state and local building codes and be performed by a contractor holding a California contractor's license where applicable.

Key definitions

Mechanical air cleaners

DefinitionMechanical air cleaners use only physical filtration (e.g., pleated or HEPA filters) and do not generate ozone or ions

Permitted for Asthma RemediationOnly mechanical air cleaners are allowed; electronic air cleaners that generate ozone or ions are excluded

Regulatory referenceCalifornia Air Resources Board maintains a list of certified air cleaning devices (includes mechanical and electronic); for Asthma Remediation only mechanical options are permitted

Background and rationale

Asthma remediation interventions—supplies and physical modifications—are intended to reduce environmental triggers in the home and thereby help prevent acute asthma episodes, emergency department visits, and hospitalizations. Services must be medically appropriate for the member as documented by a completed in‑home environmental trigger assessment under the Asthma Preventive Services (APS) benefit within the prior 12 months. Interventions are limited to those that address the member’s specific needs and must comply with applicable building codes and provider qualifications (for example, permanent adaptations require a California contractor’s license).