Asthma Remediation HRSN Services
Asthma Remediation Services are intended to address multiple home environmental asthma triggers to improve the recipient Member’s residence and capacity for asthma self-management. Components include delivery of asthma self-management education, provision of remediation services to remove indoor environmental allergens, and dissemination of supportive products to eliminate or reduce asthma triggers in the Member’s home. Services will be tailored to the individual needs of the Member and the primary residence (owner-occupied or rental dwelling) of the Member.
Who is Eligible for Asthma Remediation Services?
1) Member belongs to one or more covered (Enhanced) populations
2) Identified during the Accountable Health Communities HRSN Screening to have unmet HRSN risk factors related to housing
3) Requires a clinically appropriate home modification/remediation service
4) Has a health condition that is exacerbated by the individual’s physical living environment
5) Has a diagnosis of asthma and meets the following additional clinical criteria:
- One or more hospital inpatient stays(s) related to asthma within the last 12 months; or
- Two or more ED visits related to asthma within last 12 months; or
- Three or more urgent care visits related to asthma within the last 12 months; or
- Two or more prescribing events for oral steroid use related to an asthma diagnosis within the last 12 months; or
- Three to eleven prescribing events for a rescue inhaler, including albuterol within the last 12 months
The Social Care Navigator is required to document the qualifying clinical criteria for asthma remediation in the Member’s Social Care Plan.
Asthma Remediation Enhanced HRSN Services
2.3 Asthma Remediation
- Component A: Asthma Self-Management Education (ASME)
- Component B: Dwelling Assessment & Scope of Work (SOW) Development (including SOW Technical Review)
- Component C: Home Remediation and Provision of Supportive Products
- Component D: Quality Assurance (QA) Inspection
Asthma Self-Management Education (ASME)
The ASME provider must notify the Social Care Navigator if the Member has additional care coordination needs outside of the ASME service (i.e clinical follow-up, etc.). The ASME provider can supply asthma supportive products and indoor allergen reduction products and bill them towards the Member’s cap.
Initial Visit: must be conducted in-person in the Member’s dwelling to provide initial asthma and home environmental assessments and ensure appropriateness of asthma remediation services. The initial visit must identify Member/caregiver knowledge, skills, and needs related to asthma, determine asthma control status by administrating and scoring a validated, age-appropriate asthma control screening questionnaire (ACT, C-ACT, TRACK), and provide education on home environmental factors / triggers potentially impacting asthma.
Final Visit: may be conducted in-person in the Member’s dwelling or face to face virtually (e.g, video call) and must be
no earlier than 45 days post completion of all home remediation services. In the rare circumstance where the Member does not allow a final
face-to-face visit in-person or virtually, the final visit may be conducted telephonically. The final visit must include asthma and home environmental
post-assessments, administration and scoring of a validated age-appropriate asthma control screening questionnaire
(ACT, C-ACT, TRACK) to determine changes in asthma control status, reinforcement of ASME education, and reporting on
Member’s progress and improvements in the home environment.
ASME is health education tailored to the needs of the Member and family / caregivers to expand asthma knowledge, such as early warning signs and management of worsening symptoms, asthma control and medication adherence, and identification and reduction of asthma triggers. ASME should be conducted in alignment with national asthma guidelines and support education for a partnership in asthma care.
ASME must be provided by a qualified nonphysician health care professional, such as a certified asthma educator specialist (AE-C), respiratory therapist (RT), or specially trained lay health worker (e.g., health educator, community health worker (CHW), etc.), with documented training and demonstrated competency in delivering guidelines-based asthma self-management education and comprehensive home environmental assessments to identify and provide education on reducing asthma triggers.
ASME must include an asthma and environmental assessment performed in two separate visits. The ASME provider must notify the Social Care Navigator if the Member has additional care coordination needs outside of the ASME service (i.e clinical follow-up, etc.). The ASME provider can supply asthma supportive products and indoor allergen reduction products and bill them towards the Member’s cap.
Dwelling Assessment & Scope of Work (SOW) Development (including SOW Technical Review)
b.1 Dwelling Assessment & SOW Development:
A comprehensive dwelling assessment of the primary residence to identify home remediations needed to reduce or eliminate asthma triggers and improve the indoor environment of the dwelling should be conducted by a qualified home improvement contractor with industry-standard credentials in building science and healthy homes principles and incorporate results and relevant environmental findings from the initial ASME visit.
The SOW should outline recommended remediation services, supportive products, and associated pricing and must be approved by the Social Care Navigator.
b.2 SOW Technical Review:
Each SOW should receive an SOW Technical Review by a qualified reviewer with industry-standard credentials in building science and healthy homes principles working independently of the HRSN service provider performing installation of approved Asthma Remediation measures.
The SOW Technical Review should ensure clear indication within the SOW when recommended services are considered to be invasive. If the SOW includes invasive measures, written approval from the property owner (landlord in case of a rental) is required to be obtained by Social Care Navigator and/or provider of component c. Home Remediation and Provision of Supportive Products.
Home Remediation and Provision of Supportive Products
Installation services and supportive products may address ventilation and air quality, removal of asthma triggers, and Integrated Pest Management (IPM). Remediation services and supportive products will be limited to the list of allowable services which are recommended in the SOW and approved by the Social Care Navigator after component b.2 SOW Technical Review.
Member written approval is required to begin installation of approved SOW services. Services requiring invasive measures require written approval from the property owner (landlord, if the residence is rented).
Remediation service providers must provide proof of credentials/licensure/industry-accepted certifications and training (including advanced requirements for specialized services such as HVAC, IPM, etc.) AND have experience identifying and remediating asthma-related home environmental triggers.
Total costs of services for Asthma Remediation may not exceed per Member cap listed in the HRSN Fee Schedule for duration of Waiver period.
Quality Assurance (QA) Inspection
Within 90 days of service completion, a QA inspection should be conducted in alignment with Building Performance Institute (BPI) and other industry technical standards for QA for a minimum of 10 percent of households where asthma remediation services are provided by the SCN.
QA provider should be independent of provider of component c. Home Remediation and Provision of Supportive Products.
Asthma Remediation Workflow
Allowable Remediation Services & Supportive Products
Asthma trigger remediation services and supportive products are limited to those that are of direct medical or remedial benefit to the Medicaid Managed Care Member.
Indoor Air Quality
• Installation of air conditioner
• Ventilation system upgrades / installation / repair
• Whole-house fan
• Heating unit clean and tune, repairs, or replacement
• Forced air-furnace filter replacement and provision of (6) additional filters
• Installation / repair of exhaust fan (kitchen and bathroom)
• Dryer venting and cleaning
• Air duct maintenance
• Carpet steam cleaning
• Insulation
• Air sealing
• Replacement of air filters in HVAC system
Mold Remediation & Moisture Control
• Plumbing repairs to support moisture control and water damage
• Repairs to boilers (steam and water)
• Repairs to condensate drain
• Basement water proofing (coatings, drainage systems)
• Sum pump repair / replacement
• Carpet removal or removal of moldy wet flooring and installation of asthma-friendly flooring
• Dirt floor vapor barrier basement / crawlspace
• Cleaning / repair / installation of gutter downspout system and gutter screens
• *Mold remediation (less than 10 square feet)
• *Mold remediation (greater than 10 square feet)
*Remediations may include finishing (e.g., drywall and painting) to return the home to a habitable condition, but do not include aesthetic embellishments.
Indoor Allergen Reduction
• Vacuum with HEPA filter and filter replacements
• Allergen impermeable pillow and mattress encasement
Asthma Friendly Cleaning
• Hygrometer (Humidity gauge)
• Microfiber cleaning cloths
• Green scrubbers
• Cleaning buckets and spray bottle
• Microfiber mop
• Castile soap
• Cleaning vinegar (with recipe for mixing)
Integrated Pest Management
• Sealing or patching cracks or openings in walls, baseboards, and around plumbing
• Application of environmentally friendly pesticides, baits, and traps (use away from children and according to manufacturer’s instructions)
• Airtight food storage containers
Accessibility and Safety Modifications: Air conditioners, humidifiers and air filtration devices (limited to mechanical only) will be available to eligible Members eligible for Asthma Remediation. These services will be funded under 2.2 Home Remediation Service. Members may be assessed and deemed eligible by a Social Care Navigator for additional services under 2.1 Home Accessibility and Safety Modifications and 2.2 Home Remediation Services, services will be connected to corresponding
funding caps.
NOTE: Asthma Remediation measures must be conducted in accordance with applicable state and local building codes. Services requiring invasive measures will require written approval from property owner (landlord, if the residence is rented).
Asthma Remediation HRSN Providers
Allowable Providers include:
– Contracted asthma remediation service providers that are designated as a non-profit Community Based Organization 501 (c)(3) or 501(c)(4).
– Asthma Remediation service may be performed by a contracted for-profit organization at the SCN Lead Entity’s discretion in absence of an available 501(c)(3) or 501(c)(4) Community Based Organization.
See HRSN Network Capacity and Access section for details. (need link)
| HRSN Services Provider Type | Qualification Requirements | Considerations |
|---|---|---|
| Asthma Self- Management Education (ASME) Provider (a.) | Qualified nonphysician health care professional with documented training and demonstrated competency in delivering guidelines based asthma self-management education and comprehensive home environmental assessments to identify and provide education on reducing asthma triggers. | ASME provider examples: certified asthma educator specialist (AE-C), respiratory therapist (RT), and specially trained lay health worker (e.g., health educator, CHW) |
| Dwelling Assessor (b.1) | Qualified home improvement contractor with industry-standard credentials in building science and healthy homes principles. | May be the same HRSN service provider (home improvement contractor) performing component c. Home Remediation and Provision of Supportive Products. |
| SOW Technical Reviewer (b.2) | Qualified reviewer with industry-standard credentials in building science and healthy homes principles working independently of the HRSN service provider (home improvement contractor) performing installation of approved Asthma Remediation measures under component c. | SOW Technical Reviewer must work independently of the HRSN service provider (home improvement contractor) performing component c. Home Remediation and Provision of Supportive Products. |
| Home Improvement Contractor (c.) | Qualified home improvement contractor with proof of credentials/licensure/industry- accepted certifications and trainings (including advanced requirements for specialized services such as HVAC, IPA, mold remediation, etc.) AND demonstrated experience providing home installation improvement services including identifying and remediating asthma-related home | May be the same HRSN service provider (home improvement contractor) conducting the Dwelling Assessment under component b.1. |
| Quality Assurance Inspector (d.) | Qualified inspector holding industry- standard credentials in building science and healthy homes principles with expertise to conduct a QA inspection in alignment with Building Performance Institute (BPI) and other industry technical standards for QA. | QA Inspector must work independently of the HRSN service provider (home improvement contractor) performing component c. Home Remediation and Provision of Supportive Products. |
Need Technical Assistance?
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Learn More About NYHER & Asthma Remediation Offerings
Social Care Networks (SCNs)
Health-Related Social Needs (HRSN) Services
Resources & Training
Questions?
- Inquiries and/or feedback related to NYHER and the Social Care Networks can be emailed to [email protected]
- The American Lung Association is available through the NYS Children’s Asthma Initiative to provide technical assistance related to NYHER’s Asthma Remediation HRSN Services. For more information, email NYSCAI here.