Current through Register Vol. 49, No. 18, September 16, 2024
(1) Administration. Asthma Education and
In-Home Environmental Assessment services shall be administered by the MO
HealthNet Division. Asthma education and in-home environmental assessments
services covered and not covered, the limitations under which services are
covered, and the maximum allowable fees for all covered services shall be
determined by the MO HealthNet Division and shall be included in the MO
HealthNet Physician Provider Manual, which is incorporated by reference and
made part of this rule as published by the Department of Social Services, MO
HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its
website at http://manuals.momed.com/manuals/, May 14, 2021. This rule does not
incorporate any subsequent amendments or additions. Asthma Education and
In-Home Environmental Assessment services covered by the MO HealthNet program
shall include only those which are clearly shown to be medically necessary.
(A) The following definition(s) will be used
in administering this rule:
1. "Asthma
Education" means direct training of the patient and family by qualified asthma
education provider in areas including, but not limited to, avoiding triggers,
medication compliance, proper use of inhalers, and use of durable medical
equipment;
2. "In-Home
Environmental Assessment" means thorough and detailed analysis of the home
environment by a qualified environmental assessment provider evaluating for
asthma triggers including, but not limited to, rodent excrement, mites, animal
dander, insects, dust, mold with recommendations for remedial actions.
(2) Asthma
Education and In-Home Environmental Assessment Services. Asthma Education and
In-Home Environmental Assessment Services are interventions for increasing
control of asthma symptoms in high risk youth.
(A) A prescribing provider's referral is
required as part of a normal office visit for evaluation and management for
both asthma education and in-home environmental assessment. The prescribing
provider will need to prescribe the service in the participant's plan of
care.
(B) As part of the referral,
the prescribing provider determines and specifies the level and type of asthma
education and in-home environmental assessment based on available history and
in consultation with asthma educators and in-home environmental assessors, as
needed.
(C) A prescribing provider
is defined as a licensed practitioner authorized to prescribe within their
scope of practice either directly or by protocol consistent with their scope of
practice under state law.
(D)
Asthma education. Asthma educators may bill for-
1. Asthma education non-physician, (thirty-
(30-) minute sessions, twice per year); or
2. Preventive medicine counseling,
individual, (fifteen- (15-) minute sessions four (4) times per year);
or
3. Preventive medicine
counseling, individual, (thirty- (30-) minute sessions twice per year);
or
4. Self-Management Education
using standardized effective curriculum, individually, either incident to a
clinical encounter or as preventative service, (ninety- (90-) minute session
once per year).
5. The annual limit
for asthma education visits will be dependent on the codes used, but shall not
exceed one (1) hour per year with the exception of one (1) ninety- (90-) minute
self-management session.
(E) Asthma Environmental Assessment.
1. An asthma environmental assessor may bill
for an asthma environmental assessment non-physician, two (2) assessments per
year.
2. Asthma environmental
assessments may include, but are not limited to, a thorough assessment of the
home including home history and ownership, building occupant behaviors and job
history, home cleaning techniques, laundry processes, pets and pests histories,
kitchen processes, structure deficiencies, ventilation and moisture conditions,
conducting and recording basic air sampling procedures, and examination of the
external environment of the home to identify and support the reduction of
disease causing agents leading to medical complications of asthma.
3. In-home assessments for asthma triggers do
not include remediation of issues identified in the home.
4. Annual limit for asthma environmental
assessment services shall not exceed two (2) in-home environmental
assessments.
(F) The
prescribing provider will need to seek prior authorization for asthma education
and in-home environmental assessment services from MO HealthNet prior to
starting the program.
(G) Any
additional asthma education and environmental in-home assessments beyond the
initial allocation will need an additional prior authorization and be deemed
medically necessary.
(3)
Participant Criteria. In order to qualify for, and receive, asthma education
and/or in-home environmental assessments, the participant must have a primary
diagnosis of asthma and meet the MO HealthNet Division's (MHD) definition of a
youth participant with uncontrolled asthma or at risk for an exacerbation of
asthma by meeting the following criteria:
(A)
Be currently enrolled in MO HealthNet;
(B) Be twenty (20) years of age or younger;
and
(C) Have had one (1) of the
following events related to asthma in the last twelve (12) months:
1. One (1) or more inpatient hospital stays;
2. Two (2) or more Emergency Department (ED)
visits;
3. Three (3) or more urgent
care visits; or
4. One (1) ED visit
or one (1) urgent care visit related to asthma with a high rate of short-acting
beta-agonist inhaler fills and/or low rates of inhaled corticosteroid
refills.
(4)
Provider Participation. To be eligible for participation as a provider in the
MO HealthNet Asthma Education and In-Home Environmental Assessment services-
(A) All asthma education and in-home
environmental assessment service providers must be enrolled as MO HealthNet
providers; and
(B) A qualified
provider must meet the minimum education and certification requirements to
qualify as a provider of asthma education and/or in-home environmental
assessments set forth in this subsection.
1.
Asthma Education-
A. Asthma educators must
have the credentials set forth in this subsection-
(I) Shall be certified by a national program
or a state program. Eligibility criteria for admission into the certification
programs are determined by the administrator of the program;
(II) Asthma educators must have one (1) of
the following certifications in good standing:
(a) Current and active National Asthma Educator
Certification (AE-C).
I. These providers must
maintain the national certification determined by The National Asthma Educator
Certification Board; and
(b) State certification. The provider must have a
current certificate from a Missouri state training program.
2. In-Home
Environmental Assessments-
A. Asthma In-Home
Environmental Assessors must have the credentials set forth in this subsection:
(I) Shall be certified by a national program
or a state program. Eligibility criteria for admission into the certification
programs are determined by the administrator of the program;
(II) An In-Home Environmental Assessor must
have one (1) of the following certifications in good standing:
(a) National Certification-
I. Renewal of National Environmental Health
Association (NEHA) Healthy Home Specialist; or
II. Building Performance Institute (BPI) Healthy Home
Evaluator Micro-Credential; and
B. State Certification. The provider must
have a current certificate from a Missouri state training program.
(I) A Missouri state certificate program
means a program provided by an accredited institute of higher education, such
as a university, that provides a training program utilizing curriculum
incorporating similar guidelines to national certification programs. It is
preferable that the curriculum is also accredited. Upon successful completion
of the training program a certificate must be provided. A certificate means
that the student has successfully completed the training program and is
competent to provide in-home environmental assessment.
(II) Mentor program for asthma educators. A
mentee is someone who is working towards a certificate. Once certified, the
asthma educator can become a mentor for individuals that are seeking their
national certification. Mentors, who must be an enrolled Medicaid provider, can
have a maximum of three (3) mentees at a time. Mentors have the capability of
billing MHD for their services, while mentees cannot. Services provided by a
mentee under the supervision of the mentor can be billed to MHD by the mentor.
The asthma education activities and interventions of the mentee shall be
performed pursuant to the mentor's order, control, and full professional
responsibility.
(5) Qualifying Academic University-based Centers
function to track and ensure current certification of asthma education
providers and asthma environmental assessors by providing MHD with the
following services:
(A) The qualified academic
university-based centers must maintain a website with an up-to-date provider
list for physicians and their offices to utilize to consult asthma educators
and asthma in-home environmental assessors to provide services to participants
once a prior authorization has been approved.
1. The qualified academic university-based
center responsible for tracking asthma in-home environmental assessors must
maintain an up-to-date list of all certified in-home environmental assessors in
the state; and
A. The academic
university-based center responsible for tracking asthma in-home environmental
assessors must meet the following criteria:
(I) Serve as a contractor for the Centers for
Disease Control (CDC) National Asthma Control Program (NACP) funded by Missouri
Asthma Prevention and Control Program (MAPCP);
(II) Provide a vital linkage between health
care providers and public health resources through a Central Access Point
(CAP);
(III) Maintain a
comprehensive database that contains information on individuals trained
specific to Home Environmental Assessments (HEAs) for asthma trigger
identification and reduction in the home setting; and
(IV) Track quality indicators and collect
required outcomes data.
2. The qualified academic university-based
center responsible for tracking asthma educators must maintain an up-to-date
list of all trained asthma educators in the state.
A. The academic university-based center
responsible for tracking asthma educators must meet the following criteria:
(I) Serve as the contractor for the CDC NACP
funded MAPCP;
(II) Maintain a
comprehensive database that contains information on individuals trained
receiving Expert Panel Report 3 (EPR-3) compliant asthma training;
(III) Staff providing the training must be a
Certified Asthma Educator as recognized by the National Association of Asthma
Educators; and
(IV) Provide
training that focuses on educational/behavioral objectives in four (4) key
areas-
(a) Inhaled corticosteroid
adherence;
(b) Inhalation
technique;
(c) Environmental
trigger reduction; and
(d)
Importance of regular check-ups with assessment of lung function and asthma
control.
