Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.260 - Payment Policy for Asthma Education and In- Home Environmental Assessments

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the MO HealthNet
				  payment policy for asthma education and in-home environmental assessments. To
				  improve the health of MO HealthNet's participants with asthma and to reduce MO
				  HealthNet's costs associated with participants with uncontrolled asthma, MO
				  HealthNet will implement a statewide asthma education and home assessment
				  program focusing on youth participants who are most at risk of having
				  uncontrolled asthma.
(1) The
				following definition(s) will be used in administering this rule:
(A) Asthma Education-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;
(B) In-Home Environmental Assessment-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;
(C) Uncontrolled Asthma-those with a primary
				diagnosis of asthma with one (1) or more asthma-related hospitalization in a
				twelve-(12-) month period, two (2) asthma-related emergency department visits
				in a twelve- (12-) month period, or three (3) or more urgent care visits in a
				twelve- (12-) month period, and over use of rescue inhalers and/or under use of
				inhaled corticosteroids;
(D)
				Qualified Academic University-Based Centers.
1. The academic university-based center
				responsible for tracking asthma educators must meet the following criteria:
A. 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);
B. Maintain a comprehensive database that
				contains information on individuals trained receiving Expert Panel Report 3
				(EPR-3) compliant asthma training;
C. Staff providing the training must be a
				Certified Asthma Educator as recognized by the National Association of Asthma
				Educators; and
D. Provide training
				that focuses on educational/behavioral objectives in four (4) key areas-
(I) Inhaled corticosteroid
				adherence;
(II) Inhaled
				technique;
(III) Environmental
				trigger reduction; and
(IV) Regular
				check-ups with control measures.
2. The academic university-based center
				responsible for tracking asthma in-home environmental assessors must meet the
				following criteria:
A. Serve as the
				contractor for the CDC NACP funded MAPCP;
B. Provide a vital linkage between health
				care providers and public health resources through a Central Access Point
				(CAP);
C. 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
D. Track quality indicators and collect
				required outcomes data;
(E) Qualified providers (asthma education and
				environmental assessment)-a professional with appropriate training, as defined
				in section (4) of this regulation, in asthma education or environmental/home
				assessment, as evidenced by a national and/or state certification from an
				accepted program; and
(F) Youth
				participants-any individual younger than the age of twenty- one (21).