Intermediate Indicators

Changes in language describing covered benefits, as found in Medicaid contracts with MCOs/ACOs:

• Documentation of change in coverage benefits for evidence-based treatments, leading to a new or enhanced Medicaid service/benefit, compared to prior language describing benefits.

Resource:

• Proposing a Potential New or Enhanced Medicaid-Covered Benefit: Template for Enhanced Asthma Control Services.

Changes in language describing covered benefits, as found in State Plan Amendments, Section 1115 waiver letters, or documents that give notice of administrative changes to covered benefits (example: annual notice of requirements or other relevant documents) –

Resources:

• State plan amendment application (Maryland)
  • To the Centers for Medicare & Medicaid Services.
  • For a Health Services Initiative under the Children’s Health Insurance Program.
• State plan amendment approval letter (Missouri)
  • Added asthma education and assessments to the state plan.
• State plan amendment approval letter (Missouri)
  • Health Home – added additional chronic care conditions as qualifying conditions for Primary Care Health Home participants.
• Community Health Workers: Delivering Home-Based Asthma Services.
  • Increased flexibility to pay for preventive services, such as home based asthma interventions, delivered by CHWs and other providers that may fall outside of a state’s clinical licensure system.

Changes in language describing covered benefits, or changes in services offered, as implemented by MCOs/ACOs –   

Resource:

• Managed Care Organization Survey Questions to Assess Asthma Control Services
  • This tool can help 6|18 teams assess changes in how asthma control services and medications are being covered, promoted, reimbursed, tracked and evaluated by managed care organizations.
  • Also, 6|18 teams may use these survey questions during intervention planning to identify the most impactful opportunities to address asthma control.

Documentation of other actions taken to finance in-home asthma care:

Resource:

• An overview of Financing In-Home Asthma Care.
  • Exploring Pathways to Reimbursement for In-Home Asthma Interventions.

Based on state activities

Asthma self-management education (AS-ME) completion rates ^CDC

AS-ME includes education for people with asthma and their families to:

• Use asthma medications correctly;
• Reduce exposures to asthma triggers such as cockroaches or mold; and
• Manage their condition when asthma symptoms worsen.
  • AS-ME Completion Rates^CDC—
    • Number and demographics of people with asthma who initiated and attended at least 60% of sessions of guidelines-based, asthma self-management education (AS-ME).
      • Please consult your CDC Asthma EXHALE evaluator, if applicable, for measure specifications.

Home visits for reducing triggers.

Asthma control – Improvement in asthma control among AS-ME completers.^CDC

• The number of participants with poorly controlled asthma on enrollment who report that their asthma is well-controlled or more after attending 60% of asthma self-management education (AS-ME).
  • Please consult your CDC Asthma EXHALE evaluator, if applicable, for measure specifications.

Annually

Follow-up – Primary care connection after emergency department visits for children with asthma (NQF 3171, PDF page 32).

• Percentage of asthma ED visits followed by evidence of care connection.

Asthma medication ratio (AMR) (NQF 1800)  ^{HEDIS, Medicaid Core Set}

• Percentage of patients who have a medication ratio of controller medications to total asthma medications of 0.50 or greater during measurement year.

Monthly or quarterly