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CHIP Quality & Performance

At the Centers for Medicare & Medicaid Services (CMS), we are focused on transforming the healthcare system into one that delivers better value to patients through competition and innovation. To achieve this, we have three main objectives: empowering patients, focusing on results, and unleashing innovation. CMS is also committed to improving the quality and completeness of the data reported to CMS.

In the Children's Health Insurance Program (CHIP), information about performance and quality of care is collected through several parts of the CHIP program:

  • CHIP State Plan Information
  • The CHIP Annual Report
  • Medicaid and CHIP Child Core Set Data
  • Medicaid and CHIP Scorecard

CHIP State Plan Performance Information

Performance information is found within the Title XXI CHIP State Plan for states with separate CHIP (SCHIP) programs.  The CHIP State Plan includes information about the state’s performance goals, strategies for meeting those goals, and how goals will be measured.

CHIP Annual Report

States are required to report quality information to CMS annually through the CHIP Annual Reporting Template System. Information collected in the CHIP Annual Report is posted on Medicaid.gov annually.  The reports detail states’ progress toward meeting the goals outlined in the Title XXI CHIP state plan, as well as information about other performance goals the state is using.  Additionally, the states provide information on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

Medicaid and CHIP Child Core Set

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) included provisions to strengthen the quality of care provided to and health outcomes of children in Medicaid and CHIP. CHIPRA required the Department of Health and Human Services to identify and publish a core measure set of children’s health care quality measures for voluntary use by state Medicaid and CHIP programs. The Child Core Set contains measures that address several areas of children’s healthcare including, primary care access and preventative care, maternal and prenatal health, behavioral health care, and dental and oral health services.

The Child Core Set promotes our objective of focusing on results by supporting federal and state efforts to collect, report, and use a standardized set of measures to drive improvement in the quality of care provided to Medicaid and CHIP beneficiaries.  Every year CMS updates the Child Core Set for voluntary state reporting.

State data derived from the core set are part of CMS’s annual Child and Adult Core Set measure reporting, which includes publication of chart packs and datasets that highlight publicly reportable measures. Send your questions or requests for technical assistance related to the Child Core Set to MACqualityTA@cms.hhs.gov.

Medicaid and CHIP Score Card

CMS developed its Medicaid and CHIP Scorecard to increase public transparency and accountability about the programs’ administration and outcomes. The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas:

  1. State Health System Performance: These measures show how states serve Medicaid and CHIP beneficiaries across key domains, including measures like:
    • Postpartum Care
    • Well-Child Visits
    • Immunizations for Adolescents
    • Initiation & Engagement of Alcohol & Other Drug Dependence Treatment
    • Follow-Up After Hospitalization for Mental Illness
  2. State Administrative Accountability: These measures provide insight into how states and the federal government work together to administer Medicaid and CHIP, including measures like:
    • State Plan Amendments: Days Awaiting Information from States
    • Managed Care Capitation Rate Review: Timing of States’ Submissions
  3. Federal Administrative Accountability: These measures provide insight into how the federal government and states work together to administer Medicaid and CHIP, including measures like:
    • State Plan Amendments: Days Under CMS Review
    • Managed Care Capitation Rate Review: Days Under CMS Review
    • Section 1115 Demonstrations: Time from Submission to Approval