Adult Health Care Quality Measures

The Social Security Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid enrollees.

2020 Adult Core Set 

The 2020 Adult Core Set was released in a November 2019 Informational Bulletin. Section 1139B of the Social Security Act, as amended by Section 2701 of the Affordable Care Act, notes that the Secretary shall issue updates to the Adult Core Set beginning in January 2014 and annually thereafter. CMS worked with Mathematica’s Annual Core Set Review Workgroup to review the Adult Core Set and to identify ways to improve it. The 2020 Final Report contains information on the annual review process, selection criteria, and feedback to CMS.

The Adult Core Set includes several measures focused on behavioral health. These along with similarly focused measures from the Child Core Set have been identified as a Behavioral Health Core Set. Similarly, measures from the Adult and Child Core Sets’ focused on maternal and perinatal health have been identified as a Core Set of Maternal and Perinatal Health Measures for Medicaid and CHIP (Maternity Core Set). For the 2018 Adult Core Set measure list, please email MACQualityTA@cms.hhs.gov.

State data derived from the core measures 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.

Annual Reporting on the Quality of Health Care for Adults Enrolled in Medicaid

CMS annually releases information on state progress in reporting the Adult Core Set measures and assesses state-specific performance for measures that are reported by at least 25 states and which met internal standards of data quality. Information about performance on frequently-reported health care quality measures in the Adult Core Set is provided below, in addition state-specific quality information can also be viewed in the Quality of Care section of the State Medicaid & CHIP Profiles web page.

Adult Medicaid Quality Measurement Program

By January 1, 2013, a Medicaid Quality Measurement Program will be established to fund the development, testing, and validation of emerging and innovative evidence-based adult health quality measures. As specified in the legislation, this program is to be established in the same manner as the Pediatric Quality Measures Program.