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Adult Health Care Quality Measures

Adult Core Set Resources

 

The Adult Core Set consists of a range of standardized quality measures that assess various aspects of both physical and mental health care for adults.

The Adult Core Set is updated annually, in compliance with section 1139B of the Social Security Act. The Core Set Annual Review Workgroup reviews the Adult Core Set and identifies ways to improve it, using the annual review and selection process. A draft report from the workgroup meeting is made available for public comment. A final report, including the workgroup recommendations and public comments is then provided to CMS. CMS issues an annual update to the Adult Core Set based on the workgroup recommendations. The Core Set History table and Historical Policy Guidance documents provide a history of the updates to the measures included in the Child and Adult Core Sets.

Reporting of the behavioral health measures on the Adult Core Set became mandatory for states in 2024. CMS' August 2023, final rule outlines the requirements for annual mandatory reporting. Annual state reporting of the Core Set typically takes place in the Fall. CMS releases data for Core Set measures that are reported by at least 25 states and meet CMS standards for data quality.

2026 Adult Core Set

The 2026 Child and Adult Core Sets were released in a December 2024 State Health Official (SHO) Letter. Reporting on the 2026 Adult Core Set, for services primarily provided during 2025, will take place in Fall 2026. 

The Annual Workgroup for the 2026 Core Sets took place in February 2024. The recommendations and public comments are found in the 2026 Final Report.

2025 Adult Core Set

The 2025 Child and Adult Core Sets were released in a May 2024 State Health Official Letter, which also provided details on mandatory reporting. Reporting on the 2025 Adult Core Set will occur in Fall 2025. 

The Annual Workgroup for the 2025 Core Sets took place in April 2023. The recommendations and public comments are found in the 2025 Final Report.

2024 Adult Core Set

The 2024 Child and Adult Core Sets were released in a November 2022 CMCS Informational Bulletin (CIB). Reporting on the 2024 Adult Core Set, for services primarily provided during 2023, took place in Fall 2024.

The Annual Workgroup for the 2024 Core Sets took place in April 2022. The recommendations and public comments are found in the 2023 and 2024 Final Report.

Adult Core Set Data – Reflecting Quality of Care for Adults in Medicaid

CMS annually releases information on the Adult Core Set measures that are reported by at least 25 states and met CMS standards for data quality. The Core Set year represents the year that data is reported to CMS, the data generally represents care delivered the prior year. Information about performance on frequently reported health care quality measures in the Adult Core Set is provided below and on the Core Set Data Dashboard. 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.