U.S. flag

An official website of the United States government

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. The  Adult Core Set includes a range of quality measures encompassing both physical and behavioral health.  Beginning in 2024, reporting on the behavioral health measures on the Adult Core Set is mandatory for states. The Adult Core set will continue to be updated annually, with future updates provided in a manner to allow states to address any changes ahead of mandatory reporting periods.

2023 & 2024 Adult Core Sets

In order to support states’ efforts to meet the upcoming 2024 mandatory reporting requirements and to provide sufficient time for states to prepare, the Centers for Medicare & Medicaid Services (CMS) released both the 2023 and 2024 Child and Adult Core Health Care Quality Measurement Sets in a November 2022 Informational Bulletin. As noted above, reporting on the 2023 Adult Core Set will occur in Fall 2023 and reporting on the 2024 Adult Core Set will occur in Fall 2024. There will not be any changes to the 2023 Adult Core Set, and the 2024 Adult Core Set will remain the same unless there are emerging public health issues necessitating changes. In that case, CMS will ask the Core Set Annual Review Workgroup to discuss potential modifications to the 2024 Core Sets.

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. The Core Set Annual Review Workgroup reviews the Adult Core Set and identifies ways to improve it, using the annual review and selection process. The 2023 and 2024 Final Report includes  the Workgroup recommendations, public comments and feedback to CMS. The Core Set History table provides a history of the measures included in the Child and Adult Core Sets.

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 the: 

Similarly, measures from the Child and Adult Core Sets’ focused on maternal and perinatal health have been identified as the:

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 that 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, 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.