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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.

2023 Adult Core Set 

The 2023 Adult Core Set was released in a November 2022 Informational Bulletin and describes updates to the 2023 and 2024 Adult Core Set.  The Centers for Medicare & Medicaid Services (CMS) expects that the 2023 and 2024 Adult Core Sets will remain the same unless there are emerging public health issues necessitating changes. In that case, CMS will ask the Mathematica 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 which CMS has implemented through an annual review and selection process. CMS worked with Mathematica’s Annual Core Set Review Workgroup to review the Adult Core Set and to identify ways to improve it. The 2023 Final Report contains information on the annual review process, selection criteria, and feedback to CMS. The 2023 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 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).

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. 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.