Children's Health Care Quality Measures

Core Set of Children's Health Care Quality Measures

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 the Children's Health Insurance Program (CHIP). The core set includes a range of children’s quality measures encompassing both physical and mental health.

• 2023 Child Core Set
• Annual Reporting on the Quality of Care for Children in Medicaid & CHIP
• State Reporting Resources & Technical Assistance
• Related Initiatives
• 2023 Informational Bulletin

2023 Child Core Set

The 2023 Child Core Set was released through a November 2022 Informational Bulletin and describes updates to the 2023 and 2024 Child Core Sets. The Centers for Medicare & Medicaid Services (CMS) expects that the 2023 and 2024 Child 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 1139A of the Social Security Act notes that the Secretary shall issue updates to the Child Core Set beginning in January 2013 and annually thereafter which CMS has implemented through an annual review and selection process. CMS worked with the Mathematica’s Core Set Annual Review Workgroup to review the Child 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 Child Core Set includes several measures focused on behavioral health. These along with similarly focused measures from the Adult 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 Care for Children in Medicaid and CHIP

CMS annually releases information on state progress in reporting the Child 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 Child 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.

• 2021 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP (FFY 2020)
  • Overview of Child and Adult Core Set Reporting for FFY 2020 (September 2021)
  • Criteria for Using the Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP, FFY 2020 (September 2021)
  • 2021 Child Core Set Chart Pack, FFY 2020 (November 2021)
  • 2021 Behavioral Health Core Set Chart Pack, FFY 2020 (January 2022)
  • 2021 Maternity Core Set Chart Pack, FFY 2020 (November 2021)
  • Performance on the Child Core Set Measures, FFY 2020 (September 2021)
  • Child Health Quality Measures Dataset, FFY 2020 (September 2021)
• 2020 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP (FFY 2019)
  • Overview of the Child and Adult Core Set Reporting for FFY 2019 (September 2020)
  • Criteria for Using the Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP, FFY 2019 (September 2020)
  • 2020 Child Core Set Chart Pack, FFY 2019 (October 2020)
  • 2020 Behavioral Health Core Set Chart Pack, FFY 2019 (February 2021)
  • 2020 Maternity Core Set Chart Pack, FFY 2019 (December 2020)
  • Performance on the Child Core Set Measures, FFY 2019 (September 2020)
  • Child Health Quality Measures Dataset, FFY 2019 (September 2020)
• 2019 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP (FFY 2018)
  • Overview of the Child and Adult Core Set Reporting for FFY 2018 (September 2019)
  • Criteria for Using the Child and Adult Core Set Measures to Assess Trends in State Performance in Medicaid and CHIP, FFY 2018 (November 2019)
  • 2019 Child Core Set Chart Pack, FFY 2018 (September 2019)
  • Performance on the Child Core Set Measures, FFY 2018 (September 2019)
  • Child Health Quality Measures Dataset, FFY 2018 (September 2019)
• 2018 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP (FFY 2017)
  • Overview of Child and Adult Core Set Reporting for FFY 2017 (December 2018)
  • 2018 Child Core Set Chart Pack, FFY 2017 (December 2018)
  • Performance on the Child Core Set Measures, FFY 2017 (December 2018)
  • Child Health Quality Measures Dataset, FFY 2017 (December 2018)
• 2017 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP (FFY 2016)
  • Overview of Child and Adult Core Set Reporting for FFY 2016
  • 2017 Child Core Set Chart Pack, FFY 2016
  • Performance on the Child Core Set Measures, FFY 2016
  • Child Health Quality Measures Dataset, FFY 2016 
• 2016 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP (FFY 2015)
  • 2016 Child Core Set Chart Pack, FFY 2015
  • Performance on the Child Core Set Measures, FFY 2015
  • Child Health Quality Measures Dataset, FFY 2015
• 2015 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP
  • Overview of the Child Core Set Measures, FFY 2014
  • Performance on the Child Core Set Measures, FFY 2014
  • Child Findings from EQR Reports Submitted During the 2014-2015 Reporting Cycle
  • 2015 Domain-Specific Reports
  • 2015 Child Core Set Chart Pack, FFY 2014
  • Child Health Quality Measures Dataset, FFY 2014
• 2014 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP
  • Overview of the Child Core Set Measures, FFY 2013
  • Performance on the Child Core Set Measures, FFY 2013 
  • Findings from EQR Reports Submitted During the 2013-2014 Reporting Cycle
  • FFY 2013 Medicaid/CHIP Child Core Set Chart Pack
  • Dental Services Excerpt from the 2014 Secretary's Report
  • Perinatal Care Excerpt from the 2014 Secretary's Report
• 2013 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP
  • Appendix: Measure Snapshots
    • Overview of the Child Core Set Measures, FFY 2012
    • Performance on the Child Core Set Measures, FFY 2012
    • Findings from EQR Reports Submitted During the 2012-2013 Reporting Cycle
• 2012 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP
  • Executive Summary: 2012 Annual Report on the Quality of Care for Children in Medicaid and CHIP
  • Appendices: 2012 Annual Report on the Quality of Care for Children in Medicaid and CHIP
• 2011 Annual Reporting on the Quality of Care for Children in Medicaid and CHIP
  • Appendices: 2011 Annual Report on the Quality of Care for Children in Medicaid and CHIP
• First Annual Reporting on the Quality of Care for Children in Medicaid and CHIP
  • Appendices: First Annual Report on the Quality of Care for Children in Medicaid and CHIP

Related Initiatives

Other Children’s Quality Measures Initiatives

CMS also has other initiatives that relate to children’s quality measures, including a Pediatric Quality Measures Program (PQMP) and the Pediatric Electronic Health Record Format. Quality measures are used to evaluate or quantify specific health care processes, outcomes, patient perceptions, or other factors related to health care delivery. The pediatric quality measures are used by state Medicaid and Children’s Health Insurance Programs (CHIP) and other public and private programs, providers, plans, patients, and their families to measure and improve the quality of children’s health care. On October 3, 2016, the Agency for Healthcare Research and Quality (AHRQ) and CMS announced awards totaling $13.4 million in funding over four years to six new PQMP grantees focused on implementing new pediatric quality measures developed by the PQMP Centers of Excellence (COE).

Children's Electronic Health Record Format

The AHRQ/CMS-sponsored work to develop the Children's Electronic Health Record (EHR) Format began in 2009 and culminated in the 2013 public release of the format. In 2010, CMS issued quality demonstration grants to 18 states. Two of these states, North Carolina and Pennsylvania, completed demonstration projects to provide CMS with information on the use and impact of standard EHR components for children. These grantee experiences informed the development of the 2015 Priority List.  It is hoped the adaptation of EHRs to meet the 2015 Priority List requirements will lead to safer medication use, better tracking and completion of childhood immunizations, improved communication and knowledge about growth and development, better screening and management of children with special health care needs, and a variety of other specific benefits. An explicit goal of this work is to draw vendor, provider, and stakeholder attention to the needs of children, which are often de-prioritized given a limited IT marketplace for pediatric products and a large number of meaningful use EHR certification requirements that consume vendor and practice resources.

Resources:

• Quality Technical Advisory Group Presentation on Children’s EHR Format, February 2016