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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), leading to the establishment of the Child Core Set. The Child Core Set includes a range of children’s quality measures encompassing both physical and mental health. Beginning in 2024, reporting on the Child Core Set is mandatory for states. The Child 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 Child 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 Child Core Set will occur in Fall 2023 and reporting on the 2024 Child Core Set will occur in Fall 2024. There will not be any changes to the 2023 Child Core Set, and the 2024 Child 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 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. The Core Set Annual Review Workgroup reviews the Child 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 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 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 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. 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 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.

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.