Child and Adult Core Sets
The purpose of the Child and Adult Core Sets is to measure the overall national quality of care for beneficiaries, monitor performance at the state level, and improve the quality of health care. State reporting of these measure sets has historically been voluntary; however, state reporting of the Child Core Set and the behavioral health measures on the Adult Core Set will become mandatory in Federal Fiscal Year (FFY) 2024. CMS released a final rule in August 2023 that outlines the reporting requirements that will lead to standardized quality measures for all States, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, and Guam. While American Samoa and the Mariana Islands are not required to report Child and Adult Core Sets measures, they are encouraged to consider reporting.
- Mandatory Core Set Reporting Final Rule
- Child Core Set, annual reports, and reporting resources
- Adult Core Set, annual reports, and reporting resources
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). CHIPRA required the Department of Health and Human Services (HHS) to identify and publish a core measure set of children’s health care quality measures for voluntary use by state Medicaid and CHIP programs and to review and update the list annually (initially published for public comment in December 2009). The Bipartisan Budget Act of 2018 made reporting of the Child Core Set mandatory for States beginning in FFY 2024.
Similarly, 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 for voluntary use by state Medicaid programs and to review and update the list annually. The first Adult Core Set was published in January 2012. Section 5001 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018 made reporting of the behavioral health measures on the Adult Core Set mandatory for States beginning in FFY 2024.