Adult Health Care Quality Measures
Initial Core Set of Adult Health Care Quality Measures for Medicaid-Eligible Adults
The Affordable Care 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 law requires that measures designated for the core set be currently in use. To aid in the assessment of the quality of care for Medicaid-eligible adults, the law calls for HHS to:
- Develop a standardized reporting format for the core set of measures:
- Establish an adult quality measurement program;
- Issue an annual report by the Secretary on the reporting of adult Medicaid quality information;
- Publish updates to the initial core set of adult health quality measures that reflect new or enhanced quality measures.
In January 2012, HHS published an initial core set of for voluntary use by Medicaid. These measures reflect the diverse populations served by Medicaid.
Updated Adult Core Set
The 2019 Adult Core Set was released in a November 2018 Informational Bulletin. 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. CMS worked with the National Quality Forum's (NQF) Measures Application Partnership (MAP) to review the Adult Core Set and to identify ways to improve it. A background report contains information on the MAP's review process, selection criteria, and feedback to CMS.
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). For the 2018 Adult Core Set measure list, please email MACQualityTA@cms.hhs.gov.
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.
How States Voluntarily Report Medicaid Adult Core Set Measures
States can voluntarily collect the 2019 Adult Core Set measures by using the 2019 Technical Specifications and Resource Manual. A summary of updates to the adult core set technical specifications and resource manual for FFY 2019 is also available.
Additional Reporting Resources
Archived Reporting Resources
For the 2018 technical specifications and value set directories, please email MACQualityTA@cms.hhs.gov.
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.
Technical Assistance and Analytic Support Program
CMS is committed to supporting states’ efforts to measure and improve the quality of health care for children and adults enrolled in Medicaid and CHIP. To increase the number of states consistently collecting, reporting, and using the Medicaid Adult Core Set measures, CMS established the Technical Assistance and Analytic Support (TA/AS) Program with an award of a contract to Mathematica Policy Research. Mathematica – teamed with the National Committee for Quality Assurance and the Center for Health Care Strategies – works with CMS to support states’ adult health care quality measurement and improvement efforts. The overarching goals are to increase the number of states consistently collecting and uniformly reporting the voluntary core measures set, and to help states understand how to use these data to improve the quality of care for adults. As part of the technical assistance effort, CMS will share promising practices for collecting the core measures with states. For more information, see the Technical Assistance and Analytical Support Program fact sheet.
Questions or requests for technical assistance related to the Medicaid Adult Core Set or quality improvement initiatives can be submitted to MACqualityTA@cms.hhs.gov.
Technical Assistance Webinar
- Technical Assistance to Support Adult, Child, and Health Home Core Set Reporting for FFY 2018 – September 25, 2018
- Presentation slides
- Pt 1: Technical Assistance FFY 2018 QM Reporting of Child, Adult & Health Home Core Sets (13:49)
- Pt 2: Technical Assistance FFY 2018 QM Reporting of Child, Adult & Health Home Core Sets (continued) (16:49)
- Pt 3: MACPro Access & Roles, FFY 2018 Updates, Tips/Tricks, & Additional Resources (19:32)
Technical Assistance Resources
Fact Sheet: Overview of Substance Use Disorder Measures in the Adult Core Set (Updated March 2019)
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 which met internal standards of 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.
- 2018 Annual Reporting on the Quality of Care for Adults in Medicaid (FFY 2017)
- Overview of Child and Adult Core Set Reporting for FFY 2017 (December 2018)
- 2018 Adult Core Set Chart Pack, FFY 2017 (December 2018)
- Performance on the Adult Core Set Measures, FFY 2017 (December 2018)
- Adult Health Quality Measures Dataset, FFY 2017 (December 2018)
- 2017 Annual Reporting on the Quality of Care for Adults in Medicaid (FFY 2016)
- 2016 Annual Reporting on the Quality of Care for Adults in Medicaid (FFY 2015)
- 2015 Annual Reporting on the Quality of Care for Adults in Medicaid
- 2014 Annual Reporting on the Quality of Health Care for Adults Enrolled in Medicaid
Benchmarks for Medicaid Adult Health Care Quality Measures (November 2014)