CHIPRA Initial Core Set of Children's Health Care Quality Measures

Initial 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 CHIP. CHIPRA required 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. On December 29, 2009, the Secretary posted for public comment in the Federal Register, an initial core set of 24 children's health care quality measures for voluntary use by Medicaid and CHIP programs. The core set includes a range of children’s quality measures encompassing both physical and mental health.

Updated Child Core Set

The 2016 Child Core Set was released through a December 2015 Informational Bulletin. The CHIPRA legislation provides that the Secretary shall issue updates to the Child Core Set beginning in January 2013 and annually thereafter. CMS worked with the National Quality Forum’s (NQF) Measures Application Partnership (MAP) to review the Child 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 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

State data derived from the core measures are part of the Secretary's Annual Report on the Quality of Care for Children in Medicaid and CHIP

How States Voluntarily Report Child Core Set Measures

States can voluntarily report the 2016 Child Core Set measures by using the 2016 Technical Specifications and Resource Manual. A summary of updates to the child core set technical specifications and resource manual for FFY 2016 is also available. 

Additional Reporting Resources

2016 Child Core Set HEDIS Value Set Directory

2016 Child Core Set BHRA Value Set Directory

FFY 2016 Child Core Set Measurement Periods

2016 Child Core Set ICD-10 Codes

FFY 2016 Child Core Set Data Quality Checklist  

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 the Centers for Medicare & Medicaid Services (CMS) announced awards totaling $13.4 million in funding over four years to six new Pediatric Quality Measures Program (PQMP) grantees focused on implementing new pediatric quality measures developed by the PQMP Centers of Excellence (COE). For more information, visit

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 Child Core Set measures, CMS established the Technical Assistance and Analytic Support (TA/AS) Program with an award of a contract to Mathematica Policy Research in May 2011. Mathematica – teamed with the National Committee for Quality Assurance and the Center for Health Care Strategies– works with CMS to support states’ child 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 children. 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 Child Core Set or quality improvement initiatives can be submitted to

Technical Assistance Webinars

Additional Technical Assistance Resources

Quality Improvement Workshop Series

Pediatric Electronic Health Record Format

Section 401(f) of CHIPRA provides for the development of a model electronic health record (EHR) format for children enrolled in Medicaid or CHIP. As existing EHR systems often do not optimally support the provision of health care to children, AHRQ, through an intra-agency agreement with the CMS, is working to develop the model EHR format for children, and demonstrate that it can be readily used and package it in a way that facilitates broad incorporation into EHR systems.

North Carolina and Pennsylvania will evaluate the impact of the model children’s EHR format as part of their CHIPRA Demonstration Grants.

Secretary's Annual Report on the Quality of Care for Children in Medicaid and CHIP

Section 401(a) of CHIPRA requires the Secretary of HHS to summarize state-specific information on the quality of health care furnished to children under Medicaid and CHIP. The first report was published in 2010 and annually thereafter.