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 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. 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 2018 Child Core Set was released through a November 2017 Informational Bulletin. The CHIPRA legislation provides that the Secretary shall issue updates to the Child Core Set beginning in January 2013 and annually thereafter. The Centers for Medicare & Medicaid Services (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. 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.

How States Voluntarily Report Child Core Set Measures

States can voluntarily report the 2018 Child Core Set measures by using the 2018 Technical Specifications and Resource Manual. A summary of updates to the child core set technical specifications and resource manual for federal fiscal year (FFY) 2018 is also available.

Additional Reporting Resources

Archived Reporting Resources

For the 2017 technical specifications and value set directories, please email MACQualityTA@cms.hhs.gov.

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).

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 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 TA/AS Program fact sheet

Send your questions or requests for technical assistance related to the Child Core Set or quality improvement initiatives to MACqualityTA@cms.hhs.gov

Technical Assistance Webinars

Additional Technical Assistance Resources

Quality Improvement Workshop Series

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:

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 which met internal standards of 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.