Each year, the Centers for Medicare & Medicaid Services (CMS), an operating division of the Department of Health and Human Services (HHS), publishes sets of core measures showing the quality of care and health outcomes for adults participating in Medicaid, and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
Child Core Set
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.
Adult Core Set
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. 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.
- Benchmarks for Medicaid Adult Health Care Quality Measures (PDF, 1.35 MB) (November 2014)
- CMCS Informational Bulletin on the Adult Health Care Quality Measures (PDF, 80.27 KB)