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Medicaid and CHIP Quality Resource Library

The Center for Medicaid and CHIP Services (CMCS) partners with states to share best practices and provide technical assistance to improve the quality of care for our beneficiaries. Type in a key search term to see what resources are available, or use the filters below to search and browse our quality improvement resources by Medicaid and CHIP Core Set domain and other fields.

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CMS External Quality Review (EQR) Protocols
Fact Sheet or TA Briefs - Presents the new protocol for conducting an External Quality Review to evaluate managed care plans. In 2020, the Centers for Medicare & Medicaid Services (CMS) is exploring new and innovative opportunities to leverage EQR organizations to ensure a more robust approach to optimizing managed care quality oversight. The protocols are one part of this larger strategy, Controlling High Blood Pressure (CBP-AD)


  1. Resource: CMS External Quality Review (EQR) Protocols
Search Terms
Care of Acute and Chronic Conditions, Cardiovascular Disease
Improving the Health of Mothers and Infants in Medicaid and CHIP: Investing in the Future of Our Nation
Fact Sheet or TA Briefs, State experiences, Webinar - Provides overview of the Maternal and Infant Health Initiative, describes focus of increasing postpartum care and use of contraceptives, shares best practices in New York, Illinois, and North Carolina, provides guidance on quality measurement.






  1. Webinar Slides: Improving the Health of Mothers and …
  2. Webinar Recording: Improving the Health of Mothers a…
  3. Webinar Transcript: Improving the Health of Mothers …
Search Terms
Maternal and Perinatal Health, Birth Outcomes, Adult Screenings, Diabetes
Medicaid and CHIP managed care rule
Fact Sheet or TA Briefs, Policy Guidance - Summarizes the Managed Care Final Rule - CMS-2408-F. 


  1. Resource: Medicaid and CHIP managed care rule
Search Terms
Dental and Oral Health Services
2019 Revised EQR protocols
Policy Guidance, Quality Measure Guidance, Template or Toolkit - Features a EQR protocol guide for assessing Medicaid managed care performance. Each protocol describes the purpose of EQR-related activity; and how to conduct each activity within the protocol.


  1. Resource: 2019 Revised EQR protocols
Search Terms
Adult Health Quality Measures Dataset, FFY 2018
Data and Statistics - Provides data sets on performance rates of frequently reported health care quality measures in the CMS Medicaid/CHIP Adult Core Sets, for FFY 2018 reporting, Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET-AD), Medical Assistance With Smoking and Tobacco Use Cessation (MSC-AD), Antidepressant Medication Management (AMM-AD), Screening for Depression and Follow-Up Plan: Age 18 and Older (CDF-AD), Follow-Up After Hospitalization for Mental Illness: Age 18 and Older (FUH-AD), Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD-AD), Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPCMI-AD), Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA-AD), Follow-Up After Emergency Department Visit for Mental Illness (FUM-AD), Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA-AD), Controlling High Blood Pressure (CBP-AD), Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPC-AD), PQI 01: Diabetes Short-Term Complications Admission Rate (PQI01-AD), PQI 05: Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate (PQI05-AD), PQI 08: Heart Failure Admission Rate (PQI08-AD), PQI 15: Asthma in Younger Adults Admission Rate (PQI15-AD), Plan All-Cause Readmissions (PCR-AD), Asthma Medication Ratio: Ages 19–64 (AMR-AD), HIV Viral Load Suppression (HVL-AD), PC-01: Elective Delivery (PC01-AD), Prenatal and Postpartum Care: Postpartum Care (PPC-AD), Contraceptive Care – Postpartum Women Ages 21–44 (CCP-AD), Contraceptive Care – All Women Ages 21–44 (CCW-AD), Cervical Cancer Screening (CCS-AD), Chlamydia Screening in Women Ages 21–24 (CHL-AD), Screening for Depression and Follow-Up Plan: Age 18 and Older (CDF-AD), Breast Cancer Screening (BCS-AD), Adult Body Mass Index Assessment (ABA-AD)


  1. Resource: Adult Health Quality Measures Dataset, FFY…
Search Terms
Maternal and Perinatal Health, Contraceptive Care, Postpartum Care, Primary Care Access and Preventative Care, Adult Screenings, Weight Assessment and Counseling, Behavioral Health, Antipsychotic Drugs, Care of Transitions and Follow-Up, Medication Management, Multiple Complex Conditions, Opioids, Screenings and Follow-Up, Substance Abuse or Dependence Treatment, Tobacco Use Treatment, Care of Acute and Chronic Conditions, Ambulatory Care, Asthma And/or COPD, Cardiovascular Disease, Diabetes, HIV Care, Hospitalizations and Readmissions
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