DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
CMCS Informational Bulletin 
 
 
DATE:   January 24, 2013 
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Medicaid and CHIP Updates 
 
This Informational Bulletin provides information on two topics: 
  State Health Official Letter: 2013 Childrens Core Set of Health Care Quality Measures 
  Performance Indicators for Medicaid and CHIP Business Functions 
 
State Health Official Letter: 2013 Childrens Core Set of Health Care Quality Measures 
 
The Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires the 
Secretary of the Department of Health and Human Services to identify an initial core set of 
recommended pediatric quality measures for voluntary use by State Medicaid and the Childrens 
Health Insurance Programs (CHIP.) 
 
Over the past two years, the Centers for Medicare & Medicaid Services (CMS) has worked 
closely with states to support the voluntary collection of the initial core set of health care quality 
measures (Initial Childrens Core Set) for children in Medicaid and CHIP. 
 
Today CMS released a letter to State Health Officials that provides an overview of the steps 
undertaken to improve the Initial Core Set of Childrens Health Care Quality Measures for 
Medicaid and CHIP; identifies changes to the measure set; and presents the timing for the 
implementation of the changes.  
 
For additional information, please access the letter at http://www.medicaid.gov/Federal-Policy-
Guidance/Federal-Policy-Guidance.html.  
 
 
Performance Indicators for Medicaid and CHIP Business Functions 
 
The Affordable Care expands access to health insurance coverage through improvements to 
Medicaid and CHIP and the establishment of Affordable Insurance Exchanges (Exchanges.)  It 
assures coordination between Medicaid, CHIP, and the Exchange so individuals are enrolled in 
the appropriate insurance affordability program and can retain coverage over time even as their 
circumstances change.   
 
The Centers for Medicare & Medicaid Services (CMS) is working with states to ensure that 
Medicaid and CHIP support modern approaches to business processes and standards of  CMCS Informational Bulletin  Page 2 
 
performance management as are found in the private sector and high-performing public 
programs. To that end, we are seeking public input to aid in the development of an initial set of 
business process indicators for all Medicaid and CHIP programs. 
 
CMS indicated in two final rules that it would begin to collect business process performance 
indicators for all Medicaid and CHIP programs in association with the development of new 
information technology systems: Federal Funding for Medicaid Eligibility Determination and 
Enrollment Activities (75 FR 21950) and Eligibility Changes under the Affordable Care Act of 
2010 (77 FR 17144.)  We intend to begin collecting and reporting on indicators in two primary 
domains:  individual (applicant and beneficiary) experience with eligibility and enrollment; and 
provider experience with enrollment and claims payment. We intend to begin by generating 
baseline data and in subsequent years, as we progress in the development and testing of 
indicators, CMS and states will work together, with input from other stakeholders, to develop 
benchmarks and targets for performance improvement. 
 
For more information about the business process performance indicators and the public input we 
are seeking, please see the request for information online at http://www.medicaid.gov/Medicaid-
CHIP-Program-Information/By-Topics/Data-and-Systems/Data-and-Systems.html. The request 
for information also contains instructions for providing comments. 
 
Comments will be most helpful if received by March 8, 2013.