DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS Informational Bulletin  
 
DATE:  December 11, 2015 
 
FROM:  Vikki Wachino  
Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:  2016 Updates to the Child and Adult Core Health Care Quality Measurement Sets  
 
 
This informational bulletin describes the 2016 updates to the core set of childrens health care quality 
measures for Medicaid and the Childrens Health Insurance Program (CHIP) (Child Core Set) and the 
core set of health care quality measures for adults enrolled in Medicaid (Adult Core Set).  
 
Background  
 
The Center for Medicaid and CHIP Services (CMCS) has worked with stakeholders to identify two 
core sets of health care quality measures that can be used to assess the quality of health care provided 
to children and adults enrolled in Medicaid and CHIP (see http://www.medicaid.gov/medicaid-chip-
program-information/by-topics/quality-of-care/quality-of-care--performance-measurement.html). 
The core sets are tools states can use to monitor and improve the quality of health care provided to 
Medicaid and CHIP enrollees. The goals of this effort are to:  
 
  Encourage national reporting by states on a uniform set of measures; and  
  Support states in using these measures to drive quality improvement.  
 
Part of implementing an effective quality measures reporting program is to periodically reassess the 
measures that comprise it since many factors, such as changes in clinical guidelines and experiences 
with reporting and performance rates, may warrant modifying the measure set. In addition, CMCS 
continues to prioritize working with federal partners to promote quality measurement alignment 
across programs (e.g., Meaningful Use, Hospital Inpatient Quality Reporting Program, Physician 
Quality Reporting System) recognizing that this reduces burden on states reporting data to multiple 
programs and helps to drive quality improvement across payers and programs.  
 
For the 2016 updates to the Child and Adult Core Sets, CMCS, once again, worked with the National 
Quality Forums (NQF) Measure Applications Partnership (MAP),1 a public-private partnership that 
reviews measures for potential use in federal public reporting,  to review and identify ways to 
improve the core sets. Collaborating with NQFs MAP process for core set updates promotes measure 
alignment across CMS since NQF also reviews measures for other CMS reporting programs.  
                                                           
1 http://www.qualityforum.org/Setting_Priorities/Partnership/Measure_Applications_Partnership.aspx  CMCS Informational Bulletin  Page 2 
 
CMCS is encouraged by state reporting on the core measures. For the Child Core Set, fifty states and 
the District of Columbia voluntarily reported, for federal fiscal year (FFY) 2014, a median of 16 
measures. For the Adult Core Set, 34 states reported a median of 17 measures in FFY 2014.  
Additional information on state reporting and performance on each core set can be found in the 
forthcoming respective 2015 Annual Report on the Quality of Care for Children in Medicaid and 
CHIP and the 2015 Annual Report on the Quality of Care for Adults Enrolled in Medicaid . CMCS 
looks forward to working with states on the core measures reporting for FFY 2015.  
 
2016 Child Core Set  
 
Since the release of the initial Child Core Set in 2011, CMCS has collaborated with state Medicaid 
and CHIP agencies to voluntarily collect, report, and use the measures to drive quality improvements. 
Section 1139A of the Social Security Act, as amended by Section 401(a) of the Childrens Health 
Insurance Reauthorization Act (CHIPRA) of 2009, provides that, beginning annually in January 
2013, the Secretary shall publish recommended changes to the core measures.2  
 
For the 2016 Child Core Set update, CMCS will add two measures:  
  Use of Multiple Concurrent Antipsychotics in Children and Adolescents3 
  Audio logical Evaluation no later than 3 months of age4 
 
The addition of these two measures allows CMCS to expand the measurement of quality of care for 
two populations  children prescribed psychotropic drugs and children at-risk of hearing problems.   
CMCS also is engaged in a pilot of a reporting process for the child version of the hospital Consumer 
Assessment of Healthcare Providers and Systems survey (Child HCAHPS)5 in order to determine 
whether or not to include HCAHPS in a future Child Core Set. This measure was recommended by 
the 2014 MAP to help address gaps noted in the measure set in three areas: inpatient care; patient 
experience; and care coordination. Additional information about the 2015 Child Core Set MAP 
review process and their recommendations to CMCS can be found at: http://medicaid.gov/medicaid-
chip-program-information/by-topics/quality-of-care/chipra-initial-core-set-of-childrens-health-care-
quality-measures.html.  
 
2016 Adult Core Set  
 
In January 2012, CMCS released its initial Adult Core Set. Section 1139B of the Social Security Act, 
as amended by Section 2701 of the Affordable Care Act, notes that the Secretary shall issue updates 
to the Adult Core Set beginning in January 2014 and annually thereafter.6, 7 
                                                           
2 The first update was issued via a State Health Official Letter 2013 Childrens Core Set of Health Care Quality 
Measures, SHO #13-002. http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-002.pdf .  The 2014 
update was issued via a CMCS Informational Bulletin 2014 Updates to the Child and Adult Core Health Care Quality 
Measurement Sets. http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12-19-13.pdf   as was the 2015 
Updates to the Child and Adult Health Care Quality Measurements Sets.  http://www.medicaid.gov/federal-policy-
guidance/downloads/cib-12-30-2014.pdf  
3 Measure steward: AHRQ-CMS CHIPRA National Collaborative for Innovation in Quality Measurement (NCINQ), Not 
NQF Endorsed 
4 Measure steward: Centers for Disease Control and Prevention, NQF #1360 
5 Measure steward: Center for Quality Improvement and Patient Safety-Agency for Healthcare Research and Quality, 
NQF#2548 
6 The first update was issued via a CMCS Informational Bulletin 2014 Updates to the Child and Adult Core Health Care 
Quality Measurement Sets. http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12-19-13.pdf    CMCS Informational Bulletin  Page 3 
 
 
For the 2016 Adult Core Set update, CMCS will add two measures:  
  Use of Opioids from Multiple Providers at High Dosage in Persons Without Cancer: Opioid 
High Dosage8 
  Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using 
Antipsychotic Medications9 
 
The addition of these two measures allows CMCS and states to expand the measurement of quality of 
care in Medicaid for two population groups  adults with substance use disorders and/or mental 
health disorders. Additional information about the 2015 Adult Core Set MAP review process and 
their recommendations to CMCS can be found at: http://www.medicaid.gov/Medicaid-CHIP-
Program-Information/By-Topics/Quality-of-Care/Adult-Health-Care-Quality-Measures.html   
 
Next Steps 
 
The 2016 updates to the Core Sets will take effect in the FFY 2016 reporting cycle, which will begin 
no later than December 2016. To support states in making these changes, CMCS will release updated 
technical specifications for both Core Sets in spring 2016 and make them available at: 
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Quality-
of-Care.html. States with questions or that need further assistance with reporting and quality 
improvement regarding the Child and Adult Core Sets can submit questions or requests to: 
MACQualityTA@cms.hhs.gov.  
 
If you have questions about this bulletin, please contact Marsha Lillie-Blanton, Children and Adults 
Health Programs Group, at marsha.lillie-blanton@cms.hhs.gov. 
                                                                                                                                                                                                    
7 The second update was issued via a CMCS Informational Bulletin 2015 Updates to the Child and Adult Core Health 
Care Quality Measurement Sets.http://www.medicaid.gov/federal-policy-guidance/downloads/cib-12-30-2014.pdf  
8 Measure steward: Pharmacy Quality Alliance, Not NQF Endorsed 
9 Measure steward: NCQA, NQF #1932