DEPARTMENT OF HEALTH  & HUMAN SERVICES  
Centers for Medicare & Medicaid Services  
7500 Security Boulevard,  Mail  Stop S2-26-12  
Baltimore, Maryland    21244-1850  
 
  SHO # 13-002 
 
January  24, 2013  
 
  Re: 2013 Childrens  Core Set  of Health Care 
  Quality Measures  
  
Dear State Health Official:  
Dear State Medicaid Director:  
 
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 the Childrens Health  
Insurance Program (CHIP).  The Childrens Health Insurance Program Reauthorization Act of  
2009 (CHIPRA) (Pub. L.  111-3) added Section 1139A(a) to the Social Security Act  (the Act)  
which 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 CHIP programs.  The  Initial Childrens  Core Set was released officially  via a state health  
official letter (SHO# 11-001) in February 2011.  Early successes demonstrate increased state 
voluntary  reporting on the  Initial Childrens  Core Set, with forty-eight states and the District of  
Columbia (DC) voluntarily reporting one or more  of the initial core set of  childrens health care  
quality measures for  federal fiscal  year (FFY) 2011.  The median number of measures  reported 
by states this  year was 12, which is an increase from 7 measures reported in FFY 2010.  
 
Section 1139A(b)(5) of the Social Security Act provides that, beginning January 1, 2013 and 
annually thereafter,  the Secretary shall publish recommended changes to the Initial Childrens  
Core Set.  This letter provides an overview of the  steps undertaken to improve the  Initial 
Childrens  Core Set,  identifies changes to the Initial  Childrens Core Set, and presents the timing  
for the implementation of the 2013 Childrens Core Set.  Similar to the  way  that CMS and states  
have used the Initial Childrens Core Set to assess quality and access to health care, this portfolio 
of measures must be assessed periodically to ensure that its measures are relevant to current  
approaches to health  care delivery.  For example, the measure set should address updates to 
clinical guidelines,  feedback from states on the challenges of collecting the measures, under-
reported measurement domains, and changes in the health care landscape.    
 
I.   Approach to Identifying Additional Measures   
 
As part of a multi-stakeholder process, the Agency  for Healthcare Research and Quality  
(AHRQ), in partnership with CMS, conducted a February 2012 public call for nominations  of 
measures for consideration for inclusion in the 2013 Childrens  Core Set.  The goal of   Page 2    State Health Official/State Medicaid Director  
 
identifying  new  measures  for possible inclusion in the 2013 Childrens  Core Set  is to find 
opportunities to build upon the original measure set  by addressing gap  areas, improving upon 
existing Initial Childrens  Core Set measures,  and aligning with national quality measurement 
activities.   As  a result  of this  iterative process, the childrens core set of health care quality  
measures  will become more  robust  and  will better support states and CMSs quality  
measurement  needs.   AHRQ received  a total of  77 measure submissions.  Sixty-four measures  
were received through a public call for measures  and 13 measures  were submitted by  the AHRQ
CMS Pediatric Quality  Measures Programs Centers of Excellence.   An overview of the AHRQ
CMS Pediatric Quality  Measures Program and the Centers of Excellence can be found  
at  http://www.ahrq.gov/chipra/pqmpfact.htm.   Measure nominations  covered a range of topics,  
from  school  days missed due to illness  to pediatric heart surgery mortality.   Over the summer  of 
2012,  AHRQ convened a Subcommittee to its National Advisory Committee (SNAC)  on Quality  
Measures for  Children's Healthcare to review the submitted  measures.   The SNAC was asked to 
recommend measures for the 2013 Childrens  Core  Set.  Of the 77  measure  submissions, the  
SNAC reviewed  and scored  63  of the measures.   Fourteen measures  submitted  through the public  
nominations process  did not include sufficient  information  (e.g., no numerator or denominator  
information)  for the SNAC  to conduct an assessment.  
 
The  SNAC evaluated  which measures  were best suited for the improved core set based on their  
validity, feasibility of use by Medicaid and CHIP  programs,  and importance to improving health 
outcomes for children.  The SNAC  ultimately  recommended  seven measures.   CMS had the  
discretion to identify uses for these measures.   Information about the SNAC recommendations  
and the  process used to identify  the recommendations  can be found 
at: http://www.ahrq.gov/chipra/background2012/  .  
 
II.   Changes to the  Initial Childrens  Core Set  
 
Of the measures recommended by the SNAC,  CMS is adding the following three measures  and 
retiring one measure.   Appendix  A  provides a complete listing of the 2013 Childrens  Core Set  
Measures.  
   
Measures Added  
Title    Measure Steward   Description as  per  Benefit of Including  Measure  
Measure Steward   in 2013 Childrens  Core Set  
Human  National  The percentage of   This measure serves as  a 
Papillomavirus   Committee for   female adolescents 13   compliment to  the  
(HPV) Vaccine  Quality Assurance  years of  age who had  Immunizations for  
for Female  (NCQA)   three doses of the HPV   Adolescents (NQF 1407)  
Adolescents    vaccine by their 13th   measure.  By adding this  
  birthday.   measure, the 2013 Childrens  
Core Set  better  aligns with 
Advisory Committee on 
Immunization  Practices and  
US Preventive Services  Task  
Force  immunization  
recommendations.   Page 3    State Health Official/State Medicaid Director  
 
Title    Measure Steward   Description as  per  Benefit of Including  Measure  
Measure Steward   in 2013 Childrens  Core Set  
Medication   National  Percentage of members   This measure presents an  
Management   Committee for   5-64  years of age during   opportunity to evaluate the  
for People with  Quality Assurance   the measurement  year   extent to which individuals  
Asthma   (NCQA)   who were identified as   with persistent asthma are  
having persistent asthma   consistently taking their  
and were dispensed  prescribed controller  
appropriate medications   medications.    
who remained on those    
medications during the   States can use this as a 
treatment period.   pairing measure with the 
  Asthma ED visit  (NQF 1381)  
For the purposes of the   measure in the 2013 
2013 Childrens Core   Childrens  Core Set.   
Set, states will be asked    
to collect data on this   CMS acknowledges that  a 
measure for children   similar  yet distinct measure,  
ages 5-18.   Use of Appropriate  
Medications for People  with 
Asthma, is  in stage two  of  
the EHR  Incentive Program. 
This measure monitors that 
people identified as having  
persistent asthma  are 
appropriately prescribed  
medication.  The  2013 
Childrens  Core Set  measure 
focuses on  the percentage of  
patients who remained on an 
asthma controller medication.   
The two measures, both 
developed by NCQA, are  
complimentary, using both 
the same denominator and 
similar medication lists. One 
measure monitors whether  
medication is prescribed  
whereas the other measures  
patient adherence to the 
medication.  
Behavioral   AMA-convened  Percentage of patients,   Assessing behavioral  health  
Health Risk   Physician   regardless of age, who  risk for pregnant women 
Assessment   Consortium for   gave birth during a 12 creates an opportunity to 
(for Pregnant   Performance  month period seen at   impact the quality of health  
Women)    Improvement  least once for prenatal   care  for both mother  and  Page 4    State Health Official/State Medicaid Director  
 
Title    Measure Steward   Description as  per  Benefit of Including  Measure  
Measure Steward   in 2013 Childrens  Core Set  
  (PCPITM) is  a key  care who  received a  child. This measure assesses  
member of the  behavioral health  a variety of topics  relevant to  
Pediatric  screening risk   health care quality that are 
Measurement   assessment that includes   not captured in other  2013 
Center of   the following screenings   Childrens  Core Set measures 
Excellence  at the first prenatal visit:  (e.g. depression, alcohol,  
(PMCoE)  screening for   tobacco, and drug use, 
consortium.    depression, alcohol use,  domestic violence).    
tobacco use, drug use, 
and intimate partner  
violence screening.   
 
Retired  Measure:  
As part of CMSs efforts to work with states in increasing the number of measures voluntarily  
collected, we have identified significant challenges in collecting  one of the  core measures: NQF 
# 0657, Otitis Media with Effusion Avoidance of  Inappropriate Systemic  Antimicrobials in  
Children (ages 2-12).   This measure will be retired from the Core Set.  Most Medicaid and CHIP  
agencies have not been able to report this measure  since it draws from CPT  II codes  which are 
not commonly used by  Medicaid or CHIP  agencies.   
 
III.   Implementation  Timeline  for the 2013 Childrens  Core Set  
 
The technical specifications for the three new measures will be posted  by early  spring  2013  on 
CMSs  technical assistance and analytic support webpage for the  childrens core set measures,  
available at  http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality
of-Care/CHIPRA-Initial-Core-Set-of-Childrens-Health-Care-Quality-Measures.html.   
 
States choosing to voluntarily  report  measures from the 2013 Childrens  Core Set can submit  
data results to CMS during the next reporting period (December 2013).  Technical assistance and 
analytic support  are available to states collecting  the three new measures;  questions and requests  
should be sent to:  CMSCHIPRAQualityTA@cms.hhs.gov.   
 
Conclusion  
 
The CHIPRA legislation  requires that improvements to the  initial core set of childrens health  
care quality measures  be  issued annually beginning  in  January 2013.  CMS sees this as a unique  
opportunity to meet our  goal of  continuing to fill  measurement  gap areas in the core set and  
apply  states  feedback about implementing the measures.  Additionally, these annual updates  will  
allow CMS to further demonstrate alignment with National Quality Strategy  and other HHS  
reporting programs such as the Electronic Health  Record (EHR) Medicaid  Incentive Program.  
 
We are committed to  identifying  measures that build a stronger portfolio of measures that states  
can use to  improve care for their  Medicaid  and CHIP  beneficiaries,  while  keeping in mind the   Page 5    State Health Official/State Medicaid Director  
 
additional  resources  that may be needed to implement updates.   Our staff is available to assist 
states in working through this process.  
 
We look forward to continuing to partner with states  to support the collection, reporting, and use  
of the  2013 Childrens  Core Set measures.   
 
            Sincerely,  
 
            /s/              
            Cindy Mann  
            Director  
 
cc:   
CMS Regional Administrators  
  
CMS Associate Regional Administrators   
Division of Medicaid and Childrens Health Operations  
Matt Salo  
Executive Director  
National Association of  Medicaid Directors   
 
Alan R. Weil, J.D., M.P.P.  
Executive Director  
National Academy for State Health Policy  
Ron Smith  
Director of Legislative Affairs   
American Public Human  Services Association  
 
Joy Wilson  
Director, Health Committee  
National Conference of State Legislatures  
 
Heather Hogsett  
Director, Committee on  Health &  Homeland Security  
National Governors Association  
 
Debra Miller  
Director for Health Policy  
Council of State Governments  
 
Christopher Gould  
Director, Government Relations   
Association of State and  Territorial Health Officials   Page 6    State Health  Official Letter  
 
Appendix  A   
2013 Core Set of Childrens Health Care Quality  Measures  for Medicaid and CHIP  
 
Population/Community Health  
NQF   Measure Steward   Measure Name   Alignment to  
CMS  Programs  
1959   NCQA/HEDIS     Human papillomavirus (HPV)   New measure  
Vaccine for  Female 
Adolescents  
0024   NCQA/HEDIS   Weight Assessment and    
Counseling for Nutrition and 
Physical Activity for  
Children/Adolescents: Body  
Mass Index Assessment for  
Children/Adolescents  
Clinical Care  
NQF   Measure Steward   Measure Name   Alignment to  
CMS Programs  
NA   NCQA/HEDIS   Child and Adolescent Access to  Current CHIP  reporting  
Primary Care Practitioners   element  
0038   NCQA/HEDIS   Childhood Immunization Status   EHR for Eligible  Providers  
(EPs), Physician Quality  
Reporting System (PQRS), 
Proposed in Value-Based  
Payment Modifier  
1407   NCQA/HEDIS   Adolescent Immunization   
Status  
1391   NCQA/HEDIS   Frequency of  Ongoing Prenatal   Supports Strong Start  
Care   Initiative, Maternity  
Measures Core Set      
1517   NCQA/HEDIS   Timeliness of Prenatal Care   Supports Strong Start  
Initiative, Maternity  
Measures Core Set  
1382   CDC   Live Births  Weighing Less   Supports Strong Start  
Than 2,500 Grams   Initiative, Maternity  
Measures Core Set  
0471   California   Cesarean Rate for  Nulliparous   Supports Strong Start  
Maternal Quality   Singleton Vertex   Initiative, Maternity  
Care Collaborative   Measures Core Set  
NA   AMA-PCPI   Behavioral Health Risk   New measure  
Assessment (for Pregnant  
Women)  
1448   Oregon Health and  Developmental Screening in the   
Science  First Three Years of Life  
University, 
CAHMI   Page 7    State Health  Official Letter  
 
Clinical Care  - continued  
NQF   Measure Steward   Measure Name   Alignment to  
CMS Programs  
0060   NCQA   Annual Pediatric Hemoglobin  EHR for EPs, Proposed in 
A1C  Testing   Value-Based Payment  
Modifier, Measures Under  
Consideration (MUC) in 
PQRS  
1392   NCQA/HEDIS   Well-Child Visits in the  First 15    
Months of  Life  
1516   NCQA/HEDIS   Well-Child Visits in the  3rd,   
4th, 5th, and 6th Years of  Life  
NA   NCQA/HEDIS   Adolescent Well-Care Visit    
0033   NCQA/HEDIS   Chlamydia Screening   Adult Medicaid Core Set, 
EHR for EPs, PQRS, 
Proposed in Value-Based  
Payment Modifier  
NA   CMS   Preventive Dental Services   CMS Form 416, CMCS  Oral  
Health Initiative  
NA   CMS   Dental  Treatment Services   CMS Form 416, CMCS  Oral  
Health Initiative  
1799   NCQA/HEDIS   Medication Management for   New measure  
People with Asthma    
Care Coordination  
NQF   Measure Steward   Measure Name   Alignment to  
CMS Programs  
0576   NCQA/HEDIS   Follow-up After Hospitalization   Adult Medicaid Core Set, 
for Mental Illness   Medicare Part C, Physician  
Feedback, MUC in  Inpatient  
Psych, PQRS, and Value-
Based Payment Modifier  
  NCQA/HEDIS   Follow-Up Care for Children  EHR for EPs, Proposed in 
Prescribed Attention Deficit  Value-Based Payment  
Hyperactivity Disorder   Modifier, MUC in PQRS  
Medication  
Safety  
NQF   Measure Steward   Measure Name   Alignment to  
CMS Programs  
0139   CDC   Pediatric Central-Line   Hospital Compare, Hospital  
Associated  Blood Stream   Inpatient Quality Reporting   
Infections    Neonatal Intensive  (IQR), Hospital Value-Based  
Care Unit and  Pediatric  Purchasing, LTCH, PPS  
Intensive Care Unit   Exempt Cancer Hospital,  
MUC in Hospital Acquired 
Condition Payment  
Reduction Program   Page 8    State Health  Official Letter  
 
Efficiency and Cost Reduction  
NQF   Measure Steward   Measure Name   Alignment to  
CMS Programs  
0002   NCQA/HEDIS   Appropriate Testing for   EHR for EPs, Physician 
Children with Pharyngitis   Feedback, PQRS, Proposed 
in Value-Based Payment  
Modifier  
1381   Alabama Medicaid   Annual Percentage of  Asthma    
Patients 2 Through 20 Years old 
with One or More  Asthma-
Related Emergency Room  
Visits  
N/A   NCQA/HEDIS   Ambulatory Care: Emergency    
Department Visits  
Person and Caregiver Centered Experience  
NQF   Measure Steward   Measure Name   Alignment to  
CMS Programs  
N/A   NCQA/HEDIS   Consumer Assessment of   Can be used to support  
Healthcare Providers  and   CHIPRA requirement.  
Systems (CAHPS) 4.0H   CHIPRA requires Title XXI  
(Child Version Including  programs to submit to CMS  
Medicaid and Children with  beginning in December  
Chronic Conditions   2013, data regarding access  
Supplemental Items)   to primary  and specialty  
services, accesses to  
network of care, and care  
coordination provided under  
the state child health plan,  
using quality of care  and 
consumer satisfaction 
measures included in the  
Consumer Assessment of  
Healthcare Providers  and  
Systems (CAHPS) survey.