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:  December 5, 2016 
 
FROM:  Vikki Wachino  
Director  
Center for Medicaid & CHIP Services  
 
SUBJECT:  2017 Updates to the Child and Adult Core Health Care Quality Measurement 
Sets  
 
This informational  bulletin  describes the 2017 updates to the core set of childrens health care 
quality measures for Medicaid and the Childrens Health Insurance Program (CHIP) (the Child 
Core Set) and the core set of health care quality measures for adults enrolled in Medicaid (the 
Adult Core Set).  
 
Background  
 
The Center for Medicaid & 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 
https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/index.html).   
 
The core sets are tools states can use to monitor and improve the quality  of health care provided 
to Medicaid and CHIP enrollees.  Under statute, state reporting on these measure sets is 
voluntary.  1 2  The goals of this effort are to encourage national reporting by states on a uniform 
set of measures and to 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 
                                                             
1 The Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA) required the Secretary of the 
U.S. Department of Health and Human Services (HHS) to establish a program to standardize the measurement of 
health care quality for children in Medicaid and the Childrens Health Insurance Program (CHIP) and facilitate 
voluntary reporting and use of the measures for quality improvement. 
2 The Affordable Care Act required the Secretary of the U.S. Department of Health and Human Services (HHS) to 
establish an adult health care quality measurement program to standardize the measurement of health care quality 
across state Medicaid programs and facilitate voluntary reporting and use of the measures for quality improvement.  
This program builds and expands upon HHSs quality measurement program established for children as part of the 
Childrens Health Insurance Program Reauthorization Act (CHIPRA) of 2009.  
  CMCS Informational Bulletin  Page 2 
 
measurement alignment across programs (e.g., Quality Payment Program), recognizing  that this 
reduces burden and helps to drive quality improvement  across payers and programs.  
 
For the 2017 updates to the Child  and Adult Core Sets, CMCS worked with the National Quality 
Forums (NQF) Measure Applications  Partnership (MAP),3 a public-private  partnership that 
reviews measures for potential use in federal public reporting and identifies  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.  
 
Since the core sets were established in 2010 and 2012, states have made progress reporting on 
the core measures.  All states and the District of Columbia  (DC) voluntarily  reported at least one 
Child Core Set measure in FFY 2015, with 41 states voluntarily  reporting at least 12 of the 23 
Child Core Set measures for FFY 2015.  The median number of Child Core Set measures 
reported by states for FFY 2015 remained consistent with reporting for FFY 2013 and FFY 2014 
(16 measures for each year), an increase from 14 measures reported for FFY 2012.  For the Adult 
Core Set, the number of states reporting measures has increased steadily from 30 states in FFY 
2013 to 34 states for FFY 2014 and 39 states for FFY 2015.  The median number of Adult Core 
Set measures reported remained the same, with 16 measures reported in both FFY 2014 and FFY 
2015.  
 
2017 Child Core Set  
 
Since the release of the initial  Child Core Set in 2010, 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.4  This year CMS will be adding two measures to the Child Core Set and retiring one 
measure. 
 
For the 2017 Child  Core Set update, CMCS will add two measures:  
 
  Use of First-Line Psychosocial Care for Children  and Adolescents on Antipsychotics  (the 
percentage of children and adolescents 117 years of age with a new prescription for an 
antipsychotic,  but no indication  for antipsychotics,  who had documentation  of 
psychosocial care as first-line  treatment).5  
                                                             
3 http://www.qualityforum.org/Setting_Priorities/Partnership/Measure_Applications_Partnership.aspx 
4 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  and 2016 Updates to the Child and Adult Core Health Care 
Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib-12-11-15.pdf  
5 Measure Steward National Committee for Quality Assurance (NCQA): NQF # 2801  CMCS Informational Bulletin  Page 3 
 
  Contraceptive Care  Postpartum (the percentage of women ages 15 through 44 who had 
a live birth and were provided a most or moderately effective method of contraception 
within 3 and 60 days of delivery).6 
 
The addition  of the measure, Use of First-Line Psychosocial Care for Children and Adolescents 
on Antipsychotics,  to the existing Core Set measure (Use of Multiple  Concurrent Antipsychotics 
in Children  and Adolescents) will focus attention on the important challenge of providing  access 
to appropriate care for Medicaid and CHIP insured children on these medications.  The 
Contraceptive Care - Postpartum measure focuses on measuring the provision  of contraception to 
mothers in the postpartum period which can help women space pregnancies to their desired inter-
pregnancy interval and help to improve future birth outcomes.  As Healthy People 20207 
recommends an inter-pregnancy interval of at least 18 months, providing  contraception in the 
postpartum period can be considered an indicator of quality care.  For consistency and ease of 
reporting this measure will also be added to the Adult Core Set.   
 
CMS will  retire the standalone Human Papilloma Virus (HPV) measure from the Child Core Set.  
The stand-alone HPV Vaccination for Female Adolescents measure (NQF #1959) has been 
retired by the measure steward,8 and added to the Immunizations  for Adolescents (IMA) 
Measure (NQF #1407) already in the Child Core Set.9  CMS will update the IMA measure and 
provide detailed reporting instructions in the 2017 Technical Specifications  and Resource 
Manual. 
 
The child version of the Hospital Consumer Assessment of Healthcare Providers and Systems 
survey (Child HCAHPS)10 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.   As part 
of the Pediatric Quality Measures Program (PQMP),11 CMS and the Agency for Healthcare 
Research and Quality (AHRQ) will further test the Child  HCAHPS measures in real-world 
settings and assess the extent to which this hospital-level  measure can be reported at the state-
level.  As such, CMCS will not be adding this measure to the Child Core Set at this time but will 
continue to assess its feasibility  for possible addition  in future Core Sets.   
 
Additional  information  about the 2016 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.  
 
                                                             
6 Measure Steward US Office of Population Affairs, NQF # 2902 
7 MICH-16.6 | Healthy People 2020 
8 The measure steward refers to the organization that is responsible for providing the required measure information 
for the measure maintenance process that occurs approximately every three years and is responsible for making the 
necessary updates to the measure and for informing NQF about any changes that are made to the measure on an 
annual basis.   
9 https://www.ncqa.org/Portals/0/PublicComment/HEDIS2017/12.%20HPV_IMA.pdf  
10 Measure steward: Center for Quality Improvement and Patient Safety-Agency for Healthcare Research and 
Quality, NQF#2548 
11 PQMP Dissemination and Implementation of Child Health Quality Measures Cooperative Research GrantsNew 
Grantee Information  CMCS Informational Bulletin  Page 4 
 
2017 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.12  This year 
CMS will  add three measures to the Adult Core Set and retire one measure.  
 
For the 2017 Adult Core Set update, CMCS has decided to add three measures to the Adult Core 
Set:  
  Diabetes Care for People with Serious Mental Illness: Hemoglobin  (HbA1c) Poor 
Control (>9.0%) (the percentage of patients 18-75 years of age with a serious mental 
illness and diabetes (type 1 or type 2) whose most recent HbA1c level during the 
measurement year is >9.0%).13 
  Follow-up  after Discharge from the Emergency Department for Mental Health or Alcohol 
or Other Drug Dependence (the percentage of discharges for patients 18 years of age and 
older who had a visit to the emergency department with a primary diagnosis of mental 
health or alcohol or other drug dependence during the measurement year, who had a 
follow-up  visit with any provider with a corresponding primary diagnosis of mental 
health or alcohol or other drug dependence within 7- and 30-days of discharge).14  
  Contraceptive Care Postpartum (the percentage of women ages 15 through 44 who had a 
live birth and were provided a most or moderately effective method of contraception 
within 3 and 60 days of delivery).15 
 
The addition  of these three measures will allow 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 and reproductive age women.   
 
CMCS is also adding the electronic clinical  quality measure (e-measure) format of NQF measure 
#0469 PC-01 Elective Delivery, already a measure on the adult core set.16  The addition  of this e-
measure will provide states an additional  reporting method for an existing measure.   
 
After consulting  with states, CMCS has decided to retire one measure, the Timely Transmission 
of Transition  Record (Discharges from an Inpatient Facility  to Home/Self Care or Any Other Site 
                                                             
12 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 .  The 
2015 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.  The 
2016 update was issued via a CMCS Information Bulletin 2016 Updates to the Child and Adult Core Health Care 
Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib-12-11-15.pdf  
13 Measure steward: NCQA, NQF # 2607 
14 Measure steward: NCQA, NQF # 2605 
15 Measure Steward: US Office of Population Affairs, NQF # 2902 
16 Measure steward: The Joint Commission, NQF #2829.  This measure is the e-measures version of NQF #0469 
which is already included in the Adult Core Set.   CMCS Informational Bulletin  Page 5 
 
of Care),17 due to the low number of states reporting this measure, a decrease in the number of 
states reporting over time, and the challenges states have described in collecting  it.   
 
Additional  information  about the 2016 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 2017 updates to the Core Sets will take effect in the FFY 2017 reporting cycle, which will 
begin no later than fall 2017.  To support states in making these changes, CMCS will release 
updated technical specifications for both Core Sets in spring 2017 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 Karen Matsuoka, PhD at 
karen.matsuoka@cms.hhs.gov,  or call (410)786-9726. 
 
                                                             
17 Measure steward: American Medical Association-Physician Consortium for Performance Improvement (AMA-
PCPI_, NQF # 0648