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 30, 2014  
 
FROM:    Cindy Mann 
Director  
    Center for Medicaid and CHIP Services  
 
SUBJECT:   2015 Updates to the Child and Adult Core Health Care Quality 
Measurement Sets  
 
This informational bulletin describes the 2015 updates to the core set of childrens health care 
quality measures for Medicaid and the Childrens Health Insurance Program (CHIP) (Child Core 
Set) and to 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.  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:  
 
1)  encourage national reporting by states on a uniform set of measures; and 
2)  support states in using these measures to drive quality improvement.   
 
Part of implementing an effective quality measures reporting program is to periodically re-
assess the measures that comprise it since many factors, such as changes in clinical guidelines 
and challenges with reporting, may warrant modifying the measure set.   In addition, CMCS 
continues to prioritize working with federal partners to promote quality measurement alignment 
across programs recognizing that this reduces burden on states reporting data to multiple 
programs and helps to drive quality improvement across payers and programs. 
 
For the 2015 updates to the Child and Adult Core Sets, CMCS worked with the National Quality 
Forums (NQF)1 Measure Applications Partnership (MAP), a public-private partnership that 
reviews measures for potential use in federal public reporting,2 to review and identify ways to 
improve the core sets.  Collaborating with NQFs MAP process for core set updates promotes 
measure review alignment across CMS since NQF also updates measures for other CMS 
reporting programs.   
 
                                                           
1 http://www.qualityforum.org/story/About_Us.aspx 
2 http://www.qualityforum.org/map/  CMCS Informational Bulletin  Page 2 
 
CMCS is encouraged by state reporting on the core measures.  For the Child Core Set, all states 
voluntarily reported two or more of the measures for federal fiscal year (FFY) 2013, with a 
median of 16 measures reported by states.  For the Adult Core Set, 30 states reported a median of 
17 measures and 25 states reported on at least 8 core set measures in FFY 2013.  Additional 
information on state reporting for each core set can be found in the respective 2014 Annual 
Report on the Quality of Care for Children in Medicaid and CHIP and the 2014 Annual Report 
on the Quality of Care for Adults Enrolled in Medicaid.3,4  CMCS looks forward to working with 
states on the core measures reporting now underway for FFY 2014.  
 
2015 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 provides that, beginning annually in 
January 2013, the Secretary shall publish recommended changes to the core measures.5 
 
For the 2015 Child Core Set update, CMCS will: 
  retire one measure, Percentage of Eligibles that Received Dental Treatment Services;6  
  add two measures:  
- Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk;7and   
- Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment.8   
 
In addition, CMS will pilot a reporting process for FFY 2015 for the child version of the hospital 
Consumer Assessment of Healthcare Providers and Systems survey (Child HCAHPS) in order to 
determine whether or not to include HCAHPS in the Core Set.9  Since the Child HCAHPS is a 
survey conducted by hospitals, CMS will work with CMS hospital reporting programs and states 
to obtain the survey data.  CMS views the Child HCAHPS as an important tool for monitoring a 
familys experiences and satisfaction with hospital-based pediatric care.  This measure was 
recommended to help address gaps noted in the measure set in three areas: inpatient care; patient 
experience, and care coordination. Additional information about the Child Core Set MAP review 
process and their recommendations to CMS can be found 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 
 
                                                           
3 http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/downloads/2014-child-
sec-rept.pdf  
4 http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/downloads/2014-adult-
sec-rept.pdf  
5 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 
second 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 
6 Measure steward: CMS, Not NQF Endorsed 
7 Measure steward: American Dental Association on behalf of the Dental Quality Alliance, NQF#2508 
8 Measure steward: American Medical Association - Physician Consortium for Performance Improvement (AMA-
PCPI), NQF#1365 
9 Measure steward: Center for Quality Improvement and Patient Safety-Agency for Healthcare Research and 
Quality, Underdoing NQF Endorsement Review NQF#2548  CMCS Informational Bulletin  Page 3 
 
 
2015 Adult Core Set 
In January 2012, CMCS released its initial core set of health care quality measures for adults 
enrolled in Medicaid (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.10 
 
For the 2015 Adult Core Set update, CMCS will:  
  retire the Comprehensive Diabetes Care: LDL-C Screening measure;11 and 
  add the Comprehensive Diabetes Care: Hemoglobin A1c Poor Control (>9.0%) 
measure.12   
The replacement of the diabetes screening measure allows CMCS and states to expand the 
measurement of health care outcomes in Medicaid.  Additional information about the Adult Core 
Set MAP review process and their recommendations to CMS 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 updates to the Core Sets will take effect in the FFY 2015 reporting cycle, which will begin 
no later than December 2015.  To support states in making these changes, CMCS will release 
updated technical specifications for both Core Sets in spring 2015 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 
                                                           
10 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 
11 Measure steward: National Committee for Quality Assurance, NQF#0063 
12 Measure steward: National Committee for Quality Assurance, NQF#0059