§ 437.15 Annual reporting on the Child, Adult, and Health Home Core Sets. ( a ) *General rules.* ( 1 ) Except as provided in paragraphs (a)(2) and (a)(4) of this section, the agency— ( i ) Must report by December 31, 2024, on all measures on the 2024 Child Core Set and the behavioral health measures in the Adult Core Set;
( ii ) In subsequent years, must report annually, by December 31st, on all measures on the Child Core Set and the behavioral health measures in the Adult Core Set that are identified by the Secretary pursuant to § 437.10(b)(1)(iii);
( iii ) Must report annually, by December 31st, on all measures in the 1945 or 1945A Health Home Core Sets (as applicable) that are identified by the Secretary pursuant to § 437.10(b)(1)(iii), if the agency has elected to offer health home services under the State plan under section 1945 or section 1945A of the Act, and if the applicable health home program has an effective date and has been implemented more than 6 months prior to the December 31st reporting deadline; and
( iv ) May report on all other measures in the Adult Core Set that are not described in paragraphs (a)(1)(i) and (ii) of this section.
( 2 ) Measures identified per § 437.10(b)(1)(iv) will be reported by the Secretary on behalf of the agency.
( 3 ) The agency must adhere to the reporting guidance described in § 437.10(b), except as described in paragraph (a)(4) of this section, when reporting on measures in the Core Sets.
( 4 ) In reporting on all Child and Adult Core Set measures, the agency is required to report on all Medicaid and CHIP beneficiaries, including those enrolled in fee-for-service and managed care, unless— ( i ) The Secretary specifies in annual guidance that the population is not required to be reported in accordance with § 437.10(b)(5); or
( ii ) The Secretary grants the agency an exemption from reporting one or more Child and Adult Core Set measures for a specific population in accordance with paragraph (a)(6) of this section.
( 5 ) In reporting on all 1945 and 1945A Health Home Core Sets measures, the agency is required to report on all beneficiaries enrolled in an approved health home program.
( 6 ) ( i ) The agency may request a 1-year exemption from reporting for a specific population defined by the State for one or more Child and/or Adult Core Set measures if the agency demonstrates that it: ( A ) Is unable to obtain access to data required to report the relevant Child and Adult Core Set measure or measures for that population despite making reasonable efforts to do so; and
( B ) Has a reasonable timeline of actions underway to resolve data access problems.
( ii ) The agency must submit a request for an exemption by September 1st of the applicable reporting year.
( iii ) If the Secretary determines that the agency satisfies the conditions set forth in paragraph (6)(i) of this section, the Secretary will approve the exemption only for that year's Child and/or Adult Core Set reporting and the exemption will apply only for the specific population for which the State requests an exemption. If the Secretary determines that the agency does not satisfy the conditions set forth in paragraph (a)(6)(i) of this section, the Secretary will communicate a denial of the exemption request to the agency, and the agency will be expected to include the relevant population in that year's Child and Adult Core Sets reporting.
( iv ) The agency may request an exemption to reporting Child and Adult Core Set measures for the same population in accordance with this paragraph in more than one reporting year.
( b ) *Reporting of Medicaid and CHIP beneficiaries.* In States that have implemented a separate child health program (“separate CHIP”) under part 457 of this chapter: ( 1 ) The agency must report, in accordance with attribution rules established by the Secretary pursuant to § 437.10(b)(6), on measures included in the Child Core Set for— ( i ) The Medicaid beneficiaries (including those for whom the State claims Federal financial participation under both Title XIX and Title XXI) in the age range to which the measure applies, as per reporting guidance described in paragraph § 437.10(b)(2); and
( ii ) The beneficiaries in the State's separate CHIP in the age range to which the measure applies, as per reporting guidance described in paragraph § 437.10(b)(2).
( 2 ) If the separate CHIP elects to report on Adult Core Set measures for individuals enrolled in their separate CHIP, the agency must report on individuals described in paragraphs (b)(1)(i) and (ii) of this section.