Adult Health Care Quality Measures

Initial Core Set of Adult Health Care Quality Measures for Medicaid-Eligible Adults

The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid enrollees. The law requires that measures designated for the core set be currently in use. To aid in the assessment of the quality of care for Medicaid-eligible adults, the law calls for HHS to:

1. Develop a standardized reporting format for the core set of measures:
2. Establish an adult quality measurement program;
3. Issue an annual report by the Secretary on the reporting of adult Medicaid quality information;
4. Publish updates to the initial core set of adult health quality measures that reflect new or enhanced quality measures.  

In January 2012, HHS published an initial core set of for voluntary use by Medicaid. These measures reflect the diverse populations served by Medicaid. 

Updated Adult Core Set 

The 2017 Adult Core Set was released in a December 2016 Informational Bulletin. 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. CMS worked with the National Quality Forum's (NQF) Measures Application Partnership (MAP) to review the Adult Core Set and to identify ways to improve it. A background report contains information on the MAP's review process, selection criteria, and feedback to CMS.

The Adult Core Set includes several measures focused on behavioral health. These along with similarly focused measures from the Child Core Set have been identified as a Behavioral Health Core Set.

State data derived from the core measures are part of the Secretary's Annual Report on the Quality of Health Care for Adult Enrolled in Medicaid. 

How States Voluntarily Report Medicaid Adult Core Set Measures

States can voluntarily collect the 2016 Adult Core Set measures by using the 2016 Technical Specifications and Resource Manual. A summary of updates to the adult core set technical specifications and resource manual for FFY 2016 is also available.

Updates to the Technical Specifications for FFY 2017 reporting will be available in Spring 2017. 

Additional Reporting Resources

2016 Adult Core Set Value Set Directory

FFY 2016 Adult Core Set Measurement Periods

2016 Adult Core Set ICD-10 Codes

FFY 2016 Adult Core Set Data Quality Checklist

Adult Medicaid Quality Measurement Program

By January 1, 2013, a Medicaid Quality Measurement Program will be established to fund the development, testing, and validation of emerging and innovative evidence-based adult health quality measures. As specified in the legislation, this program is to be established in the same manner as the Pediatric Quality Measures Program.

Technical Assistance and Analytic Support Program

CMS is committed to supporting states’ efforts to measure and improve the quality of health care for children and adults enrolled in Medicaid and CHIP. To increase the number of states consistently collecting, reporting, and using the Medicaid Adult Core Set measures, CMS established the Technical Assistance and Analytic Support (TA/AS) Program with an award of a contract to Mathematica Policy Research. Mathematica – teamed with the National Committee for Quality Assurance and the Center for Health Care Strategies – works with CMS to support states’ adult health care quality measurement and improvement efforts. The overarching goals are to increase the number of states consistently collecting and uniformly reporting the voluntary core measures set, and to help states understand how to use these data to improve the quality of care for adults. As part of the technical assistance effort, CMS will share promising practices for collecting the core measures with states. For more information, see the Technical Assistance and Analytical Support Program fact sheet.

Questions or requests for technical assistance related to the Medicaid Adult Core Set or quality improvement initiatives can be submitted to MACqualityTA@cms.hhs.gov. 

Technical Assistance Webinar

Technical Assistance to Support Adult and Child Core Set Reporting for FFY 2016 (October 18, 2016)

• Presentation Slides

Technical Assistance Resources

Technical Assistance Brief: Approaches to Developing State-Level Rates Using Data from Multiple Sources (Updated October 2014)

Technical Assistance Brief: Using the Hybrid Method to Calculate Measures from the Child and Adult Core Sets (October 2014)

Archived Adult Core Set Measures Lists and Technical Specifications and Resource Manuals  

Secretary's Annual Report on the Quality of Health Care for Adults Enrolled in Medicaid

Section 2701 of the Affordable Care Act requires the Secretary of HHS to summarize state-specific information on the quality of health care furnished to adults covered by Medicaid. The first report was published in 2014, and will be published annually thereafter.

• 2015 Annual Report on the Quality of Care for Adults in Medicaid

  • Overview of the Adult Core Set Measures, FFY 2014
  • Performance on the Adult Core Set Measures, FFY 2014
  • Adult Findings from EQR Reports Submitted During the 2014-2015 Reporting Cycle
  • 2015 Domain-Specific Reports
  • 2015 Adult Core Set Chart Pack (FFY 2014)
• 2014 Annual Report on the Quality of Health Care for Adults Enrolled in Medicaid
  • Findings from EQR Reports Submitted During the 2013-2014 Reporting Cycle

Related Resources

Benchmarks for Medicaid Adult Health Care Quality Measures (November 2014)

CMCS Informational Bulletin on the Adult Health Care Quality Measures

Background Report on the Adult Quality Measures