CHIPRA Initial Core Set of Children's Health Care Quality Measures

Initial Core Set of Children's Health Care Quality Measures

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) included provisions to strengthen the quality of care provided to and health outcomes of children in Medicaid and CHIP. CHIPRA required HHS to identify and publish a core measure set of children’s health care quality measures for voluntary use by State Medicaid and CHIP programs. On December 29, 2009, the Secretary posted for public comment in the Federal Register, an initial core set of 24 children's health care quality measures for voluntary use by Medicaid and CHIP programs. The core set includes a range of children’s quality measures encompassing both physical and mental health.

Updated Child Core Set

The 2017 Child Core Set was released through a December 2016 Informational Bulletin. The CHIPRA legislation provides that the Secretary shall issue updates to the Child Core Set beginning in January 2013 and annually thereafter. CMS worked with the National Quality Forum’s (NQF) Measures Application Partnership (MAP) to review the Child 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 Child Core Set includes several measures focused on behavioral health. These along with similarly focused measures from the Adult 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 Care for Children in Medicaid and CHIP

How States Voluntarily Report Child Core Set Measures

States can voluntarily report the 2016 Child Core Set measures by using the 2016 Technical Specifications and Resource Manual. A summary of updates to the child 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 Child Core Set HEDIS Value Set Directory

2016 Child Core Set BHRA Value Set Directory

FFY 2016 Child Core Set Measurement Periods

2016 Child Core Set ICD-10 Codes

FFY 2016 Child Core Set Data Quality Checklist  

Other Children’s Quality Measures Initiatives

CMS also has other initiatives that relate to children’s quality measures, including a Pediatric Quality Measures Program (PQMP) and the Pediatric Electronic Health Record Format. Quality measures are used to evaluate or quantify specific health care processes, outcomes, patient perceptions, or other factors related to health care delivery. The pediatric quality measures are used by state Medicaid and Children’s Health Insurance Programs (CHIP) and other public and private programs, providers, plans, patients, and their families to measure and improve the quality of children’s health care. On October 3, 2016, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) announced awards totaling $13.4 million in funding over four years to six new Pediatric Quality Measures Program (PQMP) grantees focused on implementing new pediatric quality measures developed by the PQMP Centers of Excellence (COE). For more information, visit http://www.ahrq.gov/policymakers/chipra/pqmp.html.

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 Child Core Set measures, CMS established the Technical Assistance and Analytic Support (TA/AS) Program with an award of a contract to Mathematica Policy Research in May 2011. Mathematica – teamed with the National Committee for Quality Assurance and the Center for Health Care Strategies– works with CMS to support states’ child 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 children. 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 Child Core Set or quality improvement initiatives can be submitted to MACqualityTA@cms.hhs.gov. 

Technical Assistance Webinars

Additional Technical Assistance Resources

Quality Improvement Workshop Series

Children's Electronic Health Record Format

The AHRQ/CMS-sponsored work to develop the Children’s Electronic Health Record (EHR) Format began in 2009 and culminated in the 2013 public release of the Format. In 2010, CMS issued quality demonstration grants to 18 states. Two of these states, North Carolina and Pennsylvania, completed demonstration projects to provide CMS with information on the use and impact of standard EHR components for children. These grantee experiences informed the development of the 2015 Priority List.  It is hoped the adaptation of EHRs to meet the 2015 Priority List requirements will lead to safer medication use, better tracking and completion of childhood immunizations, improved communication and knowledge about growth and development, better screening and management of children with special health care needs, and a variety of other specific benefits. An explicit goal of this work is to draw vendor, provider, and stakeholder attention to the needs of children, which are often de-prioritized given a limited IT marketplace for pediatric products and a large number of meaningful use EHR certification requirements that consume vendor and practice resources.

For more information on the Format or to download the 2015 Priority List visit:

https://healthit.ahrq.gov/health-it-tools-and-resources/childrens-electronic-health-record-ehr-format

Resources:

Quality Technical Advisory Group Presentation on Children’s EHR Format, February 2016.

Secretary's Annual Report on the Quality of Care for Children in Medicaid and CHIP

Section 401(a) of CHIPRA requires the Secretary of HHS to summarize state-specific information on the quality of health care furnished to children under Medicaid and CHIP. The first report was published in 2010 and annually thereafter.