National Standards Perspectives: December 2016

April 6, 2017


Standards Perspectives

Healthcare regulations and policies are very complex and ever-evolving. It’s important for managers of health plans and state Medicaid agencies to understand what new legislation means and how it affects their programs. Standards Perspectives brings you the latest details on new policies and standards so you can quickly and clearly learn what’s important to make the right decisions.


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The Center for Medicaid & CHIP Services (CMCS) has released an informational bulletin about the 2017 Updates to the Child and Adult Core Healthcare Quality Measurement Sets. CMCS has worked with stakeholders to identify updates to two core sets of healthcare quality measures that can be used to assess the quality of healthcare provided to children and adults enrolled in Medicaid and CHIP. Under statute, state reporting on these measure sets is voluntary. 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. States are urged to use these measures to monitor and improve the quality of healthcare provided to Medicaid and CHIP enrollees.

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. 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. State data derived from the core measures are included in the Secretary’s Annual Report on the Quality of Care for Children in Medicaid and CHIP and the Secretary’s Annual Report on the Quality of Healthcare for Adult Enrolled in Medicaid.


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 Children’s Health Insurance Reauthorization Act (CHIPRA) of 2009, provides that, beginning annually in January 2013, the Secretary shall publish recommended changes to the core measures.

The 2016 Child Core Set consists of 26 measures organized into five healthcare categories:

  • Access to Care
  • Preventive Care
  • Maternal and Perinatal Care
  • Behavioral Health
  • Care of Acute and Chronic Conditions
  • Experience of Care

For 2017, CMS will be adding two measures to the Child Core Set and retiring one measure.

  • Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
  • Contraceptive Care – Postpartum
  • CMS will retire the standalone Human Papilloma Virus (HPV) measure from the Child Core Set

For the 2017 Adult Core Set update, CMCS has decided to add three measures to the 2016 list:

  • Diabetes Care for People with Serious Mental Illness
  • Follow-up after Discharge from the Emergency Department for Mental Health or Alcohol or Other Drug Dependence
  • Contraceptive Care – Postpartum
  • CMCS will retire one measure, the Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site


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 here.


What this means for Medicaid

In 2010, CMCS initiated the National Quality Strategy (NQS). The NQS is a nationwide effort to provide direction for improving the quality of health and healthcare in the United States. It is guided by three aims: better care, healthy people and communities and affordable care. These quality measures have guided Meaningful Use as well as pay for performance assessment and verification.

CMS strongly encourages states to report on the core quality measures and to include such reporting requirements within their MCO and ACO contracts. As the nation’s healthcare reimbursement shifts toward Pay for Value, including standardized healthcare measurements will be an important component in fairly judging the quality of care provided.

You can read more Conduent insights about healthcare regulations in previous editions of Standards Perspectives.


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