Mandatory Medicaid and Children’s Health Insurance Program (CHIP) Core Set Reporting
In August 2022, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule, which, if promulgated, would create mandatory annual reporting requirements for states on three core sets of quality measures (collectively, “the Core Sets”):
- The Child Core Set: The Core Set of Children’s Health Care Quality Measures for Medicaid and the Children’s Health Insurance Program (CHIP), established under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA);
- The Adult Core Set: The behavioral health measures within the Core Set of Adult Health Care Quality Measures for Medicaid, established under the Affordable Care Act (ACA)); and
- The Core Sets of Health Home Quality Measures for Medicaid.
Historically, states have voluntarily reported on the Core Sets, although there has been significant variation in reporting across states. According to 2021 data, states reported on anywhere from 2 to 24 Child Core Set measures with a median of 19 Child Core Set measures. 2021 Child Core Set measures included Childhood Immunization Status, Prenatal and Postpartum Care, and Follow-Up After Hospitalization for Mental Illness. Similarly, states reported on anywhere from 0 to 31 Adult Core Set measures with a median number of 22 Adult Core Set measures reported. 2021 Adult Core Set measures included Cervical Cancer Screening, Controlling High Blood Pressure, and Use of Pharmacotherapy for Opioid Use Disorder.
Collecting these data sets through mandatory reporting would allow for an evaluation of both the quality and access to health care services delivered to Medicaid and CHIP beneficiaries, both nationally and as compared across states. The proposed rule would also require states to stratify certain Core Sets measures by race, ethnicity, sex, age, rural/urban status, disability, and language, which would strengthen the power of the Core Sets and paint a more accurate picture of health care and equity. Ultimately, the goal of this new rule is that, through assessing national and state-level health care quality and access, quality of health care for Medicaid and CHIP beneficiaries would improve over time.
Both states and stakeholders collaborated with CMS to ensure that the new reporting requirements would be manageable and not unduly burdensome for states while still generating meaningful data. CMS also sought public input on the burdens and feasibility of these new reporting requirements during the public comment period, which closed on October 21st. PCG subject matter experts compiled a fact sheet on the rule, which provides insight into the key areas of the proposed rule that states should consider as they prepare for a likely transition from voluntary to mandatory reporting on the Core Sets.