NQF Issues 2016 Recommendations for Medicaid and CHIP Core Measures 

SEP 07, 2016

CONTACT: Sofia Kosmetatos

NQF Issues 2016 Recommendations for Medicaid and CHIP Core Measures

Washington, DC—The National Quality Forum (NQF) released three new reports from its Measure Applications Partnership (MAP) that provide recommendations for core measures to improve the quality of care for the more than 87 million adults and children enrolled in Medicaid. The reports continue NQF’s foundational work to help the federal government assist states in improving Medicaid services using select, standardized measures.

“Quality measurement is essential to improving the quality and value of healthcare for the growing Medicaid population, which includes the nation’s most vulnerable individuals: low-income children and pregnant women, people with disabilities, and low-income elderly Americans,” said Marcia Wilson, NQF’s senior vice president of quality measurement. “An important goal of NQF’s work on behalf of Medicaid and CHIP is to help foster state reporting on core measures. Reporting on the same measures strengthens the nation’s ability to compare performance across states, reduces states’ and health plans’ burden of collecting and reporting data, and focuses quality improvement in the most needed areas.”

The Centers for Medicare and Medicaid Services (CMS) released a core set of children’s healthcare quality measures, known as the Child Core Set, in 2011, and published an initial core set of adult health care quality measures, the Adult Core Set, in 2012. States are increasingly using these core measure sets. All states and the District of Columbia (DC) reported on at least one Child Core Set measure in 2014, and the completeness of Child Core Set data is improving, with more states reporting measures for both Medicaid and CHIP enrollees. Meanwhile, 33 states and DC reported on Adult Core Set measures in 2014, up from 30 states in 2013, the first year in which states began reporting on Adult Core Set measures.

NQF’s new reports are the latest in several years of guidance to the U.S. Department of Health and Human Services on these measure sets, as well as on measures to assess the quality of care for Americans who are eligible for both Medicaid and Medicare.

In Strengthening the Core Set of Healthcare Measures for Adults Enrolled in Medicaid, 2016, MAP recommends the addition of six measures to the Adult Core Set to help address high-priority areas, including substance abuse, diabetes care for people with mental illness, and medication management for people with asthma.

In Strengthening the Core Set of Healthcare Measures for Children Enrolled in Medicaid and CHIP, 2016, MAP recommends the phased addition of five measures to the core set to address high-priority areas, including maternity care, behavioral health, and care for individuals with sickle cell disease. MAP recommends the removal of two measures, citing one as having limited effectiveness as a tool for improvement and another as presenting a limited opportunity for improvement because performance is very high overall. Addressing an opportunity to better align the Medicaid core measure sets, MAP recommended adding a Child Core Set medication management measure for people with asthma to the Adult Core Set.

In Advancing Person-Centered Care for Dual Eligible Beneficiaries through Performance Measurement, 2016, MAP recommends the addition of four measures to address pressure ulcer monitoring, patient-reported functional status, and kidney care, all of which can have a major impact on a beneficiary’s ability to remain healthy and independent.

NQF’s MAP Medicaid Task Forces and Dual Eligible Beneficiaries Workgroup represent more than 50 expert volunteers. Together, they identified the growing role of community supports and services in helping vulnerable individuals—especially those with multiple chronic conditions—remain as healthy and independent as possible. They also called for the development of measures that capture the importance of connection to and coordination of both medical and social services for medically complex patients, using data that are portable and accessible by all types of care providers.


The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at www.qualityforum.org

Updated on September 13, 2016