CMS Finalizes Set of 35 Core Quality Measures for the Care of Medicaid-Eligible Adults

On January 4, the federal Centers for Medicare and Medicaid Services (CMS) announced, through publication in the Federal Register, an Initial Core Set of Health Care Quality measures for Medicaid-Eligible Adults, in compliance with a provision in the federal Affordable Care Act (ACA) of 2010. The set of 35 measures was created for voluntary use by state programs administered under Title XIX of the Social Security Act, health insurers that enter into contracts with state Medicaid programs, and providers of items and services under those programs.

The CMS notice stated that “Identification of the initial core set of measures for Medicaid-eligible adults is an important first step in an overall strategy to encourage and enhance quality improvement. States that choose to collect the initial core set will be better positioned to measure their performance and develop action plans to achieve the three-part aims of better care, healthier people, and affordable care as identified in HHS’s Strategy for Quality Improvement in Health Care.

“The initial core set of quality measures for voluntary annual reporting,” the notice added,” has been determined based on recommendations from the Agency for Healthcare Research and Quality’s Subcommittee to the National Advisory council for Healthcare Research and Quality, as well as public comments, before being finalized by the Secretary [Kathleen Sebelius]. These core set measures will support HHS and its state partners in developing a quality-driven, evidence-based, national system for measuring the quality of healthcare provided to Medicaid-eligible adults.”

Among the 35 measures are the following:

> “Flu shots for adults ages 50-64”
> “Adult BMI [body mass index] assessment"
> “Plan all-cause readmission”
> “Diabetes, short-term complications admission rate”
> “Chronic obstructive pulmonary disease (COPD) admission rate”
> “Congestive heart failure admission rate”
> “Follow-up after hospitalization for mental illness”
> “Comprehensive diabetes care: hemoglobin A1c testing”
> “Antidepressant medication management”
> “Adherence to antipsychotic for individuals with schizophrenia”
> “Care transition—transition record transmitted to health care professional”

The federal notice also stated that “The initial core set will be used by states to assess the quality of healthcare provided in their Medicaid programs for adults (ages 18 years and older) and across all healthcare delivery systems (for example, fee-for-service, managed care, primary care management)> We understand that some of the measures are currently specified only for a particular delivery system (for example, managed care),” the notice said. “However, additional guidance will be provided to states so that these measures can be used across delivery systems, and Medicaid-funded programs targeting adults, including long-term services and supports.”

The Medicaid Adult Quality Measures Program will be rolled out throughout the year, with CMS expected to release technical specifications by September.