I. Background

National Advisory Council Subcommittee: Identifying Quality Measures for Medicaid-eligible adults

I. Background

On March 23, 2010, President Obama signed the Affordable Care Act (Public Law 111-148). The Affordable Care Act requires the Secretary of the Department of Health and Human Services (HHS) to identify and publish a core set of health quality measures for Medicaid-eligible adults (go to Appendix 2 for the legislative provision). This legislation parallels the requirement under Title IV of the Children's Health Insurance Program Reauthorization Act (CHIPRA; Public Law 111-3) to identify and publish a recommended initial core set of quality measures for children in Medicaid and the Children's Health Insurance Program.

As with the CHIPRA, the Affordable Care Act calls for the core measures to be reported to Congress every 3 years on the Secretary's efforts to improve the quality of care received by adults in Medicaid. To aid in the assessment of the quality of care, the legislation calls for HHS to develop a standardized reporting format for the core set of measures: Establish an adult quality measurement program; issue an annual report by the Secretary on the reporting of adult Medicaid quality information; and publish updates to the initial core set of adult health quality measures that reflect new or enhanced quality measures. Go to Table 1 for specific details.

Table 1. Summary of requirements in the Affordable Care Act regarding adult quality measurement in Medicaid

Similar to efforts to implement the quality provisions of the CHIPRA legislation, the effort to identify a preliminary initial core set of quality measures for Medicaid-eligible adults is a collaboration of the Centers for Medicare & Medicaid Services (CMS), which is operationally responsible for the Medicaid program at the Federal level, and the Agency for Healthcare Research and Quality (AHRQ), which is charged with improving the quality, safety, efficiency, and effectiveness of health care. AHRQ and CMS entered into an intra-agency agreement to formalize this collaboration. To facilitate an evidence-based and transparent process for prioritizing measures, AHRQ's National Advisory Council created a Subcommittee for identifying quality measures for Medicaid-eligible adults. This report documents the process, deliberations, and results of the Subcommittee's efforts. The Subcommittee's advice was reported to the Chair of the National Advisory Council and was considered further by Medicaid officials and staff in the Office of the Secretary of HHS prior to posting in the Federal Register.

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