Background Report for the Request for Public Comment on Initial, Recommended Core Set of Children's Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP Programs
Title IV (Section 401(a)) of the Children's Health Insurance Program Reauthorization Act (CHIPRA; Public Law 111-3; February 3, 2009) amended Section 1139 of Title XI (42 U.S.C. 1301 et seq.) by adding a new section 1139A on Child Health Quality Measures (Appendix A-2).
Section 1139A called for the Secretary of the U.S. Department of Health and Human Services (HHS) to "identify and publish for general comment an initial, recommended core set of child health quality measures for use by State programs administered under titles XIX and XXI, health insurance issuers and managed care entities that enter into contracts with such programs, and providers of items and services under such programs."
The legislation called for identification of "existing quality of care measures for children that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time."
Further, measures were asked to be identified for the following topics, although others could be included: duration of enrollment and coverage; preventive and health promotion services; treatment and management for acute and chronic conditions in children; family experiences of care, most integrated health care settings; and availability of services. CHIPRA also calls for evidence-based measures and measures that can identify disparities in health care quality by race and ethnicity, socioeconomic status, and special health care need.
Consultation was required with entities identified in subsection (b)(3) of 1139A ("States; pediatricians, children's hospitals, and other primary and specialized pediatric health care professionals (including members of the allied health professions) who specialize in the care and treatment of children, particularly children with special physical, mental, and developmental health care needs; dental professionals, including pediatric dental professionals; health care providers that furnish primary health care to children and families who live in urban and rural medically underserved communities or who are members of distinct population sub-groups at heightened risk for poor health outcomes; national organizations representing children, including children with disabilities and children with chronic conditions; national organizations representing consumers and purchasers of children's health care; national organizations and individuals with expertise in pediatric health quality measurement; and voluntary consensus standards-setting organizations and other organizations involved in the advancement of evidence-based measures of health care." The measures are to be published no later than January 1, 2010.
In response to this legislative directive, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) signed Memorandum of Understanding MOU 9-119 in April 2009 giving AHRQ leadership responsibilities for identifying the initial core set, working in very close partnership with CMS. CMS has the authority for implementation of all CHIPRA provisions.