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

Deadline Required Activity
By January 1, 2011 Publish recommended initial core set in the Federal Register for public comment
By January 1, 2012 Publish final initial core set
By January 1, 2013 Develop a standardized reporting format on the core set and procedures to encourage voluntary reporting by the States
By January 1, 2013 Establish a Medicaid Quality Measurement Program to fund development, testing, and validation of emerging and innovative evidence-based measures
By January 1, 2014 Report to Congress on the Secretary's efforts to improve the quality of health insurance coverage, health care services, State efforts in voluntary reporting of quality measures, and recommendations for legislative changes to improve the quality of care for adults in Medicaid
By September 30, 2014 Collect, analyze, and make publicly available the information reported by the States
Beginning January 1, 2015 Annually publish recommended changes to the initial core set

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.

Page last reviewed October 2014
Page originally created December 2010
Internet Citation: I. Background. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.