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Compilation of Annual Updates to the Child and Adult Core Health Care Quality Measurement Sets

The Core Sets are a foundational tool for understanding the quality of health care provided in Medicaid and CHIP. They help CMS and states assess the access to and quality of health care being provided to Medicaid and CHIP beneficiaries and identify and improve understanding of the health disparities experienced by Medicaid and CHIP beneficiaries. CMS encourages states to use Core Set data to identify disparities in care and to develop targeted quality improvement efforts to advance health equity.

The Initial Medicaid and Children’s Health Insurance Program (CHIP) Core Set of measures (the Child Core Set) was released via a State Health Official (SHO) in 2011 for voluntary reporting beginning in 2013, per section 1139A of the Social Security Act (the Act). Section 1139A of Act also provides that, beginning annually in January 2013, the Secretary shall publish recommended changes to the Child Core Set measures.  The Initial Adult Core Set was released in 2012, for voluntary reporting beginning in 2014, per section 1139B of the Act. Section 1139B of the Act also provides that the Secretary shall issue updates to the Adult Core Set beginning in January 2014 and annually thereafter.  The Core Sets are updated annually (Annual Core Set Review and Selection Process), as many factors, such as changes in clinical guidelines, experiences with reporting, and performance rates, may warrant modifying the measure set (Core Set History Table).

The Bipartisan Budget Act of 2018 made reporting of the Child Core Set mandatory for States and Section 5001 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018 made reporting of the behavioral health measures on the Adult Core Set mandatory beginning in Federal Fiscal Year (FFY) 2024. To implement this, in August 2024, CMS released a final rule  to require reporting of standardized quality measures for all States, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, and Guam. American Samoa and the Mariana Islands will not be required to report Child and Adult Core Sets measures, but are encouraged to consider reporting.

States with questions or that need further assistance with reporting and quality improvement regarding the Child and Adult Core Sets. may submit questions or requests to: MACQualityTA@cms.hhs.gov.

Included below are the annual updates to the Child and Adult Core Sets:

Initial Mandatory Reporting Guidance:

Joint Mandatory Child and Adult Core Set Updates

  • 2025 Updates to the Child and Adult Core Health Care Quality Measurement Sets and Mandatory Reporting Guidance. https://www.medicaid.gov/federal-policy-guidance/downloads/sho24001.pdf
  • Child Core Set Update:
    • One measure was retired because it was retired by the measure steward: Ambulatory Care: Emergency Department (ED) Visits (AMB-CH).
    • Three provisional measures were added: Oral Evaluation During Pregnancy: Ages 15 to 20 (OEVP-CH), Postpartum Depression Screening and Follow-Up: Under Age 21 (PDS-CH), and Prenatal Immunization Status: Under Age 21 (PRS-CH). These provisional measures are not considered part of the 2025 Child Core Set. CMS expects to add these provisional measures to the Core Set for mandatory reporting in 2026.
  • Adult Core Set Update: 
    • Four new measures were added for voluntary reporting in 2025: Adult Immunization Status (AIS-AD), Ambulatory Care Sensitive Emergency Department Visits for Non-Traumatic Dental Conditions in Adults (EDV-AD), Oral Evaluation During Pregnancy: Ages 21 to 44 (OEVP-AD), and Prenatal Immunization Status: Age 21 and Older (PRS-AD). 
    • One provisional behavioral health measure was added: Postpartum Depression Screening and Follow-Up: Age 21 and Older (PDS-AD). This provisional measure is not considered part of the 2025 Adult Core Set. CMS expects to add this provisional measure to the Core Set for mandatory reporting in 2026.

Joint voluntary Child and Adult Core Sets Updates:

  • 2024 Updates to the Child and Adult Health Care Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib111522.pdf
    • Child Core Set Update: Starting with the 2024 Child Core Set, the Prenatal and Postpartum Care measure includes both the prenatal and postpartum care rates. For the Child Core Set, the rates are reported for beneficiaries under age 21.
    • Adult Core Set: Starting with the 2024 Adult Core Set, the Prenatal and Postpartum Care measure includes both the prenatal and postpartum care rates. For the Adult Core Set, the rates are reported for beneficiaries age 21 and older. In addition, one measure was retired because it was retired by the measure steward: Flu Vaccinations for Adults Ages 18 to 64 (FVA-AD).
  • 2023 and 2024 Updates to the Child and Adult Core Health Care Quality Measurement Sets were released at the same time to provide states with sufficient time to prepare for mandatory reporting. https://www.medicaid.gov/federal-policy-guidance/downloads/cib111522.pdf 
    • Child Core Set Update: Two measures were added: (1) Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis: Ages 3 Months to 17 Years, and (2) Lead Screening in Children.
    • Adult Core Set Update: One measure was added: Long-Term Services and Supports (LTSS) Comprehensive Care Plan and Update (CPU-AD). 
  • 2022 Updates to the Child and Adult Core Health Care Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib121021.pdf.
    • Child Core Set Update: Four measures were added: (1) Oral Evaluation, Dental Services, (2) Topical Fluoride for Children, (3) Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence: Ages 13 to 17, and (4) Follow-Up After Emergency Department Visit for Mental Illness: Ages 6 to 17. Two measures were retired from the Child Core Set: (1) Audiological Diagnosis No Later than 3 Months of Age, and (2) Percentage of Eligibles Who Received Preventive Dental Services.
    • Adult Core Set Update: One measure was retired: PC-01: Elective Delivery. Two measures were added: (1) Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis, and (2) Colorectal Cancer Screening.
  • 2021 Updates to the Child and Adult Core Health Care Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib111920.pdf. 
    • Child Core Set Update: One measure was added: Sealant Receipt on Permanent First Molars. It replaces the retired Dental Sealants for 6–9 Year-Old Children at Elevated Caries Risk measure. The former Well-Child Visits in the First 15 Months of Life measure was revised to Well-Child Visits in the First 30 Months of Life. The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life and Adolescent Well-Care Visits measures have been combined into Child and Adolescent Well-Care Visits. The Low-Risk Cesarean Delivery (LRCD) measure replaced the Cesarean Birth (PC-02) measure.
    • Adult Core Set Update: One measure was retired: Adult Body Mass Index Assessment, because it was retired by the measure steward. No new measures were added.
  • 2020 Updates to the Child and Adult Core Health Care Quality Measurement Sets. https://www.medicaid.gov/Federal-Policy-Guidance/Downloads/cib111919.pdf. 
    • Child Core Set Update: One measure was added: Metabolic Monitoring for Children and Adolescents on Antipsychotics. CMCS also modified the existing Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents measure to add the two other indicators of this measure to the Child Core Set: (1) Counseling for Nutrition, and (2) Counseling for Physical Activity. Previously, the Child Core Set measure included only the Body Mass Index Percentile Documentation indicator. Three measures were retired: (1) Use of Multiple Concurrent Antipsychotics in Children and Adolescents, (2) Children and Adolescents’ Access to Primary Care Practitioners, and (3) Pediatric Central Line-Associated Bloodstream Infections).
    • Adult Core Set Update: Two measures were added: (1) National Core Indicators (NCI) Survey, and (2) Use of Pharmacotherapy for Opioid Use Disorder. Two measures were retired: (1) Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing, and (2) Annual Monitoring for Patients on Persistent Medications.
  • 2019 Updates to the Child and Adult Core Health Care Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib112018.pdf. 
    • Child Core Set Update: No measures were added to or removed from the 2019 Child Core Set.
    • Adult Core Set Update: One measure was retired: PC03: Antenatal Steroids. No new measures were added. The electronic specification format of HIV Viral Load Suppression, already a measure in the Adult Core Set, was added.
  • 2018 Updates to the Child and Adult Core Health Care Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib111417.pdf. 
    • Child Core Set Update: Three measures were added: (1) Screening for Depression and Follow-Up Plan: Ages 12 to 17; (2) Contraceptive Care – All Women Ages 15 to 20; and (3) Asthma Medication Ratio: Ages 5 to 18. In addition, four measures were retired from the Child Core Set: (1) Frequency of Ongoing Prenatal Care, (2) Medication Management for People with Asthma, (3) Behavioral Health Risk Assessment (for pregnant women); and (4) Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment.
    • Adult Core Set Update: Three measures were added: (1) Asthma Medication Ratio: Ages 19 to 64, (2) Concurrent Use of Opioids and Benzodiazepines, and (3) Contraceptive Care – All Women Ages 21 to 44. No measures were retired.
  • 2017 Updates to the Child and Adult Core Health Care Quality Measures Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib120516.pdf. 
    • Child Core Set Update: Two measures were added: (1) Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics, and (2) Contraceptive Care−Postpartum Women Ages 15 to 20. In addition, the standalone Human Papilloma Vaccine for Female Adolescents measure was retired as a separate measure and added to the Immunizations for Adolescents measure.
    • Adult Core Set Update: Three measures were added: (1) Contraceptive Care – Postpartum Women Ages 21 to 44, (2) Follow-Up After Emergency Department Visit for Mental Illness or Alcohol and Other Drug Abuse or Dependence, and (3) Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control [>9.0%]). In addition, the electronic specification format of PC-01: Elective Delivery, already a measure in the Adult Core Set, was added. One measure was retired: Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care).
  • 2016 Updates to the Child and Adult Core Health Care Quality Measurement Sets. https://www.medicaid.gov/federal-policy-guidance/downloads/cib-12-11-15.pdf. 
    • Child Core Set Update: Two measures were added: (1) Use of Multiple Concurrent Antipsychotics in Children and Adolescents, and (2) Audiological Evaluation No Later Than 3 Months of Age.
    • Adult Core Set Update: Two measures were added: (1) Use of Opioids at High Dosage in Persons Without Cancer, and (2) Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications.
  • 2015 Updates to the Child and Adult Health Care Quality Measurements Sets. http://www.medicaid.gov/federal-policy-guidance/downloads/cib-12-30-2014.pdf.
    • Child Core Set Update: Two measures were added: (1) Dental Sealants for 6–9 Year-Old Children at Elevated Caries Risk, and (2) Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment, and one measure was retired: Percentage of Eligibles that Received Dental Treatment Services. In addition, CMS is conducting a pilot of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey.
    • Adult Core Set Update: One measure was replaced: Comprehensive Diabetes Care: LDL Screening was replaced by Comprehensive Diabetes Care: Hemoglobin A1c Poor Control (>9.0%).
  • 2014 Updates to the Child and Adult Core Health Care Quality Measurement Sets. http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12-19-13.pdf. 
    • Child Core Set Update: Three measures were retired: (1) Appropriate Testing for Children with Pharyngitis, (2) Annual Pediatric Hemoglobin A1C Testing, and (3) Asthma-Related Emergency Department Visits.
    • Adult Core Set Update: One measure was replaced: Annual HIV Medical Visit was replaced by HIV Viral Load Suppression.

Child Core Set

  • 2013 Child Core Set Update. Three measures were added to the 2013 Child Core Set: (1) Behavioral Health Risk Assessment (for Pregnant Women), (2) Human Papillomavirus Vaccine for Female Adolescents, and (3) Medication Management for People with Asthma, and one measure was retired: Otitis Media with Effusion. The first update was issued via a SHO Letter “2013 Children’s Core Set of Health Care Quality Measures,” SHO #13-002. http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-002.pdf. 
  • The Initial Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP was issued in 2011 via a State Health Official (SHO) letter “CHIPRA Quality Measures,” SHO #11-001. http://downloads.cms.gov/cmsgov/archiveddownloads/SMDL/downloads/SHO11001.pdf.

Adult Core Set