CHIPRA Core Set

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 provides renewed focus and momentum for the use of standardized performance reporting in Medicaid and CHIP. With the national interest in transparency and accountability, we are presented with an unprecedented opportunity to use the tools of measurement to inform and encourage improvement efforts and make performance information available for public comparisons.

Title IV of CHIPRA 2009 encourages voluntary, standardized reporting of a core set of child health quality measures for children enrolled in Medicaid and CHIP.

In February 2011, the Centers for Medicare & Medicaid released technical specifications for measures in the final core set.

Sixteen of the 24 core measures are NCQA measures. In addition, NCQA develops the measures for CAHPS© 4.0 Child version (Medicaid and Children with Chronic Conditions).

  • Adolescent Well-Care Visits
  • Ambulatory Care: ED Visits
  • Appropriate Testing for Children with Pharyngitis
  • Child and Adolescent Access to Primary Care Practitioners
  • Childhood Immunization Status
  • Chlamydia Screening in Women
  • Developmental Screening in the First 3 Years of Life (NCQA and CAHMI)
  • Follow-Up after Hospitalization for Mental Illness
  • Follow-Up Care for Children Prescribed ADHD Medication
  • Frequency of Ongoing Prenatal Care
  • HEDIS CAHPS/Chronic Conditions
  • Immunizations for Adolescents
  • Prenatal and Postpartum Care: Timeliness of Prenatal Care
  • Weight Assessment and Counseling for Nutrition and Physical Activity in Children and Adolescents
  • Well Child Visits in the First 15 months of Life
  • Well Child Visits/Third, Fourth, Fifth, Sixth Years of Life

CHIPRA Initial Core Set Technical Specifications Manual

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