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Children's Health Insurance Program Reauthorization Act (CHIPRA)

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CHIPRA Children's Health Care Quality Measurement and Improvement Activities

The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 was signed into law by President Obama in January 2009. Since that time, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) have been working together with the CHIPRA Federal Quality Workgroup to implement selected provisions of the legislation related to children's health care quality.

Title IV of CHIPRA promises a new day for children's health care quality, especially for those 39 million children covered by Medicaid and CHIP programs. We are pleased to share the latest information about how our work is progressing and to provide key stakeholders an opportunity to share their views on this critical endeavor.

Please send comments to CHIPRAqualitymeasures@ahrq.hhs.gov.

CHIPRA—What's New?

PQMP Health Care Quality MeasuresMeasures Reviewed in 2012
CHIPRA Quality Demonstration Grant Program AHRQ Leads the National Evaluation


Contents

Overview
Improving the Initial Core Set: The CHIPRA Pediatric Quality Measures Program
National Evaluation of the CHIPRA Quality Demonstration Grant Program
Model Children's EHR Format
Institute of Medicine Report
Identification of the Initial Core Set of Children's Health Care Quality Measures
More AHRQ Resources
Centers for Medicare & Medicaid Services
Archived Materials

Overview

The Agency for Healthcare Research and Quality (AHRQ) is working in collaboration with CMS, the CHIPRA Federal Quality Workgroup, and external experts to fulfill a number of requirements under Title IV of CHIPRA:

  • Identify an initial core set of children's health care quality measures for voluntary use by Medicaid and CHIP programs (select for a list of final, posted measures and archived materials).
  • Implement the CHIPRA Pediatric Quality Measures Program (PQMP) using grants and contracts. The PQMP will contribute to the CHIPRA-required identification of improved core children's health care quality measures for use by Medicaid and CHIP and other public and private programs, providers, plans, and patients.
  • Evaluate CMS's Quality Demonstration project awards and create a Model Children's Electronic Health Record Format.

This site provides information on these activities and links to additional AHRQ and CMS resources on children's health care quality.

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Improving the Initial Core Set: The CHIPRA Pediatric Quality Measures Program

As a followup to identifying the initial core measure set of children's health care quality measures, CHIPRA required establishment of a Pediatric Quality Measures Program (PQMP) of grants and contracts. Results of the PQMP are to be used to develop future enhanced and improved core sets of measures and provide for development of new measures as needed. To meet these requirements, AHRQ has awarded grants for the CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence and a contract for a Coordinating and Technical Assistance Center.

AHRQ's National Advisory Council on Healthcare Research and Quality has appointed a Subcommittee on Quality Measures for Children's Healthcare to review publicly nominated and Centers of Excellence (CoE)-developed children's health care quality measures for potential inclusion in improved core measure sets and for other CHIPRA purposes.

Timeline

Date Event

Feb. 2009

CHIPRA signed into law.

Dec. 2009

The initial core set of children's health care measures published in Federal Register.
http://www.ahrq.gov/chipra/index.html#Core

Dec. 2010

Federal Register notice published December 3: Priority-setting process for development and enhancement of children's health care quality measures. Submission period ends January 14.

Feb. 2011

CMS posted technical specifications for the initial core set of children's health care measures for reporting by State Medicaid and CHIP programs.

March 2011

Centers of Excellence Awarded.
http://www.ahrq.gov/chipra/pqmpfact.htm

Sept. 2011

Expert panel discusses criteria by which to evaluate children's health care quality measures, and required documentation to demonstrate how criteria are met (September 18).

Feb. 2012

Federal Register notice published February 24: "Request for Nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2013 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP." Submission period ends April 24.

April 2012

Federal Register notice published April 18 with request for comments on the "CHIPRA Pediatric Quality Measures Program Candidate Measure Submission Form" (to nominate measures for potential inclusion in future Improved Core Sets of Health Care Quality Measures for Medicaid/CHIP). This Measure Submission Form indicates the proposed set of attributes about a pediatric quality measure that would be considered by the Subcommittee on Quality Measures for Children's Healthcare (SNAC) of AHRQ's National Advisory Council (NAC). Submission period ends June 18.

Period ends for submitting nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2013 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP (April 24).

June 2012

Second Annual National Medicaid and CHIP Quality Conference in Baltimore, Maryland (PDF File; Plugin Software Help) (June 14-15).

Period ends for submitting comments on the "CHIPRA Pediatric Quality Measures Program Candidate Measure Submission Form" (June 18).

Sept. 2012

SNAC in-person meeting to be held September 12 (PDF File, Plugin Software Help); SNAC to recommend CHIPRA 2013 Improved Core Set of Health Care Quality Measures for Voluntary Use by Medicaid/CHIP and for other CHIPRA purposes to NAC (September 12).

Jan. 1, 2013

Improved set of core measures for 2013 published in Federal Register.

Federal Register notice published: "Request for Nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2014 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP."

Feb. 2013

Members of the public (in response to the Federal Register notice requesting nominations) and the CoEs use the online CHIPRA Pediatric Quality Measures Program Candidate Measure Submission Form to nominate measures.

April 2013

Period ends for submitting nominations of Children's Healthcare Quality Measures for potential inclusion in the CHIPRA 2014 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP Voluntary Use and other CHIPRA purposes.

Sept. 2013

SNAC meeting held in conjunction with the AHRQ Annual Conference. SNAC recommends CHIPRA 2014 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP Voluntary Use and for other CHIPRA purposes to NAC.

Oct. 2013

AHRQ and CMS consider and make recommendations to Secretary of HHS for CHIPRA 2014 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP.

CMS may post additional technical specifications to the January 2013 improved core sets of measures.

Jan. 1, 2014

Improved set of core measures for 2014 published in Federal Register.

Feb. 2014

Federal Register notice published: Request for Nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2015 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP Voluntary Use and for other CHIPRA purposes.

Members of the public (in response to the Federal Register notice requesting nominations) and the CoEs use the online CHIPRA Pediatric Quality Measures Program Candidate Measure Submission Form to nominate measures

April 2014

Period ends for submitting nominations of Children's Healthcare Quality Measures for Potential Inclusion in the CHIPRA 2015 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP Voluntary Use and other CHIPRA purposes.

Sept. 2014

SNAC meeting held in conjunction with the AHRQ Annual Conference. SNAC recommends CHIPRA 2015 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP Voluntary Use and other CHIPRA purposes to NAC.

Oct. 2014

AHRQ and CMS consider and make recommendations to Secretary of HHS for CHIPRA 2015 Improved Core Set of Health Care Quality Measures for Medicaid/CHIP Voluntary Use.

CMS may post additional technical specifications to the January 2014 improved core sets of measures.

Jan. 1, 2015

Improved set of core measures for 2015 published in Federal Register.

Oct. 2015

CMS may post additional technical specifications to the improved core sets of measures.

Select for more information about the PQMP.

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National Evaluation of the CHIPRA Quality Demonstration Grant Program

In February 2010, CMS awarded grants to 10 States to identify effective, replicable strategies to enhance quality of care and improve care delivery for children enrolled in Medicaid and CHIP. Through partnerships and collaboration, 18 States are implementing 51 projects in five general categories: the use of quality measures, health information technology applications, provider-based delivery models, use of a model format for pediatric electronic health records, and other innovative approaches to improve quality.

AHRQ is leading the national evaluation of this program. Select for more information about the National Evaluation of the Quality Demonstration Grant Program.

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Model Children's EHR Format

Existing electronic health record (EHR) systems often do not optimally facilitate care for children. To address this deficiency, AHRQ and CMS are cosponsoring the development, testing, and dissemination of a model children's EHR format. The model format describes a set of requirements for child-specific items and items of special importance for children that should be included in a pediatric EHR. Several States are planning to field-test a prototype of the model children's EHR format. It is anticipated that the model format could become more widely available for public review in the fall of 2012.

Select for more information about the model pediatric EHR format.

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Institute of Medicine Report

The CHIPRA legislation called for the Institute of Medicine (IOM) to study and prepare a report on efforts to measure child health status and the quality of health care for children across the pediatric age span. The report is available at http://iom.edu/Reports/2011/Child-and-Adolescent-Health-and-Health-Care-Quality.aspx. Exit Disclaimer

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Identification of the Initial Core Set of Children's Health Care Quality Measures

CHIPRA required that an initial core set of children's health care quality measures for voluntary use by Medicaid and CHIP programs be posted for public comment by January 1, 2010. The legislation required that the measure set:

  • Be drawn from measures already in use to measure children's health care quality.
  • Cover:
    • A full array of health care quality domains.
    • A broad array of health care services affecting children.
    • Children of all ages, all children's health care settings and providers.
  • Be evidence-based.
  • Be understandable to families.
  • Allow identification of disparities by race, ethnicity, socioeconomic status, and special health care need status.

The legislation called for the measures, when taken together, to be appropriate for use to estimate the overall national quality of health care for children.

AHRQ organized a publicly transparent, evidence-informed process to identify the initial core set of measures for consideration by CMS and the Secretary of HHS. The SNAC submitted a report to AHRQ (select for the SNAC Report detailing their work). The measure set was posted for public comment by the legislative deadline. In February 2011, CMS posted technical specifications for the measures to be used by State programs (http://www.cms.gov/MedicaidCHIPQualPrac/Downloads/CHIPRACoreSetTechManual.pdf; Plugin Software Help).

At AHRQ's request, SNAC Co-Chair Rita Mangione-Smith prepared a thoughtful overview and evaluation of the Subcommittee's work in identifying the initial core set of quality measures, including a number of "lessons learned" along the way that could benefit similar future endeavors. The report, Lessons Learned from the Process Used to Identify an Initial Core Quality Measure Set for Children's Health Care in Medicaid and CHIP, is now available.

Additional reports, meeting transcripts, and other documents pertaining to the SNAC and the process of identifying the initial core set of measures are available. (Select Archived Materials.)

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More AHRQ Resources

Child Health Care Quality, Medicaid, and CHIP

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Centers for Medicare & Medicaid Services

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Current as of September 2012


Internet Citation:

Children's Health Care Quality: Activities Related to the Children's Health Insurance Program Reauthorization Act (CHIPRA). September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chipra/index.html


 

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