Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set), 2017

Category Measure
Primary care access and preventive care
  • Cervical cancer screening (NQF #0032)
  • Chlamydia screening in women age 21–24 (NQF #0033)
  • Flu vaccinations for adults age 18–64(NQF #0039)
  • Screening for clinical depression and follow-up plan (NQF #0418)
  • Breast cancer screening (NQF #2372)
  • Adult body mass index assessment
Maternal and perinatal health
  • PC-01: Elective delivery (NQF #0469)
  • PC-03: Antenatal steroids (NQF #0476)
  • Contraceptive care—postpartum women age 21–44 (NQF #2902)
  • Prenatal and postpartum care: postpartum care
Care of acute and chronic conditions
  • Controlling high blood pressure (NQF #0018)
  • Comprehensive diabetes care: Hemoglobin A1c (HbA1c) testing (NQF #0057)
  • Comprehensive diabetes care: HbA1c poor control (>9.0%) (NQF #0059)
  • PQI 01: Diabetes short-term complications admission rate (NQF #0272)
  • PQI 05: Chronic obstructive pulmonary disease or asthma in older adults admission rate (NQF #0275)
  • PQI 08: Heart failure admission rate (NQF #0277)
  • PQI 15: Asthma in younger adults admission rate (NQF #0283)
  • Plan all-cause readmissions (NQF #1768)
  • HIV viral load suppression (NQF #2082)
  • Annual monitoring for patients on persistent medications (NQF #2371)
Behavioral health and substance use
  • Initiation and engagement of alcohol and other drug dependence treatment (NQF #0004)
  • Medical assistance with smoking and tobacco use cessation (NQF #0027)
  • Antidepressant medication management (NQF #0105)
  • Follow-up after hospitalization for mental illness: Age 21 and older (NQF #0576)
  • Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (NQF #1932)
  • Follow-up after emergency department visit for mental illness or alcohol and other drug dependence (NQF #2605)
  • Diabetes care for people with serious mental illness: HbA1c poor control (>9%) (NQF #2607)
  • Use of opioids from multiple providers at high dosage in persons without cancer: Opioid high dosage (NQF #2940)
  • Adherence to antipsychotics for individuals with schizophrenia
Experience of care
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS®) health plan survey, version 5.0 (NQF #006)

Note: Measures that have received National Quality Forum (NQF) endorsement are indicated with the relevant number. NQF endorsement is not a prerequisite for inclusion in the adult core set.
Source: Department of Health and Human Services. 2017. Medicaid and CHIP programs: 2017 core set of adult health care quality measures for Medicaid (adult core set). https://www.medicaid.gov/medicaid/quality-of-care/downloads/2017-adult-core-set.pdf.