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Medicaid and CHIP Payment and Access Commission
MACPAC > Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set), 2020

Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set), 2020

Category Measure
Primary care access and preventive care
  • Cervical Cancer Screening (NQF #0032)
  • Chlamydia Screening in Women Ages 21–24 (NQF #0033)
  • Flu Vaccinations for Adults Ages 18 to 64 (NQF #0039)
  • Screening for Depression and Follow-Up Plan: Age 18 and Older (NQF # 0418/0418e)
  • Breast Cancer Screening (NQF #2372)
  • Adult Body Mass Index Assessment
Maternal and perinatal health
  • PC-01: Elective Delivery (0469/0469e)
  • Prenatal and Postpartum Care: Postpartum Care
  • Contraceptive Care – Postpartum Women Ages 21–44 (NQF #2902)
  • Contraceptive Care – All Women Ages 21–44 (NQF # 2903/2904)
Care of acute and chronic conditions
  • Controlling High Blood Pressure (CBP-AD) (NQF #0018)
  • Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (NQF #0059)
  • PQI 01: Diabetes Short-Term Complications Admission Rate (NQF #0272)
  • PQI 05: Chronic Obstructive Pulmonary Disease (COPD) 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 (PCR-AD) (NQF #1768)
  • Asthma Medication Ratio: Ages 19–64 (AMR-AD) (NQF #1800)
  • HRSA HIV Viral Load Suppression (HVL-AD) (NQF #2082/3210e)
Behavioral health and substance use
  • Initiation and Engagement of Alcohol and Other Drug Abuse or 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 18 and Older (NQF #0576)
  • Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (NQF #1932)
  • Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (NQF #2607)
  • Use of Opioids at High Dosage in Persons Without Cancer (NQF #2940)
  • Concurrent Use of Opioids and Benzodiazepines (NQF #3389)
  • Use of Pharmacotherapy for Opioid Use Disorder (NQF #3400)
  • Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (NQF #3488)
  • Follow-Up After Emergency Department Visit for Mental Illness (NQF #3489)
  • Adherence to Antipsychotic Medications for Individuals with Schizophrenia
Experience of care
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey 5.0H, Adult Version (Medicaid)
Long-Term Services and Supports
  • National Core Indicators Survey (NCIDDS-AD)

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. This page was updated on April 10, 2020.
Source: Centers for Medicare & Medicaid Services. U.S. Department of Health and Human Services. 2020. 2020 core set of adult health care quality measures for Medicaid and CHIP (adult core set). https://www.medicaid.gov/medicaid/quality-of-care/downloads/performance-measurement/2020-adult-core-set.pdf.