Children's Health Insurance Program Reauthorization Act (CHIPRA) | Agency for Healthcare Research & Quality (AHRQ)

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<p>Seven <em>Evaluation Highlights</em> are now available that describe how demonstration States are working to improve children’s health care quality.</p> </div> <div class="two-col-aside-flag"></div> </aside> </aside> <h1>Children's Health Insurance Program Reauthorization Act (CHIPRA)</h1> <div> <div id="email-updates"> Sign up: <a href="https://web.archive.org/web/20140702195308/https://subscriptions.ahrq.gov/accounts/USAHRQ/subscriber/new?topic_id=USAHRQ_134"><img src="/web/20140702195308im_/http://www.ahrq.gov/resources/img/mail-updates-icon.png" alt="mail-updates-icon" width="16" height="13"/> CHIPRA Quality Demonstration Evaluation Email updates</a> </div> <div id="email-updates"> Sign up: <a href="https://web.archive.org/web/20140702195308/https://subscriptions.ahrq.gov/accounts/USAHRQ/subscriber/new?topic_id=USAHRQ_133"><img src="/web/20140702195308im_/http://www.ahrq.gov/resources/img/mail-updates-icon.png" alt="mail-updates-icon" width="16" height="13"/> CHIPRA Quality Measures Email updates</a> </div> </div> <h2><br/> <br/> CHIPRA Children's Health Care Quality Measurement and Improvement Activities</h2> <p>The <a href="https://web.archive.org/web/20140702195308/http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_laws&docid=f:publ003.111">Children's Health Insurance Program Reauthorization Act</a> (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 to implement selected provisions of the legislation related to children's health care quality.</p> <p>Title IV of CHIPRA promises a new day for children's health care quality, especially for those 45 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.</p> <p>Please send comments to <a href="https://web.archive.org/web/20140702195308/mailto:CHIPRAqualitymeasures@ahrq.hhs.gov">CHIPRAqualitymeasures@ahrq.hhs.gov</a>.<a id="Contents" name="Contents"> </a></p> <h2>Contents</h2> <p><a href="#Overview">Overview</a><br/> <a href="#Core2">Improving the Initial Core Set: The CHIPRA Pediatric Quality Measures Program</a><br/> <a href="#Evaluation">National Evaluation of the CHIPRA Quality Demonstration Grant Program</a><br/> <a href="#EHR">Model Children's EHR Format</a><br/> <a href="#IOM">Institute of Medicine Report</a><br/> <a href="#Core">Identification of the Initial Core Set of Children's Health Care Quality Measures</a><br/> <a href="#Resources">More AHRQ Resources</a><br/> <a href="#CMS">Centers for Medicare & Medicaid Services</a><br/> <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/chipraarch/index.html">Archived Materials</a></p> <h2><a id="Overview" name="Overview"> </a>Overview</h2> <p>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:</p> <ul> <li>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 <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/chipraarch/index.html">archived materials</a>).</li> <li>Implement the <a href="#Core2">CHIPRA Pediatric Quality Measures Program</a> 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.</li> <li>Evaluate CMS's Quality Demonstration project awards and create a Model Children's Electronic Health Record Format.</li> </ul> <p>This site provides information on these activities and links to additional AHRQ and CMS resources on children's health care quality.</p> <p><a href="#Contents">Return to Contents</a></p> <h2><a id="Core2" name="Core2"> </a>Improving the Initial Core Set: The CHIPRA Pediatric Quality Measures Program</h2> <p>As a followup to <a href="#Core">identifying the initial core measure set</a> 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 <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/pubs/pqmpfact.html">CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence</a> and a contract for a <a href="https://web.archive.org/web/20140702195308/http://www.fbo.gov/spg/HHS/AHRQ/DCM/AHRQ-11-10001/listing.html">Coordinating and Technical Assistance Center</a>. Select <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/pqmpback.html">http://www.ahrq.gov/policymakers/chipra/pqmpback.html</a> for more information on the PQMP.</p> <h3>2012-2013 Activities—Child Core Set Update</h3> <p>As required by CHIPRA, CMS advised State Medicaid and CHIP programs of changes to the initial core set. Select <a href="https://web.archive.org/web/20140702195308/http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-002.pdf">http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-002.pdf</a> (166 KB) for the letter to State health officials (SHO letter), which includes a link to a background paper, <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/pubs/background-2012/index.html">Recommendations to Improve Children's Health Care Quality Measures: Background Report on the 2012 Process</a>.</p> <p>Select for the <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/cpcf-form.html">candidate measure submission form</a> (CPCF) used by COEs to submit measures and by the Subcommittee on Quality Measures for Children's Healthcare (SNAC) to assess submitted measures. The CPCF was approved by OMB in December 2012.<a id="Activities" name="Activities"> </a></p> <h3>2013-2014 Activities: Measure Retirement and Update to the Child Core Set</h3> <p>In 2013, AHRQ, CMS, and the <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/snac_members.html">2013 AHRQ SNAC</a> collaborated in an effort to identify measures from the <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/overview/background/tables.html">initial child core set published in 2009</a> for potential retirement. Periodic reassessment of measures’ importance, scientific acceptability, feasibility, and usability is part of a life-cycle approach to quality measurement. AHRQ, CMS, and the 2013 SNAC identified criteria that could be used to assess potential measures for retirement and an analytic approach to getting and assessing detailed information for assessing 20 of the initial child core measures against the agreed-upon criteria. AHRQ and its contractor RTI gathered, interpreted, and conveyed information to the 2013 SNAC, and the SNAC used the information in two rounds of scoring using a modified Delphi approach. SNAC recommendations were communicated to CMS in late October. CMS will take the recommendations into consideration as it prepares to inform States and the public about improvements to the child core set by January 2014 as required by the CHIPRA legislation.</p> <p>Select for the <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/measure_retirement/index.html">background report</a> for more information on the process used by the SNAC to identify measures for retirement, as well as the discussion and rationale related to each measure.</p> <h3>CHIPRA PQMP Publications</h3> <p>The following PQMP-related articles have been published recently:</p> <ul> <li>Common and Costly Hospitalizations for Pediatric Mental Health Disorders. <em>Pediatrics</em> 2014 Apr;133(4):602-9. Epub 2014 Mar 17.<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/24639270">http://www.ncbi.nlm.nih.gov/pubmed/24639270</a></li> <li>Continuity of Public Insurance Coverage: A Systematic Review of the Literature. <em>Med Care Res Rev</em> 2013 Nov 13. [Epub ahead of print]<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/24227811">http://www.ncbi.nlm.nih.gov/pubmed/24227811</a></li> <li>Development of the PROMIS® Pediatric Global Health (PGH-7) Measure<em>.</em> <em>Qual Life Res</em> 2013 Nov 22. [Epub ahead of print]<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/24264804">http://www.ncbi.nlm.nih.gov/pubmed/24264804</a></li> <li>Evidence for the Management of Adolescent Depression<em>.</em> <em>Pediatrics</em> 2013 Oct;132(4):e996-e1009.<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/24043282">http://www.ncbi.nlm.nih.gov/pubmed/24043282</a></li> <li>Individualized Plans of Care to Improve Outcomes Among Children and Adults With Chronic Illness: A Systematic Review. <em>Care Management Journals </em>2014 15(1):11-25. (<a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/Lion-Mangione-Britto.pdf">PDF File</a>, 137 KB).</li> <li>National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps<em>.</em> <em>Pediatrics</em> 2013 Mar;131 Suppl 1:S38-49.<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/23457148">http://www.ncbi.nlm.nih.gov/pubmed/23457148</a>.</li> <li>Pediatric Health Care Quality Measures: Considerations for Pharmacotherapy<em>.</em> <em>Paediatr Drugs</em> 2013 Dec;15(6):441-7<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/23918049">http://www.ncbi.nlm.nih.gov/pubmed/23918049</a>  (<a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/LomotanDougherty2013.pdf">PDF File</a>, 399 KB).</li> <li>Pediatric Medical Complexity Algorithm: A New Method to Stratify Children by Medical Complexity. <em>Pediatrics</em> 2014 Jun;133:e1647-54.<br/> <a href="https://web.archive.org/web/20140702195308/http://pediatrics.aappublications.org/content/early/2014/05/07/peds.2013-3875.abstract">http://pediatrics.aappublications.org/content/early/2014/05/07/peds.2013-3875.abstract</a></li> <li>Pediatric Readmission Prevalence and Variability Across Hospitals. <em>JAMA</em> 2013 Jan 23;309(4):372-80.<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/23340639">http://www.ncbi.nlm.nih.gov/pubmed/23340639</a>.</li> <li>Quality Measurements in Pediatrics: What Do They Assess? <em>JAMA Pediatr</em> 2013 Jan;167(1):89-90.<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/23147673">http://www.ncbi.nlm.nih.gov/pubmed/23147673</a>.</li> <li>Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for Intervention. <em>J Pediatr</em> 2014. 164:300-5.<br/> <a href="https://web.archive.org/web/20140702195308/http://www.ncbi.nlm.nih.gov/pubmed/24238863">http://www.ncbi.nlm.nih.gov/pubmed/24238863</a> (<a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/Kenyon2014.pdf">PDF File</a>, 207 KB).</li> </ul> <p>Select for <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/pqmpback.html">more information about the PQMP</a>.</p> <p><a href="#Contents">Return to Contents</a></p> <h2><a id="Evaluation" name="Evaluation"> </a>National Evaluation of the CHIPRA Quality Demonstration Grant Program</h2> <p>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.</p> <p>AHRQ is leading the national evaluation of this program. Select for more information about the <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/demoeval/index.html">National Evaluation of the Quality Demonstration Grant Program</a>.</p> <p><a href="#Contents">Return to Contents</a></p> <h2><a id="EHR" name="EHR"> </a>Model Children's EHR Format</h2> <p>The Children's EHR Format was authorized by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA) and developed by AHRQ in close collaboration with CMS. The Format was developed to bridge the gap between the functionality present in most EHRs currently available and the functionality that would more optimally support the care of children. Specifically, the Format provides information to EHR system developers and others about critical functionality, data elements, and other requirements that need to be present in an EHR system to address health care needs specific to children, especially those enrolled in Medicaid or the Children's Health Insurance Program (CHIP).</p> <p>For more information about the Children's EHR Format or to access the Format, go to <a href="https://web.archive.org/web/20140702195308/http://healthit.ahrq.gov/ChildehrFormat/">http://healthit.ahrq.gov/ChildehrFormat</a>.</p> <p><a href="#Contents">Return to Contents</a></p> <h2><a id="IOM" name="IOM"> </a>Institute of Medicine Report</h2> <p>The CHIPRA legislation called for the Institute of Medicine (IOM) to study and prepare a <a href="https://web.archive.org/web/20140702195308/http://iom.edu/Reports/2011/Child-and-Adolescent-Health-and-Health-Care-Quality.aspx">report on efforts to measure child health status</a> and the quality of health care for children across the pediatric age span.</p> <p><a href="#Contents">Return to Contents</a></p> <h2><a id="Core" name="Core"> </a>Identification of the Initial Core Set of Children's Health Care Quality Measures</h2> <p><a href="https://web.archive.org/web/20140702195308/http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_laws&docid=f:publ003.111">CHIPRA</a> 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:</p> <ul> <li>Be drawn from measures already in use to measure children's health care quality.</li> <li>Cover: <ul> <li>A full array of health care quality domains.</li> <li>A broad array of health care services affecting children.</li> <li>Children of all ages, all children's health care settings and providers.</li> </ul> </li> <li>Be evidence-based.</li> <li>Be understandable to families.</li> <li>Allow identification of disparities by race, ethnicity, socioeconomic status, and special health care need status.</li> </ul> <p>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.</p> <p>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 <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/coreset/index.html">SNAC Repor</a>t detailing their work). The <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/overview/background/tables.html">measure set</a> 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.</p> <p>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, <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/lessons.html"><em>Lessons Learned from the Process Used to Identify an Initial Core Quality Measure Set for Children's Health Care in Medicaid and CHIP</em></a>, is now available.</p> <p>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 <a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/chipraarch/index.html">Archived Materials</a>.)</p> <p><a href="#Contents">Return to Contents</a></p> <a id="Resources" name="Resources"> </a> <h2>More AHRQ Resources</h2> <p><strong>Child Health Care Quality, Medicaid, and CHIP</strong></p> <ul> <li><a href="/web/20140702195308/http://www.ahrq.gov/health-care-information/priority-populations/children/index.html">Child & Adolescent Health</a></li> <li><a href="/web/20140702195308/http://www.ahrq.gov/cpi/initiatives/chiri/index.html">Child Health Insurance Research Initiative (CHIRI™)</a></li> <li><a href="/web/20140702195308/http://www.ahrq.gov/policymakers/chipra/ehrformatfaq.html">Model Children's EHR Format: Frequently Asked Questions</a></li> <li><a href="/web/20140702195308/http://www.ahrq.gov/research/findings/nhqrdr/index.html">National Healthcare Quality Report and National Healthcare Disparities Reports</a></li> <li><a href="/web/20140702195308/http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr10/children.html">Selected findings on child and adolescent health care from the 2010 National Healthcare Quality and Disparities Reports</a></li> <li><a href="https://web.archive.org/web/20140702195308/http://www.qualitymeasures.ahrq.gov/">National Quality Measures Clearinghouse (NQMC)</a></li> <li><a href="https://web.archive.org/web/20140702195308/http://qualityindicators.ahrq.gov/Modules/pdi_resources.aspx">Pediatric Quality Indicators</a></li> <li><a href="https://web.archive.org/web/20140702195308/http://cahps.ahrq.gov/">Consumer Assessment of Healthcare Providers and Systems (CAHPS®)</a></li> <li><a href="https://web.archive.org/web/20140702195308/http://meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=2Z-1">MEPS Topics: Children's Health; reports and data files from AHRQ's Medical Expenditure Panel Survey</a></li> </ul> <p><a href="#Contents">Return to Contents</a></p> <a id="CMS" name="CMS"> </a> <h2>Centers for Medicare & Medicaid Services</h2> <ul> <li> <span><a href="https://web.archive.org/web/20140702195308/http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/CHIPRA.html">CMS CHIPRA Web site</a></span> <br/> Second Annual Multi-State Health IT Collaborative for E-Health Conference, February 8-9, 2010<br/> Handouts and an audio recording of the HITECH conference call are available for download at <a href="https://web.archive.org/web/20140702195308/http://www.cms.gov/EHRIncentivePrograms/">http://www.cms.gov/EHRIncentivePrograms</a> under "Related Links Inside CMS."</li> <li><a href="https://web.archive.org/web/20140702195308/http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/InitialCoreSetResouceManual.pdf">CMS Technical Specifications</a> (PDF File, 842 KB).</li> <li><a href="https://web.archive.org/web/20140702195308/http://www.cms.gov/CHIPRA/17_TechnicalAssistance.asp">CMS Technical Assistance</a></li> </ul> <p><a href="#Contents">Return to Contents</a></p> <div class="current-as-of">Current as of June 2014</div> <div class="citation"> <span>Internet Citation: Children's Health Insurance Program Reauthorization Act (CHIPRA). June 2014. 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