CMS Core Set Measure Reporting
As of January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) has required states to annually submit and certify specific healthcare quality measures for Medicaid and the Children’s Health Insurance Program (CHIP). By December 31 each year, reporting is mandatory for all measures in the Core Set of Children’s Health Care Quality Measures (Child Core Set) and the behavioral health measures from the Adult Core Set Reporting on other Adult Core Set measures is optional but encouraged.
Reporting Year 2025
For the 2025 reporting year, close to 50 mandatory and optional measures must be calculated and reported to CMS. These calculations need to be stratified by race/ethnicity, sex, and geography. CMS has outlined detailed and complex measure calculation logic that incorporates FFS and MCO data as well as patient attribution logic to prevent double counting.
IPRO’s Approach
IPRO assists states in fulfilling CMS Core Measure Set requirements by conducting an initial MCO readiness assessment, gathering and managing data, calculating state-wide measures, performing thorough quality assurance, and creating the final performance file in the format required for CMS submission. IPRO continually monitors and updates measure specifications to ensure compliance with new requirements.
A Turnkey Solution
IPRO’s Medicaid Core Measures Solution includes creation of a statewide performance file for all measures, including required stratifications.
Why IPRO?
Having worked with state Medicaid programs across the nation for more than 30 years, IPRO’s team is among the most experienced in managing a wide range of performance measures across its diverse portfolio of programs, products, and services. IPRO supports 11 states as an External Quality Review Organization (EQRO), covering more than 150 managed care plans. By conducting measure validation and HEDIS audits as required EQRO activities, IPRO has developed exceptional expertise in validating performance measures. IPRO has a proven track record of effectively managing complex data and measure calculations while ensuring compliance with CMS requirements.
Learn more
To learn how IPRO can support your state in fulfilling the CMS Core Measures reporting requirement, contact us at info@ipro.org.
