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

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

AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Children's Health Insurance Program Reauthorization Act (CHIPRA)

What's New

Now available: CHIPRA Webinar

The second Implementation Guide is now available. It focuses on Care Management Entities (CMEs) to coordinate services for youth with complex behavioral health needs.
Thirteen Evaluation Highlights are now available that describe how demonstration States are working to improve children's health care quality.

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, 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.
Title IV of CHIPRA promised 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 our work and provide key stakeholders an opportunity to share their views on this critical endeavor.
Please send comments to 



AHRQ collaborates with CMS and external experts to fulfill a number of requirements under Title IV of CHIPRA:
  • Identifying a 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). For the latest version of the Child Core Set, visit
  • Implementing the CHIPRA Pediatric Quality Measures Program. The PQMP contributes 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.
  • Evaluating CMS's Quality Demonstration project awards and creating a model children's electronic health record (EHR) format.
This site provides information on these activities and links to additional AHRQ and CMS resources on children's health care quality.

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). CHIPRA's charge for the PQMP:
  • Develop future enhanced and improved Child Core Sets of measures
  • Provide for development of new measures for use by:
    • Medicaid/CHIP programs
    • Other public and private programs, plans, providers, and patients
CHIPRA Pediatric Quality Measures Centers of Excellence
As part of the PQMP, AHRQ and CMS awarded cooperative agreement grants to seven CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence (COEs).
All measures developed by these COEs are publicly available for non-commercial use. The following links may be helpful:

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.

Children's EHR Format

The children’s EHR format helps bridge the gap between the functionality present in most EHRs currently available and the functionality that would more optimally support the care of children. 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).
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. Select for more information about the Children's EHR Format.

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 Link to Exit Disclaimer and the quality of health care for children across the pediatric age span.

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 Subcommittee on Quality Measures for Children's Medicaid and CHIP (SNAC) submitted a report on the measures to AHRQ. 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. At AHRQ's request, SNAC Co-Chair Rita Mangione-Smith, M.D., prepared an 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. 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.)

 More AHRQ Resources

Child Health Care Quality, Medicaid, and CHIP

 Centers for Medicare & Medicaid Services

Page last reviewed July 2015
Page originally created December 2012
Internet Citation: Children's Health Insurance Program Reauthorization Act (CHIPRA). Content last reviewed July 2015. Agency for Healthcare Research and Quality, Rockville, MD.

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