Skip to Main Content
Main Content


Overview of the Implementation Phase of Measure Development

Quality measure implementation is made up of all the activities associated with taking the measure from a development state to an active, in-use state. This includes, but is not limited to, consensus endorsement processes, measure selection processes, and measure rollout.


CMS identifies and selects measures it is considering for use through a transparent process that is open to stakeholders and public comment. CMS adopted a set of criteria to ensure a consistent approach. When considering a measure for a topic already measured in another program, CMS prefers to use the same measure or a harmonized measure.

CMS develops measures as well as considers measures submitted by other organizations, such as a specialty society. There are different paths that a measure can take for implementation depending on the program. As required for programs under Section 3014 of the Affordable Care Act, one path is through the pre-rulemaking and rulemaking process.

Measures for these programs are submitted to the Measures Under Consideration (MUC) List which makes publicly available a list of measures the Department of Health and Human Services (DHHS) is considering adopting through the federal rulemaking process for use in a select number of Medicare payment program(s). As part of the consensus endorsement process, measures may be submitted to the Measure Applications Process (MAP) (the consensus based entity currently managed by the National Quality Forum) during which multi-stakeholder groups provide input to DHHS on the selection of quality and efficiency measures. The NQF MAP also considers program and measure alignment when deciding which measures to recommend. After considering the MAP recommendation, CMS chooses which measures to implement. Programs publish in the Federal Register the rationale for the use of any quality and efficiency measures that are not endorsed by the consensus based entity.

For measures that do not go through rule-making, the implementation process works differently. Another method is for a program to issue a call letter to solicit measures. Submitted measures then go through the Department of Health and Human Services Clearance process. Once through the clearance process, the measures may go through the NQF MAP process but this step is not required. Public comments are solicited on all measures that use this path. Finally, CMS issues a final letter regarding the measures selected for implementation.

Once selected for implementation and data collection at a national level, CMS prepares a coordination and rollout plan along with business and data management processes to guide the measure rollout plan. Information will be provided to stakeholders to aid in the implementation. Measure developers should note that it is possible (in certain circumstances) that a measure could be implemented prior to full nationwide rollout.


Consensus Endorsement Process:

National Quality Forum Measure Applications Partnership Resources and the NQF Developer Guidebook


CMS Blueprint (Section 3 In-Depth Topics – 23 NQF Endorsement)

Pre-Rule Making resources

Pre-Rule Making FAQs

Pre-Rule Making 2016-2017 Timeline

NQF Multi-stakeholder Review: Criteria for Evaluating a Measure

NQF Field Guide

NQF Endorsement: What It Means

Measures Management & You: Endorsement

Measure Selection:

CMS MMS Webinar BP101 – Measures Under Consideration (MUC)

CMS Quality Measures Inventory

CMS Blueprint (Section 3. In-Depth Topics - Measure Selection (Pre-Rulemaking Process, CMS Rulemaking Process, Rollout/Production/Monitoring, Maintenance, Impact Assessment))

Measure Rollout:

CMS Blueprint (Section 3. In-Depth Topics - Measure Rollout)


Consensus Endorsement Process:

National Quality Forum Quality Positioning System of endorsed measures

CMS Blueprint (Measure Information Form Instructions)

Measure Evaluation Report

Measure Selection:

Measure Business Case

Measure Rollout:

Measure Rollout Plan

Auditing and Validation Report 

Next Phase

Return to Measure Development by Phase

Use, Continuing Evaluation and Maintenance