QRS

About the Quality Rating System (QRS)

Section 1311(c)(3) of the Patient Protection and Affordable Care Act (PPACA) directs the  U.S. Department of Health & Human Services (HHS) Secretary to develop a system that rates qualified health plans (QHPs) based on relative quality and price. It also requires Marketplaces to display QHP quality ratings on Marketplace websites to assist in consumer selection of QHPs. Based on this authority, CMS established standards and requirements related to QHP issuer data collection and public reporting of quality rating information in every Marketplace. QHP issuers must submit quality rating information (specifically QRS clinical measure data and QHP Enrollee Survey response data) for its QHPs in accordance with CMS guidelines as a condition of certification and participation in the Marketplaces. For more information:

Fact sheets:

Health Insurance Exchange Quality Rating System 101 

Choosing a High-Quality Marketplace Plan

Guidance:

  • The Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2022 (PDF) describes requirements, as a condition of certification, for QHP issuers certified to offer coverage through the Exchanges in 2022. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the CMS Marketplace Service Desk (MSD) (CMS_FEPS@cms.hhs.gov) and reference the Marketplace Quality Initiatives or "MQI-QRS.”
  • The 2022 Quality Rating System Measure Technical Specifications (PDF) includes the measure specifications and guidelines for data collection for the 2022 QRS measure set. QHP issuers will need to reference this document in order to collect and submit QRS measure data to CMS in accordance with the QRS 2022 requirements. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the Marketplace Service Desk (CMS_FEPS@cms.hhs.gov) and reference the Marketplace Quality Initiatives or "MQI-QRS."
  • CMS has posted the 2021 Quality Rating System Proof Sheet User Guide (PDF), which provides detail for QHP issuers and state Exchange administrators regarding the methodology used to produce the QRS scores and ratings as shown in the 2021 QRS Proof Sheets. The 2021 QRS Proof Sheet User Guide reflects updates to the QRS rating methodology finalized via the Final Call Letter for the 2021 Quality Rating System and Qualified Health Plan Enrollee Experience Survey.

Please direct QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the CMS Marketplace Service Desk (MSD) (CMS_FEPS@cms.hhs.gov) and reference the Marketplace Quality Initiatives or "MQI-QRS.”

Quality Rating Display

The Quality Rating Information Bulletin (PDF) announces guidance for public display of quality rating information by all Exchanges, including Federally-facilitated Exchanges (FFE), inclusive of FFE states where the state performs plan management functions, State-based Exchanges on the Federal Platform (SBE-FPs), and State-based Exchanges (SBEs).

 

QRS Image

In 2017, 2018, and 2019, CMS displayed QRS star ratings on HealthCare.gov in select FFE) states as part of a limited, phase-in pilot program.

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Public Use Files

Marketplace Quality Module

QHP Issuers can preview their quality ratings in the Marketplace Quality Module (MQM) within CMS' Health Insurance and Oversight System (HIOS). In the MQM, QHP issuers and state representatives can also access the following:

  • QRS QHP List
  • Quality Improvement reports detailing QHP Enrollee Survey results

HIOS MQM Quick Reference Guide (PDF) includes instructions to follow to register for a CMS Enterprise Identity Management account (EIDM) and request access to HIOS and MQM.

Page Last Modified:
04/27/2022 04:02 PM