About the Quality Rating System (QRS)
Section 1311(c)(3) of the Affordable Care Act directs the HHS Secretary to develop a system that rates 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 Response data) for its QHPs in accordance with CMS guidelines as a condition of certification and participation in the Marketplaces.
In 2018, CMS conducted a limited pilot with the display of Quality Rating System (QRS) star ratings on HealthCare.gov for QHPs in five Federally-facilitated Marketplace States – Michigan, Montana, New Hampshire, Virginia and Wisconsin – for the 2019 individual market open enrollment period. More information on the display of quality ratings can be found at https://www.healthcare.gov/quality-ratings/.
CMS intends to display QRS global rating and three summary indicator ratings on the HealthCare.gov website for each QHP available through HealthCare.gov, including those offered through the FFMs and SBM-FP in future years. Below is an example of the star ratings displayed during the 2019 individual marketplace open enrollment period.