Quality Rating

The Quality Rating System (QRS) rates QHPs based on relative quality and price and requires the display of QHP quality ratings on Exchange websites to assist in consumer selection of plans.

In April 2020, CMS released the COVID-19 Marketplace Quality Initiatives Memo to announce that CMS suspended activities related to the collection and reporting of clinical quality measure information for the QRS and survey measure information for the QHP Enrollee Survey for the plan year 2021 QHP certification period. CMS requested that all QHP issuers discontinue activities related to the collection of Healthcare Effectiveness Data and Information Set (HEDIS®) and Pharmacy Quality Alliance (PQA) measures and survey measures for the QRS and QHP Enrollee Survey programs.

CMS will issue further guidance on the display of quality ratings beginning during the 2021 Open Enrollment period for the individual market on the Marketplace Quality Initiatives website. CMS will publish this guidance prior to the 2021 Open Enrollment period for the individual market.

CMS anticipates issuing technical guidance for the QRS and QHP Enrollee Experience Survey for the 2021 calendar year in the fall of 2020.

The QRS QHP List includes QHP issuers and their respective reporting units that CMS previously identified as eligible for the 2020 QRS based on the 2020 QRS participation requirements. CMS encourages QHP issuers review the 2020 QHP list to validate the operational status of their reporting units. Access to the HIOS-MQM is required to review the QHP list. Details for registering and requesting access to the HIOS-MQM are included in the HIOS MQM Quick Reference Guide.