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. QHP issuers are required to submit quality rating information as a condition of certification and participation in the Federally-facilitated Exchange (FFE).

CMS will calculate the quality performance ratings for QHPs offered through all Exchanges, regardless of the Exchange model. CMS will apply the QRS rating methodology to validated QRS clinical measure data and a subset of the QHP Enrollee Survey validated response data (QRS survey measures) to produce quality ratings on a 5-star rating scale. CMS will calculate quality ratings for each QHP issuer’s product type (e.g., EPO, HMO, POS, and PPO) within each state and apply those ratings to each of the issuer’s QHPs by product type in that state. QHP issuers will receive their QRS and QHP Enrollee Survey results and have an opportunity to submit inquiries during an established preview period each year prior to public display of results.

QHP issuers should refer to the Marketplace Quality Initiatives website for more detailed information on issuer data collection and reporting requirements for the 2021 calendar year. CMS anticipates issuing technical guidance for the QRS and QHP Enrollee Experience Survey for the 2022 calendar year in the fall of 2021.

The QRS QHP List includes QHP issuers and their respective reporting units that CMS previously identified as eligible for the 2021 QRS based on the 2021 QRS participation requirements. CMS encourages QHP issuers to review the 2021 QHP list to validate the operational status of their reporting units. Access to the HIOS-Marketplace Quality Module (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 posted to the Marketplace Quality Initiatives website.