QRS Methodology
T or F: Half-Stars are included in QRS.
False. 1-5 Star scale only; no half stars or rounding rules.
Two. 1. Calculating the measure benchmarks and 2. Calculating the measure scores using the benchmarks.
T or F: The Call Letter process takes place on an annual basis.
True.
False. Only Medicaid and Marketplace are in the same dashboard.
What are the three summary indicators and their weight?
CQM: 66.67%; EE: 16.67%; PEAM: 16.67%
What percent of total number of enrollees is needed to determine which top-performing issuers to include in the benchmark calculation?
>= 10%
How many days does the industry have to submit comments on the Draft Call Letter?
Measurement year 2025 is selected. What ratings year is that?
2026.
What are the two criteria required for QRS ratings qualification?
1. Length of time on the Exchange; 2. Minimum enrollment requirements
T or F: Once measure scores are calculated within each summary indicator, they are summed together to get the overall summary indicator score.
False. The average is taken, not sum.
T or F: Measure specifications are published once a year.
False. Twice a year
Which view(s) could I go to, to see a health plans global performance?
Parent, Domain and Market.
Iowa went live on 1/1/25. What measurement year will the plan be eligible to receive a star rating?
MY26.
How many formula options are there to calculate a measure score depending on the type of measure?
Three.
Name two examples of topics covered within the Call Letter.
1. Refinements to the measures in the QRS measure set; 2. Expansions and/or modifications to the QRS measure data collection and reporting methods; 3. Revisions to the QRS scoring methodology; 4. QHP enrollee survey refinements
How many different views are there within the Marketplace QRS scorecard and what are they?
Four. 1. Parent Org; 2. Domain Summary; 3. Measure Detail; 4. Market View
What is the half-scale rule?
A reporting unit must report at least 50% of the scored measures within the given summary indicator. For example, if there are 23 scored measures, at least 12 must be reportable.
80.3
What is the official name of the Draft and Final Call Letter?
Draft/Final 2025 Call Letter for the Quality Rating System (QRS) and Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey)
Define what the following columns mean: IND B, B2, B3, B4, and B5.
INB = the measure benchmark that we are compared against using the benchmark ratio approach; B2 = the 25th percentile; B3 = the 50th percentile; B4 = the 75th percentile; and B5 = the 90th percentile.