Medicaid and CHIP Quality Rating System (MAC QRS) Measure Set Review

State Medicaid and CHIP Quality Rating System (MAC QRS) websites will be one-stop shops that empower beneficiaries and caregivers to make informed choices about the managed care plans that are available to them and increase transparency into Medicaid and CHIP managed care plan performance. In addition to comparative plan information, each MAC QRS must include quality ratings for a concise set of mandatory measures intended to evaluate performance on quality of care, access to services, and outcomes that are meaningful to MAC QRS users. The measure set is an important tool states can use to hold plans accountable for the care provided to beneficiaries and to drive improvements in plan performance and the quality of care provided to Medicaid and CHIP beneficiaries.

Ensuring that the MAC QRS measure set remains relevant to Medicaid and CHIP beneficiaries and includes reliable measures of plan quality requires periodically reassessing the mandatory measures. Many factors, such as evolving user preferences and experiences with reporting and performance rates, may warrant modifying the measure set.

Mathematica is supporting the Center for Medicaid and CHIP Services (CMCS) by establishing and convening the 2028 MAC QRS Measure Set Review Workgroup. The Workgroup will review the MAC QRS mandatory measure set and recommend updates for improvement. The Workgroup will include subject matter experts with knowledge of the opportunities and challenges for collecting, reporting, and using quality measures to improve the quality of care in Medicaid and CHIP managed care plans as well as individuals who represent beneficiary perspectives and preferences.