Access Standards
Client Alert: Medicaid and CHIP Quality Rating System
CMS Final Rule: Medicaid and Children's Health Insurance Program (CHIP) Quality Rating System

Medicaid Disproportionate Share Hospital (DSH)

January 2019


CMS requires states’ implementation of the required Medicaid and CHIP (MAC) Quality Rating System (QRS) by the end of the fourth year following the effective date of the final rule. With the final rule’s July 9, 2024, effective date, states must implement the MAC QRS requirements no later than December 31, 2028. Quality data displayed in 2028 will reflect the January 1, 2026, through December 31, 2026 measurement year.

CMS plans to update the QRS measure set at least biennially thereafter through sub-regulatory processes. CMS has included flexibility for states to request a one-time, one-year implementation extension for the MAC QRS methodology requirements. This request for an extension requires specific documentation, such as actions taken by the state to implement, barriers, and a detailed plan to implement by the end of the one-year extension. States receiving an extension must have the MAC QRS implemented by December 31, 2029. Request for an extension must be submitted to CMS by September 1, 2028.

Download our Quality Rating System final rule changes one sheet below.