[Medicaid] External Quality Review (EQR) of Medicaid and Children’s Health Insurance Program (CHIP) Managed Care, EQR Protocols, and Supporting Regulations (CMS-R-305)
[Medicaid] External Quality Review (EQR) of Medicaid and Childrenâs Health Insurance Program (CHIP) Managed Care, EQR Protocols, and Supporting Regulations (CMS-R-305)
Revision of a currently approved collection
No
Regular
Approved with change
07/10/2026
06/09/2026
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
07/31/2029
36 Months From Approved
10/31/2027
7,236
0
9,530
887,087
0
482,802
0
0
0
The results of Medicare reviews, Medicare accreditation surveys, and Medicaid external quality reviews will be used by States in assessing the quality of care provided to Medicaid beneficiaries provided by managed care organizations and to provide information on the quality of the care provided to the general public upon request.
This 2026 information collection request revises the active EQR protocols (which were last updated in 2023). The revisions include: (1) align existing protocols, appendices and worksheets with the May 13, 2024 managed care final rule (CMS-2439-F; RIN 0938-AU99), (2) add a new protocol related to assisting states with quality ratings for the MAC QRS, and (3) update burden estimates to reflect the most accurate, current, and applicable EQR activities.
The rule will revise the EQR activities to remove the requirement for PCCM entities to conduct EQR, and to add two new optional activities: assisting states with the quality rating of MCOs, PIHPs, and PAHPs for the MAC QRS and to support states in conducting quality-related evaluations, as well as a few other technical changes to the way EQR results are reported, and the timing of EQR. The rule will also require states to maintain a 5-year archive of EQR reports on their websites and to require states notify CMS via email or other electronic correspondence when they have posted their EQR reports to their websites, and to share a link.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-R-305 CMS External Quality Review (EQR) Protocols
Comment - mlv-dvb6-xstm.pdf
CMS-R-305 - Supporting Statement B (2026 version 2).docx
(State Gov't) External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364