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Design Guidance Resources

MAC QRS Prototypes

Given the visual nature of the website display requirements at 42 CFR §§ 438.520 and 457.1240(d), CMS developed two sample prototypes, one simple and one interactive, in Portable Document Format (PDF) to provide examples of how States may choose to comply with the website display requirements. They are not intended to prescribe exactly what a display of a MAC QRS must look like. 

Each website implementation phase includes minimum requirements with which the state’s website display must comply. All States must at least implement the first phase of website display features described in 42 CFR §§  438.520(a)(1)-(5) and 457.1240(d) by December 31, 2028. States may choose to implement one or more features required in phase two, described in 42 CFR §§ 438.520(a)(6) and 457.1240(d), during the first phase, but all states are required to implement all features described in 42 CFR §§ 438.520(a) and 457.1240(d) by the end of the second phase, which would occur no sooner than six years following the final rule.

CMS is not updating the prototypes to reflect the modifications to the proposed website display requirements that are finalized in the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality Final Rule, 89 FR 41002 published on May 10, 2024 (2024 Final Rule) because these modifications do not substantively affect the content displayed in either prototype. However, the prototype citation map published with the proposed rule has been replaced with an updated prototype citation map  that maps the prototype design elements to both the proposed and finalized website display requirement citation.

Prototype A

Prototype A illustrates a simple version of the display requirements promulgated in §§ 438.520(a)(1)-(5) and 457.1240(d) of the 2024 Final Rule. These display features represent the minimum that States are required to display in their MAC QRS website in the first phase of website implementation, by December 31, 2028. States would retain the flexibility to display the required features in a more interactive format, or include additional display features during this initial phase. The display features required for this phase include:

  • Information necessary for users to understand and navigate the contents of the QRS website display proposed at §§ 438.520(a)(1) and 457.1240(d);
  • Information that allows beneficiaries to identify the managed care plans available to them and that align with their coverage needs and preferences proposed at §§ 438.520(a)(2) and 457.1240(d);
  • Standardized information identified by CMS that allows users to compare available managed care plans and programs proposed at §§ 438.520(a)(3) and 457.1240(d);
  • Information on quality ratings for mandatory measures identified in the technical resource manual displayed in a manner that promotes beneficiary understanding of and trust in the ratings proposed at §§ 438.520(a)(4) and 457.1240(d); and
  • Information or hyperlinks directing users to resources on how and where to apply for Medicaid and enroll in a Medicaid or CHIP plan proposed at §§ 438.520(a)(5) and 457.1240(d).

Prototype A PDF
Video walk-though of Prototype A


Prototype B

Prototype B illustrates an interactive version of the MAC QRS website that includes the display features proposed in §§ 438.520(a)(1)-(5) and 457.1240(d) represented in Prototype A, as well as the interactive features proposed in §§ 438.520(a)(6) and 457.1240(d). Prototype B represents the minimum display features that are required in the second phase of website implementation. CMS has not announced a date by which States must implement the second phase, but the final rule establishes that States will be required to implement the phase two features no earlier than December 31, 2020, but have the flexibility to implement these interactive features sooner. These features include: 

  • A search tool that enables users to identify available managed care plans that provide coverage for a drug identified by the user proposed at §§ 438.520(a)(6)(i) and 457.1240(d);
  • A search tool that enables users to identify available managed care plans that include a provider identified by the user in the plan’s network of providers proposed at §§ 438.520(a)(6)(i) and 457.1240(d); and
  • An interactive tool that enables users to view the quality ratings for mandatory measures identified in the technical resource manual stratified by dual eligibility status, race and ethnicity, sex, age, rural/urban status, disability, language, or other factors specified by CMS proposed at §§ 438.520(a)(6)(i) and 457.1240(d).

Prototype B PDF
Video walk-though of Prototype B

Design Guide Modules

CMS’s Medicaid and CHIP Quality Rating System (MAC QRS) requires states to display quality ratings for Medicaid and CHIP managed care plans (MCPs). These ratings aim to help beneficiaries make informed plan selections by offering clear, accessible, and comparable information on MCP performance. CMS engaged states, MCPs, and other interested parties to support MAC QRS implementation. This collaborative process and its findings are summarized across three Design Guide (DG) Modules. 

  • DG Module 1 Key Findings from User Testing: This module presents what CMS learned through user testing and summarizes key user insights to help states incorporate beneficiary perspectives into the design of their MAC QRS websites. Additionally, this module describes the key findings that CMS adopted in the final rule, shows how they were applied in the prototypes, and clarifies which MAC QRS website elements are required versus recommended best practice.
  • DG Module 2 Using Human-Centered Design to Inform Website Prototypes: This module presents the key drivers CMS considered when developing MAC QRS guidance, provides an overview of the Human-Centered Design (HCD) framework, and explains how CMS implemented each HCD phase to develop the MAC QRS website prototypes.
  • DG Module 3 How States Can Use Human-Centered Design to Build their MAC QRS Website: This module describes the role and benefits of user testing in HCD, identifies key points in the website development process where states can apply the HCD framework, and shares considerations for implementing the HCD framework when building a MAC QRS website.