42 C.F.R. § 438.500

Current through October 31, 2024
Section 438.500 - Definitions
(a) Definitions. As used in this subpart, the following terms have the indicated meanings:

Measurement period means the period for which data are collected for a measure or the performance period that a measure covers.

Measurement year means the first calendar year and each calendar year thereafter for which a full calendar year of claims and encounter data necessary to calculate a measure are available.

Medicaid managed care quality rating system framework (QRS framework) means the mandatory measure set identified by CMS in the Medicaid and CHIP managed care quality rating system technical resource manual described in § 438.530, the methodology for calculating quality ratings described in § 438.515, and the website display described in § 438.520 of this subpart.

Medicare Advantage and Part D 5-Star Rating System (MA and Part D quality rating system) means the rating system described in subpart D of parts 422 and 423 of this chapter.

Qualified health plan quality rating system (QHP quality rating system) means the health plan quality rating system developed in accordance with 45 CFR 156.1120 .

Quality rating means the numeric or other value of a quality measure or an assigned indicator that data for the measure is not available.

Technical resource manual means the guidance described in § 438.530.

Validation means the review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis.

42 C.F.R. §438.500

89 FR 41279 , 7/9/2024