CMS External Quality Review Regulations for Medicaid, CHIP
Summary
CMS is seeking public comment on a revision to an existing approved information collection under the Paperwork Reduction Act, specifically for External Quality Review (EQR) activities related to Medicaid and CHIP managed care. The collection involves 681 respondents generating 7,236 responses annually and accounting for 887,086 total annual hours. Comments must be submitted to the OMB desk officer by May 22, 2026.
“Most contracts between a state Medicaid agency and their managed care plan must provide for an annual External Quality Review (EQR).”
State Medicaid agencies and their contracted EQROs that conduct annual External Quality Reviews should assess whether the proposed revision to CMS-R-305 alters the data submission requirements, protocols, or timelines. The 887,086 total annual hours across 681 respondents suggests a substantial compliance burden — entities with direct experience under the current collection should submit comments on unnecessary or overly burdensome elements before the OMB desk officer deadline.
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What changed
CMS is publishing this notice to solicit comments on a revision to an existing approved information collection (CMS-R-305, OMB control number 0938-0786) related to External Quality Review of Medicaid and CHIP managed care organizations. The collection requires states to provide their EQROs with information consistent with CMS-specified protocols for conducting annual quality reviews. Public comments regarding burden estimates or other aspects of the collection must be received by the OMB desk officer by May 22, 2026.
State Medicaid agencies, managed care organizations, and EQROs should review the proposed information collection requirements and submit comments to OMB via www.reginfo.gov within the 30-day comment window. These entities may be directly affected by any changes to the scope, frequency, or format of data collection required for annual EQR activities.
Archived snapshot
Apr 22, 2026GovPing captured this document from the original source. If the source has since changed or been removed, this is the text as it existed at that time.
Content
ACTION:
Notice.
SUMMARY:
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to
publish notice in the
Federal Register
concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection
of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send
comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and
utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated
burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection
techniques or other forms of information technology to minimize the information collection burden.
DATES:
Comments on the collection(s) of information must be received by the OMB desk officer by May 22, 2026.
ADDRESSES:
Written comments and recommendations for the proposed information collection should be sent within 30 days of publication
of this notice to www.reginfo.gov/public/do/PRAMain. Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using
the search function.
To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice,
please access the CMS PRA website by copying and pasting the following web address into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION:
Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office
of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information”
is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A))
requires federal agencies to publish a 30-day notice in the
Federal Register
concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection
of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this
notice that summarizes the following proposed collection(s) of information for public comment.
Information Collection
- Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: External Quality Review (EQR) of Medicaid and Children's Health Insurance Program (CHIP) Managed Care, EQR Protocols, and Supporting Regulations; Use: Most contracts between a state Medicaid agency and their managed care plan must provide for an annual External Quality Review (EQR). The annual EQR is conducted by an independent external quality review organization (EQRO). States must provide the EQRO with information obtained through methods consistent with the protocols specified by CMS. The information is used by the EQRO to determine the quality of care furnished by the managed care plans in the state. The publicly posted EQR results allows Medicaid/CHIP enrollees and potential enrollees to make informed choices regarding the selection of their providers. It also provides advocacy organizations, researchers, and other interested parties access to information
on the quality of care provided to Medicaid beneficiaries enrolled in Medicaid/CHIP managed care. States use the information
during their oversight of these organizations. Form Number: CMS-R-305 (OMB control number: 0938-0786); Frequency: Annually and one-time; Affected Public: Private sector and State, Local or Tribal Governments; Number of Respondents: 681; Number of Responses: 7,236; Total Annual Hours: 887,086. (For policy questions regarding this collection contact Carrie Hanlon at 410-786-1660.)
William N. Parham, III, Director, Division of Information Collections and Regulatory Impacts, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2026-07851 Filed 4-21-26; 8:45 am] BILLING CODE 4120-01-P
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