Quality initiatives in the health insurance market

The Patient Protection and Affordable Care Act (PPACA) authorized the creation of health insurance exchanges (also known as health insurance marketplaces) to help individuals and small employers shop for, choose, and enroll in high-quality, affordable private health plans.

The Market Quality Initiatives (MQIs) include four programs created by PPACA that require the US Department of Health and Human Services (HHS) to develop quality data collection and reporting tools. The Marketplace Quality Rating System (QRS), QHP Participant Experience Survey (QHP Survey), Quality Improvement Strategy (QIS), and Patient Safety Standards are Qualified Health Plan (QHP) certification requirements related to quality in all Marketplaces.

Scroll below to “Program Overview” for a description of each program.


News in the spotlight

QRS and QHP study

  • QRS and QHP Enrollee Experience Survey 2024 Technical Guidelines (September 2023): CMS publishes QRS and QHP Enrollee Survey: Technical Guidance for 2024 The technical guidance provides QHP issuers certified to offer coverage through the Exchanges in 2024 with QRS and QHP Enrollee Survey guidance required as a condition of certification.
  • Quality Assessment System Measurement Technical Specifications for 2024 (September 2023): CMS has published an updated version of the 2024 Quality Rating System Measure Technical Specifications that includes guidance on the finalized data submission requirements for the 2024 QRS measure set. Specifically, CMS added caption boxes summarizing the final decision on the measures and/or rates of the measures proposed to be added. The measures proposed for removal in the draft 2023 invitation letter and finalized in the final 2023 invitation letter are also included.
  • 2023 Final Call Letter (June 2023): CMS publishes Final 2023 Solicitation Letter for the Quality Assessment System and Qualified Health Plan Enrollee Experience Survey to communicate finalized clarifications to the study programs of QRS and QHP enrollees for rating year 2024 and beyond. This document also summarizes comments received on the 2023 draft invitation letter.

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  • Renewal of QIS Information Collection Request (ICR) (September 2023): CMS is seeking public comment on renewal of information collection related to the QIS Implementation Plan, Progress Report, and Summary of Modification Supplement forms. CMS published the following Federal Register notice on September 29, 2023, and the 60-day public comment period ends on November 28, 2023.

View the program

Quality Assessment System – QRS

The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on relative quality and cost. The goals of the QRS are to provide comparable and useful information to consumers, to facilitate QHP oversight, and to provide useful information to QHPs to improve quality and performance.

QHP Enrollee Experience Survey

Quality Improvement Strategy – QIS

A quality improvement strategy (QIS) is a payment structure that provides increased reimbursement or other incentives to improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, implement activities to promoting health and health and/or reducing health and health care disparities.

Patient safety

QHPs are required to contract with certain hospitals that use patient safety assessment systems and implement comprehensive hospital discharge programs. QHPs are also required to contract with health care providers that implement health care quality improvement mechanisms.


Upcoming deadlinewith and Issuer Events

  • Deadlines for surveying QRS/QHP enrollees
    • October 2, 2023: QHP issuer contracts with HEDIS® Compliance Organization (licensed by NCQA) to validate QHP Enrollee Survey sampling frame and QRS clinical measurement data.

Resources

  • Learn more about quality ratings: Information about health plan quality ratings is available at HealthCare.gov.
  • Learn more about quality measures: The CMS Measurement System (MMS) Management Center is the home for content related to quality measures, quality measure development, and support information. Check out the following links to MMS resources, learn more about quality measures:
  • Marketplace Quality Initiatives Listserv: We encourage you to let others know about and subscribe to CMS Marketplace Quality Initiatives Marketplace Quality Initiatives Listserv to be included in future announcements and updates.
  • Registration in the Technical Assistance Portal (REGTAP): Register with REGTAP for training and resources related to the health insurance exchanges.
  • Center for Consumer Information and Insurance Oversight (CCIIO) website: Go to the CCIIO website for more information on health insurance exchanges and QHP certification.
  • Qualified Health Plan (QHP) website: For QHP issuers operating in FFEs, find the QHP application, materials, and resources on the CMS QHP Certification website.
  • Frequently asked questions about Marketplace quality initiatives: Answers to frequently asked questions related to MQI can be found on the CMS QHP Certification website.
  • MQI Rules: The following final regulations establish the quality reporting standards related to Market Quality Initiatives (MQIs):

Marketplace Services Help Desk (MSD) (reference “Marketplace Quality Initiatives”)

QHP issuers and Exchanges with questions about QRS, QIS, or the QHP Enrollee Survey should contact MSD
[email protected] or 1-855-CMS-1515 (1-855-267-1515)

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