Health Insurance Marketplace Quality Initiatives

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The Patient Protection and Affordable Care Act (PPACA) authorizes the creation of Health Insurance Exchanges (also known as Health Insurance Marketplaces) to help individuals and small employers’ shop for, select, and enroll in high quality, affordable private health plans.

The Marketplace Quality Initiatives (MQIs) includes four programs established by the PPACA which requires the U.S. Department of Health & Human Services (HHS) to develop quality data collection and reporting tools. The Marketplace Quality Rating System (QRS), QHP Enrollee Experience Survey (QHP Survey), Quality Improvement Strategy (QIS), and patient safety standards are Qualified Health Plan (QHP) quality-related certification requirements across all Marketplaces.

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


Spotlight News

QRS and QHP Survey

  • Draft 2024 Call Letter for the QRS and QHP Enrollee Survey (PDF)  (February 2024): CMS requests comment on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2024 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey. CMS encourages interested parties to submit comments to [email protected] and reference “Marketplace Quality Initiatives (MQI)-Draft 2024 QRS Call Letter” in the subject line by the close of the comment period (March 28, 2024).
  • QRS and QHP Enrollee Experience Survey Technical Guidance for 2024 (September 2023): (PDF) CMS posted the 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 the QRS and QHP Enrollee Survey guidance required as a condition of certification.
  • 2024 Quality Rating System Measure Technical Specifications (September 2023): (PDF) CMS has posted an updated version of the 2024 Quality Rating System Measure Technical Specifications, which includes guidance on the finalized data submission requirements for the 2024 QRS measure set. Specifically, CMS added callout boxes summarizing the final decision regarding measures and/or measure rates proposed for addition.  Measures proposed for removal in the Draft 2023 Call Letter and finalized in the Final 2023 Call Letter have also been included. 

QIS: 

  • Plan Year 2025 Draft QIS Issuer List (XLSX) Published for Review (March 2024): CMS has posted the draft version of the Quality Improvement Strategy (QIS) Issuer List for the 2025 Plan Year (Draft 2025 QIS Issuer List (XLSX)) for review. 
    • Issuers will be able to review the Draft QIS Issuer List for the 2025 Plan Year to verify their information and communicate any discrepancies to CMS by emailing [email protected] by Friday, April 5. When submitting via email, please include “MQI-QIS Issuer List” and your HIOS Issuer ID in the subject line or body of the email. If you do not review the QIS Issuer List to verify your information and identify discrepancies, CMS will assume the information in the QIS Issuer List is accurate and final.
    • CMS will reconcile any discrepancies and post a final QIS Issuer list on the MQI website before the QHP Application Period begins on April 17.
  • QIS materials for the 2025 Plan Year will be posted soon.
     

Program Overview

Quality Rating System – QRS

The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on relative quality and price. The goals of the QRS are to provide comparable and useful information to consumers, facilitate oversight of QHPs, and provide actionable 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 wellness and health promotion activities, and/or reduce health and health care disparities.

Patient Safety

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


Upcoming Deadlines and Events for Issuers

  • April 5, 2024: QHP issuers communicate any discrepancies in Draft Issuer List to CMS.
  • May 17, 2024: HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer).
  • June 14, 2024: QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS).

Resources  

  • Learn more about Quality Ratings: Information about the quality ratings of health plans is available on HealthCare.gov.
  • Learn more about Quality Measures: The CMS Measure Management System (MMS) Hub is the home for content related to quality measures, quality measure development and maintenance information. Explore the following links to MMS resources learn more about quality measures:  
  • Marketplace Quality Initiatives Listserv: We encourage you to let others know about the CMS Marketplace Quality Initiatives, and to subscribe to Marketplace Quality Initiatives Listserv to be included in future communications and updates.
  • Registration for Technical Assistance Portal (REGTAP): Register for REGTAP for training and resources related to the Health Insurance Exchanges.  
  • Center for Consumer Information and Insurance Oversight (CCIIO) website: Navigate to the CCIIO website for more information about the Health Insurance Exchanges and QHP certification.
  • Qualified Health Plan (QHP) website: For QHP issuers operating in the FFE, find the QHP application, materials, and resources on CMS’ QHP certification website. 
  • Marketplace Quality Initiatives FAQs: Answers to frequently asked questions related to the MQI can be found on CMS’ QHP certification website.
  • MQI Regulations: The following final regulations established the quality reporting standards related to the Marketplace Quality Initiatives (MQI):

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

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

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