Health Insurance Marketplace Quality Initiatives

Decorative Health Insurance Marketplace Quality Initiatives Icon - a woman and a man looking at computer screen together

The Health Insurance Exchanges - also known as Health Insurance Marketplaces - help millions of Americans and small employers shop for, compare, and enroll in high-quality, affordable private health insurance plans each year.

The Marketplace Quality Initiatives (MQIs) are four programs established by the Affordable Care Act (ACA). These programs are required for Qualified Health Plans (QHPs) offered in all Marketplaces and are designed to promote quality, transparency, and patient safety. The MQIs include: 

  • The Marketplace Quality Rating System (QRS)
  • QHP Enrollee Experience Survey (QHP Enrollee Survey)
  • Quality Improvement Strategy (QIS)
  • Patient Safety standards

Scroll down to Program Overview for detailed descriptions of each initiative.

Spotlight News

QRS and QHP Survey

  • QRS and QHP Enrollee Experience Survey Technical Guidance for 2027 (September 2026) (PDF): CMS posted the QRS and QHP Enrollee Survey: Technical Guidance for 2027. The Technical Guidance provides QHP issuers certified to offer coverage through the Exchanges in 2027 with the QRS and QHP Enrollee Survey guidance required as a condition of certification.
  • 2027 Quality Rating System Measure Technical Specifications (September 2026) (PDF): CMS has posted an updated version of the 2027 Quality Rating System Measure Technical Specifications, which includes guidance on the finalized data submission requirements for the 2027 QRS measure set. Specifically, CMS added callout boxes summarizing the final decisions regarding measures and/or measure rates proposed for addition and/or removal in the Draft 2026 Call Letter and finalized in the Final 2026 Call Letter.
  • Quality Rating Information Bulletin (March 2026) (PDF): CMS released the Quality Rating Information Bulletin (PDF) to announce guidance for public display of quality rating information by all Exchanges, including the Federally-facilitated Exchanges (FFEs), State-based Exchanges on the Federal Platform (SBE-FPs), and State-based Exchanges (SBEs) that operate their own eligibility and enrollment platform, during the individual market Open Enrollment Period (OEP) for the 2027 Plan Year.

QIS

Program Overview

Quality Rating System - QRS

The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on clinical quality, member experience, and plan administration. 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 Survey

The QHP Enrollee Survey assesses consumer experience with QHPs offered through the Exchanges. The goals of the QHP Enrollee Survey are to provide comparable and useful information to consumers about the quality of health care services and enrollee experience with QHPs offered through the Exchanges. A subset of the survey results feed into the QRS star ratings.

Quality Improvement Strategy - QIS

The Quality Improvement Strategy (QIS) program requires QHPs to implement payment structures providing increased reimbursement or other incentives to improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, reduce health and health care disparities, and implement wellness and health promotion activities.

Patient Safety

Patient Safety standards require QHPs to contract with certain hospitals that use patient safety evaluation systems (PSES) 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

  • QRS/QHP Enrollee Survey Deadlines:
    • October 1, 2026: QHP issuer contracts with a HEDIS® Compliance Organization (NCQA-licensed) for validation of the QHP Enrollee Survey sample frame and the QRS clinical measure data.
  • QIS Deadlines:
    • October - November 2026: QIS Evaluation Review Results will be released. CMS will contact issuers with required corrections about entering an upcoming data change window to resubmit their QIS form(s).

Marketplace Service Help Desk (MSD)

QHP issuers and Exchanges with questions regarding the QRS, QIS, patient safety requirements, or the QHP Enrollee Survey should contact the MSD
CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515) and reference “Marketplace Quality Initiatives” or “MQI”.

Resources

 

Page Last Modified:
09/28/2026 09:35 AM