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Health Insurance Marketplace Quality Initiatives


Health Insurance Marketplace Quality Initiatives

 

Spotlight News

  • CMS is seeking public comment for the renewed approval of information collection requirements associated with the 2018 QHP Enrollee Experience Survey (https://www.regulations.gov/document?D=CMS_FRDOC_0001-2166).  CMS published the Federal Register notice on April 14, 2017  and the 60 day public comment period ends on June 13, 2017.
  • CMS posts the HHS Notice of Benefit and Payment Parameters for 2017 proposed rule in the Federal Register.  CMS proposes to strengthen QHP issuer patient safety standards to better align with current, effective patient safety interventions, beginning on or after Jan. 1, 2017.  The 30 day public comment period closes on December 21, 2015.  The proposed rule can be found at https://www.federalregister.gov/articles/2015/12/02/2015-29884/patient-protection-and-affordable-care-act-benefit-and-payment-parameters-for-2017.  
  • CMS posts the Quality Improvement Strategy: Technical Guidance and User Guide for the 2017 Coverage Year and the Quality Improvement Strategy Implementation Plan and Progress Report form and the issue brief describing these 2017 requirements. An eligible issuer participating in a Marketplace for two or more consecutive years must implement and report on at least one quality improvement strategy (QIS). Beginning in 2016 for the 2017 coverage year, issuers will use the QIS Implementation Plan and Progress Report form to report on their quality improvement strategies. The QIS Technical Guidance provides comprehensive background information about the QIS requirements, as well as step-by-step instructions for how to comply with the QIS requirements. Issuers with questions about the QIS requirements should contact the Exchange Operations Support Center (XOSC) Help Desk and reference the Marketplace Quality Initiatives-QIS or "MQI-QIS."
  • CMS approves ten survey vendor organizations to administer the 2016 QHP Enrollee Survey.  The final list of 2016 HHS-Approved QHP Survey Vendors is available at http://qhpcahps.cms.gov.  QHP issuers should use this list to contract and authorize with a survey vendor by January 5, 2015, to administer the QHP Enrollee Survey on their behalf.
  • CMS posts the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2016 and 2016 QRS Measure Technical Specifications. QHP issuers certified to offer coverage through the Marketplaces in 2016 are required to comply with QRS and QHP Enrollee Survey requirements as a condition of certification. Beginning in 2016, with the Open Enrollment Period for 2017, Marketplaces are required to prominently display QHP quality rating information on their websites to help consumers compare QHPs. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the Exchange Operations Support Center (XOSC) Help Desk and reference the Marketplace Quality Initiatives or "MQI-QRS."
  • CMS posts the 2016 QHP Enrollee Experience Survey for national implementation across Marketplaces.  The QHP Enrollee Survey will be administered by CMS-approved QHP Enrollee Survey vendors using a standardized mixed mode survey with mail, telephone, and web survey protocols to facilitate comparison of QHPs both within and across Marketplaces.  The QHP Enrollee Survey is based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) 5.0 Adult Medicaid Health Plan Survey with additional items.

 

About the Marketplace Quality Initiatives

The Affordable Care Act authorizes the creation of Health Insurance Marketplaces (Marketplaces) to help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans. Only qualified health plans (QHPs) may be offered within the Marketplaces.

The Affordable Care Act requires the U.S. Department of Health & Human Services (HHS) to develop quality data collection and reporting tools such as a Quality Rating System (QRS), a Quality Improvement Strategy (QIS) and an enrollee satisfaction survey system.  Information from the QRS, QIS, and surveys will inform consumer selection of a QHP, decisions about QHP certification, and the Federal and State Marketplaces’ monitoring of QHP performance. HHS intends a phased approach to public reporting of QHP-specific quality information, beginning in 2016.

Webinar slides describing the Marketplace Quality Initiatives, including the QRS, consumer experience surveys, and the QIS can be accessed in the Downloads section at the bottom of this page:

Proposed Rules

The HHS Notice of Benefit and Payment Parameters for 2017 published in the Federal Register on November 21, 2015 and is open for public comment.

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