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Health Insurance Marketplace Quality Initiatives

Spotlight News

  • The 2018 Quality Rating System (QRS) quality ratings and QHP Enrollee Survey results are available for preview beginning August 13th at 9am ET through August 24th at 6pm ET. Eligible QHP issuers and Exchange administrators will be able to preview the QRS preview reports, QRS proof sheets, and QHP Enrollee Survey Quality Improvement Reports for their respective reporting units in CMS’ Health Insurance Oversight System Marketplace Quality Module (HIOS-MQM). Inquiries regarding the preview results should be submitted to the CMS help desk, CMS_FEPS@cms.gov, by August 24th.
      Access to HIOS-MQM is required to preview the QRS rating information. Please navigate to the HIOS-MQM Quick Reference Guide for details about registering and accessing the HIOS-MQM.
    • CMS has posted Version 2.0 of the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2018. Version 2.0 supersedes the initial version that CMS published in October 2017; it includes the finalized 2018 QRS rating methodology and additional details regarding preview and public display of quality rating information. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the Marketplace Service Desk (MSD) Help Desk and reference the Marketplace Quality Initiatives or "MQI-QRS.”
    • CMS has posted the Final 2018 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey to communicate finalized refinements to the QRS and QHP Enrollee Survey programs for 2018, 2019, and beyond. This document also summarizes comments received on the Draft 2018 QRS Call Letter.

    QRS:

    • CMS has posted the 2018 Quality Rating System Measure Technical Specifications, which describes what QHP issuers will need to do to collect and submit QRS measure data to CMS in 2018. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the Marketplace Service Desk (MSD) and reference the Marketplace Quality Initiatives or "MQI-QRS."
    • CMS releases the 2017 Quality Rating Information Bulletin to announce the continuation of the consumer testing pilot of the display of quality rating information by the Federally-facilitated Exchanges (FFEs), including FFEs where the State performs plan management functions and State-based Exchanges on the Federal Platform (SBE-FPs), for the 2018 plan year.  CMS will continue to pilot the display of the Quality Rating System (QRS) star ratings in the same two FFE States as the previous year.  The Bulletin also notes that guidance for issuers and State-Based Exchanges articulated in 2016 will continue to apply to the second year of consumer pilot testing, with the applicable year references revised to reflect the extension of the consumer pilot test for a second year.

    QHP Survey:

    • CMS is pleased to announce that the vendor solicitation period for the Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) will occur from July 30, 2018 to August 10, 2018. Exchanges are required to publicly report information on costs, coverage, quality ratings, and enrollee experience for each Qualified Health Plan (QHP) offered. Enrollee experience data will be collected through the QHP Enrollee Survey. Required documents can be found here: 2019 QHP Enrollee Survey Minimum Business Requirements and 2019 QHP Enrollee Survey Participation Form.

    • Please seek further information for the QHP Survey on the QHP Survey Page located here.

    QIS:

    Upcoming Deadlines and Events

    QRS and QHP Enrollee Survey: Upcoming Results and Preview Webinar on the Plan Management State Coordination Webinar held via REGTAP July 25, 2018
    QRS and QHP Enrollee Survey: Upcoming Results and Preview Webinar on the QHP Issuer Series Webinar held via REGTAP August 2, 2018
    QHP issuers, Exchange administrators, and CMS preview the 2018 QHP quality rating information and QHP Enrollee Survey results. August 13-24, 2018

    QRS/QHP Enrollee Survey deadlines for issuers

    Contract with a HEDIS Compliance Organization (NCQA licensed) for validation of the QHP Enrollee Survey sample frame and QRS clinical measure data.

    December 1, 2018
    QHP issuer and HEDIS® Compliance Auditor complete the HEDIS® Compliance Audit™. January – June 2018
    Notify CMS via (MQITier2HelpDesk@bah.com) and authorized survey vendor, if applicable, within 3 business days of discovery (but no later than January 15, 2018) if it is determined that the January 1, 2018 enrollment threshold is not met. January 15, 2019
    Generate a sample frame for each reporting unit. QHP issuers arrange for HEDIS Compliance Auditor (employee of or contracted by the HEDIS® Compliance Organization) to perform and complete the sample frame validation. January 31, 2018
    Authorize an HHS-approved QHP Enrollee Survey vendor to administer the QHP Enrollee Survey by completing NCQA’s Healthcare Organization Questionnaire (HOQ). January 31, 2018

    Complete the NCQA Healthcare Organization Questionnaire (HOQ) for QRS clinical measure data submission.

    February 16, 2018
    HHS-approved QHP Enrollee Survey vendor conducts the QHP Enrollee Survey on the validated survey sampling frame. February – May 2018
    QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS). Note: Each QHP issuer must submit and plan-lock its QRS clinical measure data by June 1 to allow the HEDIS® Compliance Auditor sufficient time to review, approve, and audit-lock all submissions by the June 15 deadline. June 15, 2018

    QHP issuers, Marketplace administrators, and CMS preview the 2018 QHP quality rating information and QHP Enrollee Survey results.

    August 2018
    QIS deadlines
    Issuers should submit their quality improvement strategies during the initial Qualified Health Plan (QHP) Application Submission Window as specified in CCIIO’s Addendum to 2018 Letter to Issuers in the Federally-facilitated Marketplaces (FFMs) published on February 17, 2017. The Revised Timeline for QHP Certification in the FFMs can be found on page two of the Addendum to 2018 Letter to Issuers. Per the revised timeline, the initial QHP Application Submission Window for the 2018 Plan Year will take place from 5/10/2017 – 6/21/2017. Issuers must make their 2018 QIS submissions during this time.    May 10, 2018 – June 21, 2018

    Resources

    Marketplace Quality Initiatives Listserv
    We encourage you to let others know about the CMS Marketplace Quality Initiatives, and to share its messages. Subscribe to Marketplace Quality Initiatives Listserv to be included in future communications and updates.

     Marketplace Service Help Desk (MSD) (reference “Marketplace Quality Initiatives”):
    CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515)

    Registration for Technical Assistance Portal (REGTAP)
    http://REGTAP.info

    Center for Consumer Information and Insurance Oversight (CCIIO) website:

    https://www.cms.gov/cciio/

    .