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Health Insurance Marketplace Quality Initiatives

Spotlight News

  • CMS requests comment on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2019 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey. CMS encourages interested parties to submit comments to Marketplace_Quality@cms.hhs.gov and reference "Marketplace Quality Initiatives (MQI)-Draft 2019 QRS Call Letter" in the subject line by the close of the comment period (March 18, 2019).
  • CMS is seeking public comment on the renewal of information collection request associated with the Marketplace Quality Initiative programs (i.e., the Quality Rating System, QHP Enrollee Survey, and Patient Safety Standards). CMS published the following Federal Register Notice (https://www.federalregister.gov/documents/2019/02/14/2019-02231/agency-information-collection-activities-proposed-collection-comment-request) on February 14, 2019. The 60-day public comment period will close on April 15, 2019.
  • CMS released the 2019 Quality Rating System (QRS) and Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) Operational Instructions, which provide information on the 2019 QRS and QHP Enrollee Survey reporting requirements and detailed information on how to: Prepare reporting units to collect and submit both 2019 QRS clinical measure data and QHP Enrollee Survey response data; Generate sample frames for the QHP Enrollee Survey; Complete the National Committee for Quality Assurance’s (NCQA) Healthcare Organization Questionnaire (HOQ) (i.e., confirm reporting unit information, select an HHS-approved QHP Enrollee Survey vendor, and validate the sample frame); and Provide information regarding reporting unit ineligibility through the submission of an Ineligibility Template, if applicable. The 2019 Quality Rating System (QRS) and Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) Operational Instructions can be found here.

QRS:

  • CMS has posted the 2019 Quality Rating System Measure Technical Specifications, which includes the measure specifications and guidelines for data collection for the 2019 QRS measure set. QHP issuers will need to reference this document in order to collect and submit QRS measure data to CMS in accordance with the QRS 2019 requirements. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the Marketplace Service Desk (CMS_FEPS@cms.hhs.gov) and reference the Marketplace Quality Initiatives or "MQI-QRS."

  • CMS has posted the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2019. QHP issuers certified to offer coverage through the Exchanges in 2019 are required to comply with QRS and QHP Enrollee Survey requirements as a condition of certification. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the CMS Marketplace Service Desk (MSD) (CMS_FEPS@cms.hhs.gov) and reference the Marketplace Quality Initiatives or "MQI-QRS.”
  • CMS releases an update to the Quality Rating Information Bulletin to announce that for the 2019 Open Enrollment Period, we are extending the Quality Rating System (QRS) Star Ratings pilot to three additional states. In addition to Virginia and Wisconsin, star ratings will now be available for Michigan, Montana and New Hampshire.  This consumer pilot testing helps us analyze the impact of QRS star ratings on consumer behavior, with the ultimate goal of providing consumers with information they need to make their health plan decisions.

QHP Survey:

  • CMS is pleased to announce the 2019 approved vendors. QHP Issuers must contract with an HHS-approved survey vendor. The list of the 2019 approved vendors can be found here. 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.

  • CMS has posted the 2019 Qualified Health Plan Enrollee Experience Survey and the templates for all survey materials.

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

QIS:

Upcoming Deadlines and Events


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 3, 2018
QHP issuer and HEDIS® Compliance Auditor complete the HEDIS® Compliance Audit™. January – June 2019
Notify CMS via (MQITier2HelpDesk@bah.com) and authorized survey vendor, if applicable, within 3 business days of discovery (but no later than January 15, 2019) if it is determined that the January 1, 2019 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, 2019
Authorize an HHS-approved QHP Enrollee Survey vendor to administer the QHP Enrollee Survey by completing NCQA’s Healthcare Organization Questionnaire (HOQ). January 31, 2019

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

February 16, 2019
HHS-approved QHP Enrollee Survey vendor conducts the QHP Enrollee Survey on the validated survey sampling frame. February – May 2019
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 17 deadline. June 17, 2019

QHP issuers, Marketplace administrators, and CMS preview the 2019 QHP quality rating information and QHP Enrollee Survey results.

August 2019
QIS deadlines
More information will be released forthcoming. N/A

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/

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