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Health Insurance Marketplace Quality Initiatives

Spotlight News

  • 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.

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 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 the 2019 conditionally approved vendors. QHP Issuers must contract with an HHS-approved survey vendor. The list of the 2019 conditionally approved 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. Required documents can be found here: 2019 QHP Enrollee Survey Minimum Business Requirements and 2019 QHP Enrollee Survey Participation Form.

  • CMS has posted the 2019 Qualified Health Plan Enrollee Experience Survey and the templates for all English 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
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/

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