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Health Insurance Marketplace Quality Initiatives

Spotlight News

  • On May 7, 2019, CMS posted a file containing the 2019 Quality Rating System (QRS) QHP List to the CMS Health Insurance Oversight System Marketplace Quality Module (HIOS-MQM). The QRS QHP List includes QHP issuers and their respective reporting units that CMS identified as eligible for the 2019 QRS based on the 2019 QRS participation requirements. Access to the HIOS-MQM is required to review the QHP list. Details for registering and requesting access to the HIOS-MQM are included in the HIOS MQM Quick Reference Guide. CMS requests that you review your QHP information, and report discrepancies by Friday, May 31, 2019 to the Marketplace Service Desk (MSD) via email at CMS_FEPS@cms.hhs.gov, or by phone at 1-855-CMS-1515 (1-855-267-1515). When submitting inquiries via email, please include “MQI-QRS QHP List” and your HIOS Issuer ID in the subject line or body of the email.
  • 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
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

First QHP Application Submission Window Closes.

June 19, 2019

Second QHP Application Submission Window Closes.

August 21, 2019

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/