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Health Insurance Marketplace Quality Initiatives

 

Spotlight News

  • CMS posted the HHS Notice of Benefit and Payment Parameters for 2019 Proposed Rule in the Federal Register with a public comment period closing on Monday, November 27, 2017.  CMS includes various proposals including a proposal to further expand the role of States in the QHP certification process for Federally-facilitated Exchanges (FFEs), including FFEs where the State performs plan management functions.  Specifically, the proposal is to rely on States for additional review areas, including accreditation requirements, compliance plans, quality improvement strategy reporting, and service area.  Comments are sought on this proposal including potential benefits and unintended consequences.  CMS does not include any proposals regarding the Quality Rating System; however, we mention accounting for social risk factors in CMS quality reporting programs and seek comment on the types of social risk factors appropriate for the Exchange population as well as methods to account for such risk factors.  The Proposed Rule can be found at https://www.federalregister.gov/documents/2017/11/02/2017-23599/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019.

QRS:

  • CMS has posted the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2018. QHP issuers certified to offer coverage through the Exchanges in 2018 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 Marketplace Service Desk (MSD) and reference the Marketplace Quality Initiatives or "MQI-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:

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

QIS:

  • CMS posted  the Quality Improvement Strategy (QIS): Technical Guidance and User Guide for the 2018 Plan Year  and the 2018 Quality Improvement Strategy Implementation Plan and Progress Report form . An issuer that meets the QIS participation criteria, and has offered coverage in a Exchanges  for two or more consecutive years, must implement and report on at least one QIS. Beginning in 2017 for the 2018 Plan Year, issuers will use the 2018 QIS Implementation Plan and Progress Report form to either: (a) implement a new QIS, or (b) provide a progress update on an existing QIS (e.g., a QIS submitted in 2016 for the 2017 Plan Year). The QIS Technical Guidance and User Guide for the 2018 Plan Year provides comprehensive background information about the QIS requirements, as well as step-by-step instructions to comply with the QIS requirements. Issuers with questions about the QIS requirements should contact the MSD Help Desk and reference the Marketplace Quality Initiatives-QIS or "MQI-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 1, 2017
QHP issuer and HEDIS® Compliance Auditor complete the HEDIS® Compliance Audit™. January – June 2018
Contract with an HHS-approved QHP Enrollee Survey vendor to conduct the QHP Enrollee Survey and submit survey response data to CMS. January 5, 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, 2018
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 and QHP Enrollee Survey 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.

Anticipated 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.

Exchange Operations Support Center (XOSC) Help Desk (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/