About Quality Improvement Strategy (QIS)
A Quality Improvement Strategy (QIS) is a payment structure that incentivizes improved health outcomes of plan enrollees. A QIS should motivate high quality by tying payments to measures of performance when providers meet specific quality indicators or when enrollees make certain choices or exhibit behaviors associated with improved health. A QIS must address at least one of the following topic areas: (1) Activities for improving health outcomes; (2) Activities to prevent hospital readmissions; (3) Activities to improve patient safety and reduce medical errors; (4) Activities for wellness and health promotions; in addition to (5) Activities to reduce health and health care disparities.
The goals of the QIS are to:
- Offer increased reimbursement or other market-based incentives to improve the health outcomes of plan enrollees.
- Address key quality improvement topic areas (e.g., improve health outcomes, prevent hospital readmissions).
- Report implementation plans and progress related to quality improvement efforts.
CMS anticipates issuing the QIS Technical Guidance and User Guide at least annually. CMS proposes and communicates refinements to the QIS through the information collection request process per the Paperwork Reduction Act requirements (as appropriate).
- Answers to frequently asked questions related to QIS can be found on the Marketplace Quality Initiatives FAQs (cms.gov) page on CMS’ Qualified Health Plan (QHP) Certification Website.
Background
An issuer participating in an Exchange for two or more consecutives years must implement and report on a QIS, in accordance with section 1311(g) of the Patient Protection and Affordable Care Act (PPACA), entitled “Rewarding Quality Through Market-Based Incentives.” The QIS standards align with the CMS Quality Strategy and other federal, State, and private sector quality improvement initiatives, where possible, to help reinforce national health care quality priorities.
See the Health Insurance Exchanges Quality Improvement Strategy for Plan Year 2026: Results-at-a-Glance for the Federally-facilitated Exchanges (FFEs) (PDF) document for summary-level information about quality improvement strategies submitted by issuers offering QHPs through the FFEs and FFEs where states perform plan management.
Plan Year 2027 Materials
QIS materials for Plan Year 2027 will be published in the spring of 2026.
Draft QIS Issuer List for the 2027 Plan Year (XLSX): CMS has posted the draft version of the Quality Improvement Strategy (QIS) Issuer List for the 2027 Plan Year (Draft 2027 QIS Issuer List) for review.
- Issuers should review the Draft 2027 QIS Issuer List to verify their information and communicate any discrepancies to CMS by emailing CMS_FEPS@cms.hhs.gov by Friday, April 3. When submitting via email, please include "MQI-QIS Issuer List" and your HIOS Issuer ID in the subject line or body of the email.
- CMS will reconcile any discrepancies and post a Final 2027 QIS Issuer List on the MQI website before the QHP Application Period begins on April 15.
QIS materials for the 2027 Plan Year will be posted in the spring of 2026.
Quality Improvement Strategy (QIS) Requirements and Guidelines
Documents describing the Quality Improvement Strategy (QIS) requirements and technical guidelines are available on the Downloads page. Answers to frequently asked questions related to QIS can be found on CCIIO’s Qualified Health Plan (QHP) Certification website under “FAQs” and “Marketplace Quality Initiatives FAQs” --> “Quality Improvement Strategy.”
Marketplace Service Help Desk (MSD)
QHP issuers and Exchanges with questions regarding the QIS should contact the MSD at CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515) and reference “Marketplace Quality Initiatives- QIS”, or “MQI- QIS”.