Health Insurance Marketplace Quality Initiatives

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The Health Insurance Exchanges - also known as Health Insurance Marketplaces - help millions of Americans and small employers shop for, compare, and enroll in high-quality, affordable private health insurance plans each year.

The Marketplace Quality Initiatives (MQIs) are four programs established by the Affordable Care Act (ACA). These programs are required for Qualified Health Plans (QHPs) offered in all Marketplaces and are designed to promote quality, transparency, and patient safety. The MQIs include: 

  • The Marketplace Quality Rating System (QRS)
  • QHP Enrollee Experience Survey (QHP Enrollee Survey)
  • Quality Improvement Strategy (QIS)
  • Patient Safety standards

Scroll down to Program Overview for detailed descriptions of each initiative.

Spotlight News

QRS and QHP Survey

  • 2027 QRS Measure Technical Specifications (March 2026) (PDF): CMS has posted the 2027 Quality Rating System Measure Technical Specifications, which includes measure specifications and guidelines for data collection for the 2027 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 2027 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."
  • Quality Rating Information Bulletin (March 2026) (PDF): CMS released the Quality Rating Information Bulletin (PDF) to announce guidance for public display of quality rating information by all Exchanges, including the Federally-facilitated Exchanges (FFEs), State-based Exchanges on the Federal Platform (SBE-FPs), and State-based Exchanges (SBEs) that operate their own eligibility and enrollment platform, during the individual market Open Enrollment Period (OEP) for the 2027 Plan Year.
  • Draft 2026 Call Letter for the QRS and QHP Enrollee Survey (February 2026) (PDF): CMS requests comments on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2026 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 2026 Call Letter” in the subject line by the close of the comment period (March 20, 2026).

QIS

  • 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.

  • Plan Year 2026 QIS Results-at-a-Glance (February 2026) (PDF): CMS released the Health Insurance Exchanges Quality Improvement Strategy for Plan Year 2026: Results-at-a-Glance for the Federally-facilitated Exchanges document, which provides summary-level descriptive statistics on the Quality Improvement Strategies collected from issuers participating in the Federally-facilitated Exchanges (FFEs) and FFEs where states perform plan management during Plan Year 2026.

Program Overview

Quality Rating System - QRS

The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on clinical quality, member experience, and plan administration. The goals of the QRS are to provide comparable and useful information to consumers, facilitate oversight of QHPs, and provide actionable information to QHPs to improve quality and performance.

QHP Enrollee Survey

The QHP Enrollee Survey assesses consumer experience with QHPs offered through the Exchanges. The goals of the QHP Enrollee Survey are to provide comparable and useful information to consumers about the quality of health care services and enrollee experience with QHPs offered through the Exchanges. A subset of the survey results feed into the QRS star ratings.

Quality Improvement Strategy - QIS

The Quality Improvement Strategy (QIS) program requires QHPs to implement payment structures providing increased reimbursement or other incentives to improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, reduce health and health care disparities, and implement wellness and health promotion activities.

Patient Safety

Patient Safety standards require QHPs to contract with certain hospitals that use patient safety evaluation systems (PSES) and implement comprehensive hospital discharge programs. QHPs are also required to contract with health care providers who implement health care quality improvement mechanisms.

Upcoming Deadlines and Events for Issuers

  • QRS/QHP Enrollee Survey Deadlines:
    • May 15, 2026: HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer).
    • June 15, 2026: QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS).

Marketplace Service Help Desk (MSD)

QHP issuers and Exchanges with questions regarding the QRS, QIS, patient safety requirements, or the QHP Enrollee Survey should contact the MSD
CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515) and reference “Marketplace Quality Initiatives” or “MQI”.

Resources

 

Page Last Modified:
03/31/2026 08:11 AM
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