Health Insurance Marketplace Quality Initiatives

Spotlight News

• CMS released the Plan Year 2023 Nationwide Quality Rating System Public Use File (PUF) (ZIP) to outline underlying measure data as well as star ratings for all eligible Qualified Health Plan (QHP) issuers, operating in all Exchange types, that received QRS star ratings for Plan Year 2023. CMS also released the Quality PUF for Plan Year 2023 (ZIP) that includes star ratings assigned to plans that will be available on HealthCare.gov for Plan Year 2023 as well as a QHP Enrollee Survey PUF (ZIP) which includes QHP Enrollee Experience Survey results data for plans offered through Exchanges nationwide. Additionally, CMS released the Health Insurance Exchanges QRS Program for Plan Year 2023: Results At-A-Glance document (PDF), which summarizes the nationwide QRS results for the 2023 Plan Year, including a summary of QRS reporting and QRS eligibility for the 2023 Plan Year.

• CMS has posted the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2023 (PDF). QHP issuers certified to offer coverage through the Exchanges in 2023 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 has posted an updated version of the 2023 Quality Rating System Measure Technical Specifications (PDF), which includes guidance on the finalized data submission requirements for the 2023 QRS measure set. Specifically, CMS added callout boxes summarizing the final decision regarding measures and/or measure rates proposed for addition and those proposed for removal in the Draft 2022 Call Letter and finalized via the Final 2022 Call Letter. 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 published the 2022 Quality Rating System Proof Sheet User Guide (2022 QRS Proof Sheet User Guide) (PDF), which provides detail for Qualified Health Plan (QHP) issuers and state Exchange administrators regarding the methodology used to produce the QRS scores and ratings as shown in the 2022 QRS Proof Sheets. The 2022 QRS Proof Sheet User Guide reflects updates to the QRS rating methodology finalized via the Final Call Letter for the 2022 Quality Rating System and Qualified Health Plan Enrollee Experience Survey.  
• CMS has posted the Final 2022 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey (PDF) to communicate finalized refinements to the QRS and QHP Enrollee Survey programs for the 2022 ratings year and beyond. This document also summarizes comments received on the Draft 2022 Call Letter.
• 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 Exchange (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 2023 Plan Year.
• The Quality Improvement Strategy (QIS) materials for the 2023 Plan Year are now available for issuers to download on the Downloads page.
  • The QIS Issuer List for the 2023 Plan Year  (XLSX) includes issuers operating in Federally-facilitated Exchanges (FFEs) and FFEs where States perform plan management that meet the QIS participation criteria and are required to implement and report on at least one QIS as a condition of Qualified Health Plan (QHP) certification for the 2023 Plan Year.
  • The QIS Implementation Plan form (PDF), Progress Report form (PDF), and Modification Summary Supplement (PDF) for the 2023 Plan Year (QIS forms) collect QIS information from issuers in order to demonstrate compliance with section 1311(c)(1)(E) of the Patient Protection and Affordable Care Act.
  • The QIS Technical Guidance and User Guide for the 2023 Plan Year  (PDF) communicates finalized QIS requirements and instructions for how to complete the QIS form.
  • Issuers should submit questions about QIS to CMS' Marketplace Service Desk (MSD) by phone at 1-855-CMS-1515 (1-855-267-1515) or by email at CMS_FEPS@cms.hhs.gov. When submitting inquiries via email, please include "MQI-QIS" and your HIOS Issuer ID in the subject line or body of the email.

     

Click to learn more about the QRS, Guidance, Fact Sheets, and Display of Quality Ratings. 

 

 

Click to learn more about the QHP Survey, Guidance, and Survey Materials. 

 

 

Click to learn more about the QIS, Guidance, and Forms. 

 

 

Click to learn more about Patient Safety.

 

 

 

QRS/QHP Enrollee Survey deadlines for issuers

HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer).	May 20, 2022
QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS).	June 15, 2022
QHP issuers preview the 2022 QHP quality rating information.	August/September 2022
QIS deadlines
QHP issuers submit first round of QIS forms as part of QHP application	June 15, 2022
QHP issuers submit final QIS form(s) as part of QHP application (if updates required based on review of first round submission)	August 17, 2022