Health Insurance Marketplace Quality Initiatives

Health Insurance Marketplace Quality Initiatives

Decorative Health Insurance Marketplace Quality Initiatives Icon - a woman and a man looking at computer screen together

The Patient Protection and Affordable Care Act (PPACA) authorizes the creation of Health Insurance Exchanges (also known as Health Insurance Marketplaces) to help individuals and small employers’ shop for, select, and enroll in high quality, affordable private health plans.

The Marketplace Quality Initiatives (MQIs) includes four programs established by the PPACA which requires the U.S. Department of Health & Human Services (HHS) to develop quality data collection and reporting tools. The Marketplace Quality Rating System (QRS), QHP Enrollee Experience Survey (QHP Survey), Quality Improvement Strategy (QIS), and patient safety standards are Qualified Health Plan (QHP) quality-related certification requirements across all Marketplaces.

Scroll below to “Program Overview” for a description of each program.

Spotlight News

QRS and QHP Survey

  • Quality Rating Information Bulletin (April 2025) (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 2026 Plan Year.
  • Draft 2025 Call Letter for the QRS and QHP Enrollee Survey (March 2025) (PDF):  CMS requests comment on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2025 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 2025 QRS Call Letter” in the subject line by the close of the comment period (April 30, 2025)
  • 2026 QRS Measure Technical Specifications (March 2025) (PDF): CMS has posted the 2026 Quality Rating System Measure Technical Specifications, which includes the measure specifications and guidelines for data collection for the 2026 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 2026 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."
  • 2025 QRS and QHP Enrollee Survey Operational Instructions (November 2024) (PDF):  CMS posted the 2025 QRS and QHP Enrollee Survey Operational Instructions. The Operational Instructions provide directions to issuers to determine eligibility for the submission of QRS clinical measure data and QHP Enrollee Survey data, validate information included in the preliminary 2025 QRS QHP List, and access the QHP Enrollee Survey Website to complete the attestation to the 2025 QRS and QHP Enrollee Survey eligibility criteria by January 31, 2025.

QIS

  • Plan Year 2026 Quality Improvement Strategy (QIS) Materials are Available for Download (April 2025): The QIS materials for the 2026 Plan Year are now available for issuers to download:
  • 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.
     

Program Overview

Quality Rating System - QRS

The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on relative quality and price. 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 Experience Survey

The QHP Enrollee Experience Survey assesses consumer experience with QHPs offered through the Exchanges. The QHP Enrollee Survey aims to provide comparable and useful information to consumers about the quality of health care services and enrollee experience with QHPs offered through the Exchanges.

Quality Improvement Strategy - QIS

A Quality Improvement Strategy (QIS) is a payment structure that provides increased reimbursement or other incentives to improve health outcomes, prevent hospital readmissions, improve patient safety and reduce medical errors, implement wellness and health promotion activities, and/or reduce health and health care disparities.

Patient Safety

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

For a more detailed overview of each of these programs, refer to the Marketplace Quality Initiatives (MQI) 101 (PDF).

Upcoming Deadlines and Events for Issuers

  • QIS Deadlines:
    • April 16, 2025: The Qualified Health Plan (QHP) certification application period begins. Eligible issuers must submit their QIS documents by June 11, 2025.
  • QRS/QHP Enrollee Survey Deadlines:
    • May 17, 2025: HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer). 

    • June 14, 2025: 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) (reference “Marketplace Quality Initiatives”)

QHP issuers and Exchanges with questions regarding the QRS, QIS, or the QHP Enrollee Survey should contact the MSD
CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515)

Resources

 

Page Last Modified:
04/21/2025 10:27 AM
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