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
- Final 2024 Call Letter (June 2024) (PDF): CMS has posted the Final 2024 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey to communicate finalized refinements to the QRS and QHP Enrollee Survey programs for the 2025 ratings year and beyond. This document also summarizes comments received on the Draft 2024 Call Letter.
- Extension of the HEDIS Data Submission Deadline to June 28, 2024: Given the unprecedented cyberattack on Change Healthcare and its widespread impact on health care operations across the country, we are extending the data submission deadline for HEDIS measurement year 2023 to 5:00 p.m. Eastern Time on June 28, 2024. For questions, please email [email protected] with “MQI-QRS” and your HIOS Issuer ID in the subject line or body of the email.
- Quality Rating Information Bulletin (April 2024) (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 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 2025 Plan Year.
- 2025 Quality Rating System Measure Technical Specifications (April 2024) (PDF): CMS has posted the 2025 Quality Rating System Measure Technical Specifications, which includes the measure specifications and guidelines for data collection for the 2025 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 2025 requirements.
- QRS and QHP Enrollee Experience Survey Technical Guidance for 2024 (September 2023) (PDF): CMS posted the QRS and QHP Enrollee Survey: Technical Guidance for 2024. The Technical Guidance provides QHP issuers certified to offer coverage through the Exchanges in 2024 with the QRS and QHP Enrollee Survey guidance required as a condition of certification.
QIS:
- Plan Year 2025 QIS Materials Available for Download (April 2024): The Quality Improvement Strategy (QIS) materials for the 2025 Plan Year are now available for issuers to download on the Downloads page.
- 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 [email protected]. 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
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.
Upcoming Deadlines and Events for Issuers
- June 28, 2024: 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
[email protected] or 1-855-CMS-1515 (1-855-267-1515)
- Resources
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- Learn more about Quality Ratings: Information about the quality ratings of health plans is available on HealthCare.gov.
- Learn more about Quality Measures: The CMS Measure Management System (MMS) Hub is the home for content related to quality measures, quality measure development and maintenance information. Explore the following links to MMS resources learn more about quality measures:
- Marketplace Quality Initiatives Listserv: We encourage you to let others know about the CMS Marketplace Quality Initiatives, and to subscribe to Marketplace Quality Initiatives Listserv to be included in future communications and updates.
- Registration for Technical Assistance Portal (REGTAP): Register for REGTAP for training and resources related to the Health Insurance Exchanges.
- Center for Consumer Information and Insurance Oversight (CCIIO) website: Navigate to the CCIIO website for more information about the Health Insurance Exchanges and QHP certification.
- Qualified Health Plan (QHP) website: For QHP issuers operating in the FFE, find the QHP application, materials, and resources on CMS’ QHP certification website.
- Marketplace Quality Initiatives FAQs: Answers to frequently asked questions related to the MQI can be found on CMS’ QHP certification website.
- MQI Regulations: The following final regulations established the quality reporting standards related to the Marketplace Quality Initiatives (MQI):
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