Health Insurance Marketplace Quality Initiatives

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

• 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.
  • The QIS Issuer List for the 2025 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 2025 Plan Year.
  • The QIS Implementation Plan form (PDF), Progress Report form (PDF), and Modification Summary Supplement form (PDF) for the 2025 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 2025 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.
   

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, reduce 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

• May 17, 2024: HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer).
• June 14, 2024: QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS).

Resources  

• 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:  
  • CMS Measure Management System Hub (cms.gov)
  • Quality Measures: How They Are Developed, Used, & Maintained (cms.gov) – Last updated May 2022
  • Blueprint QuickStart Guide (cms.gov) – Last updated July 2023.
• 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):
  • Quality Rating System and Enrollee satisfaction survey system standards 
  • Quality Rating System and Enrollee satisfaction survey system standards for application and approval of survey vendors
  • Quality Improvement Strategy standards
  • Patient safety standards

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)