The Patient Protection and Affordable Care Act (PPACA) authorized the creation of health insurance exchanges (also known as health insurance marketplaces) to help individuals and small employers shop for, choose, and enroll in high-quality, affordable private health plans.
The Market Quality Initiatives (MQIs) include four programs created by PPACA that require the US Department of Health and Human Services (HHS) to develop quality data collection and reporting tools. The Marketplace Quality Rating System (QRS), QHP Participant Experience Survey (QHP Survey), Quality Improvement Strategy (QIS), and Patient Safety Standards are Qualified Health Plan (QHP) certification requirements related to quality in all Marketplaces.
Scroll below to “Program Overview” for a description of each program.
News in the spotlight
QRS and QHP study
- Draft 2024 QRS and QHP Enrollee Survey Invitation Letter (PDF) (February 2024): CMS requests comment on proposed enhancements to the QRS and QHP Enrollee Survey included in the draft 2024 Invitation Letter for 2024 for the Quality Rating System and the Qualified Enrolled Health Plan Experience Study. CMS encourages interested parties to send comments to [email protected] and indicate “Marketplace Quality Initiatives (MQI) – Draft 2024 QRS Call Letter” in the subject line by the end of the comment period (March 28, 2024).
- QRS and QHP Enrollee Experience Survey 2024 Technical Guidelines (September 2023): (PDF) CMS publishes 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 QRS and QHP Enrollee Survey guidance required as a condition of certification.
- Quality Assessment System Measurement Technical Specifications for 2024 (September 2023): (PDF) CMS publishes an updated version of the 2024 Quality Rating System Measure Technical Specifications that includes guidance on the finalized data submission requirements for the 2024 QRS measure set. Specifically, CMS added caption boxes summarizing the final decision on the measures and/or rates of the measures proposed to be added. The measures proposed for removal in the draft 2023 invitation letter and finalized in the final 2023 invitation letter are also included.
QIS: NA
View the program
Quality Assessment System – QRS
The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on relative quality and cost. The goals of the QRS are to provide comparable and useful information to consumers, to facilitate QHP oversight, and to provide useful 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, reduce hospital readmissions, improve patient safety and reduce medical errors, implement activities to wellness and health promotion and/or reducing health and health care disparities.
Patient safety
QHPs are required to contract with certain hospitals that use patient safety assessment systems and implement comprehensive hospital discharge programs. QHPs are also required to contract with health care providers that implement health care quality improvement mechanisms.
Upcoming deadlines and events for issuers
- Deadlines for surveying QRS/QHP enrollees
- January 31, 2023: The QHP issuer contracts with an HHS-approved QHP Enrollee Survey provider to conduct the QHP Enrollee Survey and submit survey response data to CMS.
Resources
- Learn more about quality ratings: Information about health plan quality ratings is available at HealthCare.gov.
- Learn more about quality measures: The CMS Measurement System (MMS) Management Center is the home for content related to quality measures, quality measure development, and support information. Check out the following links to MMS resources, learn more about quality measures:
- Marketplace Quality Initiatives Listserv: We encourage you to let others know about and subscribe to CMS Marketplace Quality Initiatives Marketplace Quality Initiatives Listserv to be included in future announcements and updates.
- Registration in the Technical Assistance Portal (REGTAP): Register with REGTAP for training and resources related to the health insurance exchanges.
- Center for Consumer Information and Insurance Oversight (CCIIO) website.: Go to the CCIIO website for more information on health insurance exchanges and QHP certification.
- Qualified Health Plan (QHP) website.: For QHP issuers operating in FFEs, find the QHP application, materials, and resources on the CMS QHP Certification website.
- Frequently Asked Questions about Market Quality Initiatives: Answers to frequently asked questions related to MQI can be found on the CMS QHP Certification website.
- MQI Rules: The following final regulations establish the quality reporting standards related to Market Quality Initiatives (MQIs):
Marketplace Services Help Desk (MSD) (reference “Marketplace Quality Initiatives”)
QHP issuers and Exchanges with questions about QRS, QIS, or the QHP Enrollee Survey should contact MSD
[email protected] or 1-855-CMS-1515 (1-855-267-1515)