Health Insurance Marketplace Quality Initiatives
CMS published a Final Notice of Benefit and Payment Parameters for 2016 in the Federal Register on February 27, 2015. In this Final Rule, CMS finalizes a phased in approach for the Quality Improvement Strategy (QIS) implementation requirement for QHP issuers. The final standards can be found here: https://www.federalregister.gov/articles/2015/02/27/2015-03751/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2016
The 60 day public comment period for the information collection requirements associated with the QIS standards has closed; however, the 30 day public comment period will begin soon (March/April 2015). The QIS information collection requirements can be found here on the Paperwork Reduction Act (PRA) Listing site, under CMS Form 10540: http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/
About the Marketplace Quality Initiatives
The Affordable Care Act authorizes the creation of Health Insurance Marketplaces (Marketplaces) to help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans. Only qualified health plans (QHPs) may be offered within the Marketplaces.
The Affordable Care Act requires the U.S. Department of Health & Human Services (HHS) to develop quality data collection and reporting tools such as a Quality Rating System (QRS), a Quality Improvement Strategy (QIS) and an enrollee satisfaction survey system. Information from the QRS, QIS, and surveys will inform consumer selection of a QHP, decisions about QHP certification, and the Federal and State Marketplaces’ monitoring of QHP performance. HHS intends a phased approach to QHP-specific quality reporting, beginning in 2016.
Webinar slides describing the QRS, consumer experience surveys, the QIS and the phased quality reporting process can be accessed in the Downloads section at the bottom of this page:
- Marketplace Quality Initiatives Update February 2015 – slides that provide an overview of the Marketplace Quality Initiatives
There are no proposed rules for public comment at this time.
Quality Rating System (QRS)
About the QRS
Section 1311(c)(3) of the Affordable Care Act directs the HHS Secretary to develop a system that rates QHPs based on relative quality and price. It also requires Marketplaces to display QHP quality ratings on Marketplace websites to assist in consumer selection of QHPs.
Data Collection Guidelines
Documents describing the QRS requirements, technical specifications, and the QRS measures are available in the Downloads section at the bottom of this page. These documents include:
- Issue Brief 4: QRS Requirements for Issuers – overview of 2015 QRS Requirements for QHP Issuers
- 2015 Beta Test of the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2015 – specifies QRS and QHP Enrollee Survey requirements for QHP issuers offering coverage through the Marketplaces
- 2015 QRS Measure Technical Specifications – describes what QHP issuers will need to do to collect and submit QRS measure data to CMS
- QRS Beta Test Measures – outlines the quality measures that QHP issuers operating in all Marketplaces are required to report as part of the 2015 QRS beta test
Consumer Experience Surveys
About the Enrollee Experience Surveys
Section 1311(c)(4) of Affordable Care Act requires the HHS Secretary to develop an enrollee satisfaction survey system that assesses consumer experience with QHPs offered through a Marketplace. It also requires public display of information by each Marketplace to allow individuals to assess enrollee experience among comparable plans. Sections 1313 and 1321(a) of Affordable Care Act provide the Secretary with general authority to establish standards and regulations related to Marketplaces and QHPs.
CMS is developing two consumer experience surveys to assess consumers’ and enrollees’ experiences with the Marketplaces and QHPs. Both surveys are scheduled for national implementation by CMS in 2016 and they are undergoing preliminary testing in 2014 and 2015.
For more information, see the following in the Downloads section at the bottom of this page:
- Issue Brief 1: Marketplace Survey and QHP Enrollee Survey Overview – provides a brief overview of the purpose and intent of the two surveys
Health Insurance Marketplace Survey
The Health Insurance Marketplace Survey (Marketplace Survey) is intended to obtain consumers’ perspectives on the services provided by Marketplaces.
See the following versions of the current survey in English, Spanish, and Chinese in the Downloads section at the bottom of this page:
- Marketplace Survey 2014 Test (English)
- Marketplace Survey 2014 Test (Spanish)
- Marketplace Survey 2014 Test (Chinese)
Marketplace Survey Improvement Guide
The Marketplace Survey Improvement Guide offers Marketplaces support in using results of the Marketplace Survey to improve the consumer experience. Available Spring 2015.
Reports for Marketplaces for for the Marketplace Survey
Survey results for the 2014 test will be available in early 2015.
Technical Assistance Related to the Marketplace Survey
Through CMS funding, American Institutes for Research (AIR) is providing technical assistance to support Marketplaces in understanding, interpreting, and using the results of the survey.
Expert Usability Testing
Conducted during the 2014 open enrollment period, the purpose of the usability testing was to determine whether the State-Based Marketplace websites adopted principles for making a website usable for consumers and whether information about determining eligibility, comparing and choosing a health plan, and enrollment was easy to find.
Results from this assessment are available in the Downloads section at the bottom of this page:
- Expert Website Usability Assessments of the State-Based Marketplace Websites
Consumer Usability Testing
Testing may be conducted during 2014/2015 open enrollment. A global report may be available in mid-2015.
Issue briefs on the following topics are available in the Downloads section at the bottom of this page:
- Issue Brief 1: Marketplace Survey and QHP Enrollee Survey Overview
- Issue Brief 2: Technical Assistance—Marketplace Improvement Guide Advisory Group and Consumer Usability Testing
- Issue Brief 3: Including the SBMs in the Marketplace Survey Beta Test
There will likely be webinars for Marketplaces to discuss the results of the 2014 and 2015 tests.
Qualified Health Plan Enrollee Experience Survey
The Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) is intended to obtain enrollees’ perspectives on the services provided by QHPs offered through the Marketplaces.
For copies of the current survey in English, Spanish, and Chinese, see the following in the Downloads section at the bottom of this page:
- QHP Enrollee Survey 2014 Test (English)
- QHP Enrollee Survey 2014 Test (Spanish)
- QHP Enrollee Survey 2014 Test (Chinese)
Technical Assistance related to the QHP Enrollee Survey
More information about the survey questionnaire, measures, and technical assistance for participating survey vendors is available at: http://qhpcahps.cms.gov
Reports for Issuers and Marketplaces for the QHP Enrollee Survey
QHP Enrollee Survey reports will be available later in 2015.
Quality Improvement Strategy (QIS)
About the QIS
Each health insurance issuer must implement a QIS to be certified to offer plans through the Marketplace as mandated by Section 1311(c)(1)(E) of the Affordable Care Act. A QIS is described in section 1311(g)(1), “Rewarding Quality Through Market-Based Incentives,” as 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 reduce health and health care disparities. The standards for the QIS align with the National Quality Strategy, the CMS Quality Strategy, and other Federal, state and private sector quality improvement initiatives, where possible, to help reinforce national health care quality priorities.
Data Collection Guidelines
Documents describing the QIS requirements and technical guidelines will be available later in 2015, in the Downloads section at the bottom of this page.
Patient Safety Standards
Section 1311(h) of the Affordable Care Act requires QHPs to contract with certain hospitals that use patient safety evaluation systems (PSES) and implement comprehensive hospital discharge programs; and requires QHPs to contract with health care providers who implement health care quality improvement mechanisms. CMS finalized a phase in approach for implementation of these patient safety requirements including requiring QHP issuers, in the initial years, to ensure that their contracted hospitals with greater than 50 beds are Medicare-certified or are Medicaid-only hospitals and are subject to Medicare Hospital Conditions of Participation (CoP) standards.
- Marketplace Quality Initiatives Update February 2015 [ZIP, 700KB]
- QRS Methodology: Summary of Key Themes from Public Comment and Changes to Methodology [PDF, 241KB]
- 2015 QRS Measure Technical Specifications [PDF, 2MB]
- 2015_QRS_and_QHP_Enrollee_Survey_Technical_Guidance_Final [PDF, 840KB]
- Expert Website Usability Assessments of the State-Based Marketplace Websites [PDF, 3MB]
- 2015 QRS Beta Test Measure Set [PDF, 114KB]
- Issue Brief 1: Marketplace Survey and QHP Enrollee Survey Overview [PDF, 203KB]
- Issue Brief 2: Technical Assistance—Marketplace Improvement Guide Advisory Group and Consumer Usability Testing [PDF, 238KB]
- Issue Brief 3: Including the SBMs in the Marketplace Survey Beta Test [PDF, 182KB]
- Issue Brief 4: QRS Requirements for Issuers [PDF, 93KB]
- 2014 Marketplace Survey and QHP Enrollee Survey [ZIP, 3MB]
- 2015 Marketplace Survey and QHP Enrollee Survey [ZIP, 1MB]
- Page last Modified: 03/20/2015 11:58 AM
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