Skip to Main Content

Health Insurance Marketplace Quality Initiatives

Update: CMS posts draft Quality Rating System (QRS) Scoring Specifications seeking public comment on CMS’ intended methodology for calculating Qualified Health Plans (QHP) quality ratings. Comments are due April 28, 2014.

The Affordable Care Act (ACA) authorizes the creation of Health Insurance Marketplaces to help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans beginning October 2013. Only qualified health plans (QHPs) may be offered within the Marketplaces. The ACA requires 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 (ESS). The purposes of these tools include informing consumer choice of a QHP, informing QHP certification and monitoring QHP performance. HHS intends a phased approach to QHP specific quality reporting, beginning in 2016.

CMS published a Notice of Proposed Rule Making in the Federal Register on March 21, 2014 describing Exchange and Insurance Market Standards for 2015 and Beyond, including QRS and ESS standards. Comments on these proposed standards must be received by CMS on April 21, 2014 in the form and manner specified in the proposed rule. These proposed standards can be found here: https://www.federalregister.gov/articles/2014/03/21/2014-06134/exchange-and-insurance-market-standards-for-2015-and-beyond-patient-protection-and-affordable-care

Quality Rating System

Section 1311(c)(3) of the Affordable Care Act directs the 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. On November 19th CMS published a Federal Register Notice (FRN) to solicit comments on a proposed QRS measure set that QHP issuers would be required to collect and report, the hierarchical structure of the measures and the elements of the QRS rating methodology. A copy of this FRN is included in the download section below for your convenience. The comment period for this notice ended on January 21st, 2014.

CMS has posted draft QRS Scoring Specifications on March 28th, for public comment. The draft QRS Scoring Specifications provide a high-level summary of the proposed steps involved in assigning quality ratings to QHPs operating in the Marketplaces. CMS is accepting comments on the draft QRS Scoring Specifications until April 28, 2014. Please email comments to Marketplace_Quality@cms.hhs.gov with subject line “QRS Scoring Specification Comments”.

Enrollee Satisfaction Survey

The Affordable Care Act Section 1311(c)(4) requires the 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. HHS is developing a QHP Enrollee survey that assesses consumer experience with qualified health plans (QHPs) offered through the Marketplaces.  Sections 1313 and 1321(a) of the Affordable Care Act provide the Secretary with general authority to establish standards and regulations related to Marketplaces and QHPs.  In addition to the QHP Enrollee Survey, HHS is developing a Marketplace survey to assess consumer experience with the Marketplace.

A FRN was published on November 1, 2013, seeking public comment on CMS' intention to collect information using the QHP Enrollee survey and the Marketplace survey. Copies of the draft surveys have been included in the download section below for your convenience. The comment period for this notice ended on December 2, 2013.