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Health Insurance Marketplace Quality Initiatives

Update: CMS posts final 2015 QRS and QHP Enrollee Survey Technical Guidance and Technical Specifications

The Quality Rating System Measure Technical Specifications includes the detailed measure specifications and data collection guidelines for the 2015 Quality Rating System (QRS) 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 QRS 2015 beta test requirements specified in the 2015 Beta Test of the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2015.

 

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. The public comment period for this proposed rule closed on April 21, 2014. 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

The public comment period for the information collection requirements associated with the above, proposed Marketplace quality standards is open until May 21, 2014.  The PRA package can be found here, under CMS Form 10520: http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html

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. The final 2015 QRS Beta Test Measure Set is available in the Downloads section below.

CMS 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. The comment period on these draft scoring specifications ended on April 28, 2014.

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. CMS 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, CMS is developing a Marketplace survey to assess consumer experience with the Marketplace.

The psychometric testing of both surveys is taking place during 2014. The beta tests will be conducted in 2015. Please see below for several issue briefs about the surveys and related activities. The most recent versions of the approved surveys for the psychometric testing are available below. The final approved QHP Enrollee Survey questionnaire for the beta test is posted at http://qhpcahps.cms.gov. The Marketplace Survey will be updated later in 2014 for the beta test.

A crosswalk of the survey measures encompassed by the QRS for 2015 can be accessed at http://qhpcahps.cms.gov.