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

• Draft 2025 Call Letter for the QRS and QHP Enrollee Survey (March 2025) (PDF):  CMS requests comment on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2025 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey. CMS encourages interested parties to submit comments to Marketplace_Quality@cms.hhs.gov and reference “Marketplace Quality Initiatives (MQI)-Draft 2025 QRS Call Letter” in the subject line by the close of the comment period (April 30, 2025)
• 2026 QRS Measure Technical Specifications (March 2025) (PDF): CMS has posted the 2026 Quality Rating System Measure Technical Specifications, which includes the measure specifications and guidelines for data collection for the 2026 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 2026 requirements. QHP issuers with questions regarding the QRS or the QHP Enrollee Survey should contact the Marketplace Service Desk (CMS_FEPS@cms.hhs.gov) and reference the Marketplace Quality Initiatives or "MQI-QRS."
• 2025 QRS and QHP Enrollee Survey Operational Instructions (November 2024) (PDF):  CMS posted the 2025 QRS and QHP Enrollee Survey Operational Instructions. The Operational Instructions provide directions to issuers to determine eligibility for the submission of QRS clinical measure data and QHP Enrollee Survey data, validate information included in the preliminary 2025 QRS QHP List, and access the QHP Enrollee Survey Website to complete the attestation to the 2025 QRS and QHP Enrollee Survey eligibility criteria by January 31, 2025.

QIS

• Plan Year 2026 Draft QIS Issuer List Published for Review (XLSX) (March 2025): CMS has posted the draft version of the Quality Improvement Strategy (QIS) Issuer List for the 2026 Plan Year (Draft 2026 QIS Issuer List (XLSX)) for review.
  • Issuers will be able to review the Draft QIS Issuer List for the 2026 Plan Year to verify their information and communicate any discrepancies to CMS by emailing CMS_FEPS@cms.hhs.gov by Friday, April 4, 2025. When submitting via email, please include "MQI-QIS Issuer List" and your HIOS Issuer ID in the subject line or body of the email. If you do not review the QIS Issuer List to verify your information and identify discrepancies, CMS will assume the information in the QIS Issuer List is accurate and final.    

  • CMS will reconcile any discrepancies and post a final QIS Issuer list on the MQI website before the QHP Application Period begins on April 16, 2025.

• QIS materials for the 2026 Plan Year will be posted in the Spring of 2025.
• 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, prevent 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.

For a more detailed overview of each of these programs, refer to the Marketplace Quality Initiatives (MQI) 101 (PDF).

Upcoming Deadlines and Events for Issuers

• QIS Deadlines:
  • April 4, 2025: Issuers review the Draft QIS Issuer List for the 2026 Plan Year to verify their information and communicate any discrepancies to CMS by emailing CMS_FEPS@cms.hhs.gov.
• QRS/QHP Enrollee Survey Deadlines:
  • May 17, 2025: HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer). 

  • June 14, 2025: QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS). 

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)