Patient Safety

Patient Safety Standards

The patient safety standards require that Qualified Health Plan (QHP) issuers verify that the hospitals they work with meet quality and patient safety requirements. The patient safety standards require QHP issuers to confirm hospitals have programs or partnerships in place to promote effective patient safety interventions. These interventions focus on things like reducing the risk of patient harm, engaging patients and families in quality improvement, improving care coordination between providers, and monitoring performance on patient safety events.

Through the patient safety standards, CMS aims to promote effective patient safety interventions to improve health care quality and reduce harm.  

Background

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 implementation of the patient safety standards, for plan years beginning on or after January 1, 2017, to require that a QHP issuer may only contract with a hospital with more than 50 beds if the hospital: (a) works with a Patient Safety Organization; or (b) meets the reasonable exception criteria by implementing an evidence-based initiative to improve health care quality through the collection, management and analysis of patient safety events that reduces all cause preventable harm, prevents hospital readmission, or improves care coordination.

A QHP issuer also must collect information to demonstrate that these contracted hospitals implement mechanisms for comprehensive person-centered hospital discharge to improve care coordination and health care quality for each patient.

Refinements to the Patient Safety Standards

CMS posted the HHS Notice of Benefit and Payment Parameters for 2024 Final Rule in the Federal Register. CMS strengthens QHP issuer patient safety standards to better align with current, effective patient safety interventions, beginning on or after June 18, 2023. The Final Rule can be found at https://www.federalregister.gov/documents/2023/04/27/2023-08368/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2024

Marketplace Service Help Desk (MSD) (reference “Marketplace Quality Initiatives”)

QHP issuers and Exchanges with questions regarding the QRS or the QHP Enrollee Survey should contact the MSD
CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515)