QIS

About Quality Improvement Strategy (QIS)

A Quality Improvement Strategy (QIS) is a payment structure that incentivizes improved health outcomes of plan enrollees. A QIS should motivate high quality by tying payments to measures of performance when providers meet specific quality indicators or when enrollees make certain choices or exhibit behaviors associated with improved health. A QIS must address at least one of the following topic areas: (1) Activities for improving health outcomes; (2) Activities to prevent hospital readmissions; (3) Activities to improve patient safety and reduce medical errors; (4) Activities for wellness and health promotions; in addition to (5) Activities to reduce health and health care disparities.

The goals of the QIS are to:

• Offer increased reimbursement or other market-based incentives to improve the health outcomes of plan enrollees.
• Address key quality improvement topic areas (e.g., improve health outcomes, prevent hospital readmissions).
• Report implementation plans and progress related to quality improvement efforts.

CMS anticipates issuing QIS technical guidance at least annually. CMS proposes and communicates refinements to the QIS through the information collection request process per the Paperwork Reduction Act requirements (as appropriate).

• Answers to frequently asked questions related to QIS can be found on the Marketplace Quality Initiatives FAQs (cms.gov) page on CMS’ Qualified Health Plan (QHP) Certification Website.  

Background

An issuer participating in an Exchange for two or more consecutives years must implement and report on a QIS, in accordance with section 1311(g) of the Patient Protection and Affordable Care Act (PPACA), entitled “Rewarding Quality Through Market-Based Incentives.” The QIS standards align with the CMS Quality Strategy and other federal, State, and private sector quality improvement initiatives, where possible, to help reinforce national health care quality priorities.

Plan Year 2025 Guidance

• Plan Year 2025 QIS Materials Available for Download (April 2024): The Quality Improvement Strategy (QIS) materials for the 2025 Plan Year are now available for issuers to download on the Downloads page.
  • The QIS Issuer List for the 2025 Plan Year (XLSX) includes issuers operating in Federally-facilitated Exchanges (FFEs) and FFEs where States perform plan management that meet the QIS participation criteria and are required to implement and report on at least one QIS as a condition of Qualified Health Plan (QHP) certification for the 2025 Plan Year.
  • The QIS Implementation Plan form (PDF), Progress Report form (PDF), and Modification Summary Supplement form (PDF) for the 2025 Plan Year (QIS forms) collect QIS information from issuers in order to demonstrate compliance with section 1311(c)(1)(E) of the Patient Protection and Affordable Care Act.
  • The QIS Technical Guidance and User Guide for the 2025 Plan Year (PDF) communicates finalized QIS requirements and instructions for how to complete the QIS form.
• 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.

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.