Centers for Medicare & Medicaid Services (CMS) Marketplace Quality Initiatives Update

The updated and final 2018 Quality Rating System (QRS) quality ratings and QHP Enrollee Survey Quality Improvement (QI) Reports are available for preview beginning September 10th at 9am ET through September 14th at 6pm ET. During the initial preview period (August 13th – 24th), CMS was notified of an improper data submission for one clinical quality measure and an error in the denominator criteria applied to two survey measures: Access to Care and Care Coordination. QHP issuers and Exchange administrators are able to review the corrected 2018 QRS quality ratings via CMS' Health Insurance Oversight System Marketplace Quality Module (HIOS-MQM) at https://portal.cms.gov. QHP issuers are also able to view their updated QHP Enrollee Survey Quality Improvement (QI) Reports. During the initial preview period, CMS was notified that the scores for the Enrollee Experience with Cost composite and the questions within the composite (Questions 51-54) were not presented in the QI reports appropriately (these scores should have been inverted when converting the mean scores into a 0-100 scale). CMS updated the Enrollee Experience with Cost composite scores in the QI Reports. CMS also updated the frequencies displayed in the QI Report for Question 43: “In the last 6 months, how often did the time that you waited to talk to your health plan’s customer service staff take longer than you expected.” These changes to the QI Reports do not impact overall QHP scores or QRS scores and ratings. As a reminder, the QRS Proof Sheet User Guide and QHP Enrollee Survey QI Report Methodology Guide are available via the MQM; these documents include details regarding the methodology used to produce the QRS scores and ratings and QI reports, respectively. The 2018 QHP List indicates which reporting units are eligible to receive a QRS rating in 2018. Reporting units that are not ratings-eligible will not receive a 2018 QRS Preview Report and QRS Proof Sheet. If you have questions or concerns about the updated QRS rating information, please contact CMS via the applicable email below by 6pm ET on September 14th. Please note it may take one to three business days to respond to inquiries.  For questions about the QRS ratings: State-based Exchanges: Please submit questions to your respective CMS State Officer. QHP Issuers and all other entities: Please submit questions to CMS' Marketplace Service Desk (MSD) via email at CMS_FEPS@cms.hhs.gov or via phone at 1-855-267-1515.  For technical support or assistance with accessing the QRS ratings, please contact CMS' MSD via email at CMS_FEPS@cms.hhs.gov or via phone at 1-855-267-1515. Please reference "MQM Access" in the email subject  line.

Centers for Medicare & Medicaid Services (CMS) has sent this Marketplace Quality Initiatives Update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.