Quality Improvement

All issuers offering QHPs through the Exchanges that meet the Quality Improvement Strategy (QIS) participation criteria must comply with the QIS requirements as a condition of certification and participation in the Exchanges. CMS annually publishes the QIS Technical Guidance and User Guide, a detailed guide to the QIS requirements, and the QIS Implementation Plan and Progress Report Form, which is the QIS reporting tool for issuers applying for QHP certification.

In April 2020, CMS released the COVID-19 Marketplace Quality Initiatives Memo to announce that CMS suspended activities related to the collection and reporting of clinical quality measure information related to QIS submissions. In line with this guidance, issuers applying for QHP certification in the Exchanges for the 2021 plan year that meet the applicable QIS participation criteria are not expected to submit a QIS Implementation Plan and Progress Report Form during the 2021 QHP Application Submission and Review Period.

CMS anticipates issuing additional guidance via the Marketplace Quality Initiatives website for issuers required to submit QIS forms for plan year 2022 in the fall of calendar year 2020.

Plan Year 2021 QIS Issuer List

The Draft QIS Issuer List for the 2021 Plan Year (2021 QIS Issuer List) is being made available for issuers to download from the Marketplace Quality Initiatives website. The Draft Plan Year 2021 QIS Issuer List includes issuers that meet the QIS participation criteria and would have, under normal circumstances, been required to submit at least one QIS Implementation Plan and Progress form as part of their 2021 QHP Applications to either: (a) implement a new QIS beginning no later than January 2021, or (b) provide a progress update on an existing QIS. The 2021 Draft QIS Issuer List includes issuers operating in Federally-facilitated Exchanges (FFEs) and FFEs where states perform plan management. Issuers operating in State-based Exchanges (SBEs), including SBEs on the Federal Platform (SBE-FPs), are not included on the list.

Although issuers on this list are not expected to submit data, issuers should still review the data it contains to verify its accuracy as the Plan Year 2021 Issuer List will be used to inform the Plan Year 2022 QIS Issuer List.

Issuers should submit questions about the Plan Year 2021 Draft QIS Issuer List to the Marketplace Service Desk (MSD) by phone at 1-855-CMS-1515 or by email at CMS_FEPS@cms.hhs.gov. When submitting inquiries via email, please include “MQI-QIS Issuer List” and your HIOS Issuer ID in the subject line or body of the email.