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2021 QRS and QHP Enrollee Survey Technical Guidance · PDF file NCQA portal. 6.6.3.2 QHP...

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  • The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing requirements under the law.

    Health Insurance Exchange

    Quality Rating System and Qualified Health Plan Enrollee

    Experience Survey: Technical Guidance for 2021

    September 2020

  • Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2021

    pg. i

    Document Change Log Description Date

    Release of the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2021. This guidance addresses requirements for 2021, which include data submission in the 2021 calendar year for quality rating information that will be publicly reported by the Exchanges, beginning during the open enrollment period for the 2022 Plan Year.

    09/30/2020

  • Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2021

    pg. ii

    Table of Contents 1. Document Purpose and Scope ............................................................................................... 1

    1.1 Section Guide ................................................................................................................ 1 2. Background ............................................................................................................................ 5 3. Overview ................................................................................................................................ 5 4. Implementation Schedule for the QRS and QHP Enrollee Survey ........................................ 6 5. Exchange Oversight Responsibilities .................................................................................... 7 6. QRS and QHP Enrollee Survey Requirements ...................................................................... 8

    6.1 Participation Criteria for QHP Issuers .......................................................................... 8 6.2 QHP Enrollee Survey Sample Frame ......................................................................... 13

    6.2.1 Create the Sample Frame (QHP Issuers) ........................................................ 13 6.2.2 Validate Sample Frame ................................................................................... 15 6.2.3 Provide Sample Frame to Vendor ................................................................... 16

    6.3 Reporting Ineligible Reporting Units .......................................................................... 16 6.4 QRS Measure Set ........................................................................................................ 16 6.5 QHP Enrollee Survey .................................................................................................. 19 6.6 Data Collection, Validation, and Submission ............................................................. 19

    6.6.1 Data Collection ............................................................................................... 20 6.6.2 Data Validation ............................................................................................... 21 6.6.3 Data Submission ............................................................................................. 23

    7. QRS Rating Methodology.................................................................................................... 24 7.1 Measures and Scoring ................................................................................................. 24 7.2 QRS Hierarchy ............................................................................................................ 26 7.3 Overview of Process for Calculating QRS Scores and Ratings .................................. 26

    8. Quality Rating Information and QHP Enrollee Survey Results and Preview ..................... 28 8.1 QRS and QHP Enrollee Survey Preview via CMS’ HIOS-MQM .............................. 28

    8.1.1 Instructions for Accessing QRS and QHP Enrollee Survey Results .............. 29 8.2 Additional Ratings Preview by SBEs ......................................................................... 30 8.3 Preview Period Inquiries ............................................................................................. 30

    9. Display Guidelines for QHP Quality Rating Information ................................................... 30 9.1 Display on HealthCare.gov ......................................................................................... 31 9.2 Display Guidance for SBEs ........................................................................................ 31 9.3 Display Guidance for Direct Enrollment Entities ....................................................... 31

    10. Marketing Guidelines for QHP Quality Rating Information ............................................... 32 Appendix A. Relevant Statutory and Regulatory Citations ........................................................ 35 Appendix B. QRS Measure Summaries ..................................................................................... 40 Appendix C. Crosswalk of 2021 QHP Enrollee Survey Questions Included in the QRS .......... 51 Appendix D. Final 2021 QRS Rating Methodology .................................................................. 54 Appendix E. QRS Hierarchy ...................................................................................................... 70

  • Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2021

    pg. iii

    Appendix F. Overview of QHP Enrollee Survey Results .......................................................... 72 Appendix G. Glossary and List of Acronyms ............................................................................ 74 Appendix H. Sample Frame Layout for 2021 QHP Enrollee Survey ........................................ 82

    List of Exhibits Exhibit 1. Implementation Schedule for the 2021 QRS and QHP Enrollee Survey ....................... 6 Exhibit 2. QRS and QHP Enrollee Survey Data Submission Eligibility Roadmap ...................... 11 Exhibit 3. QRS and QHP Enrollee Survey Enrollee Inclusions and Exclusions .......................... 12 Exhibit 4. Example Reporting Units for a QHP Issuer Assessed Against 2021 QRS and QHP

    Enrollee Survey Participation Criteria ....................................................................... 13 Exhibit 5. Enrollee Eligibility Requirements for the 2021 QHP Enrollee Survey (Survey

    Eligible Enrollees) ..................................................................................................... 14 Exhibit 6. Sample Frame Validation Process ............................................................................... 16 Exhibit 7. QRS Measure Set ......................................................................................................... 17 Exhibit 8. QHP Enrollee Survey Topics ....................................................................................... 19 Exhibit 9. QRS Clinical Measure and QHP Enrollee Survey Response Data Process Flow ........ 20 Exhibit 10. QRS Measures and Scoring ....................................................................................... 25 Exhibit 11. Reporting Unit Data Submission and Scoring Example ............................................ 25 Exhibit 12. Overview of QRS Rating Methodology ..................................................................... 26 Exhibit 13. Steps for Calculating QRS Scores and Ratings.......................................................... 27 Exhibit 14. QRS and QHP Enrollee Survey Documents Available for Preview on the HIOS-

    MQM Website ........................................................................................................... 29 Exhibit 15. Patient Protection and Affordable Care Act, 42 U.S.C. Sec. 18031 (March 23,

    2010) .......................................................................................................................... 35 Exhibit 16. Patient Protection and Affordable Care Act; Establishment of Exchanges and

    Qualified Health Plans; Exchange Standards for Employers, Final Rule, 77 Fed. Reg. 18310-18475 (March 27, 2012) ........................................................................ 36

    Exhibit 17. Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014; Final Rule, 78 Fed. Reg. 65046-65105 (October 30, 2013) ...................................................................... 36

    Exhibit 18. Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond, Final Rule, 79 Fed. Reg. 30240-30353 (May 27, 2014) .......................................................................................................... 37

    Exhibit 19. Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans (May 14, 2020)......................................................................... 39

    Exhibit 20. QRS Measure Summaries .......................................................................................... 40 Exhibit 21. Crosswalk of 2021 QHP Enrollee Survey Questions Included in the QRS ............... 51 Exhibit 22. Audit Designations ..........................................................

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