CMS: How should exchange plans be assessed for quality?

Agency asks for input on how to build a quality rating system

CMS is developing a rating system for health policies sold through the Affordable Care Act's (ACA) insurance exchanges, and it is seeking input on the quality measures the system will use to evaluate the plans.

The deadline to submit proposals for the rating system is Jan. 20.

The notice comes as the Obama administration seeks to minimize blowback over insurance policy cancellations for Americans whose health plans were deemed insufficient under the ACA. However, the quality initiative was mandated under the original legislation and is not related to the backlash.

The request for information, which was published in the Federal Register on Tuesday, asked for guidance on how to:

  • Develop ratings that assess the relative quality, price, and health outcomes of qualified health plans offered through the exchange;
  • Administer a survey assessing enrollee satisfaction;
  • Ensure the integrity of the rating system.

According to Modern Healthcare, regulations currently require insurers to provide some quality measures to exchanges in which they sell plans. In subsequent regulations, CMS plans to created rules regarding the submission of quality data, as well as technical guidance on measure specifications, rating methodology, and data reporting and procedures.

The notice states that as exchange plans progress and enrollment expands, the agency will weigh creating additional quality reporting systems for specific offerings, including standalone dental plans, catastrophic plans, and health saving accounts (Dickson, Modern Healthcare, 11/18 [subscription required]).


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