Quality Improvement Strategy Data
A quality improvement strategy (QIS) is required for each QHP issuer intending to participate on the exchange. QIS is defined as a “payment structure that provides increased reimbursement or other incentives for improving health outcomes of plan enrollees, and the implementation of activities to prevent hospital readmissions, improve patient safety and reduce medical errors, promote wellness and health, and reduce health and health care disparities.” [30]
HHS is proposing to make aggregated, summary-level QIS information publicly available.[31] This would be done annually, beginning on January 1, 2026 with information from 2025. This was finalized as proposed. This data is already provided by insurers and would not increase the reporting burden. Guidance, definitions, and technical guidance is expected to be released prior to the release of the QIS data.
The data expected to be made available includes:
(1) value-based payment models used in QHPs offered by the issuer;
(2) QIS topic area;
(3) QIS market-based incentive types;
(4) clinical areas addressed by QIS;
(5) QIS activities; and
(6) QRS measures used in QIS
Other Items
The Model Consent Form was developed to be used by agents and brokers to meet the “the documentation of consumer review and confirmation of the accuracy of the eligibility application information requirements.”[32] Agents and forms can use the form directly, or can use as a starting point for their own consent form. A proposal was made to update the Model Consent Form to include sections related to consumer review and confirmation of accuracy of their review of Exchange eligibility requirements. The form will also have the ability to document compliance using an audio recording. The modifications to the Model Consent Form were finalized as proposed.
Consumers are required to file taxes and reconcile income to ensure eligibility for APTCs. Previously, HHS noted that an Exchange may only determine enrollees ineligible for APTCs if they failed to file and reconcile (FTR) for 2 consecutive years, but did not specify any required notification. Later notification was required to be provide after the first year of FTR, but not the second year. HHS is now proposing Exchanges be required to notify enrollees or their tax filers that they have not filed and reconciled for 2 consecutive years, educating them about the process, and warning them they may lose eligibility if they do not file and reconcile.[33] This was finalized as proposed. Exchanges are permitted to send direct or indirect notices to comply with requirements, and a link to sample notices was provided at https://www.cms.gov/marketplace/in-person-assisters/applications-forms-notices/notices.
[30] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 9. Quality Improvement Strategy (§156.1130)
[31] 9. Quality Improvement Strategy (§156.1130)
[32] C. Part 155—Exchange Establishment Standards and Other Related Standards –2. Ability of States To Permit Agents and Brokers and Web-Brokers To Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in QHPs (§155.220) – c. Model Consent Form Updates
[33] C. Part 155—Exchange Establishment Standards and Other Related Standards – 3. Requirement for Notification of Tax Filers and Consumers Who Have Failed To File and Reconcile APTC for Two Consecutive Tax Years (§155.305)