The U.S. Department of Health and Human Services (HHS) is soliciting comments on its proposed quality rating system framework for evaluating qualified health plans (QHPs) offered through Exchanges. 

Under the Affordable Care Act (ACA), health plans must meet specific standards to be certified as QHPs and offer coverage in an Exchange.  The ACA also requires HHS to develop reporting requirements as part of a system that rates QHPs based on relative quality and price.

HHS intends to use information collected from enrollee satisfaction surveys and ratings based on health care quality, outcomes, and cost of care in the quality rating system.  Quality-performance data will be reported to HHS by health insurance issuers on a product-level basis (e.g., HMO or PPO level reporting) for the initial years of the rating system. Reported data will include reports on clinical effectiveness of care, patient safety, care coordination, prevention of disease and illness, access to care, member experience, plan services and efficiency, and cost reduction.

HHS also proposed elements of performance information and rating methodology components for the quality rating system, discussed measure selection criteria, and listed specific measures for adult individual, family, and child-only QHPs.  HHS is also soliciting comments on the quality rating system measures, methods to ensure integrity of ratings, and identification of priority areas for rating system measure enhancement and development.

Those interested in submitting comments may do so on or before January 21, 2014. Comments may be submitted electronically and by mail at: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3288-NC, P.O. Box 8016, Baltimore, MD 21244-8016.