CurrentMedicarePolicy N/A

Suspension of QRS, QHP Enrollee Survey, and QIS Activities for PY2021

CMS directs eligible Qualified Health Plan (QHP) issuers to suspend collection and reporting of Quality Rating System (QRS) clinical measures, the QHP Enrollee Survey, and Quality Improvement Strategy (QIS) submissions for the Plan Year 2021 QHP certification period; applies to issuers participating in Federally-facilitated Exchanges and recommends state-based exchanges adopt similar approaches.

Policy Summary

PayerMedicare

PolicySuspension of QRS, QHP Enrollee Survey, and QIS Activities for PY2021

Policy CodePolicy N/A

Change TypeOperational guidance — suspension

Effective DateN/A

Next Review DateN/A

Key ActionDiscontinue collection of clinical quality measure data and survey measure data normally reported between May and June 2020.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

May–June 2020reporting timeframe suspended

PY2021QHP certification period affected

Federally-facilitatedprimary scope

0submissions displayed during 2021 OE

Operational Directives for PY2021

Operational directives

Operational expectations for QHP issuers during the PY2021 certification period:

Discontinue collection of clinical quality measure data and survey measure data that would normally be reported between May and June 2020

Discontinue reporting for the Quality Rating System (QRS) and QHP Enrollee Survey for display as quality ratings on Exchange websites beginning during the 2021 Open Enrollment period

Issuers eligible to submit Quality Improvement Strategy (QIS) submissions are no longer required to make such submissions for the PY2021 QHP certification period for participation in the Federally-facilitated Exchanges

States with State-based Exchanges are encouraged to adopt a similar approach for QIS submission requirements by their respective QHP issuers for the PY2021 certification period

Policy Summary

PayerMedicare

PolicySuspension of QRS, QHP Enrollee Survey, and QIS Activities for PY2021

Policy CodePolicy N/A

Change TypeOperational guidance — suspension

Effective DateN/A

Next Review DateN/A

Key ActionDiscontinue collection of clinical quality measure data and survey measure data normally reported between May and June 2020.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Required Actions for Issuers

Documentation Required

Temporary suspension: discontinue May–June 2020 quality data collection and QIS submissions

Effective immediately, CMS directs all eligible QHP issuers to discontinue collection of clinical quality measure data and survey measure data that would normally be reported between May and June 2020. Issuers eligible to submit QIS are no longer required to make such QIS submissions for the PY2021 QHP certification period for participation in the Federally-facilitated Exchanges.

Discontinue collection and reporting of QRS clinical measures and QHP Enrollee Survey data for May–June 2020.
Issuers eligible to submit QIS do not need to submit QIS for PY2021 for Federally-facilitated Exchanges.
States with State-based Exchanges are encouraged to adopt a similar approach for QIS submission requirements.
CMS encourages continued internal use of quality measures, QIS information, and survey data for quality improvement.

Key Terms and Acronyms

QRS — definition

TermQRS (Quality Rating System)

PurposeAnnual federal quality ratings for Qualified Health Plans based on audited clinical data (e.g., HEDIS and PQA measures)

Data collection timeframeAudited clinical data reported to CMS during the May–June timeframe each year

Data sourcesHEDIS and PQA measures that often require medical record review or information from physician offices

QHP Enrollee Survey — definition

TermQHP Enrollee Survey

AdministratorContracted HHS‑approved survey vendors

PurposeTo assess enrollee experience with their Qualified Health Plan (QHP)

ReportingSurvey results are submitted by issuers to CMS following vendor administration

QIS — definition and purpose

TermQIS (Quality Improvement Strategy)

PurposeIssuer submissions describing targets and measures for quality improvement

Data relianceMany issuers rely on clinical measure data (HEDIS, PQA) when reporting targets and measures for QIS

Typical requirementQIS submissions are tied to clinical measure reporting used in the QRS