Qualified Health Plan Enrollee Experience Survey

The Qualified Health Plan (QHP) Enrollee Experience Survey (EES) exists in response to Section 1311(c)(4) of the Patient Protection and Affordable Care Act (PPACA). The Act requires the United States Department of Health and Human Services Secretary to develop an enrollee satisfaction survey system that assesses consumer experience with QHPs offered through a Health Insurance Exchange. It also requires public display of information by each Marketplace to allow individuals to assess enrollee experience among comparable plans. 

The goals of the survey are to provide comparable and useful information to consumers about the quality of health care services and enrollee experience with QHPs offered through the Exchanges, facilitate oversight of QHP issuer compliance with quality reporting standards, and provide actionable information that QHP issuers can use to improve quality and performance. This webpage provides Vendor Applicants, Conditionally Approved Vendors, Approved Vendors, and Public Use File Users with a multipurpose interface to support survey data submissions.

The type of information to be collected and maintained includes:

Contact Us Page - Name, e-mail address

Vendor - vendor name, address, point of contact name, point of contact e-mail address, point of contact phone number, and username 

System Administrators - User Account Name, Device Identifier (IP number),  and events logged.

The QHP website/application utilizes and inherits CMS' Identity Management (IDM) system for identity management and authentication for the protection of PII data. IDM is leveraged by CMS business applications used across CMS. Users of all business applications that integrate with IDM can use a single set of user credentials to access any integrated application. The CMS IDM incorporates Multi-factor Authentication (MFA) into user authentication. MFA is an authentication method that requires the user to provide two or more verification factors to gain access to the QHP website/application. This includes the user providing account username, password and a six-digest code delivered by text message to a mobile device. 

Section 1311(c) of the Patient Protection and Affordable Care Act (PPACA) directs the Secretary of the Department of Health & Human Services (HHS) to establish an enrollee satisfaction survey to assess enrollee satisfaction with each QHP offered through the Health Insurance Exchanges (Exchanges) (also known to consumers as Health Insurance Marketplaces) and Small Business Health Options Program (SHOP) with more than 500 enrollees in the prior year. Additionally, Section 1311(c) of the PPACA directs the Secretary to develop a quality rating for each QHP offered through an Exchange. Based on this authority, CMS issued a regulation in May 2014 to establish standards and requirements related to QHP issuer data collection and public reporting of quality rating information in every Exchange.

As a condition of certification and participation in the Exchanges, CMS requires that QHP issuers submit QHP Enrollee Survey response data and Quality Rating System (QRS) clinical measure data for their respective QHPs offered through an Exchange in accordance with CMS guidelines. Exchanges are also required to display QHP quality rating information on their respective websites. 

The goals of the QRS and the QHP Enrollee Survey are to:

• Provide comparable and useful information to consumers about the quality of health care services and enrollee experience with QHPs offered through the Exchanges
• Facilitate oversight of QHP issuer compliance with quality reporting standards set forth in the PPACA and implementing regulations, and
• Provide actionable information that QHP issuers can use to improve quality and performance.
• CMS aligned federal quality reporting standards for QHP issuers with other federal and state quality reporting program standards, as well as with the Meaningful Measures Initiative, aimed at identifying the highest priority areas for quality measurement and quality improvement in order to assess core quality of care issues that are most vital to advancing the agency’s work to improve patient outcomes. States have the flexibility to build upon the federal quality reporting standards for QHP issuers by setting additional standards that reflect state priorities and population-based needs. 

QHP issuers that offered coverage through an Exchange in the prior year are required to submit third-party validated QRS clinical measure data and QHP Enrollee Survey response data to CMS as a condition of certification.

The QHP Enrollee Survey is the only survey used to measure the experience of the enrollee population in the Exchanges. While the survey utilizes questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), modifications and new questions were designed specifically for use with the enrollee population. 

Consistent with other CAHPS instruments, the QHP Enrollee Survey uses a six-month reference period. The survey assesses enrollee experience with a QHP offered through an Exchange on the topics presented in Exhibit 6. Measures derived from a subset of survey questions are included in the QRS measure set and accompanying ratings. For a crosswalk that maps each QHP Enrollee Survey item question source and relevant QRS measure.
QHP Enrollee Survey Topics

•    Access to Care*
•    Access to Information*
•    Care Coordination*
•    Cultural Competence
•    Doctor Communication
•    Enrollee Experience with Cost
•    Plan Administration*
•    Prevention*
* Survey questions within this topic are included in QRS measure set.

QHP EES web application provides a centralized web site that will allow the different user types the ability to understand what the QHP EES program is, details on how prospective survey vendors can apply to become an approved vendor and approved vendors the ability to login and submit the survey results they have collected.  It will also include functionality that will allow the QHP EES team to manage submissions and manage the meta data of the web application.

The QHP ESS web application has a user centric design and is architected using serverless technologies in Amazon Web Services (AWS).

The Vendor and Issuer User Account names are used to retrieve their respective PII maintained within the QHP website.

The information collected and maintained for System Administrators include their User Account Name, Device Identifier (IP number), actions and events conducted in support of QHP. 

The QHP website/application utilizes and inherits CMS' Identity Management (IDM) system for identity management and authentication for the protection of PII data. IDM is leveraged by CMS business applications used across CMS. Users of all business applications that integrate with IDM can use a single set of user credentials to access any integrated application.  The CMS IDM incorporates Multi-factor Authentication (MFA) into user authentication.  MFA is an authentication method that requires the user to provide two or more verification factors to gain access to the QHP website/application.   This includes the user providing account username, password and a six-digest code delivered by text message to a mobile device. 

• Name
• E-Mail Address
• Phone Numbers
• Mailing Address
• Device Identifiers
• Other - User account name

• Online

• Other - Not applicable. PII is not from a Government source.

• Private Sector
• Other - Vendors

• Private Sector: QHP Survey Vendors will collect, and thus have immediate access to, PII for the QHP issuers. The QHP Issuers will have access to the PII after data collection for quality improvement purposes. The intent of the program is to collect quality of care data from beneficiaries to focus issuers’ quality improvement programs. The PII will support those efforts.

• Users: Users will only have access to their specific PII
• Administrators: Administrators require access to Vendor PII to maintain and control access to the website.
• Contractors: Contractors are direct and fulfill the roles of administrator and require access to PII to fulfill their contract responsibilities.

PII within QHP ESS is maintained as long as needed to support providing information to consumers about the quality of health care services and enrollee experience the Health Insurance Exchanges.

QHP operates in accordance with National Archives and Records Administration (NARA) General Records Schedule DAA-GRS-2013-0002.

As required by regulation, HHS must ask NARA for a variance when not following the retention periods outlined by these schedules (36 CFR 1228.40(c)). 

PII is secured in the system using administrative, technical, and physical controls, in accordance with policies and regulations detailed in the CMS Information Security Acceptable Risk Safeguards-Minimum Security
Requirements (ARS). 

Administrative controls include role-based permissions to access Center for Consumer Information and Oversight (CCIIO) Customer Relations Management System (CCRMS) web pages and applications, request and authentication through the CMS Enterprise Identity Management (EIDM) system, periodic review of users and deletion of non-active accounts, security and network policies and procedures as well as security and privacy training regarding securing PII.

Technical controls include role-based access, inactivity timeout, multi-factor authentication. data encrypted at rest, data encrypted while being transmitted electronically, network firewall, anti-virus/malware prevention, intrusion detection/prevention technologies, centralized event log monitoring and event alerts. CCRMS, being hosted in the cloud inherit physical security controls from the Federal Risk and Authorization Management Program (FedRAMP) Salesforce Cloud and Amazon Web
Services Cloud.

https://qhpsurvey.cms.gov 

This URL and website will not be available until 3/1/2023 after the ATO has been received.