[Federal Register Volume 77, Number 228 (Tuesday, November 27, 2012)]
[Notices]
[Pages 70786-70788]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-28473]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9962-NC]
Request for Information Regarding Health Care Quality for
Exchanges
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Request for Information.
-----------------------------------------------------------------------
SUMMARY: This notice is a request for information to seek public
comments regarding health plan quality management in Affordable
Insurance Exchanges.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on December 27,
2012.
ADDRESSES: In commenting, refer to file code CMS-9962-NC. Because of
staff and resource limitations, we cannot accept comments by facsimile
(FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to http://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-9962-NC, P.O. Box 8010, Baltimore, MD
21244-8010.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-9962-NC, Mail Stop C4-26-05, 7500
Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. Alternatively, you may deliver (by hand or
courier) your written comments ONLY to the following addresses:
a. For delivery in Washington, DC--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Room 445-G, Hubert
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC
20201.
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without
[[Page 70787]]
Federal government identification, commenters are encouraged to leave
their comments in the CMS drop slots located in the main lobby of the
building. A stamp-in clock is available for persons wishing to retain a
proof of filing by stamping in and retaining an extra copy of the
comments being filed.)
b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
call telephone number (410) 786-9994 in advance to schedule your
arrival with one of our staff members.
Comments erroneously mailed to the addresses indicated as
appropriate for hand or courier delivery may be delayed and received
after the comment period.
For information on viewing public comments, see the beginning of
the ``SUPPLEMENTARY INFORMATION'' section.
FOR FURTHER INFORMATION CONTACT: Rebecca Zimmermann, (301) 492-4396.
SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments
received before the close of the comment period are available for
viewing by the public, including any personally identifiable or
confidential business information that is included in a comment. We
post all comments received before the close of the comment period on
the following Web site as soon as possible after they have been
received: http://www.regulations.gov. Follow the search instructions on
that Web site to view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
Last year, the Department of Health and Human Services (HHS)
adopted the National Strategy for Quality Improvement in Health Care
(National Quality Strategy) to create national aims and priorities that
would guide local, state, and national efforts to improve the quality
of health care in the United States. The priorities of the National
Quality Strategy include making care safer; ensuring person- and
family-centered care; promoting effective communication and
coordination of care; promoting the most effective prevention and
treatment for the leading causes of mortality, starting with
cardiovascular disease; working with communities to promote wide use of
best practices to enable healthy living; and making quality care more
affordable.\1\ As discussed in the National Quality Strategy, ``[t]he
Affordable Care Act seeks to increase access to high-quality,
affordable health care for all Americans.'' To that end, the Affordable
Care Act contains several provisions that help to foster and support
health care quality improvement across the insurance marketplace,
including section 2717 of the Public Health Service Act (PHS Act). The
Affordable Care Act places additional quality-related requirements on
health insurance issuers offering qualified health plans (QHPs) in the
new Exchange marketplace, including section 1311 which directs QHP
issuers to implement quality improvement strategies, enhance patient
safety through specific contracting requirements, and publicly report
quality data. The Affordable Care Act also directs the Secretary of HHS
to develop and administer a quality rating system and an enrollee
satisfaction survey system, the results of which will be available to
Exchange consumers shopping for insurance plans. In addition, section
10329 of the Affordable Care Act, which relates to plans both inside
and outside the Exchange, directs the Secretary, in consultation with
relevant stakeholders, to develop a methodology for calculating the
value of a health plan.
---------------------------------------------------------------------------
\1\ See Report to Congress: National Strategy for Quality
Improvement in Health Care available at http://www.healthcare.gov/law/resources/reports/quality03212011a.html.
---------------------------------------------------------------------------
HHS's strategy for establishing quality reporting requirements to
ensure that quality health care is delivered through the Exchange
marketplace includes the consideration of existing relevant quality
measure sets and quality improvement initiatives in conjunction with
other factors, such as characteristics of the Exchange population.
States, employers, health insurance issuers, and other stakeholders, in
addition to the Centers for Medicare and Medicaid Services (CMS) and
other HHS agencies, are currently engaged in health plan quality
reporting and improvement initiatives. As indicated in the National
Quality Strategy, HHS is interested in promoting effective quality
measurement while minimizing the burden of data collection by aligning
measures across programs. These efforts would also ease comparability
across plans, providers, and insurance markets, and promote delivery of
high-quality and high-value health care.
As set forth in the May 2012 General Guidance on Federally-
facilitated Exchanges, HHS intends to propose a phased approach to
quality reporting and display standards for all Exchanges and QHP
issuers. No new quality reporting standards would be in place until
2016 (other than those related to accreditation, if applicable), which
allows time to develop standards appropriately matched to the Exchange
enrollee population and plan offerings. Until final regulations are
issued, state-based Exchanges would have the choice of adopting a
similar approach or implementing their own quality reporting standards
immediately and over time.\2\
---------------------------------------------------------------------------
\2\ See ``General Guidance on Federally-facilitated Exchanges,''
available at http://cciio.cms.gov/resources/files/FFE_Guidance_FINAL_VERSION_051612.pdf.
---------------------------------------------------------------------------
In preparation for the implementation of the quality provisions
affecting QHPs in the new Exchange marketplace under the Affordable
Care Act, HHS is requesting information through this notice from
stakeholders regarding existing quality measures and rating systems,
strategies and requirements for quality improvement, purchasing
strategies to promote care redesign and patient safety, as well as
effective methodologies to measure health plan value. This notice also
offers the opportunity to provide recommendations on the most effective
ways to enhance and align the quality reporting and display
requirements for QHPs starting in 2016 in conjunction with existing
quality improvement initiatives, such as the National Quality Strategy.
We note that this notice should not be viewed as final policy that will
be adopted pursuant to rulemaking.
II. Solicitation of Comments
CMS is requesting information regarding the following:
Understanding the Current Landscape
1. What quality improvement strategies do health insurance issuers
currently use to drive health care quality improvement in the following
categories: (1) Improving health outcomes; (2) preventing hospital
readmissions; (3) improving patient safety and reducing medical errors;
(4) implementing wellness and health promotion activities; and (5)
reducing health disparities?
2. What challenges exist with quality improvement strategy metrics
and
[[Page 70788]]
tracking quality improvement over time (for example, measure selection
criteria, data collection and reporting requirements)? What strategies
(including those related to health information technology) could
mitigate these challenges?
3. Describe current public reporting or transparency efforts that
states and private entities use to display health care quality
information.
4. How do health insurance issuers currently monitor the
performance of hospitals and other providers with which they have
relationships? Do health insurance issuers monitor patient safety
statistics, such as hospital acquired conditions and mortality
outcomes, and if so, how? Do health insurance issuers monitor care
coordination activities, such as hospital discharge planning
activities, and outcomes of care coordination activities, and if so,
how?
Applicability to the Health Insurance Exchange Marketplace
5. What opportunities exist to further the goals of the National
Quality Strategy through quality reporting requirements in the Exchange
marketplace?
6. What quality measures or measure sets currently required or
recognized by states, accrediting entities, or CMS are most relevant to
the Exchange marketplace?
7. Are there any gaps in current clinical measure sets that may
create challenges for capturing experience in the Exchange?
8. What are some issues to consider in establishing requirements
for an issuer's quality improvement strategy? How might an Exchange
evaluate the effectiveness of quality improvement strategies across
plans and issuers? What is the value in narrative reports to assess
quality improvement strategies?
9. What methods should be used to capture and display quality
improvement activities? Which publicly and privately funded activities
to promote data collection and transparency could be leveraged (for
example, Meaningful Use Incentive Program) to inform these methods?
10. What are the priority areas for the quality rating in the
Exchange marketplace? (for example, delivery of specific preventive
services, health plan performance and customer service)? Should these
be similar to or different from the Medicare Advantage five-star
quality rating system (for example, staying healthy: screenings, tests
and vaccines; managing chronic (long-term) conditions; ratings of
health plan responsiveness and care; health plan members' complaints
and appeals; and health plan telephone customer service)? \3\
---------------------------------------------------------------------------
\3\ For more information on Medicare Advantage rating system
domains see http://www.cms.gov/Medicare/Health-Plans/HealthPlansGenInfo/Downloads/2013-Call-Letter.pdf; http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html.
---------------------------------------------------------------------------
11. What are effective ways to display quality ratings that would
be meaningful for Exchange consumers and small employers, especially
drawing on lessons learned from public reporting and transparency
efforts that states and private entities use to display health care
quality information?
12. What types of methodological challenges may exist with public
reporting of quality data in an Exchange? What suggested strategies
would facilitate addressing these issues?
13. Describe any strategies that states are considering to align
quality reporting requirements inside and outside the Exchange
marketplace, such as creating a quality rating for commercial plans
offered in the non-Exchange individual market.
14. Are there methods or strategies that should be used to track
the quality, impact and performance of services for those with
accessibility and communication barriers, such as persons with
disabilities or limited English proficiency?
15. What factors should HHS consider in designing an approach to
calculate health plan value that would be meaningful to consumers? What
are potential benefits and limitations of these factors? How should
Exchanges align their programs with value-based purchasing and other
new payment models (for example, Accountable Care Organizations) being
implemented by payers?
Dated: November 6, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: November 16, 2012.
Kathleen Sebelius,
Secretary.
[FR Doc. 2012-28473 Filed 11-23-12; 11:15 am]
BILLING CODE 4120-01-P