The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), has formally announced an opportunity for public comment on two distinct yet critical information collection activities. Published in the Federal Register on July 14, 2026, these notices invite stakeholders to provide input on a proposed new collection focused on measuring improper payments in State Exchanges and a planned revision to an established survey assessing consumer experience with Qualified Health Plans. This open comment period, mandated by the Paperwork Reduction Act of 1995, underscores the federal government's commitment to transparency, program integrity, and the continuous refinement of health care oversight mechanisms. Comments must be received by the OMB desk officer by August 13, 2026, offering a vital window for public engagement.
Measuring Improper Payments in State Exchanges
CMS is introducing a new information collection effort, identified as CMS-10942, specifically designed to measure improper payments associated with Advance Premium Tax Credits (APTC) administered by State Exchanges. This initiative directly responds to the Payment Integrity Information Act of 2019 (PIIA), which mandates federal agencies to annually identify, review, measure, and report on programs susceptible to significant improper payments. In 2016, HHS had already determined that APTC payments fell into this category, subjecting them to PIIA's requirements.
Previously, starting in Fiscal Year 2022, HHS began reporting improper payments for APTC administered through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs) as part of its existing Exchange Improper Payment Measurement (EIPM) program. To extend this crucial oversight to State Exchanges, HHS initiated the Improper Payment Pre-Testing and Assessment (IPPTA) in 2024, preparing these state entities for the upcoming State Exchange Improper Payment Measurement (SEIPM) program.
Under the proposed SEIPM program, State Exchanges would be required to submit a sample of tax household information from Qualified Health Plans that have APTC payments. The samples would be of sufficient quantity to produce a statistically valid estimate of improper payments, adhering to Office of Management and Budget (OMB) requirements. This measurement would occur annually for all State Exchanges, with the aggregate improper payment rate reported in the HHS Agency Financial Report. CMS estimates a burden of no more than 8 hours for each sample collected from the approximately 20 State, Local, or Tribal Governments identified as respondents, totaling 800 annual hours. This move signifies a broader push for financial accountability across all layers of the Affordable Care Act's health insurance marketplaces.
Refining Consumer Experience Surveys for Health Plans
Concurrently, CMS is seeking to revise and renew its existing information collection for the Qualified Health Plan (QHP) Enrollee Experience Survey, identified as CMS-10488. This survey fulfills a mandate under Section 1311(c)(4) of the Affordable Care Act (ACA), which requires HHS to develop a system for assessing enrollee satisfaction and publicly displaying this information to aid consumers in comparing health plans. The QHP Enrollee Survey is designed to gather data on communication with providers and access to health care services, employing principles from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. Its objectives include assisting consumers in plan selection, providing actionable data for QHP improvement, informing regulatory and accreditation bodies, and building a comprehensive database for research.
CMS previously secured approval for the survey's administration from 2016 through 2026. The current notice seeks renewal for the 2027-2029 period, alongside several substantive revisions aimed at enhancing the survey's effectiveness and reducing respondent burden. Proposed changes include removing four questions related to tobacco usage and replacing two demographic questions concerning race and ethnicity with a single question that aligns with the latest OMB Statistical Policy Directive No. 15. The agency also plans to refine telehealth-related questions to better align with the CAHPS 5.1 Survey and introduce five gate questions, allowing participants to bypass detailed follow-up questions that do not apply to their experience.
Further procedural and presentational modifications are proposed. CMS intends to allow customization of mail and internet survey instruments to feature the specific QHP issuer's name, potentially improving recognition and response rates. The sampling protocol would also be updated to permit oversampling at any level, offering greater flexibility in data collection. To improve response rates, CMS proposes adding a third email reminder and extending the telephone dialing period. Finally, the agency plans to revise the survey instrument itself, along with prenotification letters, reminder letters, cover letters, and emails, to employ plain language, reduce repetition, and enhance readability. These revisions aim to ensure the survey remains a robust and user-friendly tool for gathering essential consumer feedback.
