CMS-10371 Start-up Outcomes Metrics - Quarterly Reports

Start-up Outcomes Metrics – Quarterly Reports
Data Element/ Category
Current health insurance
coverage (only applies to
applicants for financial
assistance)

Assistance with QHP
enrollment submission

Data Specifics
Number and percent of individuals applying for APTC who
are currently enrolled in: Medicaid, CHIP, Medicare,
TRICARE, Peace Corps, VA health care programs, Other,
Uninsured; Number and percent of family applications
who are currently enrolled in Medicaid, CHIP, Medicare,
TRICARE, VA health care programs, Peace Corps,
Employer Insurance, COBRA, Retiree Health Plan, Other,
Uninsured
Percent and number by web, phone, mail, in person,
multiple channels; by assistance (Navigators, In-person
assistors, CACs, Agents/Brokers, Web Brokers, Medicaid
authorized reps, Other Assistant); Number of requests for
language assistance/Number fulfilled; Time taken to
provide language assistance; Form of language assistance
(e.g., translated forms, individual assistance)

Timeliness of eligibility
determinations

Percent of eligibility determinations made within the
month that were completed in a single application session
or within 24 hours; percent resolved within 7 days of
intake; median time for eligibility determination per
month

Number of customer
complaints and grievances
about eligibility and enrollment
problems in Marketplace

Number of individuals and families submitting eligibility
application/enrollees in QHPs; Customer complaints per
capita regarding enrollment (categories in development)

Appeals - Number of QHP
eligibility determination
appeals per application
(Categories and types of
appeals is under development)

Number of QHP eligibility determination appeals/Number
of QHP eligibility determinations

Percentage of initial QHP
eligibility determinations
upheld or reversed in an appeal

Upheld or reversed appeals/All appeals

Median time to resolve appeal
for QHP eligibility
determination

Median time to resolve from date of filing appeal to date
of final disposition