SPH Analytics has completed vendor certification and training for the administration of the 2018 CAHPS® 5.0H, Medicare CAHPS, and QHP Enrollee Surveys. As a convenient reference, we’ve compiled a summary of the 2018 updates and/or changes relating to the survey content or survey administration.
NCQA continues to advocate the use of the adult (Commercial and Medicaid) and child versions of the core Health Plan CAHPS 5.0H Survey (also referred to as the HEDIS CAHPS Survey) to assess, measure, and compare the experience of health plan members and the performance of health plans.
Following is summary of key updates and timeframes for the administration of 2018 CAHPS 5.0H Surveys:
|Survey vendors contract with health plans to administer HEDIS surveys||November–December 2017|
|Health plans generate a sample frame for each survey sample. If applicable, health plans arrange for an NCQA-Certified HEDIS Compliance Auditor to validate the integrity of the sample frame||January 2018|
|NCQA makes the Healthcare Organization Questionnaire (HOQ) available to plans in the NCQA database||January 2018|
|Survey vendors receive validated sample frames from health plans depicting confirmation from NCQA-Certified HEDIS Compliance Auditor||January–February 2018|
|Survey vendors and health plans submit “new” supplemental questions to NCQA for approval||Final Round: January 2–12, 2018|
|Survey vendor draw sample according to HEDIS/CAHPS protocol||January–February 2018|
|Health Plans complete the HOQ||On or before February 16, 2018|
|Survey vendor administers CAHPS Surveys||January–May 2018|
|Survey vendors upload HEDIS/CAHPS member-level data file submissions to NCQA (IDSS)||May 7–May 30, 2018|
* For additional information about Commercial and Medicaid CAHPS 5.0H refer to: http://www.ncqa.org/hedis-quality-measurement/data-reporting-services/cahps-5-0-survey/cahps-5-0h-survey
CMS collects information to share with consumers about Medicare beneficiaries’ experiences with Medicare Advantage (MA-only), Medicare Advantage Prescription Drug (MA-PD), and Medicare Prescription Drug Plans (PDP) via the Medicare CAHPS Survey.
|Plan sends request for contract-level oversample. (Authorized contract staff submit a web-based request in which they select the desired contract, enter the size of the requested oversample)||December 1, 2017|
|Plan must complete the web-based survey vendor authorization process to designate a survey vendor for each contract eligible for the 2018 MA & PDP CAHPS Survey||December 5, 2017|
|Survey vendors must submit any supplemental questions for approval||December 7, 2017|
|Survey vendors must submit Spanish (and Chinese and Vietnamese, if applicable) mail survey materials to the MA & PDP CAHPS Survey Project Team||December 19, 2017|
|Survey vendors download 2018 sample file||February 8, 2017|
|Survey vendor conducts survey fielding and data collection to include 3 waves of mail and telephone follow up to non-respondents of the mail questionnaires.||March 6, 2018 – June 1, 2018|
|Submit final MA & PDP CAHPS data files to CMS approximately two weeks after close of data collection||June 19-20, 2018|
|Official 2018 CAHPS preview reports emailed to Medicare Compliance Officers||August 2018|
|Official CAHPS plan reports will be mailed (on a CD) to Medicare Compliance Officers||Late September/Early October 2018|
|Medicare CAHPs survey results publicly reported by CMS for each contract in the Medicare & You Handbook on the Medicare Plan Finder Web site (www.medicare.gov)||Late September/Early October 2018|
* For additional information about Medicare CAHPS refer to: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/mcahps.html
CMS/HHS requires certified Qualified Health Plans (QHPs) offered through a Health Insurance Exchange to annually conduct the QHP Enrollee Experience Survey (better known as the QHP Enrollee Survey) for each reporting unit in accordance with CMS’ standardized protocols and guidelines.
CMS calculates the Quality Rating System (QRS) scores based on the QRS clinical measure and QHP Enrollee Survey response data submitted.
Following is a summary of updates and/or changes reported by CMS for the 2018 version of the QHP Enrollee Survey tool:
|1||Enrollee’s health plan?|
|3||Getting needed care right away?|
|5||Made appointment for routine care?|
|7||Number of visits to a doctor’s office or clinic for care?|
|12||Does enrollee have personal doctor?|
|30||Made appointment to see a specialist?|
|34||Looked for information about health plan?|
|36||Looked for information on cost for health care services or equipment?|
|38||Looked for information about prescription medicines?|
|40||Did enrollee get info or help from health plan’s customer service?|
|44||Did health plan give enrollee forms to fill out?|
|50||Global rating of health plan|
|51||Did health plan not pay for care that enrollee’s doctor said was needed?|
|52||Did enrollee have to pay out-of-pocket for care that they thought their health plan would pay for?|
|53||Did enrollee delay visiting or not visit a doctor because they were worried about the cost?|
|54||Did enrollee delay filling or not fill a prescription because they were worried about the cost?|
1. Got care for illness/injury as soon as needed;
2. Got non-urgent appointment as soon as needed;
3. How often it was easy to get necessary care, tests, or treatment; and
4. Got appointment with specialists as soon as needed.
|QHP Issuer contracts with a HEDIS® Compliance Organization (NCQA-licensed) for validation of the QHP Enrollee Survey sample frame.||December 1, 2017|
|QHP Issuer generates a sample frame for each reporting unit.
QHP issuers arrange for HEDIS Compliance Auditor (employee of or contracted by the HEDIS Compliance Organization) to complete the sample frame validation by January 31, 2018.
|January 1-31, 2018|
|QHP Issuer contracts with an HHS-approved QHP Enrollee Survey vendor to conduct the QHP Enrollee Survey and submit survey response data||January 5, 2016|
|QHP Issuer authorizes an HHS-approved QHP Enrollee Survey vendor to administer the QHP Enrollee Survey by completing NCQA’s Hospital Organization Questionnaire (HOQ).||January 31, 2018|
|QHP Issuer notifies CMS via (MQITier2HelpDesk@bah.com) of authorized survey vendor.||January 15, 2018|
|QHP Issuer completes the NCQA Healthcare Organization Questionnaire (HOQ) to prepare for QHP Enrollee Survey data submission.||February 18, 2018|
|QHP Issuer preview their QHP Enrollee Survey results.||August 2018|
|Survey vendors receive validated sample frames from QHP issuers.
Survey vendors also obtain confirmation from the QHP issuer that HEDIS Compliance Auditor validated the sample frame.
Survey vendors draw the survey sample from the validated sample frame.
|Survey vendor administers QHP Enrollee Surveys per sampling and data collection protocols.||January–May 2018|
|Survey Vendor submits all data files to the QHP Enrollee Survey to CMS in accordance with the data file specifications by 11:59 p.m. (ET) on May 25, 2018.||May 11–25, 2018|
* For additional information about the QHP Enrollee Survey refer to: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/Consumer-Experience-Surveys/Surveys-page.html
Important Note: The contents of this blog are not meant to replace official NCQA or CMS instructions or specifications. For further details or information, organizations are advised to refer to the technical specification and guidance provided by CMS and/or NCQA via the websites noted above (*).