2018 CAHPS/Regulatory Survey Updates

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.

2018 NCQA CAHPS 5.0H Health Plan Survey Updates

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:

• Overall, minor changes have been made in the CAHPS 5.0H survey technical specifications and guidelines (i.e., disposition coding, systematic sampling method, quality oversight) for the 2018 survey administration.
• NCQA did retire the HEDIS^® Aspirin Use and Discussion Measure in 2017. The CAHPS 5.0H survey items aligned with this measure have been removed. This includes questions 50, 51, and 52.
• Total number of 2018 CAHPS 5.0 survey questions are as follows:
  • Adult Commercial – 60
  • Adult Medicaid – 53
  • Child without CCC Measures – 48
  • Child with CCC Measures – 83

• For 2018, NCQA has included what it refers to as an “anchor date” requirement to the CAHPS sample population’s enrollment eligibility criteria for HEDIS/CAHPS measures. Member eligibility criteria now include all members who satisfy requirements for continuous enrollment and meet the anchor date enrollment requirement. The anchor date specifies a required active enrollment date for the eligible population. The allowable gap in continuous enrollment must not occur on the anchor date. The anchor date is more often noted as December 31 of the measurement year.

2018 CAHPS 5.0H Survey Administration Key Tasks and Timeframes

* For additional information about Commercial and Medicaid CAHPS 5.0H refer to: https://www.ncqa.org/hedis-quality-measurement/data-reporting-services/cahps-5-0-survey/cahps-5-0h-survey

2018 CMS Medicare CAHPS Survey Updates

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.

• For 2018, CMS has made no changes to the content of the Medicare CAHPS Surveys.
• CMS added a Vietnamese translation of the surveys for 2018.
• When the Vietnamese language questionnaires are used, they must be available for both the mail and telephone component of survey administration.

2018 Medicare CAHPS Survey Administration Key Tasks and Timeframes

* For additional information about Medicare CAHPS refer to: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/mcahps.html

2018 CMS QHP Enrollee Experience Survey Updates

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:

• The number of survey questions has been reduced from 90 questions in 2017 to 82 questions for the 2018 survey due to deletion of the following questions:
  • Questions 7 and 8: Access to after-hours care
  • Question 53: Recommend this health plan to family/friends
  • Questions 65, 66, and 67: Aspirin Use and Discussion
  • Questions 68 and 69: Do you have any of the following conditions:
    • Question 68: High cholesterol, high blood pressure, family history
    • Questions 69: Heart attack, angina/heart disease, stroke, diabetes or high blood sugar, etc.

• CMS has re-instated its position of not allowing supplemental/custom questions.
• CMS has made minor changes to the QHP Enrollee Survey fielding timeframes:
  • Increased the time between mailing of the prenotification letter and the first questionnaire from 3 days to 4 days.
  • Decreased time between mailing of first questionnaire and second questionnaire from 28 days to 27 days.
  • Clarified the last day of fielding is “Day 70” and that data from mail surveys received after this date (on Day 71) may not be included in data submission.

• CMS has revised the number of key survey items from 18 to 16 (list below). The number of key survey items that must be answered to meet the definition of a completed survey has been changed from 9 to 8. 

Key Survey Items

• In 2018, “Ease of getting care after regular office hours” has been removed from the calculation of the Access to Care QRS survey measure. Survey items now include:

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.

• For the 2018 data submissions, CMS has clarified that QHP issuers in Medicaid Expansion states where the Medicaid expansion population is eligible to enroll in on-Exchange QHPs should include Medicaid enrollees in their Quality Rating System (QRS) data submissions (which include the QHP Enrollee Survey). 

2018 QHP Enrollee Survey Key Tasks and Timeframes

* 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 (*).