In general, all Medicare-certified hospices (identified by CMS Certification Number [CCN]) must participate in the CAHPS Hospice Survey in order to receive their full APU. However, certain exemptions are granted by CMS for size or newness.

Exemption for Size

• If a hospice has served fewer than 50 survey-eligible decedents/caregivers during the “reference period” (see table below) the hospice can apply for an exemption from the CAHPS Hospice Survey.
• Exemptions on the basis of size are active for one year only. If a hospice remains eligible for this exemption in subsequent years, it will need to request this exemption on an annual basis.
• To apply for the exemption, the hospice must fill out and submit a Participation Exemption for Size Form. The CY 2024 Participation Exemption for Size Form is available for submission until December 31, 2024.

CY – Calendar Year
FY – Fiscal year

Exemption for Newness

• The exemption for newness is based on how recently the hospice received its CCN, also known as the Medicare Provider Number. The criterion for this exemption is that the hospice must have received its CCN on or after the first day of the performance year for the CAHPS Hospice Survey.
  • For the calendar year (CY) 2024 data collection period, hospices who received their CCN on or after January 1, 2024 are eligible for a one-time exemption for newness. For example, if a hospice receives its CCN any time in 2024 whether it is in January 2024 or December 2024, it is exempt from survey administration for the remainder of 2024. A hospice that receives its CCN any time in 2024 is required to start participating in the CAHPS Hospice Survey beginning with January 2025 decedents. 
• This is a one-time exemption for each hospice as identified by CCN
• Hospices eligible for this exemption will be identified by CMS, as this exemption is based on when the hospice’s CCN is assigned. There is no form for hospices to submit.

The CAHPS Hospice Survey is currently a “pay-for-reporting” program, which means that the submission of required data by specified deadlines determines compliance. Data submission requirements include the following:

• Hospices must contract with a CMS-approved survey vendor, which will collect and submit the data on the hospice's behalf
• For 2024, hospices are required to submit 12 months of data to the CAHPS Hospice Survey Data Warehouse
• The participation requirements for CY 2024 will affect the FY 2026 APU. Participation requirements for subsequent years will impact subsequent APUs.

• Organizations must meet all the Minimum Business Requirements which can be accessed here
• Organizations seeking approval to administer the CAHPS Hospice Survey must complete and submit a Vendor Participation Form. The Vendor Participation Form may only be submitted during the participation period, which occurs each spring.
• Organizations must also participate in the CAHPS Hospice Survey Training Webinar session and successfully complete the post-training quiz  

Data collection for sampled decedents/caregivers must be initiated two months following the month of patient death. The data collection process must be completed within 42 calendar days after initial contact. Submission of the data to the CAHPS Hospice Survey Data Warehouse will occur quarterly. Please see the schedule outlined in the table below.

• Topics include:
  • Communication with Family 
  • Getting Timely Help 
  • Treating Patient with Respect 
  • Emotional and Spiritual Support 
  • Help for Pain and Symptoms 
  • Training Family to Care for Patient 
  • Rating of this Hospice
  • Willingness to Recommend this Hospice

• Hospices with fewer than 50 survey-eligible decedents/caregivers during the prior calendar year are exempt from the CAHPS Hospice Survey data collection and reporting requirements for payment determination, provided the Participation Exemption for Size Form has been submitted by the submission deadline
• Hospices with 50 to 699 survey-eligible decedents/caregivers in the prior calendar year will be required to survey all cases
• Hospices with 700 or more survey-eligible decedents/caregivers in the prior calendar year will be required to survey a minimum sample of 700 cases and may conduct a census 

• Participating hospices must contract directly with, and pay, a CMS-approved CAHPS Hospice Survey vendor to administer the survey on behalf of the hospice

• The CAHPS Hospice Survey is designed to be administered to the person who is most knowledgeable (primary informal caregiver) about the hospice care received by the decedent. The caregiver relationship to the decedent should fall into one of the following categories: spouse/partner, parent (or step parent), child (or step child), other family member, friend, or other. A non-familial legal guardian or non-familial paid caregiver cannot be considered a primary informal caregiver for the purposes of the CAHPS Hospice Survey. The hospice is responsible for identifying the primary informal caregiver that may be eligible to receive and respond to the CAHPS Hospice Survey.

• A caregiver may associate their family member’s care with the facility where hospice care was received, rather than the actual name of the hospice organization. Therefore, “Facility Name” refers to the name of the facility (e.g., name of the assisted living facility, nursing home, hospital, or hospice house) where care was received. For example, if the decedent received care from Hospice ABC while in Facility XYZ, Facility XYZ is the “Facility Name.”

• Decedents/Caregivers are eligible for the CAHPS Hospice Survey if all of the following criteria are met:
  • Decedents age 18 and over at time of death
  • Decedents with death at least 48 hours following last admission to hospice care
  • Decedents for whom there is a caregiver of record
  • Decedents whose caregiver is someone other than a non-familial legal guardian or paid caregiver
  • Decedents for whom the caregiver has a U.S. or U.S. Territory home address

Decedents/Caregivers who initiate or voluntarily request at any time during their stay that the hospice 1) not reveal the patient's identity and/or 2) not survey him or her will be excluded from the sample frame. Patients whose last admission to hospice resulted in a live discharge will also be excluded.

For more detailed information about determining survey eligibility, please see the Quality Assurance Guidelines, available here