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 Annual Payment Update (APU). However, certain exemptions are granted by CMS for size or newness.

Exemption for Size

• If your hospice has served fewer than 50 survey-eligible decedents/caregivers during the “reference period” (see table below) you can apply for an exemption from the CAHPS Hospice Survey. The reference year is the calendar year (CY) immediately prior to the CY for which the exemption is requested.
• For example: If a hospice served fewer than 50 survey-eligible decedents/caregivers during the year from January 1, 2023 through December 31, 2023 (or from assignment of CCN), the hospice may apply for a CY 2024 annual exemption on the basis of size
• Exemptions on the basis of size are active for one year only. If your hospice remains eligible for this exemption in subsequent years, your organization will need to request this exemption on an annual basis.

FY – Fiscal Year

• 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.

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.

• If your hospice is exempt from participation because of size or newness, you will not need to contract with a survey vendor
• If your hospice does not meet the exemptions for size or newness, then your hospice will need to select a survey vendor, negotiate a contract with the survey vendor, and authorize the survey vendor to collect and submit data on your hospice’s behalf. The approved survey vendor list is available here.

• The CAHPS Hospice Survey Vendor Authorization Form will be submitted online, on the CAHPS Hospice Survey website (www.hospicecahpssurvey.org)
• To authorize a survey vendor, a hospice representative must complete the CAHPS Hospice Survey Vendor Authorization Form and submit it online prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse
• The individual who completes this form for the hospice will be considered the CAHPS Hospice Survey administrator for that hospice. Hospices may also designate, on the form, an individual within the hospice organization to serve as the main point of contact with the CAHPS Hospice Survey project team and to review data submissions by the survey vendor.
• This form must be submitted online prior to the data submission deadline. If you have questions, contact the CAHPS Hospice Survey Project Team via email at: hospicecahpssurvey@hsag.com.

• If a hospice wishes to change CAHPS Hospice Survey vendors, it may do so only at the beginning of a calendar quarter. A quarter is based on the CY and will correspond to the month of patient death. For example, Q1 2024 begins with January 2024 patient deaths (caregivers to be surveyed in April 2024).
• The CAHPS Hospice Survey Vendor Authorization Form is submitted online, on the CAHPS Hospice Survey website (www.hospicecahpssurvey.org).
• To change a survey vendor, the hospice’s CAHPS Hospice Survey Administrator must complete the CAHPS Hospice Survey Survey Vendor Authorization Form and submit it online one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse by the new survey vendor.

• Your hospice will work with its contracted survey vendor to determine a date each month to submit the monthly decedents/caregivers list and counts of cases ineligible due to live discharges and voluntary requests for no contact (“no publicity”)
• There is specific information that the hospice will need to provide to its survey vendor. This information can be found in Appendix D of the CAHPS Hospice Survey Quality Assurance Guidelines V11.0. This manual is available here.

• 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. Please note, hospices should not necessarily prioritize a primary informal caregiver that is a family member over a friend, as one caregiver category does not automatically have preference over another.
• Staff members or employees of the hospice or care setting in which the patient received care should not be considered primary informal caregivers.

• For your hospice to access and review the data submitted by your survey vendor, a login to the CAHPS Hospice Survey Data Warehouse (https://kiteworks.rand.org) is required. Hospices must submit a CAHPS Hospice Survey Data Warehouse Access Form.
• The CAHPS Hospice Data Warehouse Access Form is submitted online, on the CAHPS Hospice Survey website (www.hospicecahpssurvey.org).
• The RAND Corporation will provide a login to the CAHPS Hospice Survey Data Warehouse. It is important to designate two people from your hospice to have access to the CAHPS Hospice Survey Data Warehouse in order to be able to review quarterly data submission reports.
• Make sure to notify the CAHPS Hospice Survey Data Coordination Team of any staff changes by submitting an updated CAHPS Hospice Survey Data Warehouse Form online.
• Hospices have their own folders in the CAHPS Hospice Survey Data Warehouse.
• Hospices are responsible for accessing and reviewing the CAHPS Hospice Survey Data Submission Reports.
• Successfully submitted files will be put through a series of edit checks. Survey vendors (data administrator and backup data administrator) and hospices (data administrator and backup data Administrator) will receive an email indicating that the CAHPS Hospice Survey Data Submission Reports are available for viewing in their respective folders on the CAHPS Hospice Survey Data Warehouse. Reports will be posted by 5:00 p.m. eastern standard time on the next business day after upload. CAHPS Hospice Survey Data Submission Reports for a hospice will include information only for that hospice.
• Survey vendors and hospices need to review their CAHPS Hospice Survey Data Submission Reports to determine what errors were found in the files, and survey vendors will be required to resubmit a corrected survey data file. A hospice will receive updated reports after new data are submitted for its hospice, until its data set has passed all edit checks.

If you have questions about the Data Submission Reports for your hospice, contact the CAHPS Hospice Survey Data Coordination Team via email at: cahpshospicetechsupport@rand.org.

Below is a brief overview of what is presented in your hospice’s reports. These reports will be posted to your hospice’s data warehouse folder within two days following an upload by your survey vendor. The four reports are:

• Data Submission Detail Report (Part I): This report indicates whether or not the data submitted by your survey vendor was accepted and processed. If the uploaded file fails to conform to the correct XML specifications, the file will not be processed and the remainder of the reports will not be generated. A corrected file will need to be resubmitted prior to the data submission deadline.
• Data Submission Detail Report (Part II): This report indicates if the submitted data passed data quality checks. If any values are out of range, “Data Value Checks Status” will show as “Rejected,” the report will list all of the errors in the file, and the survey vendor must submit a new file. If all data values pass the data quality checks, “Data Value Checks Status” will show as “Accepted,” and no further action is needed.
• Survey Status Summary Report: This report lists whether a Hospice Record was accepted, the sample size, the number of decedent/caregiver administrative records, the number of valid survey status codes, and the number of completed surveys within the file. These are listed separately by month of death, and overall.
• Review and Correction Report: This report lists the number of valid and invalid responses to each variable in the file.

Hospices are required to participate in the CAHPS Hospice Survey on an ongoing monthly basis.

• Data collection for sampled decedents/caregivers must be initiated two months following the month of patient death
  • For example, if a patient dies in January 2024, the vendor must surveying that patient’s primary caregiver starting April 1, 2024
• For more information on the survey administration timeline, refer to the CAHPS Hospice Survey Data Collection and Submission Timeline.
  
  

• If a hospice wants to let caregivers know that they may receive a survey and encourage them to complete it, the hospice must inform all caregivers. For example, hospices may inform caregivers during the hospice admission process that they may receive the CAHPS Hospice Survey or provide this information with a bereavement letter. Hospices may send the Informational Flyer to caregivers as part of a bereavement package.
• It is not permissible to show or provide the CAHPS Hospice Survey materials, including envelopes, to caregivers while they are in the hospice or at any time prior to the administration of the survey.
• Your organization may communicate the name of the survey vendor that will be administering the survey to all caregivers during the hospice admission process.

It is permissible for patients and/or their caregivers to be asked questions about their care during their hospice stay or during bereavement calls where this is a normal part of quality improvement activities.

Activities and encounters that are intended to provide or assess clinical care or promote patient/family well-being are permissible. If patients or their caregivers are asked questions during their hospice care, we suggest that such questions be worded in a neutral tone and not slanted toward a particular outcome. In addition, questions must not resemble CAHPS Hospice Survey items or their response categories. Hospices should focus on overall quality of care rather than the measures reported to CMS.

Caregivers should not be given any formal, CAHPS Hospice Survey-like, patient experience/satisfaction survey during their family member’s hospice stay or after the death of the patient. A formal survey, regardless of the mode employed, is one in which the primary goal is to ask standardized questions of a significant portion of a hospice’s patient/caregiver population.

• When asking non-CAHPS Hospice Survey questions, do not use CAHPS Hospice Survey-like response categories (for instance, “Always,” “Usually,” “Sometimes,” or “Never”)
• The following are examples of the types of questions that are not permissible:
  • “On a scale of 0 to 10, how would you rate your family member’s hospice care?”
  • “Is there a way we could always….?”
  • “Did the hospice team explain things in a way you could understand?”
  • “Overall, how would you rate the care you received from the hospice?”

Activities and encounters that are primarily intended to influence how caregivers, or which caregivers, respond to CAHPS Hospice Survey items must be avoided.

• To allow for fair comparisons across hospices CMS applies adjustments for case mix and mode of survey administration when calculating CAHPS Hospice Survey measure scores. Differences between scores calculated by survey vendors and those calculated by CMS are often due to these adjustments.
• As a reminder, only CAHPS Hospice Survey measure scores calculated by CMS are official results; results provided by your survey vendor are not official CAHPS Hospice Survey scores. Survey vendors and hospices may closely replicate scores calculated by CMS by following CMS guidance:
  • For details regarding the definition that CMS uses to determine whether a survey is “completed,” please see the CAHPS Hospice Survey QAG Version 11.0.
  • For details regarding the steps that CMS uses to calculate top-box scores, please see the Scoring and Analysis page and the Public Reporting podcast.
  • Please note that only responses from caregivers who indicated that their family member received care at home or in an ALF are included in the calculation of the Training Family to Care for Patient measure.