Hospice agencies must authorize an approved CAHPS Hospice Survey vendor to submit data on their behalf for the administration of the CAHPS Hospice Survey.
In order to authorize a survey vendor or switch to a new vendor, a hospice representative must submit the CAHPS Hospice Survey Vendor Authorization Form one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse by that vendor.
Approved Survey Vendors may be located at: Approved Vendor List
A quarter is based on the calendar year (CY) and will correspond to the month of patient death. For example, Quarter 4 2023 begins with October 2023 patient deaths (caregivers to be surveyed January 2024).
|Caregivers are Surveyed:
|Corresponding to Patient Deaths:
|Vendor Authorization Form MUST be Submitted by:
|January 31, 2024
|April 30, 2024
|July 31, 2024
|October 31, 2024
If a hospice wishes to change CAHPS Hospice Survey vendors, it may do do ONLY at the beginning of a calendar quarter.
If the quarter you are trying to authorize is not listed in the table above or the form below, you must contact the CAHPS Hospice Survey Project Team at email@example.com. Do not submit the form for an incorrect quarter as it will delay your organization's data submission.
The individual who completes the CAHPS Hospice Survey Vendor Authorization Form for the hospice will be considered the CAHPS Hospice Survey Administrator for that hospice.
Please note that a separate CAHPS Hospice Survey Vendor Authorization Form must be submited for each hospice CCN.
Please type in the required fields to complete the form, print the completed form for your records, and submit the form.
After submission of the CAHPS Hospice Survey Vendor Authorization Form, no further action is required by the hospice to notify CMS of their survey vendor selection.