1. Management Relationships
* Current/Future Relationships with Hospices:
Survey vendor is not an:
organization or division within an organization that owns or operates a hospice or provides hospice services,
even if the division is run as a separate entity to the hospice;
organization that provides telehealth, monitoring of hospice patients, or teleprompting services for the hospice; and
organization that provides staffing to hospices for providing care to hospice patients, whether personal care aides
or skilled services staff.
Yes
No
2. Relevant Survey Experience
* Number of Years in Business: Survey vendor has been in business a minimum of four years
Yes
No
* Number of Years Conducting Surveys in the Requested Mode: Survey vendor has conducted surveys
in the requested mode(s) of survey administration for a minimum of three years
Yes
No
* Number of Years Conducting Patient-Specific Surveys: Survey vendor has conducted patient-specific
surveys as an organization for a minimum of two years
Yes
No
* Sampling Experience:
Survey vendor has two years prior experience selecting a random sample based on specific eligibility criteria:
Work with contracted client(s) to obtain patient data for sampling via Health Insurance Portability and Accountability Act-
(HIPAA) compliant electronic data transfer processes
Adequately document sampling process
Survey vendors are responsible for conducting the sampling process and must not subcontract this activity
Yes
No
3. Organizational Survey Capacity
* Personnel:
Survey vendor has designated CAHPS Hospice Survey personnel:
Project Director with minimum two years prior experience conducting patient-specific surveys in the requested mode(s)
Staff with minimum one year prior experience in sample frame development and sample selection
Programmer (subcontractor designee, if applicable) with minimum one year prior experience receiving large encrypted data files in different
formats/software packages electronically from an external organization; processing survey data needed for survey administration and survey
response data; preparing data files for electronic submission; and submitting data files to an external organization
Call Center/Mail Center Supervisor (subcontractor designee, if applicable) with minimum one year prior experience in role
Yes
No
Have appropriate organizational back-up staff for coverage of key staff
(Volunteers are not permitted to be involved in any aspect of the CAHPS Hospice Survey administration process )
Yes
No
* Physical Plant and System Resources
Physical plant resources available to handle the volume of surveys being administered, including computer and technical equipment:
A secure commercial work environment
Home-based or virtual interviewers cannot be used to administer the CAHPS Hospice Survey nor may they conduct any survey administration processes
Physical facilities and electronic equipment and software to collect, process, and report data securely
If offering telephone surveys, must have the equipment, software and facilities to conduct computer-assisted telephone interviewing (CATI) and to monitor interviewers
Yes
No
Electronic or alternative survey management system to:
Track fielded surveys throughout the protocol, avoiding respondent burden and losing respondents
Assign random, unique, de-identified identification number (Tracking ID) to track each sampled patient/primary informal caregiver
(i.e., family member or friend of the hospice patient)
Yes
No
Organizations that are approved to administer the CAHPS Hospice Survey must conduct all of their business operations within the United States.
This requirement applies to all staff and subcontractors or other organizations involved in survey administration.
Yes
No
All System Resources are subject to oversight activities, including site visits to physical locations
Yes
No
* Sample Frame Creation:
Survey vendor has two years prior experience selecting a random sample based on specific eligibility criteria:
Generate the sample frame data file that contains all individuals who meet the eligible population criteria
Draw random sample of individuals for the survey who meet the eligible population criteria
Yes
No
* Mail Only Mode of Survey Administration (if applicable): Mail survey administration activities
are not to be conducted from a residence, nor from a virtual office.
Survey vendor has the capability and capacity to:
Obtain and update addresses of sampled caregivers of hospice decedents
Produce and print professional quality survey instruments and materials according to guidelines; a sample of all mailing materials must be submitted for review
Merge and print sample name and address on personalized mail survey cover letters and print unique Tracking ID on the survey questionnaire
Mail out survey materials
Receive and process (key-enter or scan) completed questionnaires
Track and identify non-respondents for follow-up mailing
Assign final survey status codes to describe the final result of work on each sampled record
Yes
No
Not Requested
* Telephone Only Mode of Survey Administration (if applicable): Telephone interviews are not
to be conducted from a residence, nor from a virtual office.
Survey vendor has the capability and capacity to:
Obtain, verify and update telephone numbers
Develop CATI system
Collect telephone interview data for the survey using CATI system; a sample of the telephone script and interviewer screen
shots must be submitted for review
Identify non-respondents for follow-up telephone calls
Schedule and conduct callbacks to non-respondents at varying times of the day and different days of the week
Assign final survey status codes to reflect the final results of attempts to obtain a completed interview with each sampled record
Yes
No
Not Requested
* Mixed Mode of Survey Administration (if applicable): Mail survey administration and telephone
interviews are not to be conducted from a residence, nor from a virtual office.
Survey vendor has the capability and capacity to:
Adhere to all Mail Only and Telephone Only survey administration requirements (described above)
Track cases from mail survey through telephone follow-up activities
Yes
No
Not Requested
* Data Submission: Survey vendors are responsible for conducting data submission and must not
subcontract this process. Survey vendor has two years prior experience transmitting data via secure methods (HIPAA-compliant).
Survey vendor has the capability and capacity to:
Register as a user of the CAHPS Hospice Survey Data Warehouse
Confirm contracted hospices have authorized survey vendor to submit data on behalf of the hospice
Import scanned or key-entered data from completed mail surveys into a data file, if applicable
Import (as necessary) data from CATI system into a data file, if applicable
Develop data files and edit and clean data according to standard protocols
Follow all data cleaning and data submission rules, including verifying that data files are de-identified and contain no duplicate cases
Export data from the electronic data collection system to the required format for data submission, confirm that the data are exported correctly
and that the data submission files are formatted correctly and contain the correct data headers and data records
Encrypt and submit data electronically in the specified format to the CAHPS Hospice Survey Data Warehouse
Work with CMS’ contractors to resolve data problems and data submission issues
Yes
No
* Data Security: Survey vendor has the capability and capacity to secure electronic data taking the
following actions:
Use a firewall and/or other mechanisms for preventing unauthorized access to electronic files
Implement access levels and security passwords so that only authorized users have access to sensitive data
Implement daily data back-up procedures that adequately safeguard system data
Test back-up files on a quarterly basis, at a minimum, to make sure the files are easily retrievable and working
Perform frequent saves to media to minimize data losses in the event of power interruption
Develop procedures for identifying and handling breaches of confidential data
Yes
No
* Data Retention and Storage: Survey vendor has the capability and capacity to securely store all data related
to survey administration taking the following actions:
Store CAHPS Hospice Survey-related data files, including decedents/caregivers lists and de-identified electronic data files, for all applicable survey
modes for a minimum of three years. Archived electronic data files must be easily retrievable.
Store de-identified returned mail questionnaires in a secure and environmentally safe location (e.g., locked file cabinet, locked closet or room), if
applicable. Paper copies or optically scanned images of the questionnaires must be retained for a minimum of three years and be easily retrievable.
Yes
No
* Technical Assistance/Customer Support: Survey vendor has two years prior experience providing telephone customer
support and capacity to provide a toll-free customer support line.
Survey vendor has the capability and capacity to:
Offer customer support in all languages that the survey vendor administers the survey in
Return calls within 24-28 hours
Yes
No
* Organizational Confidentiality Requirements:
Survey vendor has the capability and capacity to:
Develop confidentiality agreements which include language related to HIPAA regulations and the protection of personal identifying information (PII)
and obtain signatures from all personnel with access to survey information, including staff and all subcontractors
or other organizations involved in survey administration and data collection. Confidentiality agreements must be reviewed and
re-signed periodically, at the discretion of the survey vendor, but not to exceed more than a three-year period.
Execute Business Associates Agreement(s) (BAA) in accordance with HIPAA regulations
Confirm that staff and subcontractors or other organizations involved in survey administration are compliant with HIPAA
regulations in regard to decedent/caregiver protected health information (PHI) and PII
Establish protocols for secure file transmission. Emailing of PHI or PII via unsecure email is prohibited.
Yes
No
4. Participation in Quality Control Activities and Documentation Requirements
* Demonstrated Quality Control Procedures:
Survey vendor has incorporated well-documented quality control procedures (as applicable) for:
Training of in-house staff and subcontractors or other organizations involved in survey operations
Printing, mailing and recording receipt of survey questionnaires
Telephone administration of survey
Coding and verifying of survey data and survey-related materials
Scanning or keying-in survey data
Preparation of final person-level data files for submission
Submitting Discrepancy Reports immediately upon discovering a discrepancy in following CAHPS Hospice Survey protocols
All other functions and processes that affect the administration of the CAHPS Hospice Survey
Yes
No
Survey vendor must participate in any conference calls and site visits as part of overall quality monitoring activities:
Provide documentation as requested for site visits and conference calls, including but not limited to: staff training records, telephone
interviewer monitoring records, and file construction documentation
Yes
No
* Documentation Requirements:
Survey vendor has the capability and capacity to:
Keep electronic or hard copy files of staff training and training dates
Maintain electronic documentation of telephone monitoring, if applicable
Maintain documentation of mail production quality checks, if applicable
Maintain documentation of all survey administration activities and related quality checks for review during site visits
Develop a Quality Assurance Plan (QAP) for survey administration in accordance with CAHPS Hospice Survey Quality
Assurance Guidelines and update the QAP at the time of process and/or key personnel changes as part of retaining participation status
Yes
No
* Survey Training:
Survey vendor has the capability and capacity to:
Attend the Introduction to CAHPS Hospice Survey Training session and all CAHPS Hospice Survey Update Training sessions
(at a minimum, survey vendor’s Project Manager and subcontractors or other organizations involved in survey administration
assigned key roles must attend training)
Complete the post-training quiz measuring comprehension of CAHPS Hospice Survey protocols
Yes
No
* Administer the Survey According to all Survey Specifications:
Survey vendor has the capability and capacity to:
Review and follow all procedures described in the CAHPS Hospice Survey Quality Assurance Guidelines that are applicable to the selected survey
data collection mode(s)
Yes
No
Fully comply with the CAHPS Hospice Survey oversight activities
Approved survey vendors are expected to maintain active contract(s) for CAHPS Hospice Survey administration with client hospice(s). An “active
contract” is one in which the CAHPS Hospice Survey vendor is authorized by hospice client(s) to collect and submit CAHPS Hospice Survey data
to the CAHPS Hospice Survey Data Warehouse. If a CAHPS Hospice Survey vendor does not have any contracted hospice clients within two years (a
consecutive 24 months) of the date they received approval to administer the CAHPS Hospice Survey, then that survey vendor’s “Approved“ status for
survey administration will be withdrawn. If approval status is withdrawn, the organization must once again follow the steps to apply for reconsideration
for approval to administer the CAHPS Hospice Survey.
Yes
No