CAHPS® Hospice Survey

Participation Exemption for Size
     

Participation Exemption for Size Process

The Participation Exemption for Size process has been created to provide hospices that have fewer than 50 survey-eligible decedents/caregivers in the "reference period" (see table below) with a means to request an exemption from participation in the CAHPS Hospice Survey. For the calendar year (CY) 2018 data collection period, Medicare-certified hospices that served fewer than 50 survey-eligible decedents/caregivers in CY 2017 (January 1, 2017 through December 31, 2017) can apply for an exemption from CY 2018 CAHPS Hospice Survey data collection and reporting requirements.

“Reference Period” or Decedent Date of Death Exemption Form Deadline Exemption Request Review by CMS Affects APU
Jan 1 to Dec 31, 2014 Aug 15, 2015 2016 FY 2017
Jan 1 to Dec 31, 2015 Dec 31, 2016 2017 FY 2018
Jan 1 to Dec 31, 2016 Dec 31, 2017 2018 FY 2019
Jan 1 to Dec 31, 2017 Dec 31, 2018 2019 FY 2020
Jan 1 to Dec 31, 2018 Dec 31, 2019 2020 FY 2021

APU – Annual payment update; FY – Fiscal year

The Participation Exemption for Size Form will be available to complete on the CAHPS Hospice Survey Web site until December 31, 2018. Please note, exemptions on the basis of size are active for one year only. If a hospice continues to meet the eligibility requirements for this exemption in subsequent years, the organization will need to again request the exemption.

The CAHPS Hospice Survey Participation Exemption for Size Form for the CY 2017 CAHPS Hospice Survey data collection and reporting requirements is no longer available. The deadline to complete and submit this form was December 31, 2017.


Items Needed to Complete the Participation Exemption for Size Form

The Participation Exemption for Size Form will need to include for CY 2017 the number of patients who were discharged alive, the number of patients who died while in hospice care and a count of patients who fell into the following categories. (Do not include a patient in more than one of the following categories.)

  • Patients who were discharged alive
  • Decedents:
    • who were under the age of 18
    • who died within 48 hours of admission to hospice care
    • for whom there is no caregiver of record
    • for whom the caregiver is a non-familial legal guardian
    • for whom the caregiver has a foreign (non-U.S. or U.S. Territory) home address
    • whose caregiver requested that they not be contacted

Note: For multiple hospice programs sharing one CCN, the survey-eligible decedent/caregiver count is the total from all facilities.

Note: The number of patients who were discharged alive should include patients who have the occurrence code "42" – Date of Revocation (only) (FL 31-34) and patients who have the following Patient Status Codes (FL17):

  • “01” – Discharge to Home or Self Care (Routine Discharge)
  • “50” – Discharged/Transferred to a Hospice – “Hospice Home” (Routine or Continuous Home Care [CHC])
  • “51” – Discharged/Transferred to a Hospice – “Hospice Medical Facility” (Inpatient Respite or General Inpatient Care [GIP])

Review your organization’s information prior to submitting the Participation Exemption for Size Form. A suggested review process is provided in the example below.

Example:

Participation Exemption for Size Request (Do not leave any fields blank – enter 0 [zero] if applicable)
1. Enter the total number of patients who died while in hospice care between January 1, 2017 and December 31, 2017 (CY 2017)* 45
2. Enter the total number of patients during CY 2017 who fall into the following categories. Do not include a patient in more than one of the following categories:
   a. Enter the number of patients who were discharged alive* 12
   b. Enter the number of decedents:
      i. who were under the age of 18* 2
      ii. who died within 48 hours of admission to hospice care* 4
      iii. for whom there is no caregiver of record* 0
      iv. for whom the caregiver is a non-familial legal guardian* 1
      v. for whom the caregiver has a foreign (non-U.S. or U.S. Territory) home address* 0
      vi. for whom the caregiver requested not to be contacted* 1

   

Suggested Review Process:

  • Add the counts to be submitted for Questions 2bi. – 2bvi. to obtain the total survey-ineligible decedents/caregivers
    • 2 + 4 + 0 + 1 + 0 + 1 = 8
  • Subtract the total survey-ineligible decedents/caregivers (8) from the total number of patients who died while in hospice care (Question 1)
    • 45 - 8 = 37
  • The total number of survey-eligible decedents/caregivers is 37 which is fewer than 50; and therefore, the hospice in this example would be eligible for the Participation Exemption for Size

 


Review Process

The CAHPS Hospice Survey Project Team will confirm receipt of the Participation Exemption for Size Form. Confirmation of receipt of the Participation Exemption for Size Form does not constitute approval or denial of this request. CMS will determine the eligibility for size exemption in 2019 when CMS reviews all hospices' data to see if they met the Fiscal Year (FY) 2020 Annual Payment Update (APU). If your exemption is accepted, you will not face a 2% reduction. However, if CMS data indicates that you have served 50 or more survey-eligible patients in 2017, you would not qualify for the exemption and in that instance, you would face the reduction. Therefore, it is the responsibility of the hospice submitting the Participation Exemption for Size Form to accurately portray that the hospice meets the fewer than 50 survey-eligible decedents/caregivers for the CY 2017 and provide the number of patients who died while in hospice care and count of patients who fell into the categories listed on the form.


Participation Exemption for Size Form

The Participation Exemption for Size Form must be completed and submitted online on the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org).

All required fields are indicated with an asterisk (*). Note: For multiple hospice programs sharing one CCN, the survey-eligible decedent/caregiver count is the total from all facilities.

The Participation Exemption for Size Form has been successfully submitted once you are redirected to a “Thank you for your submission” page.

 

This page was last modified on 05/15/2018

 

I. General Information
CCN is required. Too few characters. Must be 6 characters Too many characters. Must be 6 characters
10/21/2018
The Name of the Organization is required.

II. Contact Person at Hospice for this Exemption for Size Request Confirmation email will be sent to the Contact Person.
Name is required.
Title is required.
Mailing Address 1 is required.
City is required.
State is required.
Zip Code is required.
Telephone is required.
Fax must be 10 digit number
Email is required.

III. Participation Exemption for Size Request Do not leave any fields blank - enter 0 (zero) if applicable
The Total Patients Deceased is required.
The Total Discharged Alive is required.
The Total Under 18 is required.
The Total Died 48hrs is required.
The Total No Caregiver is required.
The Total No Guardian is required.
The Total Foreign Address is required.
The Total Request No Contact is required.
Note: Please print completed Exemption Report form before submitting.