U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Federal Employees Health Benefits Program

This letter provides OPM policies and instructions for conducting the 2005 Consumers Assessment of Health Plans Survey (CAHPS^® ). We require Federal Employees Health Benefits (FEHB) plans with at least 500 FEHB subscribers (contracts) as of March 31, 2004, to conduct CAHPS. There are no changes to the survey and the sample size remains at 1100 members for 2005. A copy of the CAHPS 3.0H Adult Commercial Questionnaire is included as Appendix A.

Special Notices

• Beginning in 2006, plans offering multiple option plans (i.e., High, Standard, Consumer Driven, High Deductible Health Plan or other hybrids) must conduct separate CAHPS surveys for each plan option offered under the FEHB Program. Our goal is to report more plan specific results for each plan type or option. We encourage as many plans as possible to consider implementing this change in 2005.

• NCQA has added additional variables to the file specifications for the CAHPS Member-Level Data file. Please ensure that your CAHPS vendor includes data for the newly added fields.

To enable us to compare Medicare eligible member ratings against non-Medicare eligible members, we require Fee-For-Service (FFS) plans to insert the following supplemental question into the survey. (We will provide detailed instructions on how to report results for this question separately):

58a. Medicare is made up of Parts A (hospitals) and B (doctors). Are you currently enrolled in Medicare?

• No, I am not enrolled in Medicare
• Yes, I am enrolled in Medicare Part A only
• Yes, I am enrolled in Medicare Part B only
• Yes, I am enrolled in Medicare Parts A and B

The following additional instructions and information are applicable to all plans:

• All surveys must be administered by an National Committee for Quality Assurance (NCQA)-Certified HEDIS^® vendor and must be conducted according to NCQA protocols contained in HEDIS^® 2005, Volume 3: Specifications for Survey Measures. You may order a copy of Volume 3 through the following link: http://www.ncqa.org/communications/publications/hedispub.htm
• We do not require FEHB plans to administer the CAHPS 3.0H Child Survey (with or without the Children with Chronic-Conditions measurement set).
• Regardless of the size of your FEHB enrollment, if you conduct any 2005 CAHPS Commercial Survey (Adult or Child), you must send us a copy of your survey results and you must meet all other requirements contained in this letter.
• You may use an alternative or enhanced protocol or add supplemental questions to the survey with prior NCQA approval.
• Over-sampling (above the required 1100 members) is allowed according to the protocols in Volume 3.
• All Plans must submit their member level data files to NCQA for calculation of survey results and generation of validated member level and summary level data files. Before submitting your results to NCQA, you will need to complete NCQA's Healthcare Organization Questionnaire (HOQ) through NCQA's secured Website. Please check with your vendor or contact NCQA's Data Collection department directly at HOQ@ncqa.org if you need help or have questions regarding the HOQ.
• We require you to provide a Crosswalk file along with your survey results that maps your NCQA submission ID(s) to your FEHB plan name and Sub-Code. The Crosswalk file is due two weeks after NCQA issues submission IDs. (See additional information regarding the Crosswalk below.)
• The reporting deadline for you to provide your final member-level data files, summary-level data files in NCQA format and Crosswalks to our contractor, Office Remedies, Inc. (ORI), is June 17, 2005.
• The OPM data processing fee is $474 per carrier code. Plans submitting data to OPM will be charged the data processing fee regardless of the plans' FEHB Program status for 2006.

Public Burden Statement

You must include the following statement on questionnaires you mail to respondents: "This information collection has been approved by the U.S. Office of Management and Budget (Control Number 3206-0236) and is in compliance with the Paperwork Reduction Act of 1995. We estimate that it will take an average of 20 minutes to complete, including the time to read instructions and to gather necessary information. You may send comments about our estimate or any suggestions for minimizing respondent burden, reducing completion time or any other aspect of this information collection to the U.S. Office of Personnel Management (OPM), Reports and Forms Officer (OMB Number 3206-0236), Washington, DC 20415-7900. Your participation in this information collection is voluntary. The OMB Number, 3206-0236, is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed." Also, include the following statement in the upper right corner of each questionnaire: "Form approved: OMB No. 3206-0236."

Data Collection Vendor

As mentioned above, you must use an NCQA-Certified HEDIS Survey Vendor to administer your surveys. You may contract with any NCQA Certified vendor. A list of approved vendors is available at http://www.ncqa.org/Programs/HEDIS/index.htm. Please check the list to verify that your vendor is NCQA-Certified to administer HEDIS 2005 CAHPS 3.0H Surveys.

Survey Participation Form

All FEHB plans must complete the enclosed Survey Participation Form (Appendix B) and email it to us by January 21, 2005. If you plan to conduct multiple surveys, please list the name and FEHB Sub-Code (See Appendix C - Sub-Code List) for each plan or option that you plan to survey. Please email the completed form to rpierce@opm.gov. You may submit the form by facsimile at (202) 606-0036.

Pre-Administration Audit Requirement

Plans seeking NCQA Accreditation and those that intend to include their survey results in NCQA's information products (i.e., Quality Compass^®) must have their sample frame validated by an NCQA-Certified HEDIS Compliance Auditor. If your plan is not seeking NCQA Accreditation and you do not intend to publish your survey results in NCQA information products we do not require an audited sample frame. Please contact NCQA's Policy Clarification Support system at http://www.ncqa.org/programs/faq/PCS.asp if you have questions about this requirement.

Survey Instruments & Protocols

Your vendor must use the CAHPS 3.0H questionnaire (see Appendix A). Vendors must administer the survey and report survey results according to the protocols in NCQA's HEDIS^® 2005, Volume 3, Specifications for Survey Measures and subsequent updates. All NCQA-Certified vendors have access to HEDIS^® - Volume 3, which includes the survey instruments and protocols.

Membership Data & Sample Frame

Please work closely with your vendor to ensure that member addresses and telephone numbers are current before you generate the appropriate sample frame for your survey. HMO and POS plans must generate the sample frame according to NCQA specifications. FFS plans must also follow the NCQA specifications for generating the sample frame with one exception: FFS plans must include all currently enrolled FEHB members, regardless of their Medicare status.

Crosswalk

When your vendor submits member level and summary level data to OPM, they will need to provide a "Crosswalk" file to identify plan data submissions. The Crosswalk will allow us to match up NCQA submission IDs with your plan's unique FEHB Sub-Code. Also, the Crosswalk will identify plans that are sharing survey data. Appendix C contains a list of FEHB plans and their unique SubCodes.

The Crosswalk file must include the names of the plan(s) you will survey, the State(s) in which the plan provide services, and the plan's FEHB Sub-Code. (See Appendix D for an example of what the Crosswalk should look like.) The file includes: member level file name, summary level file name and the plan's NCQA Sub-ID. A Crosswalk must accompany each data submission to OPM. Please direct questions regarding the Crosswalk to: Paul Kallaur or Pauline Kim with the Center for the Study of Service at (202) 454-3030 or (202) 454-3059, or by email at: pkallaur@cssresearch.org or pkim@cssresearch.org.

Reporting Survey Data to OPM

Your vendor must submit CAHPS 3.0H member level data files to NCQA according to NCQA's Adult Survey File Specifications and Layouts. Again, we will provide FFS plans separate instructions for reporting results for Q.58a (Medicare supplemental question).

To ensure consistency and comparability of survey results we require all plans to have the survey vendor submit the member level data files to NCQA for calculation of survey results. NCQA will calculate survey results and create validated member level data files and summary level data files on behalf of vendors. To comply with HIPAA's privacy rules, survey vendors should use appropriate encryption technology to transmit survey data.

Reporting Format

We will accept your member level data files and summary level data files after they have been processed by NCQA. Your vendor may submit data via email, diskette or compact disc (CD). You may include results for multiple plans on a single diskette or CD. All submissions must include a content label/sheet and a Crosswalk. Please direct questions regarding data files to Sue Lynd or Carla Trexler with ORI at (703) 478-0910. Please send all data files to ORI via email at oridata@aol.com or by overnight mail to:

Processing Fee

Each plan participating in the survey will be responsible for a pro rata share of the total cost of compiling, processing and reporting survey data to OPM. The fee remains at $474 per carrier code for 2005. ORI will send you an invoice for the data processing fee and your payment will be due on June 17, 2005. Any plan that withdraws from the FEHB Program after submitting CAHPS data to OPM is liable for the processing fee.

Reporting Deadlines

All materials must be received by the following deadlines:

• January 21, 2005 - Survey Participation Form (all FEHB Plans must complete this form)
• April 15, 2005 (tentative) Crosswalk file (due two weeks after NCQA issues your submission ID(s)
• June 17, 2005 - Member level data file and final summary level data files (must be NCQA validated)

Please contact Ralph Pierce at rpierce@opm.gov or by telephone at (202) 606-2758, if you have any questions. Thank you for your support and cooperation in collecting and reporting CAHPS® survey data for the benefit of our members.

Appendix A
Appendix B
Appendix C
Appendix D
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