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

Federal Employees Health Benefits Program

FEHB Program Carrier Letter All Carriers	U.S. Office of Personnel Management Insurance Services Programs
Letter No. 2006-31	Date: December 27, 2006

Fee-for-service [27]   Experience-rated HMO [28]   Community-rated [26]

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SUBJECT: 2007 Consumer Assessment of Healthcare Providers and Systems Program Requirements

This letter provides instructions for conducting and reporting your 2007 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Program results. We require Federal Employees Health Benefits (FEHB) plans with at least 500 FEHB subscribers (contracts) as of March 30, 2006, to administer the CAHPS Health Plan Survey 4.0H Adult Version. Please note that the CAHPS 3.0H Adult Survey is no longer a valid survey instrument. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

A copy of the CAHPS 4.0H Adult Questionnaire is included as Attachment 1. The survey sample size remains at 1,100 members for 2007.

Below we have noted some of the significant changes to the CAHPS 4.0H Adult Survey. Please refer to HEDIS 2007, Volume 3: Specifications for Survey Measures for specific changes to the survey.

• Questions referring to complaints and courteous and helpful office staff have been deleted. Additional questions have also been deleted.
• Four new composite measures have been added in 2007 and will not be reported since they are first year measures. Additional questions have been added to the demographic section.
• Some questions have been re-worded. In addition, there are no longer any questions with the scale: “A big problem,” “A small problem,” “Not a problem.” Some of these questions have been reworded into a question with the scale: “Never,” “Sometimes,” “Usually,” and “Always.”
• The new survey has been re-ordered as follows:
  • Your Health Care
  • Your Personal Doctor
  • Getting Health Care from Specialists
  • Your Health Plan
  • About You
• Some questions that were included in “Your Health Care” on CAHPS 3.0H are now in “Your Personal Doctor” on CAHPS 4.0H
• Plans can now add 20 (instead of 15) extra questions to their survey instrument. Survey vendors submit all extra questions for approval to the National Committee for Quality Assurance (NCQA).

Special Notices

• Fee-for-service (FFS) plans offering more than one option (i.e., High, Standard, Consumer Driven, High Deductible Health Plan or other option) are required to conduct a separate CAHPS survey for each option.
• Health maintenance organizations (HMO) do not have to conduct a separate survey for their standard and high options. We will allow the same data to be used for both high and standard options.
• HMOs offering a Consumer Driven Plan or a High Deductible Health Plan must conduct a separate CAHPS survey for each option.
• All surveys must be conducted according to NCQA protocols described in HEDIS 2007, 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.
• Plans must use the standardized layout and format for the sample frame data file described in Volume 3 and must include all required data elements in Table S-1 (see p.51).
• Each plan reporting survey data to OPM is responsible for a pro rata share of the cost of compiling, processing and reporting the survey results. The 2007 processing fee is $497.85 per sample. The fee is applicable to each unique 2-digit FEHB enrollment code/plan option combination for which data is submitted to OPM. If a plan must submit more that one NCQA data file per FEHB enrollment code/plan option, the plan will be charged $497.85 for each NCQA data file submitted. Any plan that withdraws from the FEHB Program after submitting data to OPM is liable for the processing fee. Our CAHPS data collection contractor Office Remedies, Inc. (ORI) will send you an invoice for the processing fee and the amount due is payable directly to our contractor. The payment due date is June 15, 2007.
• So that we may continue to track and 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 to FFS plans on how to report results for this question separately):

  53a. 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 NCQA-Certified HEDIS® survey vendor. You may contract with any NCQA Certified vendor. A list of approved survey vendors is available at http://www.ncqa.org/Programs/HEDIS/index.htm. Please check the list to verify that your survey vendor is NCQA-Certified to administer HEDIS 2007 CAHPS 4.0H Surveys. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
• 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 a 2007 CAHPS Adult or Child survey you must report your survey results to us 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 survey 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 (Attachment 4) 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 is June 15, 2007. We will provide the contractor’s name and contact information within the next few weeks.
• The OPM data processing fee will be charged to all plans submitting CAHPS data regardless of the plans’ FEHB Program status for 2008.

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.”

Survey Participation Form

All FEHB plans must complete the enclosed Survey Participation Form (Attachment 2) and email it to us by February 1, 2007. If you plan to conduct multiple surveys, please list the name and FEHB Sub-Code (See Attachment 3 – Sub-Code List) for each plan or option that you plan to survey. Please email the completed form to angela.calarco@opm.gov or you may fax the form to Angela M. Calarco 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. Quality Compass is a registered trademark of the National Committee for Quality Assurance (NCQA).

Survey Instruments & Protocols

Your survey vendor must use the CAHPS 4.0H questionnaire (see Attachment 1). Survey vendors must administer the survey and report survey results according to the protocols in NCQA’s HEDIS® 2007, Volume 3, Specifications for Survey Measures and subsequent updates. All NCQA-Certified survey vendors have access to HEDIS® - Volume 3, which includes the survey instruments and protocols.

Membership Data & Sample Frame

Please work closely with your survey 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 survey vendor submits member level and summary level data to OPM, they will need to provide a “Crosswalk” file (Attachment 4) 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. Attachment 3 contains a list of FEHB plans and their unique Sub-Codes.

The Crosswalk file must include the names of the plan(s) you will survey and the plan’s FEHB Sub-Code. (See Attachment 4 for an example of a properly completed Crosswalk) 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: Angela Calarco at: angela.calarco@opm.gov or (202) 606-5139.

Reporting Survey Data to OPM

Your survey vendor must submit CAHPS 4.0H 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.53a (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 survey 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 and you have provided NCQA with a signed Attestation of Accuracy. Your survey vendor may submit data via email or other electronic or digital format. All submissions must include a content label/sheet and a Crosswalk. We will provide additional instructions for reporting your survey data files within the next few weeks.

Reporting Deadlines

All materials must be received by the following deadlines:

• February 1, 2007 – Attachment 2 - Survey Participation Form (all FEHB Plans must complete this form)
• April 13, 2007 (tentative) – Attachment 4 - Crosswalk file (due two weeks after NCQA issues your submission ID(s)
• June 15, 2007 – Member level data file and final summary level data files (must be NCQA validated)

Please contact Angela Calarco at: angela.calarco@opm.gov or by telephone at (202) 606-5139, if you have any questions. We appreciate your continued support and look forward to working with you on this important project in the coming months.

Sincerely, Robert F. Danbeck Associate Director for Human Resources Products and Services

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Attachment 1: CAHPS^® 4.0H Adult Questionnaire [85 KB]

Attachment 2: Survey Participation Form [21 KB]

Attachment 3: CAHPS^® Plan codes [237 KB]

Attachment 4: Sample Crosswalk [29 KB]

Download this Letter as a PDF File [52 KB]


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