2018 CAHPS/Regulatory Survey Updates

January 10, 2018


SPH Analytics has completed vendor certification and training for the administration of the 2018 CAHPS® 5.0H, Medicare CAHPS, and QHP Enrollee Surveys. As a convenient reference, we’ve compiled a summary of the 2018 updates and/or changes relating to the survey content or survey administration.

2018 NCQA CAHPS 5.0H Health Plan Survey Updates

NCQA continues to advocate the use of the adult (Commercial and Medicaid) and child versions of the core Health Plan CAHPS 5.0H Survey (also referred to as the HEDIS CAHPS Survey) to assess, measure, and compare the experience of health plan members and the performance of health plans.

Following is summary of key updates and timeframes for the administration of 2018 CAHPS 5.0H Surveys:

  • Overall, minor changes have been made in the CAHPS 5.0H survey technical specifications and guidelines (i.e., disposition coding, systematic sampling method, quality oversight) for the 2018 survey administration.
  • NCQA did retire the HEDIS® Aspirin Use and Discussion Measure in 2017. The CAHPS 5.0H survey items aligned with this measure have been removed. This includes questions 50, 51, and 52.
  • Total number of 2018 CAHPS 5.0 survey questions are as follows:
    • Adult Commercial – 60
    • Adult Medicaid – 53
    • Child without CCC Measures – 48
    • Child with CCC Measures – 83
  • For 2018, NCQA has included what it refers to as an “anchor date” requirement to the CAHPS sample population’s enrollment eligibility criteria for HEDIS/CAHPS measures. Member eligibility criteria now include all members who satisfy requirements for continuous enrollment and meet the anchor date enrollment requirement. The anchor date specifies a required active enrollment date for the eligible population. The allowable gap in continuous enrollment must not occur on the anchor date. The anchor date is more often noted as December 31 of the measurement year.

2018 CAHPS 5.0H Survey Administration Key Tasks and Timeframes

Survey vendors contract with health plans to administer HEDIS surveys November–December 2017
Health plans generate a sample frame for each survey sample. If applicable, health plans arrange for an NCQA-Certified HEDIS Compliance Auditor to validate the integrity of the sample frame January 2018


NCQA makes the Healthcare Organization Questionnaire (HOQ) available to plans in the NCQA database January 2018
Survey vendors receive validated sample frames from health plans depicting confirmation from NCQA-Certified HEDIS Compliance Auditor January–February 2018
Survey vendors and health plans submit “new” supplemental questions to NCQA for approval Final Round: January 2–12, 2018
Survey vendor draw sample according to HEDIS/CAHPS protocol January–February 2018
Health Plans complete the HOQ On or before February 16, 2018
Survey vendor administers CAHPS Surveys January–May 2018
Survey vendors upload HEDIS/CAHPS member-level data file submissions to NCQA (IDSS) May 7–May 30, 2018

* For additional information about Commercial and Medicaid CAHPS 5.0H refer to: http://www.ncqa.org/hedis-quality-measurement/data-reporting-services/cahps-5-0-survey/cahps-5-0h-survey

2018 CMS Medicare CAHPS Survey Updates

CMS collects information to share with consumers about Medicare beneficiaries’ experiences with Medicare Advantage (MA-only), Medicare Advantage Prescription Drug (MA-PD), and Medicare Prescription Drug Plans (PDP) via the Medicare CAHPS Survey.

  • For 2018, CMS has made no changes to the content of the Medicare CAHPS Surveys.
  • CMS added a Vietnamese translation of the surveys for 2018.
  • When the Vietnamese language questionnaires are used, they must be available for both the mail and telephone component of survey administration.

2018 Medicare CAHPS Survey Administration Key Tasks and Timeframes

Plan sends request for contract-level oversample. (Authorized contract staff submit a web-based request in which they select the desired contract, enter the size of the requested oversample) December 1, 2017


Plan must complete the web-based survey vendor authorization process to designate a survey vendor for each contract eligible for the 2018 MA & PDP CAHPS Survey December 5, 2017
Survey vendors must submit any supplemental questions for approval December 7, 2017
Survey vendors must submit Spanish (and Chinese and Vietnamese, if applicable) mail survey materials to the MA & PDP CAHPS Survey Project Team December 19, 2017
Survey vendors download 2018 sample file February 8, 2017
Survey vendor conducts survey fielding and data collection to include 3 waves of mail and telephone follow up to non-respondents of the mail questionnaires. March 6, 2018 – June 1, 2018
Submit final MA & PDP CAHPS data files to CMS approximately two weeks after close of data collection June 19-20, 2018
Official 2018 CAHPS preview reports emailed to Medicare Compliance Officers August 2018
Official CAHPS plan reports will be mailed (on a CD) to Medicare Compliance Officers Late September/Early October 2018
Medicare CAHPs survey results publicly reported by CMS for each contract in the Medicare & You Handbook on the Medicare Plan Finder Web site (www.medicare.gov) Late September/Early October 2018

* For additional information about Medicare CAHPS refer to: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/mcahps.html

2018 CMS QHP Enrollee Experience Survey Updates

CMS/HHS requires certified Qualified Health Plans (QHPs) offered through a Health Insurance Exchange to annually conduct the QHP Enrollee Experience Survey (better known as the QHP Enrollee Survey) for each reporting unit in accordance with CMS’ standardized protocols and guidelines.

CMS calculates the Quality Rating System (QRS) scores based on the QRS clinical measure and QHP Enrollee Survey response data submitted.

Following is a summary of updates and/or changes reported by CMS for the 2018 version of the QHP Enrollee Survey tool:

  • The number of survey questions has been reduced from 90 questions in 2017 to 82 questions for the 2018 survey due to deletion of the following questions:
    • Questions 7 and 8: Access to after-hours care
    • Question 53: Recommend this health plan to family/friends
    • Questions 65, 66, and 67: Aspirin Use and Discussion
    • Questions 68 and 69: Do you have any of the following conditions:
      • Question 68: High cholesterol, high blood pressure, family history
      • Questions 69: Heart attack, angina/heart disease, stroke, diabetes or high blood sugar, etc.
  • CMS has re-instated its position of not allowing supplemental/custom questions.
  • CMS has made minor changes to the QHP Enrollee Survey fielding timeframes:
    • Increased the time between mailing of the prenotification letter and the first questionnaire from 3 days to 4 days.
    • Decreased time between mailing of first questionnaire and second questionnaire from 28 days to 27 days.
    • Clarified the last day of fielding is “Day 70” and that data from mail surveys received after this date (on Day 71) may not be included in data submission.
  • CMS has revised the number of key survey items from 18 to 16 (list below). The number of key survey items that must be answered to meet the definition of a completed survey has been changed from 9 to 8. 

Key Survey Items

1 Enrollee’s health plan?
3 Getting needed care right away?
5 Made appointment for routine care?
7 Number of visits to a doctor’s office or clinic for care?
12 Does enrollee have personal doctor?
30 Made appointment to see a specialist?
34 Looked for information about health plan?
36 Looked for information on cost for health care services or equipment?
38 Looked for information about prescription medicines?
40 Did enrollee get info or help from health plan’s customer service?
44 Did health plan give enrollee forms to fill out?
50 Global rating of health plan
51 Did health plan not pay for care that enrollee’s doctor said was needed?
52 Did enrollee have to pay out-of-pocket for care that they thought their health plan would pay for?
53 Did enrollee delay visiting or not visit a doctor because they were worried about the cost?


Did enrollee delay filling or not fill a prescription because they were worried about the cost?


  • In 2018, “Ease of getting care after regular office hours” has been removed from the calculation of the Access to Care QRS survey measure. Survey items now include:

1.   Got care for illness/injury as soon as needed;

2.   Got non-urgent appointment as soon as needed;

3.   How often it was easy to get necessary care, tests, or treatment; and

4.   Got appointment with specialists as soon as needed.

  • For the 2018 data submissions, CMS has clarified that QHP issuers in Medicaid Expansion states where the Medicaid expansion population is eligible to enroll in on-Exchange QHPs should include Medicaid enrollees in their Quality Rating System (QRS) data submissions (which include the QHP Enrollee Survey). 

2018 QHP Enrollee Survey Key Tasks and Timeframes

QHP Issuer contracts with a HEDIS® Compliance Organization (NCQA-licensed) for validation of the QHP Enrollee Survey sample frame. December 1, 2017
QHP Issuer generates a sample frame for each reporting unit.


QHP issuers arrange for HEDIS Compliance Auditor (employee of or contracted by the HEDIS Compliance Organization) to complete the sample frame validation by January 31, 2018.

January 1-31, 2018
QHP Issuer contracts with an HHS-approved QHP Enrollee Survey vendor to conduct the QHP Enrollee Survey and submit survey response data January 5, 2016
QHP Issuer authorizes an HHS-approved QHP Enrollee Survey vendor to administer the QHP Enrollee Survey by completing NCQA’s Hospital Organization Questionnaire (HOQ). January 31, 2018
QHP Issuer notifies CMS via (MQITier2HelpDesk@bah.com) of authorized survey vendor. January 15, 2018
QHP Issuer completes the NCQA Healthcare Organization Questionnaire (HOQ) to prepare for QHP Enrollee Survey data submission. February 18, 2018
QHP Issuer preview their QHP Enrollee Survey results. August 2018
Survey vendors receive validated sample frames from QHP issuers.


Survey vendors also obtain confirmation from the QHP issuer that HEDIS Compliance Auditor validated the sample frame.

Survey vendors draw the survey sample from the validated sample frame.

January–February 2018
Survey vendor administers QHP Enrollee Surveys per sampling and data collection protocols. January–May 2018
Survey Vendor submits all data files to the QHP Enrollee Survey to CMS in accordance with the data file specifications by 11:59 p.m. (ET) on May 25, 2018. May 11–25, 2018

* For additional information about the QHP Enrollee Survey refer to: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/Consumer-Experience-Surveys/Surveys-page.html

Important Note: The contents of this blog are not meant to replace official NCQA or CMS instructions or specifications. For further details or information, organizations are advised to refer to the technical specification and guidance provided by CMS and/or NCQA via the websites noted above (*).

Previous Article
The Importance of Member and Patient Engagement
The Importance of Member and Patient Engagement

Targeted outreach and engagement can have a significant impact on the quality of patient and health plan me...

Next Article
Open Enrollment and Building Long-term Satisfaction and Loyalty
Open Enrollment and Building Long-term Satisfaction and Loyalty

Open Enrollment has begun. The yearly period when people can enroll in a health insurance plan runs from No...


First Name
Last Name
Company Name
Thank you!
Error - something went wrong!