Updates from Member Experience CAHPS Vendor Training

Member experience training


Fall is the season when survey vendors attend vendor training sessions for HEDIS® CAHPS®, the QHP Enrollee Survey, and the MA & PDP CAHPS survey. SPH would like to share with you the program updates from both NCQA and CMS that impact each of these programs.  


One of the key HEDIS CAHPS changes is an update to the survey questionnaires used for Commercial Adult, Medicaid Adult, Medicaid Child, and Medicaid Child CCC programs.

New NCQA HEDIS CAHPS Questionnaires 

NCQA released updated versions of the HEDIS CAHPS surveys after vendor training. These are now called the CAHPS 5.1H surveys (instead of 5.0H). There are not any new questions, but existing questions have been modified so that the respondents know they should include telehealth visits as an appointment type as they respond to the survey. For instance, the introductory language to a section now reads (emphasis added to highlight, bold font is not part of the question format):

These questions ask about your own health care from a clinic, emergency room, or doctor’s office. This includes care you got in person, by phone, or by video. Do not include care you got when you stayed overnight in a hospital. Do not include the times you went for dental care visits.

This new wording about care “in person, by phone or by video” has been added to appropriate questions and introductions throughout the survey.

Below are some of the other key highlights and updates: 

  • CAHPS Survey Measure Specifications Moved to Volume 2
    • Flu Vaccinations for Adults Ages 18–64 (FVA)
    • Flu Vaccinations for Adults Ages 65 and Older (FVO)
    • Medical Assistance with Smoking and Tobacco Use Cessation (MSC)
    • Pneumococcal Vaccination Status for Older Adults (PNU)
  • Survey Administration Survey vendors have the option to field the HEDIS CAHPS survey via Internet in conjunction with mail-only or mixed mode protocols. Prior approval for this is no longer required.
  • Data Cut Date Whereas in prior years, data could be collected up to the end of the data submission period, NCQA has officially communicated a data cut date of May 19, 2021, which means that survey vendors must end data collection on this date. Final data submission runs from May 3 – May 26, 2021.
  • Member-Level File Layout There is a new field for survey completion date.
  • Vendor Remote Options NCQA will continue to allow vendors to use remote call center agents and limited aspects of mail protocol remotely for 2021.
  • Response Rates Response rates continue to decline across all survey types.

QHP Enrollee Survey

SPH attended CMS vendor training for the QHP Enrollee Survey in mid-October. As expected, CMS announced updates to the survey tool to address telehealth:

  • CMS added 2 questions (Q17 and Q21) and updated question numbering accordingly
    • Q17. In the last 6 months, how often did you need medical care but could not get it because of a public health emergency (such as the coronavirus outbreak)?
    • Q21. In the last 6 months, did your personal doctor offer telephone or video appointments, so that you did not need to physically visit their office or facility?
  • Added “include in-person, telephone, or video appointments” to 11 questions (Q22 – Q28, Q33, Q37, Q41 – Q42)

Most of the other updates were relatively minor or served to clarify previous guidance. These changes and clarifications include:

  • QRS and QHP Enrollee Survey requirements do not apply to:  
    • Indemnity plans (i.e., fee for service plans), stand-alone dental plans, or child-only plans
    • Basic health program (BHP) plans
  • There were updates to the process for exception requests and for monitoring sessions for vendors
  • Because of the pandemic, for 2021 reporting units are eligible to be scored if the reporting unit met criteria for data submission and has been in operation as the same product type for 2018, 2019, and 2021
  • There have been some updates to the sample frame file layout
  • Due to the COVID-19 public health emergency:
    • CMS will display ratings for QHPs that received a rating during the 2019 ratings year  
    • State-based Exchanges (SBEs) whose consumers do not use HealthCare.gov may continue to display 2019 QHP quality rating information on their respective websites during the individual market OEP for PY 2021 or follow a state-specific approach

On January 4, 2021, vendors must submit their preliminary QHP client list and oversampling requests.

Additional QHP Documentation: CMS released the following documents regarding the 2021 QRS and QHP Enrollee Survey:  

In the Final 2020 Call Letter, CMS says that they do intend to continue to update the QHP Enrollee Survey:

  • CMS anticipates proposing to remove items from the QHP Enrollee Survey beginning with the 2022 QHP Enrollee Survey. CMS will comply with the PRA, as applicable, in implementing any such changes. 
  • At this time, CMS is not considering removing survey questions that feed into the survey measures in the QRS measure set. However, when proposing refinements to the questions included in the QRS survey measures, CMS will provide additional information, including the anticipated impact to the QRS.


There were not many updates to the program for this year:

  • Tagalog has been added as an optional language.
  • There is a wording update to the last question about eliciting permission for further contact from CMS.

Supplemental questions must be submitted by December 3, 2020. Note that CMS did not make any modifications to the survey to address telehealth appointments. 

SPH has 35 years of experience and success in administering and managing regulatory and non-regulatory experience survey programs for health plans and providers. Read more about what surveys would best support your patient/member experience and improvement initiatives here.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).


About the Author

Esther Turner, Principal, Product Management for SPH Analytics, has been with SPH Analytics for more than eight years. She is an expert in member experience, and her responsibilities focus on our health plan products and survey solutions. Esther monitors requirements and updates from both NCQA and CMS. Her graduate work at Emory University included public policy and both qualitative and quantitative analysis.

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