GETTING STARTED WITH THE HHCAHPS SURVEY: HHA RESPONSIBILITIES, HOW TO PARTICIPATE, AND HH-CAHPS^® PARTICIPATION REQUIREMENTS FOR THE APU

The purpose of this document is to summarize the responsibilities of Medicare-certified home health agencies (HHAs) participating in the Home Health Care CAHPS (HHCAHPS) Survey. The information in this document:

• describes HHA responsibilities once their participation in HHCAHPS has begun;
  
  
• lists the steps that HHAs must take before beginning their participation in the HHCAHPS Survey; and
  
  
• explains the calendar year (CY) 2022 Annual Payment Update (APU) requirements. 

Home Health Agency Responsibilities

It is the responsibility of Medicare-certified HHAs to participate every month in the HHCAHPS Survey to obtain the annual payment update (APU) from CMS. The majority of HHAs are eligible to participate; however, some may be exempted from participation for a given APU period. The only two scenarios under which a Medicare-certified HHA can be exempted from participation in the HHCAHPS Survey are described below:

• If an HHA received Medicare certification from CMS after the cutoff date for a given APU period, it is considered too new to participate in the upcoming APU. This is a one-time exemption only, and HHAs do not need to apply for it. Medicare Certification eligibility cutoff dates and the period that each APU covers are provided in the Home Health Prospective Payment System (HH PPS) Final Rule for each calendar year. As of the date of this version of the Protocols and Guidelines Manual, the most recently published Rule is the Home Health Prospective Payment System (HH PPS) Final Rule for the Calendar Year.
  
  
• • If an HHA was certified before the cutoff date specified in the HH PPS Rule, that HHA may only receive an exemption if it served 59 or fewer survey-eligible patients during the 12-month period that the APU covers. To request an exemption, an HHA must submit a Participation Exemption Request (PER) form for that APU period through the HHCAHPS website. HHAs must submit a PER for every APU year that they believe they qualify for and wish to seek an exemption from participating in the HHCAHPS Survey.
  
  

Each APU has an associated reference count period and participation period that runs from April of one year to March of the following year. The reference count period (which HHAs should use to determine eligibility for the APU) is the year prior to the current APU participation period. More information on participation requirements for the APU is available on the HHCAHPS website at the following link: https://homehealthcahps.org/Portals/0/HHA_Responsibilities_List.pdf 

If an HHA is eligible to participate, it must:

• Contract with an approved HHCAHPS survey vendor to conduct its survey;
• Authorize the contracted survey vendor to collect and submit HHCAHPS Survey data to the HHCAHPS Survey Data Center on the agency’s behalf;
• Work with its approved vendor to determine a date each month by which the vendor will need the monthly patient information file for sampling and fielding the survey;
• By the agreed-upon date each month, compile and deliver to the survey vendor a complete and accurate list of patients (i.e., the monthly patient information file) and information that will enable the vendor to administer the survey;
• Use a secure method to transmit monthly patient information files to the survey vendor, ensuring that data are encrypted prior to sending to the vendor;
• Review data submission reports to ensure that its survey vendor has submitted data on time and without data problems;
• Review HHCAHPS Survey results prior to public reporting;
• Avoid influencing patients in any way about how to answer the HHCAHPS Survey; for example, HHAs may not hand out any information to patients about how to answer the survey (please refer to the section in this chapter titled Communications with Patients About the HHCAHPS Survey); and
• Understand the APUs, including key date ranges and deadline dates; again, information about APU Periods and Medicare Certification eligibility cutoff dates is provided in the Home Health Prospective Payment System (HH PPS) Final Rule for each calendar year.

Communications With Patients About the HHCAHPS Survey

Because home health patients may be sicker and more vulnerable than other patient populations and they receive care from the home health provider in their homes, they may be more susceptible to actions that may influence their responses to the HHCAHPS Survey. Any information or communication about the survey from HHAs may introduce bias to the survey. It is acceptable for HHAs to inform patients during their next scheduled assessment that they may be asked to respond to a patient experience survey as long as all patients are notified in this way.

It is not acceptable, however, for an HHA to do the following:

• Mail or e-mail information to patients in advance alerting them about the survey, other than the information provided to all patients;
• Provide a copy of the HHCAHPS Survey questionnaire or cover letters to the patients;
• Include words or phrases verbatim from the HHCAHPS Survey in its marketing or promotional materials (CMS is encouraging HHAs not to use text from HHCAHPS questions in their marketing and promotional materials);
• Attempt to influence their patients’ answers to the HHCAHPS Survey questions;
• Tell the patients that the agency hopes or expects that its patients will give it the best or highest rating or to respond in a certain way to the survey questions;
• Offer incentives of any kind to the patients for participating (or not) in the survey;
• Help the patient answer the survey questions, even if the patient asks for the home care provider’s help;
• Ask patients why they gave a certain response or rating to any of the HHCAHPS Survey questions; and
• Include any messages or materials promoting the HHA or the services it provides in survey materials, including mail survey cover letters and questionnaires and telephone interview scripts.

HHAs should never ask their patients if they would like to be included in the survey. All patients selected to participate in the HHCAHPS Survey must be able to decide on their own whether they wish to participate and will be provided an opportunity to do so as part of the survey process.

Administering HHCAHPS in Conjunction With Other Surveys

Some HHAs may wish to conduct other patient surveys to support internal quality improvement activities. A “survey,” for purposes of this project, is defined as a formal, HHCAHPS-like, patient experience/satisfaction survey. A formal survey, regardless of the data collection mode employed, is one in which the primary goal is to ask standardized questions of a sample of the HHA’s patient population. Contacting patients to assess their care at any time or calling a patient to check on services received are both considered to be routine patient contacts, not surveys.

To ensure that valid data are collected on the HHCAHPS Survey and that the data collected represent patients’ perspectives of the home health care they receive, HHAs should use the following guidelines when administering other surveys in conjunction with HHCAHPS:

• For each sample month, the HHCAHPS Survey sample must be selected prior to selecting the samples for any other HHA survey.
• In other surveys that an HHA conducts, the agency can include questions that ask for more in-depth information about HHCAHPS issues but should not repeat the HHCAHPS questions or include questions that are very similar.
• HHAs may not ask their patients why they gave a certain response or rating to any of the HHCAHPS Survey questions.

The following are some examples of the types of questions that should not be included in any other surveys the agency conducts:

• “Did the home health agency office answer all of your questions?” (This question is similar to Q22 in the HHCAHPS Survey Questionnaire.)
• “On a scale of 0 to 10, how would you rate the home health care you received?” (This question is the same as Q20 in the HHCAHPS Survey Questionnaire.)
• “Would you recommend this agency to your family or friends?” and “Would you recommend our services or call us in the future?” (These questions are similar to Q25 in the HHCAHPS Survey Questionnaire.)
• “Was our staff friendly, professional, and courteous?” (This question is similar to Q19 in the HHCAHPS Survey Questionnaire.)

Guidelines for selecting the HHCAHPS Survey sample in conjunction with other surveys are provided in Chapter IV of the manual.

Getting Started on HHCAHPS (Steps to Take Before Participation)

Each HHA must complete the following tasks before beginning its participation in the HHCAHPS Survey

1. Contract with an approved HHCAHPS survey vendor to administer the HHCAHPS Survey and submit HHCAHPS Survey data to the HHCAHPS Data Center on the HHA’s behalf.
   
   
2. Register for credentials to access the private links on https://homehealthcahps.org.
   
   
3. Authorize an HHCAHPS survey vendor on https://homehealthcahps.org, to collect and submit HHCAHPS Survey Data to the HHCAHPS Data Center.

Questions and Answers About Getting Started

The following 9 questions and answers are provided to clarify some of the steps in getting started with participation in the HHCAHPS Survey.

1. Where do I find a list of the approved HHCAHPS survey vendors?
   
   Answer:  A list of the approved HHCAHPS survey vendors is available at the following link: https://homehealthcahps.org/GeneralInformation/ApprovedSurveyVendors.aspx 
   
   
2. Why do I need to register for login credentials on https://homehealthcahps.org?
   
   Answer: The official site, https://homehealthcahps.org, has links that are available to the general public and also private, secured links. The private links are accessible only to HHAs that have been issued user credentials by the HHCAHPS Coordination Team. Each agency will need to access the private links on https://homehealthcahps.org for certain functions, including completing the online form to authorize a vendor to submit HHCAHPS data on the HHA’s behalf, to view the contracted survey vendor’s Data Submission Reports, and to “preview” the agency’s HHCAHPS Survey results before they are publicly reported on Home Health Compare on https://www.medicare.gov. 
   
   
3. How do I register for login credentials to access the private links on https://homehealthcahps.org?
   
   Answer: Go to the link below to complete the online registration form.
   https://homehealthcahps.org/ForHHAs/RegisterforLoginCredentials.aspx
   
   
4. Once I register online for credentials to access the private links on https://homehealthcahps.org, how and when will I receive user credentials?
   
   Answer: The HHCAHPS Coordination Team will e-mail credentials for accessing the private links on https://homehealthcahps.org to the e-mail address provided by the HHA within 2 hours after the online registration form is submitted. 
   
   
5. My agency has 10 CMS Certification Numbers (CCNs, formerly known as the Medicare Provider ID numbers). Do I have to register for credentials for each of these CCNs?
   
   Answer: Each HHA with a unique CCN will need to designate an agency employee as its HHCAHPS Survey Administrator, who will be responsible for authorizing access to the private links on https://homehealthcahps.org for other agency personnel. All communications from the HHCAHPS Coordination Team will be sent to the person designated as the Survey Administrator. An HHA has to register all of its HHCAHPS relevant CCNs; however, an HHA can designate a different person for each of its CCNs, or one person can be designated as the Survey Administrator for all of the CCNs. If the designated Survey Administrator will represent more than one HHA, the HHA can include up to 45 CCNs on one Consent Form. If the agency has more than 45 CCNs, the HHA must complete a new registration for any CCNs beyond the initial 45 CCNs. 
   
   
6. Why do HHAs have to authorize an approved HHCAHPS survey vendor?
   
   Answer: This is for the security of your agency’s data. This information reflects your agency’s performance, and we want to be sure the data submitted come from the vendor you hired, not someone else. The HHCAHPS Data Center will not accept HHCAHPS Survey data unless the HHA has authorized the survey vendor to collect and submit HHCAHPS Survey data on its behalf. If a survey vendor attempts to submit data and the HHA did not authorize the vendor, the data will not be accepted. An HHA can only authorize one survey vendor at a time. It is important that HHAs authorize a vendor as soon as possible after contracting with an HHCAHPS survey vendor so that the vendor will not have any problems submitting the data to the Data Center.
   
   
7. How do I authorize a survey vendor?
   
   Answer: You can only authorize your vendor online at the HHCAHPS website. To authorize a survey vendor to submit HHCAHPS Survey data on your agency’s behalf, you must have already been issued login credentials to access the private links on the HHCAHPS website (see Steps 2 and 3 under “Getting Started”). Log onto https://homehealthcahps.org and click on the “Authorize a Vendor” link, which is under the “For HHAs” tab. The system will bring up the Authorize a Vendor online form; follow the steps that appear at the top of that online form. 
   
   
8. When completing the online Authorize a Vendor Form, what date should I enter as the Start Date?
   
   Answer: If you are starting participation for the first time for the CY 2024 APU, you must start data collection in April 2022. Enter April 1, 2022, as your start date. Do not enter an end date. The following table illustrates the month (and year) that you should enter as the start date for data collection:
   
   

   If your vendor starts collecting data in these months	Start Date	Quarter
   January, February, March	January 1, (Year)	First Quarter
   April, May, June	April 1, (Year)	Second Quarter
   July, August, September	July 1, (Year)	Third Quarter
   October, November, December	October 1, (Year)	Fourth Quarter

9. Why should I monitor data submission reports from my survey vendor to RTI?
   
   Answer: You should monitor data submission reports to ensure that your vendor has successfully uploaded your survey results to the HHCAHPS Data Center before the data submission deadline.

HHA Responsibilities During HHCAHPS Survey Participation

After an HHA has completed the setup steps listed earlier in this document, the HHA’s responsibilities after its contracted survey vendor begins administering the HHCAHPS Survey are listed below.

1. Stay abreast of updated information about the HHCAHPS Survey by checking theannouncements posted on the HHCAHPS website(https://homehealthcahps.org/GeneralInformation/Announcements.aspx) on a regular basis. We recommend that HHAs check the website for announcements at least twice each week.
   
   
2. Prepare and submit a monthly patient information file containing information needed for sampling and fielding the survey and for data analysis to your contracted vendor by the date required by your contracted HHCAHPS survey vendor. HHCAHPS survey vendorswill select a sample and initiate the survey for each sample month within 21 days after the close of each sample month. Refer to Chapter IV in the HHCAHPS Protocols andGuidelines Manual for more information about the patient information that is required on each monthly patient information file.
   
   
3. Confirm that your HHCAHPS survey vendor is submitting your agency’s HHCAHPS Survey data to the HHCAHPS Data Center for each calendar year quarter on or before the data submission deadline for that quarter. HHAs can access their Data Submission Reports on https://homehealthcahps.org under the “For HHAs” tab. HHAs are encouraged to look for the data submission reports before the data submission deadline to ensure that their contracted vendor is submitting the HHA’s HHCAHPS Survey databefore the data submission deadline for each quarter. The Data Center will not accept data files after the data submission deadline has passed for a quarter. More information about how to view these reports can be found in the website document linked here: https://homehealthcahps.org/Portals/0/HHAGuidanceforDataSubRept.pdf.
   
   
4. Review publicly reported HHCAHPS Survey results each quarter for each CCN (HHA)for which you are responsible. Each HHA’s results will be made available to the HHA to review on https://homehealthcahps.org before they are publicly reported on Home Health Compare on www.medicare.gov. HHAs are responsible for reviewing their survey results and notifying the HHCAHPS Coordination Team if they have questions, comments, or concerns about their reported results.

Cancellation Policy

We do not believe in long contracts, which is why you are free to cancel at any time.  We simply ask that you visit the link below and review the cancellation instructions.

Cancellation Instructions