GETTING STARTED WITH THE CAHPS Hospice® SURVEY:

The following content clarifies the roles and responsibilities of participating organizations.

Hospice Roles and Responsibilities

It is the responsibility of the Medicare-certified hospice to participate every month in the CAHPS Hospice® Survey.

If a hospice is eligible to participate, it must:

  • Contract with an approved CAHPS Hospice Survey vendor to administer the survey on behalf of the hospice
  • Provide a primary and secondary (backup) CAHPS Hospice Survey contact person to the CAHPS Hospice Survey-approved Survey Vendor so that an organizational representative is always available
  • Authorize the contracted survey vendor to collect and submit CAHPS Hospice Survey data to the CAHPS Hospice Survey Data Warehouse on the hospice’s behalf by submitting a CAHPS Hospice Survey Vendor Authorization Form (refer to Appendix B) 90 days prior to the data submission deadline
    • Once an organization authorizes a survey vendor, it is not necessary to provide additional notification unless the organization chooses to de-authorize its survey vendor and switch to a different survey vendor

      Note: If an organization chooses to de-authorize its survey vendor and switch to a different survey vendor, it must contact the CAHPS Hospice Survey Project Team immediately to begin the transition process (refer to Appendix B). This change in survey vendor can only take effect at the beginning of a calendar quarter, and the timing of receipt of the request may affect when the change may be made.
  • Complete and submit a CAHPS Hospice Survey Data Warehouse Access Form for Vendors and Hospices (refer to Appendix C) 90 days prior to the data submission deadline
  • Work with their approved survey vendor to determine a date each month by when to provide their survey vendor with the monthly decedents/caregivers list
  • Compile and deliver a complete and accurate decedents/caregivers list to the survey vendor by the agreed-upon date each month with the caregiver information that will enable the survey vendor to administer the survey

    Note: Hospices must ensure that the counts provided to the survey vendor are accurate, i.e., the total decedent count minus the “no publicity” count must equal the number of decedent/caregiver record submitted to the survey vendor.
  • Use a secure method to transmit decedents/caregivers lists to the survey vendor
  • Review data submission reports in the CAHPS Hospice Survey Data Warehouse to ensure that the survey vendor has submitted data on time and without data problems
  • Preview CAHPS Hospice Survey results prior to public reporting
  • Avoid influencing caregivers in any way about whether to or how to answer the CAHPS Hospice Survey. For example, a hospice may not suggest that caregivers decline to be contacted for the survey or provide any information to caregivers about how to answer the survey.

    Note: If a hospice wants to let caregivers know that they may receive a survey and encourage them to complete it, the hospice must inform all caregivers.
  • Understand the hospice’s responsibilities regarding participation in the HQRP, including key date ranges and deadline dates

Some hospices may be exempt from participation for a given APU period. The scenarios under which a Medicare-certified hospice provider can be exempted from participation in the CAHPS Hospice Survey are described below:

  • The Participation Exemption for Size process has been created to provide hospices meeting the size criteria a means to request consideration for this exemption. For the calendar year (CY) 2023 data collection period, Medicare-certified hospices that have served fewer than 50 survey-eligible decedents/caregivers in the period from January 1, 2022 through December 31, 2022 can apply for an exemption from CAHPS Hospice Survey CY 2023 data collection and reporting requirements. To qualify for the survey exemption for CY 2023, hospices must submit a Participation Exemption for Size Form online via the Participation Exemption for Size page of the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org). For the CY 2023 data collection period, this form must be submitted no later than December 31, 2023. The form must be completed in its entirety and must be submitted each year the hospice intends to be considered for the Participation Exemption for Size. Hospices are not eligible to receive the Participation Exemption for Size if they do not submit a Participation Exemption for Size Form for the year. Hospices that are eligible to apply for an exemption are encouraged to apply, even if they are participating in CAHPS Hospice Survey data collection. Please see Appendix K for specific information to be submitted on the Participation Exemption for Size Form.
    • Hospices will need to include the total number of decedents for CY 2022, the total number of patients discharged alive and the number of decedents who fall into each ineligibility category (i.e., under the age of 18, died within 48 hours of admission to hospice care, no caregiver of record [a decedent for whom no caregiver is listed in the medical record or administrative data], caregiver is a non-familial legal guardian or paid caregiver, caregiver has a foreign home address, and no publicity decedents/caregivers).

    Note: “No publicity” status is a rare and unusual request. “No publicity” decedents/caregivers are those who initiate or voluntarily request at any time during their hospice stay that the hospice: 1) not reveal the patient’s identity; and/or 2) not survey him or her.


    Note: For multiple hospice programs sharing one CMS Certification Number (CCN), the survey-eligible decedents/caregivers count is the total from all programs sharing that CCN.
  • The Participation Exemption for Newness is based on how recently the hospice received its CCN (formerly known as the Medicare Provider Number). The criterion for this exemption is that the hospice must have received its CCN on or after the first day of the performance year for the CAHPS Hospice Survey. For example, a hospice must receive its CCN on or after January 1, 2023 to be eligible for the Participation Exemption for Newness for CY 2023. CMS will identify hospices eligible for this exemption. There is no form for hospices to submit.

    Note: The Participation Exemption for Newness is only applicable for the CY that the hospice is assigned its CCN. Hospices that become eligible to participate in the CAHPS Hospice Survey should begin participating during January of the year after they become eligible. For example, if a hospice received its CCN any time in 2023, whether it is in January 2023 or December 2023, it is exempt from survey administration for the remainder of 2023. A hospice that receives its CCN any time in 2023 is required to start participating in the CAHPS Hospice Survey beginning with January 2023 decedents.

Hospice Communication with Patients and/or Their Caregivers

The sections below are intended to provide survey vendors and hospices with guidance when conducting quality improvement activities in conjunction with the CAHPS Hospice® Survey.

Communicating with Patients and/or Their Caregivers about the CAHPS Hospice® Survey

CAHPS Hospice® Survey guidelines allow hospices to communicate about the CAHPS Hospice® Survey with patients and/or their caregivers prior to administration of the survey. For example, hospices may inform caregivers during the hospice admission process that they may receive the CAHPS Hospice® Survey. If a hospice wants to let caregivers know that they may receive a survey and encourage them to complete it, the hospice must inform all caregivers. Certain types of communications are not permitted because they may introduce bias in the survey results. For instance, hospices/survey vendors are not allowed to:

  • ask any CAHPS Hospice® Survey or CAHPS Hospice® Survey-like questions of caregivers prior to administration of the survey
  • attempt to influence or encourage caregivers to answer CAHPS Hospice® Survey questions in a particular way
  • imply that the hospice, its personnel or agents will be rewarded or gain benefits for positive feedback from caregivers by asking caregivers to choose certain responses, or indicate that the hospice is hoping for a given response, such as a “10,” “Definitely yes” or an “Always”
  • indicate that the hospice’s goal is for all caregivers to rate them as a “10,” “Definitely yes” or an “Always”
  • offer incentives of any kind for participation in the survey
  • invite or ask the caregiver if they want to participate in a survey or suggest they can “opt out” of the survey
  • show or provide the CAHPS Hospice® Survey or cover letters to caregivers while they are in the hospice or at any time prior to the administration of the survey
  • mail or distribute any pre-notification letters or postcards after patient death to inform caregivers about the CAHPS Hospice® Survey

    Note: Hospices may not contact caregivers directly regarding survey responses.

Use of Other Hospice Surveys

In this section, CMS provides guidelines to employ when asking caregivers questions regarding their family members’ or friends’ hospice care. CMS’ intent is to minimize the burden on caregivers, prevent the introduction of bias to CAHPS Hospice® Survey responses and not decrease the likelihood that caregivers will complete the CAHPS Hospice® Survey.

In general, activities and encounters that are intended to provide or assess clinical care or promote patient/family well-being are permissible. However, activities and encounters that are primarily intended to influence how caregivers, or which caregivers, respond to CAHPS Hospice® Survey items must be avoided. If patients or their caregivers are asked questions during their hospice care, we suggest that such questions be worded in a neutral tone and not slanted toward a particular outcome. Questions must not resemble CAHPS Hospice® Survey items or their response categories. In addition, references to CMS must not be included on any surveys that are not the official CAHPS Hospice® Survey. Hospices should focus on overall quality of care rather than the measures reported to CMS.

Caregivers should not be given any formal, CAHPS Hospice® Survey-like, patient experience/satisfaction survey before they receive the official CAHPS Hospice® Survey. A formal survey, regardless of the mode employed, is one in which the primary goal is to ask standardized questions of a significant portion of a hospice’s patient/caregiver population.

  • When asking non-CAHPS Hospice® Survey questions, do not use CAHPS Hospice® Survey-like response categories (for instance, “Always,” “Usually,” “Sometimes,” or “Never”)
  • The following are examples of the types of questions that are not permissible:
    • “On a scale of 0 to 10, how would you rate your family member’s hospice care?”
    • “Is there a way we could always….?”
    • “Did the hospice team explain things in a way you could understand?”
    • “Overall, how would you rate the care you received from the hospice?”

Note: It is permissible for hospices to ask patients and/or their caregivers questions about their care during their hospice stay or during bereavement calls when this is a normal part of quality improvement activities, as long as the questions and/or response categories do not resemble the CAHPS Hospice® Survey.

The CAHPS Hospice® Survey should be administered prior to administering any other survey after the patient’s death. As noted above, it is permissible for patients and their caregivers to be asked questions during their hospice stay when the focus is on the clinical care of the individual patient. The hospice or its agents must not seek to influence which caregivers receive the CAHPS Hospice® Survey or how caregivers answer CAHPS Hospice® Survey items.

Other Communications with Patients and/or Their Caregivers

When communicating with patients and/or their caregivers while in hospice care regarding their healthcare, hospices should take care to avoid introducing bias in the way caregivers may answer questions on the CAHPS Hospice® Survey. Many of the guidelines above in the Communicating with Patients and/or Their Caregivers about the CAHPS Hospice® Survey and Use of Other Hospice Surveys apply to general communications with patients and/or their caregivers.

  • Examples of statements that comply with CAHPS Hospice® Survey protocols include:
    • “We are looking for ways to improve your family member’s stay. Please share your comments with us.”
    • “What can we do to improve your family member’s care?”
    • “We want to hear from you, please share your experience with us.”
    • “Please let us know if you have any questions about your family member’s treatment plan.”
    • “Let us know if your family member’s room is not comfortable.”
  • Hospices should not:
    • permit staff to wear buttons, stickers, etc. that state “Always” or “10”
    • emphasize CAHPS Hospice® Survey response options in posters, white boards, rounding questions, in-room televisions, or other media accessible to patients and/or their caregivers. Examples of statements that do not comply with CAHPS Hospice® Survey protocols include:
      • “We expect to be the best hospice possible.”
      • “Our goal is to always address your needs.”
      • “Let us know if we are not listening carefully to you.”
      • “We treat our patients with dignity and respect.”
      • “In order to provide the best possible care, please tell us how we can always…”
      • “Our doctors and nurses always listen carefully to you.”
      • “We want to always explain things to you in a way you can understand.”
      • “We want you to recommend us to family and friends.”

CAHPS Hospice® Survey Hospice-specific Frequently Asked Questions (FAQs)

Does my hospice need to participate? How does my hospice apply for an exemption from participation?

In general, all Medicare-certified hospices (identified by CMS Certification Number [CCN]) must participate in the CAHPS Hospice Survey in order to receive their full Annual Payment Update (APU). However, certain exemptions are granted by CMS for size or newness.

Exemption for Size

  • If your hospice has served fewer than 50 survey-eligible decedents/caregivers during the “reference period” (see table below) you can apply for an exemption from the CAHPS Hospice Survey. The reference year is the calendar year (CY) immediately prior to the CY for which the exemption is requested.
  • For example: If a hospice served fewer than 50 survey-eligible decedents/caregivers during the year from January 1, 2022 through December 31, 2022 (or from assignment of CCN), the hospice may apply for a CY 2023 annual exemption on the basis of size.
  • Exemptions on the basis of size are active for one year only. If your hospice remains eligible for this exemption in subsequent years, your organization will need to request this exemption on an annual basis.
"Reference Period" or Decedent Date of Death Participation CY Exemption Form Deadline Exemption Request Review by CMS Affects APU
Jan 1 to Dec 31, 2020 2021 Dec 31, 2021 2022 FY 2023
Jan 1 to Dec 31, 2021 2022 Dec 31, 2022 2023 FY 2023
Jan 1 to Dec 31, 2022 2023 Dec 31, 2023 2023 FY 2024
Jan 1 to Dec 31, 2023 2023 Dec 31, 2023 2024 FY 2025

FY – Fiscal Year

Exemption for Newness

  • The exemption for newness is based on how recently the hospice received its CCN, also known as the Medicare Provider Number. The criterion for this exemption is that the hospice must have received its CCN on or after the first day of the performance year for the CAHPS Hospice Survey.
  • For the calendar year (CY) 2023 data collection period, hospices who received their CCN on or after January 1, 2023 are eligible for a one-time exemption for newness. For example, if a hospice receives its CCN any time in 2023, whether it is in January 2023 or December 2023, it is exempt from survey administration for the remainder of 2023. A hospice that receives its CCN any time in 2023 is required to start participating in the CAHPS Hospice Survey beginning with January 2023 decedents.
  • This is a one-time exemption for each hospice as identified by CCN
  • Hospices eligible for this exemption will be identified by CMS, as this exemption is based on when the hospice’s CCN is assigned. There is no form for hospices to submit.

Does my hospice need to have a contract with a survey vendor?

  • If your hospice is exempt from participation because of size or newness, you will not need to contract with a survey vendor
  • If your hospice does not meet the exemptions for size or newness, then your hospice will need to select a survey vendor, negotiate a contract with the survey vendor, and authorize the survey vendor to collect and submit data on your hospice’s behalf. The approved survey vendor list is available here.

How does my hospice authorize a CAHPS Hospice Survey vendor?

  • To authorize a survey vendor, a hospice representative must complete the CAHPS Hospice Survey Vendor Authorization Form and submit it to the RAND Corporation one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse.
  • The individual who completes this form for the hospice will be considered the CAHPS Hospice Survey administrator for that hospice. Hospices may also designate, on the form, an individual within the hospice organization to serve as the main point of contact with the CAHPS Hospice Survey project team and to review data submissions by the survey vendor.
  • This form must be signed and dated in the presence of a notary public, notarized, and sent to the RAND Corporation. During the public health emergency, the Authorization Form may be emailed to the RAND Corporation (This email address is being protected from spambots. You need JavaScript enabled to view it.). After the public health emergency ends, the hard copy notarized Survey Vendor Authorization Form will need to be sent to the RAND Corporation.
  • Note that, when completing the CAHPS Hospice Survey Vendor Authorization Form pertaining to multiple hospice agencies, it is appropriate to attach a list to the form (signed and dated by the CAHPS Hospice Survey administrator) of all the hospices (hospice names and CCNs). Please check the box on the form indicating that a separate document is attached and indicate the number of hospice names or CCNs listed on the separate sheet.
  • This form must be submitted to the RAND Corporation one calendar quarter (90 days) prior to the data submission deadline. If you have questions, contact the CAHPS Hospice Survey Data Coordination Team via email at: This email address is being protected from spambots. You need JavaScript enabled to view it..

How does my hospice change its CAHPS Hospice Survey vendor?

  • If a hospice wishes to change CAHPS Hospice Survey vendors, it may do so only at the beginning of a calendar quarter. A quarter is based on the CY and will correspond to the month of patient death. For example, Q4 2022 begins with October 2022 patient deaths (caregivers to be surveyed in January 2023).
  • To change a survey vendor, the hospice’s CAHPS Hospice Survey Administrator must complete the CAHPS Hospice Survey Survey Vendor Authorization Form and submit it to the RAND Corporation one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse by the new survey vendor.
  • This form must be signed and dated in the presence of a notary public, notarized, and sent to the RAND Corporation. During the public health emergency, the Authorization Form may be emailed to the RAND Corporation (This email address is being protected from spambots. You need JavaScript enabled to view it.). After the public health emergency ends, the hard copy notarized Survey Vendor Authorization Form will need to be sent to the RAND Corporation.
  • When completing the CAHPS Hospice Survey Vendor Authorization Form pertaining to multiple hospice agencies, it is appropriate to attach a list to the form of all the hospices (hospice names and CCNs). Please check the box on the form indicating that a separate document is attached and indicate the number of hospice names or CCNs listed on the separate sheet. The list must be signed and dated by the CAHPS Hospice Survey administrator.

How does my hospice submit a sample file to the survey vendor?

  • Your hospice will work with its contracted survey vendor to determine a date each month to submit the monthly decedents/caregivers list and counts of cases ineligible due to live discharges and voluntary requests for no contact (“no publicity”)
  • There is specific information that the hospice will need to provide to its survey vendor. This information can be found in Appendix D of the CAHPS Hospice Survey Quality Assurance Guidelines V8.0. This manual is available here.

How is the primary informal caregiver identified?

  • The CAHPS Hospice Survey is designed to be administered to the person who is most knowledgeable (primary informal caregiver) about the hospice care received by the decedent. The caregiver relationship to the decedent should fall into one of the following categories: spouse/partner, parent (or step parent), child (or step child), other family member, friend, or other. A non-familial legal guardian or non-familial paid caregiver cannot be considered a primary informal caregiver for the purposes of the CAHPS Hospice Survey.
  • The hospice is responsible for identifying the primary informal caregiver that may be eligible to receive and respond to the CAHPS Hospice Survey. Please note, hospices should not necessarily prioritize a primary informal caregiver that is a family member over a friend, as one caregiver category does not automatically have preference over another.
  • Staff members or employees of the hospice or care setting in which the patient received care should not be considered primary informal caregivers.

How can my hospice access the CAHPS Hospice Survey Data Warehouse?

  • For your hospice to access and review the data submitted by your survey vendor, a login to the CAHPS Hospice Survey Data Warehouse (https://kiteworks.rand.org) is required. Hospices must submit a CAHPS Hospice Survey Data Warehouse Access Form.
  • The RAND Corporation will provide a login to the CAHPS Hospice Survey Data Warehouse. It is important to designate two people from your hospice to have access to the CAHPS Hospice Survey Data Warehouse in order to be able to review quarterly data submission reports.
  • Make sure to notify the CAHPS Hospice Survey Data Coordination Team of any staff changes by sending an updated CAHPS Hospice Survey Data Warehouse Form to This email address is being protected from spambots. You need JavaScript enabled to view it..
  • Hospices have their own folders in the CAHPS Hospice Survey Data Warehouse.
  • Hospices are responsible for accessing and reviewing the CAHPS Hospice Survey Data Submission Reports.
  • Successfully submitted files will be put through a series of edit checks. Survey vendors (data administrator and backup data administrator) and hospices (data administrator and backup data Administrator) will receive an email indicating that the CAHPS Hospice Survey Data Submission Reports are available for viewing in their respective folders on the CAHPS Hospice Survey Data Warehouse. Reports will be posted by 5:00 p.m. eastern standard time on the next business day after upload. CAHPS Hospice Survey Data Submission Reports for a hospice will include information only for that hospice.
  • Survey vendors and hospices need to review their CAHPS Hospice Survey Data Submission Reports to determine what errors were found in the files, and survey vendors will be required to resubmit a corrected survey data file. A hospice will receive updated reports after new data are submitted for its hospice, until its data set has passed all edit checks.

If you have questions about the Data Submission Reports for your hospice, contact the CAHPS Hospice Survey Data Coordination Team via email at: This email address is being protected from spambots. You need JavaScript enabled to view it..


Which reports are available to my hospice on the CAHPS Hospice Survey Data Warehouse?

Below is a brief overview of what is presented in your hospice’s reports. These reports will be posted to your hospice’s data warehouse folder within two days following an upload by your survey vendor. The four reports are:

  • Data Submission Detail Report (Part I): This report indicates whether or not the data submitted by your survey vendor was accepted and processed. If the uploaded file fails to conform to the correct XML specifications, the file will not be processed and the remainder of the reports will not be generated. A corrected file will need to be resubmitted prior to the data submission deadline.
  • Data Submission Detail Report (Part II): This report indicates if the submitted data passed data quality checks. If any values are out of range, “Data Value Checks Status” will show as “Rejected,” the report will list all of the errors in the file, and the survey vendor must submit a new file. If all data values pass the data quality checks, “Data Value Checks Status” will show as “Accepted,” and no further action is needed.
  • Survey Status Summary Report: This report lists whether a Hospice Record was accepted, the sample size, the number of decedent/caregiver administrative records, the number of valid survey status codes, and the number of completed surveys within the file. These are listed separately by month of death, and overall.
  • Review and Correction Report: This report lists the number of valid and invalid responses to each variable in the file.

When does the survey take place?

Hospices are required to participate in the CAHPS Hospice Survey on an ongoing monthly basis.

  • Data collection for sampled decedents/caregivers must be initiated two months following the month of patient death
    • For example, if a patient dies in January 2023, the vendor must surveying that patient’s primary caregiver starting April 1, 2023
  • For more information on the survey administration timeline, refer to the CAHPS Hospice Survey Data Collection and Submission Timeline.


Can our hospice discuss the CAHPS Hospice Survey with decedents/caregivers?

  • If your hospice wants to let caregivers know that they may receive a survey and to encourage them to complete it, you must tell all caregivers. However, your hospice must not attempt to influence the caregivers to answer the CAHPS Hospice Survey questions in any particular way.
  • It is not permissible to show or provide the CAHPS Hospice Survey materials, including envelopes, to caregivers while they are in the hospice or at any time prior to the administration of the survey.
  • Your organization may communicate the name of the survey vendor that will be administering the survey to all caregivers during the hospice admission process.

Are there guidelines for conducting quality improvement activities in conjunction with the CAHPS Hospice Survey?

It is permissible for patients and/or their caregivers to be asked questions about their care during their hospice stay or during bereavement calls where this is a normal part of quality improvement activities.

Activities and encounters that are intended to provide or assess clinical care or promote patient/family well-being are permissible. If patients or their caregivers are asked questions during their hospice care, we suggest that such questions be worded in a neutral tone and not slanted toward a particular outcome. In addition, questions must not resemble CAHPS Hospice Survey items or their response categories. Hospices should focus on overall quality of care rather than the measures reported to CMS.

Caregivers should not be given any formal, CAHPS Hospice Survey-like, patient experience/satisfaction survey during their family member’s hospice stay or after the death of the patient. A formal survey, regardless of the mode employed, is one in which the primary goal is to ask standardized questions of a significant portion of a hospice’s patient/caregiver population.

  • When asking non-CAHPS Hospice Survey questions, do not use CAHPS Hospice Survey-like response categories (for instance, “Always,” “Usually,” “Sometimes,” or “Never”)
  • The following are examples of the types of questions that are not permissible:
    • “On a scale of 0 to 10, how would you rate your family member’s hospice care?”
    • “Is there a way we could always….?”
    • “Did the hospice team explain things in a way you could understand?”
    • “Overall, how would you rate the care you received from the hospice?”

Activities and encounters that are primarily intended to influence how caregivers, or which caregivers, respond to CAHPS Hospice Survey items must be avoided.


Why are the scores in the Provider Preview Report different than those from our survey vendor?

  • To allow for fair comparisons across hospices CMS applies adjustments for case mix and mode of survey administration when calculating CAHPS Hospice Survey measure scores. Differences between scores calculated by survey vendors and those calculated by CMS are often due to these adjustments.
  • As a reminder, only CAHPS Hospice Survey measure scores calculated by CMS are official results; results provided by your survey vendor are not official CAHPS Hospice Survey scores. Survey vendors and hospices may closely replicate scores calculated by CMS by following CMS guidance:
    • For details regarding the definition that CMS uses to determine whether a survey is “completed,” please see the CAHPS Hospice Survey QAG.
    • For details regarding the steps that CMS uses to calculate top-box scores, please see the Scoring and Analysis page and the Public Reporting podcast.
    • Please note that only responses from caregivers who indicated that their family member received care at home or in an ALF are included in the calculation of the Training Family to Care for Patient measure.

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