Change in Patient Survey Eligibility
folder_openChanges to Protocols and Guidelines, Information for Home Health Agenciescalendar_todayPosted October 23, 2009

This announcement is to alert you that, based on feedback from home health care agencies, the Centers for Medicare & Medicaid Services (CMS) has changed the patient eligibility criteria for the Home Health Care CAHPS Survey as indicated below.

• Only patients whose home health care is paid by Medicare or Medicaid will be included in the Home Health Care CAHPS Survey. This means that patients whose home health care is paid solely by sources other than Medicare or Medicaid, such as private health insurance, the Department of Veterans Affairs, TRICARE, etc., are not eligible to participate in the Home Health Care CAHPS Survey. Patients with payers in addition to Medicare or Medicaid are eligible. Agencies may conduct the survey for these other patient groups, but the survey data would not be reported to CMS.

Note that patients enrolled in a Medicare Advantage (MA) health plan such as a MA health maintenance organization, a MA preferred provider organization (PPO), or a Medicare private fee-for-service (PFFS) plan, are considered Medicare patients and are, therefore, eligible to be included in the survey. In addition, patients whose home health care is paid for by a Medicaid managed care plan are eligible to be included in the survey.

Approved Home Health Care CAHPS Survey vendors should alert their client home health agencies that they must exclude patients whose care is NOT paid for by Medicare or Medicaid from the monthly patient information files that the home health agency submits to the survey vendor unless the agency decides that it wants to survey its non-Medicare and/or non-Medicaid patients. Alternatively, the vendor can exclude this group of non-Medicare and/or non-Medicaid patients if the agency gives the vendor the necessary information to make this exclusion. If agencies decide to survey their non-Medicare and non-Medicaid patients, the survey vendor should not submit data for those patients to the Home Health Care CAHPS Survey Data Center.

Note that this change in patient eligibility will not require a change to the sources of payment variable on the XML template. Survey vendors will still be required to indicate the sources of payment on data files submitted to the Home Health Care CAHPS Survey Data Center.

V Diagnoses Codes Now Accepted

The Home Health Care CAHPS Survey Protocols and Guidelines Manual indicates that agencies cannot provide V codes as the primary and other diagnoses codes on the monthly patient information files that they submit to their survey vendor. Based on feedback from home health agencies, CMS has changed this requirement so that V-codes are now allowed to be included among the codes reported.

Home health agencies should note, however, that the reason for collecting diagnosis codes that are not V-codes is to distinguish patients who, because of their underlying condition, may have very different attitudes about the health care they receive and who may respond very differently to the questions about their health care, specifically to the CAHPS Survey items. Prior research has shown that patients rate the care they receive differently based on their characteristics. For example, older patients tend to rate more favorably than younger patients, and patients who are sicker tend to rate less favorably than those in better health.

Consider the case in which two patients are coded with one of the V57 rehab codes: one has had hip or knee surgery, and the other has had a stroke. These two patients will potentially have different perspectives and opinions about the home health care they receive and these will affect how they respond to the CAHPS Survey items, because one is inherently a sicker person than the other. The V-code does not indicate the underlying problem or its severity. In this example researchers would not be able to account for the fact that sicker patients rate their home health care less or more favorably than their healthier counterparts. For this reason, CMS urges survey vendors/home health agencies to provide numeric ICD-9 codes when possible so that survey results can be adjusted to account for any differences in responses based on patient characteristics.

Questions About these Changes?

Please note that the current version of the Home Health Care CAHPS Survey Protocols and Guidelines Manual will be revised to reflect the two changes described above (change in survey eligibility and provision of V codes). However, the next version of the Manual will not be posted until sometime in January 2010.

Please contact the Home Health Care CAHPS Survey Coordination Team if you have any questions or need clarification about these changes by sending an e-mail message to hhcahps@rti.org or by calling Vanessa Thornburg toll-free at 1-866-354-0985.