Medicare Advantage and Prescription Drug Plan CAHPS® Survey

Participation Form

Medicare Advantage and Prescription Drug Plan (MA & PDP) CAHPS® Survey 2025 Survey Administration Participation Form for Survey Vendors

A survey vendor and/or its subcontractor(s) must meet all of the Minimum Business Requirements in order to apply to administer the Medicare Advantage and Prescription Drug Plan (MA & PDP) CAHPS® Survey.

This participation form is to be completed by survey vendors requesting approval to administer the 2025 Medicare Advantage and Prescription Drug Plan CAHPS® Survey (MA & PDP CAHPS). Survey vendors approved to administer the MA & PDP CAHPS Survey must conduct all of their business operations within the United States so the MA & PDP CAHPS Survey Project Team can perform the required oversight activities.

ALL SURVEY VENDOR APPLICATIONS AND MATERIALS ARE DUE BY 7/15/2024 AT 5:00 PM (ET).

 

* Fields marked with an asterisk are required
06/24/2025

I. General Participation Application Information

This section is to be completed with general information for participation in MA & PDP CAHPS Survey Data Collection.

1. Applicant survey vendor

The Name of the Organization is required.
The Address is required.
The City is required.
The State is required.
The Zip Code is required.
Telephone is required.
Fax must at least 10 digits.

2. Applicant Contact Person

First Name is required.
Last Name is required.
Title is required.
Mailing Address 1 is required.
City is required.
State is required.
Zip Code is required.
Telephone is required.
Fax must at least 10 digits.
Email is required.

3. List of Physical Location(s) Where Survey Vendor Conducts Survey Administration Activities

At least one entry is required.
Activity is required.
Address is required.
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CMS Survey Experience

1. Have you been approved as a vendor to implement other CMS surveys in the past five years?
Answer Required.

If Yes, please provide the name of the survey(s) for which you have been approved as a vendor. 
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2. Have you been a subcontractor to an approved vendor for other CMS surveys in the past five years?
Answer Required.

If Yes, please provide the name of the survey vendor(s) and the survey(s) for which you have been a subcontractor.
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3. If Yes to 1 or 2 above, have you had any past performance issues for a CMS survey that resulted in any CMS communication regarding performance? Such communication from CMS would include, but not be limited to, the following: a notice of deficiency, a corrective action memo, a request for a quality improvement plan, or withdrawal of approval for a CMS survey.
Answer Required.
At least one entry is required.
Project Name is required.
Role is required.

Issues is required.

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CMS will consider past performance, as either a survey vendor or subcontractor, on CMS surveys when reviewing your organization’s MA & PDP CAHPS Survey Participation Form.

II. Medicare Advantage and Prescription Drug Plan CAHPS Survey Minimum Business Requirements

The following Minimum Business Requirements must be met by the applicant survey vendor and/or its subcontractor(s) where indicated. Please check Yes or No for each item below to indicate that the organization has read and meets the following Minimum Business Requirements.

1. Relevant Survey Experience 
Demonstrate recent experience in fielding surveys via Web-Mail-Phone Mode (web survey administration followed by survey administration via mail and computer assisted telephone interview [CATI] follow-up of non-respondents).
*

Survey Experience: Survey vendor and/or its subcontractor(s) demonstrate:

·        Minimum of three years prior experience conducting surveys with the Medicare population and administering CAHPS surveys

·        Minimum of three years experience conducting large-scale surveys that include mail survey administration with CATI system telephone follow-up to non- respondents within the most recent two-year time period

·        Minimum of two years conducting surveys via web-mode administration. Web-mode experience must include experience conducting surveys that include web-mode plus follow up of non-respondents via mail or phone. Web-mode experience must be within the most recent two-year time period.
The SurveyExperience field is required.

For Medicare population and CAHPS surveys list the five most recent survey projects in which survey vendor and/or its subcontractor(s) administered surveys:

At least one entry is required.
Name is required.
Average Sample Size is required.
Data Collection Period is required.
Number of Contracted Clients is required.
Mode of Survey Administration is required.

Languages in which Survey was Administered is required.
Survey Vendor or Subcontractor Administered is required.
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*

Number of years in business: Survey vendor has been in business a minimum of four years. (Subcontractor experience cannot be used to fulfill the number of years in business requirement)
The FourYearsInBusiness field is required.
*

Experience with Multiple Survey Languages:

·        Survey vendor and/or its subcontractor(s) have prior experience in conducting surveys in both English and Spanish.

·        A survey vendor will have the option of electing to conduct the MA & PDP CAHPS Survey in Chinese, Korean, Tagalog, and/or Vietnamese.
The ExperienceWithMultipleSurveyLanguages field is required.

2. Organizational Survey Capacity 
Survey Vendor and/or its subcontractor must have the organizational capability and capacity to program web surveys and collect data submitted online, handle a required volume of mail questionnaires and conduct standardized telephone interviewing in a specified time frame.
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Personnel: Survey vendor and/or its subcontractor(s) have designated personnel, including:

·        Project Manager with minimum of three years relevant Mixed Mode survey administration experience;

·        Subject Matter Expert (SME) in web survey administration with a minimum of two years previous experience as project manager for web surveys that include follow-up of non-respondents via mail or phone;

·        Telephone Survey Supervisor with a minimum of one year prior call center experience;

·        Mail Survey Supervisor with a minimum of one year prior experience in role;

·        Web Programmer with a minimum of one year previous experience programming, testing, and collecting data via web survey instruments; and

·        Lead or Primary Programmer with a minimum of one year prior experience in survey data processing and preparing data files for electronic submission.
The Personnel field is required.
*

System Resources:

·        Survey vendor and/or its subcontractor(s) have physical plant resources available to handle the volume of surveys being administered, including:

o      physical facilities

o      electronic equipment and software for secure data collection processing and reporting

o      an electronic survey management system that tracks fielded surveys through the entire protocol, removes records with completed surveys from further outreach in a timely manner across all modes of administration, and protects the confidentiality of personally identifiable information and survey data received from enrollees (e.g., password protections, firewalls, data encryption software, personnel access limitation procedures and protection from all forms of malware including virus and spyware protection)

o      computer programs for implementing web survey instruments that are accessible in mobile and computer versions that are 508 compliant; present similarly on different browser applications, browser sizes, and platforms (mobile, tablet, computer); present similar to mail survey and mirror the design principles of the mail survey (open space between question text and response options, vertical presentation of response options, use of underlining, font styles, etc.); and support use of a URL and enrollee-specific PIN code without requiring sampled enrollees to create a password or other identifier

·       Survey vendor has a disaster recovery plan in place for continued business operations in the event of a natural or human-related disaster.

  • Survey vendor business operations are conducted in a secure commercial work environment. [1]

[1] CMS is currently granting survey vendors exceptions on a case-by-case basis to MA & PDP CAHPS Survey on-site operating requirements during administration of MA & PDP CAHPS.
The SystemResources field is required.
*

Web-Mail-Phone Mode of Survey Administration:

·         Survey vendor and/or its subcontractor(s)

o   Are able to administer web surveys in accordance with specifications provided, including but not limited to:

      • Capacity to disseminate survey invitation emails that include the CMS logo (and optional plan logo), and mirror the language of the mail survey letters and adhere to templates provided by CMS
      • Capacity to disseminate survey invitation emails that include an embedded hyperlink that the enrollee can click on to directly connect to the web survey without entering a PIN or other enrollee-specific code
      • Capacity to produce hard copy letter invitations for the web survey that include a URL of no more than 25 characters and a unique PIN of no more than 10 characters for the enrollee to enter to connect to the web survey

o   Secure file transfer protocol or systems to receive enrollee email address data from contract clients

o   Capacity to clean client-provided email addresses to remove emails that do not conform to standard format of text@suffix, and/or client-provided email addresses that do not include known suffixes

o   Are capable of reproducing, printing, and mailing survey materials in accordance with specifications and timeline provided

o   Use commercial software/resources to ensure that mailing addresses and telephone numbers are accurate and correct for all sample members

o   Have capacity for conducting telephone interviews using CATI system

      • Note: If a survey vendor intends to administer the MA & PDP CAHPS Survey in Chinese, Korean, Tagalog, and/or Vietnamese, web, mail, and telephone modes must be administered in these languages. Survey vendor must have the capacity to maintain an interviewer pool that meets the needs of enrollees in all languages in which the survey is administered, and conduct accurate monitoring of interviewers in these languages.

·         Web survey administration, mail survey administration and telephone interviews shall not be conducted from a residence or virtual office unless the survey vendor has received approval from CMS.[1]
The MixedModeOfSurveyAdministration field is required.
*

Data Submission:

·        Survey vendor has the capacity to register for access to the MA & PDP CAHPS Data Warehouse and follow data specifications and procedures in order to submit and receive encrypted data via the Internet.

·        Subcontractors will not be given access to the MA & PDP CAHPS Data Warehouse and may not submit data.

·        Authorizations and business associate agreements will be established between survey vendor and health or drug plan.
The DataSubmission field is required.
*

Data Security:

·        Survey vendor will ensure Data Use Agreement (DUA) with CMS is kept up to date and that all DUA requirements are followed, including cell size suppression rules.

·        The CMS DUA must be updated within 3 business days of any change to the contact information, individual, or organizations in the DUA, including adding or removing a subcontractor.

·        Vendors must receive approval from CMS to append any additional data to the sample file.

·        Vendors must administer web surveys with a secure user PIN that is unique to each sampled enrollee, the data transmitted over a secure connection over HTTPS using transport layer security (TLS), and respondent information must be securely stored.

·        Vendors must limit access to electronic files to necessary personnel. Firewalls and/or physical barriers must be implemented to protect against unauthorized access to electronic files.

·        Required encryption protocols must be utilized for transmitting data files. Encryption protocols must include a Federal Information Process Standard (FIPS) 140-2 compliant algorithm. CMS-defined personally identifiable information (PII) must be transmitted securely (e.g., encrypted file via email, data portal, or SFTP with file-level encryption).

·        Survey vendors may not provide health or drug plans with any information that may allow contract staff to identify sampled enrollees - either directly or by inference.

·        Survey vendors must not use any MA & PDP CAHPS Survey data, whether preliminary or final results, for any purpose beyond client reports for quality improvement purposes.
The DataSecurity field is required.
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Data Retention:

·        Survey vendor has the capacity to retain all data files, data collected from web surveys, audio recordings and paper copies or scanned images of surveys for a minimum of three years, including sample information.

·        Archived electronic data files, audio recordings, paper copies and/or scanned images will be easily retrievable.

·        Data are backed up daily and back-up procedures must include backup recovery testing to verify files can be retrieved.
The DataRetention field is required.
*

Confidentiality:

Survey vendor:

·         Has the capacity to comply with all HIPAA rules and regulations and store MA & PDP CAHPS data files, including sample information, securely and confidentially

·         Will execute confidentiality agreements with staff and subcontractors (if applicable) that must be re-signed annually

·         Must not share identifying information about enrollees in the survey sample with health or drug plans
The Confidentiality field is required.
*

Technical Assistance/Customer Support:

·        Survey vendor must establish a customer support email address to answer queries from enrollees. The customer support email address should have staff available during regular business hours (to be established from the time of the pre-notification letter) to respond to enrollee emails asking for technical assistance to access or complete the web survey.

·        Survey vendor and/or its subcontractor(s) have the capability and capacity to provide toll-free customer support telephone lines with the ability to respond to both Spanish and English inquiries.

o      Note: If a survey vendor intends to administer the MA & PDP CAHPS Survey in Chinese, Korean, Tagalog, and/or Vietnamese, the survey vendor and/or its subcontractor(s) must have the capability and capacity to respond to inquiries received by phone or email in these optional languages.

·        Survey vendor must have the capacity to conduct accurate monitoring of the customer support line and customer support email inbox in all languages in which the survey is administered to ensure accurate responses are provided.
The TechnicalAssistanceCustomerSupport field is required.

3. Quality Control Procedures 
Personnel training and quality control mechanisms employed to collect valid, reliable survey data.
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Demonstrated Quality Control Procedures:

·         Survey vendor has the capacity to set up, conduct, and document quality control procedures for all phases of survey implementation including:

o   monitoring of subcontractors, if applicable

o   training; 

o   web administration of surveys via emailed and paper invitations in all languages in which survey is administered

o   printing, mailing, and recording receipt of surveys

o   telephone administration and monitoring of survey (electronic telephone interviewing system) in all languages in which the survey is administered

o   coding, editing, or keying in survey data

o   preparing final enrollee data files for interim and final submission

o   all other functions and processes that affect the administration of the MA & PDP CAHPS Survey

·         Survey vendors must develop and submit a Quality Assurance Plan by specified due date.

·         Survey vendor must submit an Event Report to CMS within one business day of becoming aware of an event in survey administration.
The DemonstratedQualityControlProcedures field is required.

4. Explanation 
Please explain any “NO” responses above.
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III. List of Key Project Staff

List of key project staff

At least one entry is required.
Project Staff Name is required.
Role is required.
Email is required.
Telephone Number is required.
Survey Vendor or Subcontractor is required.
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IV. List of Subcontractors

A subcontractor is any organization that performs key survey administration functions on behalf of an MA & PDP CAHPS Survey vendor that requires receipt of an electronic file containing beneficiary-level personally identifiable information (PII).

The HasSubContractors field is required.
4a. Do you currently use subcontractors? Yes No If no, go to Section V.

LIST OF SUBCONTRACTORS (add more lines if necessary or include as a separate attachment). Note: Survey vendors must submit any changes in subcontractors to CMS for approval. CMS will review all subcontractors prior to authorization.

At least one entry is required.
Organization Name is required.
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V. Curriculum Vitae (CV)

Please submit a CV for all identified key project staff for both survey vendor and subcontractor(s) via the MA & PDP CAHPS Technical Assistance email at MA-PDPCAHPS@hsag.com.

VI. Rules of Participation

Any survey vendor and/or its subcontractor(s) participating in the Medicare Advantage and Prescription Drug Plan (MA & PDP) CAHPS Survey must adhere to the following Rules of Participation. To be eligible, the organization must:

  1. Participate in a teleconference call with the MA & PDP CAHPS Survey Project Team to discuss relevant survey experience, organizational survey capability and capacity, quality control procedures, and role of subcontractors (as requested).
  2. Submit interim and final MA & PDP CAHPS Survey data files to CMS. Survey vendors must submit a signed Attestation document with the interim and final data submissions confirming all data collected and submitted in the data file are accurate and complete.
  3. Participate in and successfully complete MA & PDP CAHPS training webinars for vendors. At a minimum, the organization’s Project Manager, SME in web survey administration, Mail Survey Supervisor, and Telephone Survey Supervisor must attend training as representatives of the organization. Project staff member(s) responsible for the following functions are also recommended to attend training:
      • Decrypting the sample file and performing sample file quality checks
      • Programming the CATI script
      • Programming the web survey
      • Preparing and submitting the survey data file
      • Programming the sample management systems used to track and/or document survey operations for sampled enrollees during web, mail, and phone administration of the survey
    If a subcontractor will be conducting any of the functions below, at least one representative from that subcontractor organization must attend training:
      • Inserting or survey packet preparation
      • Processing of returned mail surveys
      • Conducting telephone interviews (CATI administration)
      • Conducting web surveys (programming and/or hosting)
  4. Review and follow the MA & PDP CAHPS Quality Assurance Protocols & Technical Specifications and Policy Updates.
  5. Attest to the accuracy of the organization’s data collection (as determined by CMS), following guidelines set forth in the most current version of the MA & PDP CAHPS Quality Assurance Protocols & Technical Specifications.
  6. Develop and submit an MA & PDP CAHPS Survey Quality Assurance Plan (QAP) by due date. In addition, submit materials relevant to the survey administration (as determined by CMS), including email invitations, web survey testing links for all survey versions and languages being administered that allow project team to test appearance and functionality of web survey, mailing materials (e.g., pre-notification letters, cover letters, and questionnaires) for all survey versions and languages, CATI testing links for all survey versions in English and Spanish to test functionality of CATI survey, and screenshots of all CATI screens in optional survey languages. Screenshots of the CATI survey with skip logic may be provided if provision of a CATI survey test link is not possible.
  7. Participate and cooperate (including subcontractors) in all oversight activities conducted by the MA & PDP CAHPS Survey Project Team, including in-person or remote visits to business operation site(s) to observe MA & PDP CAHPS web survey administration, mail survey packet production and insertion, CATI survey administration, and/or activities related to data preparation and submission.
  8. Acknowledge that review of and agreement with the Rules of Participation are necessary for participation and public reporting of results by the Centers for Medicare & Medicaid Services.

VII. Applicant Organization Qualification and Acceptance:

I certify that:

  • I have reviewed and agree to meet the Rules of Participation for participating in the Medicare Advantage and Prescription Drug Plan (MA & PDP) CAHPS Survey.
  • The statements herein are true, complete, and accurate to the best of my knowledge, and I accept the obligation to comply with the MA & PDP CAHPS Survey Minimum Business Requirements.
AUTHORIZED REPRESENTATIVE
Rep name required.
Title required.
Organization name is required.
06/24/2025

Submit this form online at www.ma-pdpcahps.org.

For assistance, please contact the MA & PDP CAHPS Survey Project Team by telephone at 1-877-735-8882 or email at ma-pdpcahps@hsag.com.

 

You will receive notification once the form has been successfully submitted.

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