[Federal Register Volume 77, Number 120 (Thursday, June 21, 2012)]
[Notices]
[Pages 37409-37410]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-15162]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-9963-NC]


Request for Domains, Instruments, and Measures for Development of 
a Standardized Instrument for Use in Public Reporting of Enrollee 
Satisfaction With Their Qualified Health Plan and Exchange

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: The Patient Protection and Affordable Care Act (the Affordable 
Care Act) requires the Department of Health and Human Services (HHS) to 
establish an enrollee satisfaction survey system to be administered to 
members of each qualified health plan offered through an Exchange. This 
notice solicits input on publicly-available domains (for example, broad 
functional areas such as access, communication, coordination of care, 
customer service), instruments, and measures for measuring the level of 
enrollee satisfaction with qualified health plans plus the experience 
of the consumer interacting with the health care system and the 
experience of the consumer interacting with the Exchange (for example, 
enrollment and customer service) from consumers, researchers, vendors, 
health plans, Exchanges, stakeholders, and other interested parties.

DATES: Input is sought by June 29, 2012.

ADDRESSES: Electronic submissions are encouraged, preferably as an 
email with an electronic file in a standard word processing format as 
an email attachment. Submissions may also be in the form of a letter 
to: Kathleen Jack, Center for Consumer Information and Insurance 
Oversight, Centers for Medicare & Medicaid Services, 7500 Security 
Blvd., Mailstop: C5-17-16, Windsor Mill, MD 21244, Phone: (410) 786-
7214, Email: Kathleen.Jack@cms.hhs.gov.

FOR FURTHER INFORMATION CONTACT: Kathleen Jack, 410-786-7214.

SUPPLEMENTARY INFORMATION:

I. Background

    On March 23, 2010, the President signed into law the Patient 
Protection and Affordable Care Act (Pub. L. 111-148). On March 30, 
2010, the Health Care and Education Reconciliation Act of 2010 (Pub. L. 
111-152) was signed into law. The two laws are collectively referred to 
as the Affordable Care Act. The Affordable Care Act creates new 
competitive private health insurance marketplaces, Affordable Insurance 
Exchanges (Exchanges), that will give millions of Americans and small 
businesses access to quality, affordable coverage.
    Section 1311(c)(4) of the Affordable Care Act directs HHS to 
establish an enrollee satisfaction survey system to be administered to 
members of each qualified health plan (QHP) offered through an 
Exchange. In addition, 45 CFR 156.200(b)(5) (77 FR 18310, at 18469 
(Mar. 27, 2012)) requires implementation of the enrollee satisfaction 
survey as part of QHP certification requirements. Consistent with our 
intent that QHP-specific quality ratings would be available in 2016 
open enrollment for the 2017 coverage year, HHS intends to propose that 
the enrollee satisfaction survey be implemented in 2016 and available 
for display on the Internet portal for every Exchange in 2016 open 
enrollment for the 2017 coverage year. This call for domains, 
instruments, and measures is occurring now because of the multi-phased 
survey development and testing process necessary before full 
implementation.

II. Consumer Survey

    The Centers for Medicare & Medicaid Services (CMS) is soliciting 
the submission of publicly-available domains,\1\ instruments and 
measures for

[[Page 37410]]

capturing the experience of the consumer with a QHP offered through an 
Exchange. HHS is considering how the scope of the enrollee satisfaction 
survey may also include the experience of the consumer interacting with 
the health care system as well as the experience of the consumer 
interacting with the Exchange (for example, enrollment and customer 
service). CMS is soliciting the submission of publicly-available 
domains, instruments and measures for assessing this experience as 
well. On both issues, CMS is interested in instruments and items which 
can measure quality of care from the consumer's perspective and track 
changes over time.
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    \1\ The Agency for Healthcare Research and Quality (AHRQ) 
defines domains for the purposes of the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS) survey as ``broad 
functional areas.'' See https://www.cahps.ahrq.gov/About-CAHPS/Glossary.aspx (last accessed May 18, 2012).
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    The target population for the enrollee satisfaction survey is the 
Exchange enrollees (i.e., individuals enrolled in QHPs). Exchange 
enrollees may differ from the populations who are currently 
commercially-insured in their experience with health coverage and the 
health care system, health literacy, and knowledge of quality care. CMS 
is looking for items for which (1) the people who received care are the 
best or only judge and (2) consumers and patients identified the 
information as important to them; for example, enrollees can best 
acknowledge if the QHP/Exchange met their information needs or 
explained things in ways they can understand. Existing instruments that 
have been tested should have a high degree of reliability and validity; 
evidence of wide use will be helpful.
    Section 1311(c)(4) of the of the Affordable Care Act directs that 
the enrollee satisfaction survey will ``evaluate the level of enrollee 
satisfaction with qualified health plans offered through an Exchange, 
for each qualified health plan that had more than 500 enrollees in the 
previous year.'' CMS is developing this survey system and intends to 
submit it to the Agency for Healthcare Research and Quality (AHRQ) for 
recognition as a Consumer Assessment of Healthcare Providers and 
Systems (CAHPS[supreg]) survey. CAHPS[supreg] is a registered trademark 
of AHRQ. The survey will be developed in accordance with CAHPS[supreg] 
Survey Design Principles and implementation instructions will be based 
on those for CAHPS[supreg] instruments (https://www.cahps.AHRQ.gov/About-CAHPS/Principles.aspx). Using the CAHPS[supreg] mark is 
advantageous because it assures consumers and stakeholders that the 
survey data submitted meet the original validity and reliability 
standards reported by the CAHPS[supreg] program and are comparable to 
data from other competing organizations. We intend for the enrollee 
satisfaction survey to be a trademarked CAHPS[supreg] survey to ensure 
efficacy of the enrollee satisfaction survey and to ultimately reduce 
issuer burden by streamlining potential Exchange and State reporting 
requirements. All CAHPS[supreg] surveys are available to users free of 
charge and are published on the CMS or AHRQ Web sites.

III. Submission Guidelines

    When submitting domains, include, to the extent available:
     Detailed descriptions of question domain and specific 
purpose.
     Sample questions, in all available languages.
     Relevant peer-reviewed journal articles or full citations.
    When submitting instruments, submitter shall include, to the extent 
available:
     Name of the instrument.
     Copies of the full instrument in all available languages.
     Domains included in the instrument.
     Measures derived from the instrument.
     Instrument reliability (internal consistency, test-retest, 
etc) and validity (content, construct, criterion-related).
     Results of cognitive testing.
     Results of field testing.
     Current use of the instrument (who is using it, what it is 
being used for, what population it is being used with, how instrument 
findings are reported, and by whom the findings are used).
     Relevant peer-reviewed journal articles or full citations.
     CAHPS[supreg] trademark status.
     Survey administration instructions.
     Data analysis instructions.
     Guidelines for reporting survey data.
    When submitting measures, submitter shall include, to the extent 
available:
     Measure characteristics.
     Importance of the measure.
     Populations addressed by the measure.
     Measure reliability (internal consistency, test-retest, 
etc.) and validity (content, construct, criterion-related).
     Results of cognitive testing.
     Results of field testing.
     Current use of the measure (who is using it, what it is 
being used for, how measure finding are reported, and by whom the 
findings are used).
     Status of the National Quality Forum (NQF) endorsement and 
NQF number.
    All submissions include:
     A brief cover letter summarizing the information requested 
above for submitted instruments and domains, respectively and how the 
submission will help fulfill the intent of the enrollee satisfaction 
survey;
     (Optional) Complete information about the person 
submitting the material for the purposes of follow up questions about 
the submission, including:
    ++ Name
    ++ Title
    ++ Organization
    ++ Mailing address
    ++ Telephone number
    ++ Email address
     Indication that the domain, instrument or measure is 
publicly-available.

    Dated: May 15, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Approved: June 14, 2012.
Kathleen Sebelius,
Secretary.
[FR Doc. 2012-15162 Filed 6-18-12; 11:15 am]
BILLING CODE 4120-01-P