[Federal Register Volume 87, Number 112 (Friday, June 10, 2022)]
[Notices]
[Pages 35576-35580]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-12501]


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OFFICE OF PERSONNEL MANAGEMENT


Submission for Review: CAHPS Enrollee Survey 3206-0274-RENEWAL

AGENCY: Office of Personnel Management.

ACTION: 30-Day notice with request for comment.

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SUMMARY: The Office of Personnel Management (OPM) offers the general 
public and other Federal agencies the opportunity to comment on a 
proposed information collection (ICR) 3206-0274, Consumer Assessment of 
Healthcare Providers and Systems (CAHPS[supreg]). As required by the 
Paperwork Reduction Act of 1995, as amended by the Clinger-Cohen Act, 
OPM is soliciting comments for this collection. The information 
collection was previously published in the Federal Register on February 
25, 2022 allowing for a 60-day public comment period. OPM received 
twenty-nine comments in response to this information collection. The 
organizations that submitted comments are the American Association of 
Nurse Practitioners and the Association of Federal Health Organizations 
(AFHO). The comments and OPM's responses are in the table.

DATES: Comments are encouraged and will be accepted until July 11, 
2022. This process is conducted in accordance with 5 CFR 1320.1.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting, ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.

FOR FURTHER INFORMATION CONTACT: To request more information on the 
proposed project or to obtain a copy of the data collection plans and 
instruments, contact: Michael Kaszynski, Senior Policy Analyst at 
[email protected]. Formal requests must be in writing.

SUPPLEMENTARY INFORMATION: The Office of Management and Budget is 
particularly interested in comments that:
    1. Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
    2. Evaluate the accuracy of the agency's estimate of the burden of 
the proposed collection of information, including the validity of the 
methodology and assumptions used;
    3. Enhance the quality, utility, and clarity of the information to 
be collected; and
    4. Minimize the burden of the collection of information on those 
who are to respond, including through the use of appropriate automated, 
electronic, mechanical, or other technological collection techniques or 
other forms of information technology,

[[Page 35577]]

e.g., permitting electronic submissions of responses.

Analysis

    Frequency: Annually.
    Affected Public: Federal Employees and Retirees.
    Number of Respondents: 73,505.
    Estimated Time per Respondent: 15 minutes.
    Total Burden Hours: 18,376 hours.

    U.S. Office of Personnel Management.
Kellie Cosgrove Riley,
Director, Office of Privacy and Information Management.

                    OPM Response to Comments for the CAHPS Enrollee Survey 3206-0274--Renewal
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  Public/individual  comments     Section/issue          Comment             Decision            Reasoning
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American Association of Nurse                     Requested that OPM     OPM determined    As the Agency for
 Practitioners (AANP).                             amend the survey by    that this         Healthcare Research
                                                   changing the word      feedback does     and Quality (AHRQ)
                                                   ``doctor'' to          not necessitate   is the survey
                                                   ``health care          a change to the   steward, comments
                                                   provider''             30-day notice.    related to survey
                                                   throughout the                           format or
                                                   instrument and                           questioning clarity
                                                   clarify that nurse                       should be directed
                                                   practitioners are                        to https://
                                                   included in that                         www.ahrq.gov/cahps/
                                                   definition.                              surveys-guidance/
                                                                                            index.html.
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The following section includes recommendations and responses from the Association of Federal Health
 Organizations (AFHO).
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The Association of Federal      Time Burden        AFHO members  OPM determined    The comments indicate
 Health Organizations (AFHO).    Estimate.         generally agree with   that this         a general agreement
                                                   the assessment of 15   feedback does     with the estimate.
                                                   minutes per response   not necessitate
                                                   time adding to         a change to the
                                                   18,376 hours for       30-day notice.
                                                   73,505 total
                                                   respondents. AFHO
                                                   members note that
                                                   the CAHPS survey
                                                   response time is
                                                   evidence[hyphen]base
                                                   d; however, response
                                                   time may vary by the
                                                   respondent, by
                                                   administration
                                                   method, and by a
                                                   respondent's
                                                   decision to not
                                                   respond at all. In
                                                   addition, the burden
                                                   assessment may not
                                                   reflect the
                                                   experience of
                                                   members with a
                                                   language barrier.
                                The CAHPS Survey   OPM should     OPM       OPM asks
                                 Instrument.       support refining and   determined that   Carriers to
                                                   streamlining           this feedback     implement the CAHPS
                                                   questions to be more   does not          survey as part of
                                                   direct and clearer,    necessitate a     OPM's Plan
                                                   as well as,            change to the     Performance
                                                   actionable for         30-day notice.    Assessment (PPA)
                                                   managed care           As OPM is not     annual process to
                                                   companies/PPOs.        the survey        assess the customer
                                                  [cir] For example,      steward, we       experience. As AHRQ
                                                   questions evaluating   cannot make       is the survey
                                                   provider interface     changes to the    steward, comments
                                                   with members are not   CAHPS Health      related to survey
                                                   directly actionable    Plan Survey       format or question
                                                   by plans, while        5.1H, Adult       clarity should be
                                                   questions related to   Version.          directed to https://
                                                   member website                           www.ahrq.gov/cahps/
                                                   interface with plan                      surveys-guidance/
                                                   operations or tools,                     index.html.
                                                   such as the provider                     OPM
                                                   directory or member                      understands that
                                                   website are                              Carriers have the
                                                   actionable by plans.                     best information
                                                                                            available in
                                                                                            relation to the
                                                                                            language needs of
                                                                                            their members.
                                                                                            Questions related to
                                                                                            survey translation
                                                                                            should be directed
                                                                                            to AHRQ. AHRQ
                                                                                            provides additional
                                                                                            information on CAHPS
                                                                                            translation services
                                                                                            Guidelines for
                                                                                            Translating
                                                                                            CAHPS[supreg]
                                                                                            Surveys [verbar]
                                                                                            Agency for
                                                                                            Healthcare Research
                                                                                            and Quality
                                                                                            (ahrq.gov).
                                                   Some AFHO
                                                   members assert that
                                                   CAHPS is a lengthy
                                                   survey which may
                                                   contribute to a drop
                                                   in response rates.
                                                   As many of the
                                                   topical areas in
                                                   CAHPS are unlikely
                                                   to change year-over-
                                                   year, it may be
                                                   possible to shorten
                                                   the CAHPS survey by
                                                   administering only
                                                   one topical area per
                                                   year to boost
                                                   response rates,
                                                   lessen burden, and
                                                   generate a cycle for
                                                   measuring both
                                                   relative levels of
                                                   satisfaction and
                                                   impact of
                                                   improvement
                                                   activities. The
                                                   questions would be
                                                   rotated from year to
                                                   year to allow all
                                                   questions to be
                                                   surveyed cyclically.
                                                   OPM should
                                                   identify and share
                                                   with carriers the
                                                   preferred language
                                                   of each FEHB member
                                                   to support survey
                                                   translation
                                                   prioritization and
                                                   to tailor the
                                                   distribution of
                                                   appropriate surveys
                                                   through CAHPS
                                                   vendors.
                                                   OPM should
                                                   arrange for
                                                   standardizing
                                                   translations of the
                                                   CAHPS surveys to
                                                   avoid potential
                                                   inconsistencies in
                                                   messaging (i.e.,
                                                   having AHRQ perform
                                                   translations for
                                                   consistency in
                                                   structure and
                                                   messaging across
                                                   health plans
                                                   distributing surveys
                                                   in other languages
                                                   versus health plans
                                                   following
                                                   recommendations to
                                                   generate surveys in
                                                   a variety of
                                                   languages
                                                   themselves).

[[Page 35578]]

 
                                                   Several AFHO
                                                   members service plan
                                                   members living in
                                                   other countries
                                                   where language and
                                                   terminology used in
                                                   CAHPS may not be as
                                                   common making it
                                                   challenging to track
                                                   actionable responses
                                                   via CAHPS data.
                                                   The
                                                   anonymity of CAHPS
                                                   data, while
                                                   purposeful for the
                                                   survey intent, does
                                                   impose a challenge
                                                   to implementing
                                                   targeted member
                                                   experience
                                                   improvement;
                                                   therefore, some
                                                   plans assume an
                                                   added burden in
                                                   coordinating
                                                   independent target
                                                   assessments. In
                                                   terms of the
                                                   actionability of
                                                   CAHPS information
                                                   for the health plan.
                                                   Some AFHO
                                                   members recommend
                                                   integrating open-
                                                   ended comments in
                                                   the CAHPS survey as
                                                   the high-level
                                                   nature of the CAHPS
                                                   survey presents a
                                                   challenge to
                                                   actionability.
                                                   Several of
                                                   the questions in the
                                                   survey are related
                                                   to provider behavior
                                                   versus health plan
                                                   behavior, which is
                                                   not as directly
                                                   actionable.
                                CAHPS Survey       OPM should     OPM       Multiple
                                 Data Collection.  encourage efforts to   determined that   survey methodologies
                                                   promote email and      this feedback     are allowed under
                                                   text-based member      does not          AHRQ and NCQA
                                                   outreach to increase   necessitate a     guidelines and OPM
                                                   digital survey         change to the     does not have any
                                                   responses and          30-day notice.    jurisdiction in this
                                                   improve response       As OPM is not     arena. Feedback
                                                   rates for more         the survey        related to survey
                                                   complete data          steward, we       administration
                                                   collection.            cannot make       should be directed
                                                   FEHB members   changes to the    to NCQA and AHRQ as
                                                   are more receptive     CAHPS Health      they Oversee the
                                                   to completing a        Plan Survey       survey data
                                                   paper or online        5.1H, Adult       collection
                                                   survey as opposed to   Version           guidelines.
                                                   a telephone-           administration
                                                   administered survey    guidelines.
                                                   which may take
                                                   longer to complete.
                                                   AFHO
                                                   recommends inviting
                                                   sampled individuals
                                                   to participate in
                                                   CAHPS via email or
                                                   text, when possible.
                                                   If outreach
                                                   transitions to
                                                   digital and text,
                                                   then carriers should
                                                   have the option of
                                                   forgoing mail
                                                   outreach as this is
                                                   cost prohibitive.
                                                   More
                                                   research is still
                                                   needed to better
                                                   understand the
                                                   effect of email or
                                                   text outreach on
                                                   burden. In terms of
                                                   CAHPS administrative
                                                   burden on carriers,
                                                   AFHO members have
                                                   experienced
                                                   challenges with
                                                   survey distribution
                                                   and collection.
                                                   In terms of
                                                   CAHPS administrative
                                                   burden on carriers,
                                                   AFHO members have
                                                   experienced
                                                   challenges with
                                                   survey distribution
                                                   and collection.
                                                   AFHO members
                                                   shared COVID-19
                                                   pandemic-related
                                                   supply chain
                                                   disruptions in
                                                   acquiring mailing
                                                   materials for CAHPS.
                                                   The two-week
                                                   telephone interview
                                                   field period
                                                   presents a challenge
                                                   as it requires a
                                                   large volume of
                                                   interviews to be
                                                   conducted in a short
                                                   timeframe, and at
                                                   times a member may
                                                   have already
                                                   completed a paper
                                                   survey when they are
                                                   called, but the
                                                   health plan had not
                                                   received it yet, due
                                                   to mail delays.

[[Page 35579]]

 
                                Feedback Related   CAHPS          OPM       OPM
                                 to Data Use.      provides a             determined that   understands that the
                                                   standardized method    this feedback     practicality of
                                                   of measuring and       does not          CAHPS data is
                                                   understanding member   necessitate a     determined
                                                   experience which is    change to the     individually by each
                                                   a key component of     30-day notice.    FEHB Carrier as they
                                                   health plan                              use customer
                                                   performance, as well                     satisfaction data
                                                   as any opportunities                     for planning in
                                                   to improve member                        conjunction with
                                                   experience. AFHO                         other measures that
                                                   members have                             they collect to
                                                   indicated that                           assess the customer
                                                   information                              experience. OPM
                                                   collected from CAHPS                     continues to explore
                                                   has limited                              other strategies to
                                                   practical utility.                       measure customer
                                                   The FEHB                         service. At this
                                                   serves an aging                          time, OPM has not
                                                   demographic. To                          found a suitable
                                                   ensure the                               replacement that
                                                   accessibility of                         meets the PPA
                                                   CAHPS for older                          methodology
                                                   populations, OPM                         criteria.
                                                   should take FEHB                         OPM reviews
                                                   demographics into                        CAHPS demographics
                                                   account as changes                       during the annual
                                                   to survey processes                      data evaluation.
                                                   or guidelines may                        This information is
                                                   pose a challenge to                      reviewed internally
                                                   members' ability to                      and not available
                                                   complete the survey.                     for public
                                                   OPM should                       distribution.
                                                   provide carriers                         OPM relies
                                                   with an                                  on Carriers to make
                                                   understanding of how                     determinations on
                                                   OPM's Plan                               improving Carrier
                                                   Performance                              performance as they
                                                   Assessment (PPA)                         have the best
                                                   program uses CAHPS                       understanding of
                                                   data to improve                          their member
                                                   carrier performance,                     population, benefit
                                                   given that CAHPS is                      design, and
                                                   a randomly sampled                       operating
                                                   survey with subject                      environment.
                                                   responses provided                       OPM has
                                                   based on each                            hosted a PPA Best
                                                   respondent's                             Practice Workgroup
                                                   interpretation of                        presentation on
                                                   the questions.                           methods FEHB
                                                                                            Carriers have
                                                                                            employed to improve
                                                                                            on select CAHPS
                                                                                            measures. Workgroup
                                                                                            presentations are
                                                                                            intended to give
                                                                                            insight into
                                                                                            successful quality
                                                                                            improvement efforts
                                                                                            on specific topics
                                                                                            for FEHB Carriers.
                                                                                            It is not meant to
                                                                                            dictate any business
                                                                                            activities. The PPA
                                                                                            Best Practices
                                                                                            Workgroup is a forum
                                                                                            to allow for open
                                                                                            dialogue and idea
                                                                                            sharing among FEHB
                                                                                            Carriers.
                                Feedback Related   To improve     OPM       OPM
                                 to Data           the actionability of   determined that   understands that
                                 Distribution.     collected data, OPM    this feedback     FEHB Carriers have
                                                   should create and      does not          access to the
                                                   share a demographic    necessitate a     demographic
                                                   analysis of all        change to the     breakdown of their
                                                   CAHPS surveys          30-day notice.    own member
                                                   collected by OPM       As OPM is not     population. At this
                                                   from year to year.     the survey        time, OPM does not
                                                   This analysis would    steward, we       intend to share
                                                   allow OPM, carriers    cannot make       demographic data
                                                   and the public to      changes to the    from CAHPS across
                                                   understand better      CAHPS Health      FEHB Carriers.
                                                   FEHB member            Plan Survey
                                                   demographics, such     5.1H, Adult
                                                   as geography and       Version
                                                   enrollment type.       administration
                                                   Specifically, the      guidelines.
                                                   analysis would offer
                                                   an opportunity for
                                                   carriers to identify
                                                   the demographic
                                                   aggregations that
                                                   would be most
                                                   meaningful in
                                                   assessing member
                                                   experience for
                                                   actionable quality
                                                   improvement.
                                                   OPM should
                                                   share FEHB member
                                                   race, ethnicity, and
                                                   gender identity with
                                                   carriers to optimize
                                                   diverse member data
                                                   representation in
                                                   the CAPHS surveys.
                                Feedback Related   OPM should     OPM       OPM
                                 to PPA            consider whether       determined that   continues to explore
                                 Methodology.      there is an            this feedback     other strategies to
                                                   opportunity to         does not          measure customer
                                                   better align the PPA   necessitate a     service. At this
                                                   with National          change to the     time, OPM has not
                                                   Committee for          30-day notice.    found a suitable
                                                   Quality Assurance                        replacement that
                                                   (NCQA) Ratings and                       meets the PPA
                                                   Accreditation where                      methodology
                                                   similar information                      criteria.
                                                   is also being                            The PRA
                                                   collected.                               request was not a
                                                   AFHO members                     vehicle to provide
                                                   also encourage                           feedback on PPA
                                                   better alignment                         methodology. To
                                                   with NCQA and OPM in                     provide methodology
                                                   tracking CAHPS                           feedback, please
                                                   improvement as part                      email
                                                   of NCQA                                  FEHBPerformance@opm.
                                                   accreditation.                           gov.
                                                   Reporting on
                                                   the percentage of
                                                   members who indicate
                                                   a rating of 9-10 on
                                                   rating items versus
                                                   the percentage of
                                                   members who indicate
                                                   a rating of 8-10, to
                                                   better align with
                                                   NCQA ratings or
                                                   transition to the
                                                   use of NCQA ratings
                                                   for OPM purposes to
                                                   reduce duplication
                                                   of efforts.
                                                   Extending
                                                   the review timeline
                                                   for CAHPS
                                                   performance data.
                                                   Allowing for
                                                   the review of all
                                                   FEHB plan CAHPS
                                                   reports from the
                                                   past two measurement
                                                   years rather than
                                                   one measurement year
                                                   to better assess the
                                                   actual impact of
                                                   improvement plans
                                                   using CAHPS survey
                                                   data.
                                                   Will the Net
                                                   Promoter Score (NPS)
                                                   referenced in
                                                   Carrier Letter 2018-
                                                   07 will receive
                                                   further discussion
                                                   as a potential
                                                   replacement for
                                                   CAHPS?.
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[[Page 35580]]

[FR Doc. 2022-12501 Filed 6-9-22; 8:45 am]
BILLING CODE 6325-63-P