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Introductory Webinar Nationwide CAHPS Survey of Adult Medicaid Enrollees ***UPDATED*** 9/8/2014 with new guidance from CMS.

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Presentation on theme: "Introductory Webinar Nationwide CAHPS Survey of Adult Medicaid Enrollees ***UPDATED*** 9/8/2014 with new guidance from CMS."— Presentation transcript:

1 Introductory Webinar Nationwide CAHPS Survey of Adult Medicaid Enrollees ***UPDATED*** 9/8/2014 with new guidance from CMS

2 To introduce states to the Nationwide CAHPS Survey of Adult Medicaid Enrollees and describe the collaboration that CMS is seeking from states to develop a survey sample to field the CAHPS survey in all states and the District of Columbia in Fall 2014. Nationwide CAHPS Survey of Adult Medicaid Enrollees 2 Purpose of this Webinar

3 Introductions & Overview of the Survey Effort Experiences of the Pilot States Overview of the Sampling Options Setting up the Secure Data Transfer Connection Next Steps Questions Nationwide CAHPS Survey of Adult Medicaid Enrollees 3 Webinar Agenda

4 Introductions & Overview of the Survey Effort

5 In the Fall of 2014, CMS’ Center for Medicaid and CHIP Services (CMCS) will conduct the first ever nationwide survey of access to care and experiences of care among adults enrolled in Medicaid. This survey will provide states, other stakeholders, and CMS with uniform national and state-specific data on the health care experiences of the non-institutionalized adult Medicaid population, thus informing quality improvement efforts. Nationwide CAHPS Survey of Adult Medicaid Enrollees 5 What is the Nationwide CAHPS Survey of Adult Medicaid Enrollees?

6 CMS and NORC, in collaboration with its partner, Thoroughbred Research Group (a CAHPS certified vendor), will manage a sample selection process intended to draw approximately 1.5 million adult Medicaid enrollees nationwide for the CAHPS survey. To draw the nationwide sample, NORC will work with states to obtain a sample of roughly 29,000 adult Medicaid enrollees from each state. Nationwide CAHPS Survey of Adult Medicaid Enrollees 6

7 The CAHPS sample will be stratified into four subgroups of interest: 1)adults who are dually eligible for Medicare and Medicaid; 2)adults with disabilities who are not dually eligible for Medicare and Medicaid; 3)adults who are neither dually eligible nor have disabilities, and who are enrolled in a comprehensive managed care organization; and 4)adults who are neither dually eligible nor have disabilities, and who obtain care from a fee-for-service provider or are enrolled in a primary care case management plan. Nationwide CAHPS Survey of Adult Medicaid Enrollees 7

8 The questionnaire is a modified version of the Adult Consumer Assessment of Healthcare Providers and Systems (CAHPS ® ) Medicaid 5.0H survey containing supplemental questions to assess potential access barriers more broadly. Additional topics include: 8 Nationwide Adult Medicaid CAHPS Survey Instrument Tobacco cessation Use of flu shot/flu spray Access barriers due to disability (modified MEPS and NHIS questions) Mental and behavioral health issues HHS data collection standards for race, ethnicity, sex, primary language, and disability status per Section 4302 of the ACA Nationwide CAHPS Survey of Adult Medicaid Enrollees

9 Between January – March 2014, CMS and its contractor, NORC worked with five states to pilot test three proposed sampling options, and to develop plans to mitigate any future survey challenges with regard to sample selection and data transfer. Pilot states: Alabama, Oregon, Rhode Island, Tennessee, and West Virginia The pilot examined the: Viability of different sampling options used to select samples; Quality of the samples drawn; Secure transfer of data between states, CMS, and NORC; and the Estimated level of burden on states associated with each of the proposed sampling options. Nationwide CAHPS Survey of Adult Medicaid Enrollees 9 Pilot Test of the Sampling Options

10 Experiences from Pilot States

11 Pursued Sampling Option 1 (NORC drew a sample based on OR’s recent MSIS data) Little work other than appending enrollee contact info to the file Time burden: ~1 day worth of work over a week (~average across pilot states was 8-9 hours) Effort required of the state was minimal and the process was generally clear; felt NORC and CMS were supportive and responsive Recommendations to other states: Complete and submit the Secure Data Transfer Set-up Questionnaire ASAP Identify a key state point person to lead & coordinate the effort –Track down key persons ahead of time (e.g., MSIS person, etc.) If contract will be required for subcontractor, start to get it set up Nationwide CAHPS Survey of Adult Medicaid Enrollees 11 Pilot States’ Insights – OREGON

12 Pursued Sampling Option 2 (state supplied a data extract from which NORC drew a sample) More work than under Option 1 as state had to create new files from the extracted beneficiary records, but manageable lift Across all pilot states: ~57 hours of work across 2-4 weeks –AL’s experience: 15 hours across 3 weeks Clear instructions helped move this process along smoothly; felt NORC and CMS were supportive and responsive Recommendations to other states: Complete and submit the Secure Data Transfer Set-up Questionnaire ASAP Identify a key state point person to lead & coordinate the effort –Track down key persons ahead of time (e.g., MSIS person, etc.) If contract is required for subcontractor, start to get it set up 12 Pilot States’ Insights – ALABAMA Nationwide CAHPS Survey of Adult Medicaid Enrollees

13 Overview of Sampling Options

14 In order to survey Medicaid enrollees, CMS must partner with states to obtain enrollee contact information. The data NORC is seeking includes (i.e., data that will be in the data file a state sends): –Contact information –Demographic information –Eligibility information NORC will not be seeking health claims data or other types of protected health information (PHI) / personally identifiable information (PII). Nationwide CAHPS Survey of Adult Medicaid Enrollees 14 Overview of Sampling Options

15 CMS recognizes that some state Medicaid agencies and Medicaid health plans currently survey Medicaid beneficiaries using the CAHPS instrument. This effort is not intended to interfere with any ongoing survey efforts by states. CMS and NORC have consulted with the NCQA, ACAP, and a CAHPS vendor regarding deduplication of the Nationwide CAHPS Survey with state and plan-conducted CAHPS survey efforts. Based on the feedback received during these discussions, CMS has concluded that deduplication is not operationally feasible due to prohibitions against sharing PII, except under special circumstances (see next slide). Nationwide CAHPS Survey of Adult Medicaid Enrollees 15 Avoiding Duplication with States’ CAHPS Efforts

16 In special circumstances, such as an off-cycle state CAHPS survey coinciding with the Nationwide CAHPS Survey effort this Fall, NORC may be able to remove the respondent population from the Nationwide CAHPS Survey sampling frame. Under these special circumstances the state must be the intermediary for information to deduplicate, providing NORC with either SSNs or MSIS IDs for those who participated in the earlier state CAHPS survey. This information must be transmitted from the state to NORC via the CMS secure data transfer connection. Nationwide CAHPS Survey of Adult Medicaid Enrollees 16 Special Circumstances for Deduping States’ CAHPS Efforts

17 Recognizing states’ sampling preferences differ by the unique characteristics and circumstances facing each state, there are 3 sampling options for states to consider: 1)Option 1: NORC selects a sample from the Medicaid Statistical Information System (MSIS) records. The state provides CMS the contact information for those in the sampling frame. 2)Option 2: The state provides CMS with an MMIS (or other state Medicaid data system) data extract from which NORC develops a sampling frame and selects a sample. 3)Option 3: Following CMS and NORC specifications, the state constructs the sampling frame and selects a sample of beneficiaries. 17 Overview of Sampling Options Nationwide CAHPS Survey of Adult Medicaid Enrollees

18 TaskOption 1Option 2Option 3 Complete Secure Data Transfer Questionnaire Test Data File Transmission Extract Beneficiary Contact Information Extract Eligible Beneficiary Files Extract Long Term Claims File Create Sampling Frame Create Selected Sample File Create Summary Quality Control Tables Estimated Average Time Burden 9 hours57 hours66 hours 18 Options Comparison Chart and Estimated Time Burden Nationwide CAHPS Survey of Adult Medicaid Enrollees

19 19 Decision Flow for Sampling Options Has your state submitted its MSIS eligibility (EL) file for October – December 2013 and its long- term care claims (LT) files for January – December 2013 to CMS?

20 Nationwide CAHPS Survey of Adult Medicaid Enrollees 20 Decision Flow for Sampling Options Your state should choose Option 1. YES Has your state submitted its MSIS eligibility (EL) file for October – December 2013 and its long- term care claims (LT) files for January – December 2013 to CMS?

21 Nationwide CAHPS Survey of Adult Medicaid Enrollees 21 Decision Flow for Sampling Options Your state should choose Option 1. Your state cannot choose Option 1. YES NO Has your state submitted its MSIS eligibility (EL) file for October – December 2013 and its long- term care claims (LT) files for January – December 2013 to CMS?

22 Nationwide CAHPS Survey of Adult Medicaid Enrollees 22 Decision Flow for Sampling Options Do you want NORC (as opposed to your state staff) to construct the sampling frame and select the sample of beneficiaries for the CAHPS survey?

23 Nationwide CAHPS Survey of Adult Medicaid Enrollees 23 Decision Flow for Sampling Options Do you want NORC (as opposed to your state staff) to construct the sampling frame and select the sample of beneficiaries for the CAHPS survey? Your state should choose Option 2. YES

24 Nationwide CAHPS Survey of Adult Medicaid Enrollees 24 Decision Flow for Sampling Options Do you want NORC (as opposed to your state staff) to construct the sampling frame and select the sample of beneficiaries for the CAHPS survey? Your state should choose Option 2. Your state should choose Option 3. YES NO

25 Sampling Option 1 NORC selects a sample from the Medicaid Statistical Information System (MSIS) records. The state provides CMS the contact information for sampling frame beneficiaries. *This option is only available to states that have provided CMS with MSIS files that cover October – December 2013.

26 Nationwide CAHPS Survey of Adult Medicaid Enrollees 26 Option 1: NORC bears majority responsibility for developing sampling frame Based on a pilot study, it is estimated Option 1 will take 9 hours of work, on average, across one week.

27 Sampling Option 2 The state provides CMS with an MMIS (or other state Medicaid data system) data extract from which NORC develops a sampling frame and selects a sample.

28 Nationwide CAHPS Survey of Adult Medicaid Enrollees 28 Option 2: NORC and state both responsible for developing sampling frame Based on a pilot study, it is estimated Option 2 will take 57 hours of work, on average, across 2-4 weeks.

29 Sampling Option 3 Following CMCS and NORC specifications, the state constructs the sampling frame and selects a sample of beneficiaries.

30 Nationwide CAHPS Survey of Adult Medicaid Enrollees 30 Option 3: State bears majority responsibility for developing sampling frame Based on the pilot study, it is estimated Option 3 will take 66 hours of work, on average, across 3-5 weeks.

31 Nationwide CAHPS Survey of Adult Medicaid Enrollees 31 Overview of Sampling Approaches CMCS and NORC will work with states to identify the best enrollee sampling approach for each state, making accommodations, as needed.

32 Setting up the Secure Data Transfer Connection

33 Regardless of the sampling option selected, data will need to be transferred between your state and NORC. NORC has entered a Data Use Agreement with CMS to use the MSIS data ‘pipeline’ – the secure data transfer connection states use to send MSIS data to CMS – to transfer files for this project. CMS, NORC, and states will utilize an Enterprise File Transfer (EFT) process to send and receive data to construct the sampling frame. Nationwide CAHPS Survey of Adult Medicaid Enrollees 33 Setting up the Secure Data Transfer Connection

34 Steps for establishing your state’s secure connection: 1)Identify the person or team in your state who is responsible for transferring MSIS data to CMS. 2)Use their expertise to help you fill out the Secure Data Transfer Set-up Questionnaire*. 3)Once CMS has completed the setup for your state’s connection, your state’s designated contact for file transfer will be asked to exchange test files with NORC to ensure the connection your state, CMS, and NORC is working properly. 4)Once the test files have been exchanged and both sides are able to read the other’s data, the connection is ready to be used to facilitate the survey sampling process. Nationwide CAHPS Survey of Adult Medicaid Enrollees 34 Secure Data Transfer Set-up Flow

35 Nationwide CAHPS Survey of Adult Medicaid Enrollees 35 Secure Data Transfer Set-up Flow The Secure Data Transfer set-up and testing can take between 2 and 4 weeks to complete.

36 This data transfer connection must be established BEFORE any data can flow between states, CMS and NORC, and can take some time to set up. The Secure Data Transfer set-up and testing can take about 2 – 4 weeks to complete. Please initiate the file transfer set-up process as soon as possible by filling out the Secure Data Transfer Questionnaire, even if your state is not yet prepared to select one of the sampling options. Nationwide CAHPS Survey of Adult Medicaid Enrollees 36 Secure Data Transfer Set-up Flow

37 Next Steps

38 Post-webinar, dedicated NORC state liaisons will follow- up with all persons for which NORC has contact information with a checklist of “To Dos/Next Steps” and will share the CAHPS Toolkit, including: 3 option decision tree, sampling option flows, sampling specifications, FAQs, Secure Data Transfer Questionnaire – including step-by-step instructions. Nationwide CAHPS Survey of Adult Medicaid Enrollees 38 Next Steps for NORC

39 1)Designate the state’s primary point of contact (if you have not already done so) and communicate this information to NORC via MedicaidCAHPS@norc.orgMedicaidCAHPS@norc.org 2)Complete and return the Secure Data Transfer Set- Up Questionnaire to NORC via MedicaidCAHPS@norc.org MedicaidCAHPS@norc.org 3)Declare the preferred state sampling option via MedicaidCAHPS@norc.org MedicaidCAHPS@norc.org Nationwide CAHPS Survey of Adult Medicaid Enrollees 39 Next Steps for States

40 Direct all questions and concerns to: MedicaidCAHPS@norc.org *To ensure a prompt reply, include the state name or postal abbreviation in the subject line. Resources are also available on NORC’s project page: http://www.norc.org/Research/Projects/Pages/nationwi de-adult-medicaid-cahps.aspx Nationwide CAHPS Survey of Adult Medicaid Enrollees 40 Technical Assistance

41 Questions?

42 Thank You!


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