Nationwide CAHPS Survey of Adult Medicaid Enrollees UPDATED

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

Purpose of this Webinar 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

Webinar Agenda • 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

Introductions & Overview of the Survey Effort

What is the Nationwide CAHPS Survey of Adult Medicaid Enrollees? • 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

Nationwide CAHPS Survey of Adult Medicaid Enrollees • 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

Nationwide CAHPS Survey of Adult Medicaid Enrollees • 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

Nationwide Adult Medicaid CAHPS Survey Instrument • The questionnaire is a modified version of the Adult Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Medicaid 5. 0 H survey containing supplemental questions to assess potential access barriers more broadly. Additional topics include: • Tobacco cessation • HHS data collection • Use of flu shot/flu spray standards for race, • Access barriers due to ethnicity, sex, primary disability (modified MEPS language, and disability and NHIS questions) status per Section 4302 of • Mental and behavioral the ACA health issues Nationwide CAHPS Survey of Adult Medicaid Enrollees 8

Pilot Test of the Sampling Options 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

Experiences from Pilot States

Pilot States’ Insights – OREGON • 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 – ALABAMA • 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 Nationwide CAHPS Survey of Adult Medicaid Enrollees 12

Overview of Sampling Options

Overview of Sampling Options • 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

Avoiding Duplication with States’ CAHPS Efforts • 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

Special Circumstances for Deduping States’ CAHPS Efforts • 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

Overview of Sampling Options • Recognizing states’ sampling preferences differ by the unique characteristics and circumstances facing each state, there are 3 sampling options for states to consider: 1) 2) 3) 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. 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. Option 3: Following CMS and NORC specifications, the state constructs the sampling frame and selects a sample of beneficiaries. Nationwide CAHPS Survey of Adult Medicaid Enrollees 17

Options Comparison Chart and Estimated Time Burden Task Complete Secure Data Transfer Questionnaire Test Data File Transmission Extract Beneficiary Contact Information Option 1 Option 2 Option 3 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 hours Nationwide CAHPS Survey of Adult Medicaid Enrollees 57 hours 66 hours 18

Decision Flow for Sampling Options Has your state submitted its MSIS eligibility (EL) file for October – December 2013 and its longterm care claims (LT) files for January – December 2013 to CMS? Nationwide CAHPS Survey of Adult Medicaid Enrollees 19

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

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

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? 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? YES Your state should choose Option 2. 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? YES Your state should choose Option 2. NO Your state should choose Option 3. Nationwide CAHPS Survey of Adult Medicaid Enrollees 24

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.

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. Nationwide CAHPS Survey of Adult Medicaid Enrollees 26

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.

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. Nationwide CAHPS Survey of Adult Medicaid Enrollees 28

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

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. Nationwide CAHPS Survey of Adult Medicaid Enrollees 30

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. Nationwide CAHPS Survey of Adult Medicaid Enrollees 31

Setting up the Secure Data Transfer Connection

Setting up the Secure Data Transfer Connection • 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

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

Secure Data Transfer Set-up Flow 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

Next Steps

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

Technical Assistance • Direct all questions and concerns to: Medicaid. CAHPS@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

Questions?

Thank You!