CR_OMB Advance Letter 100520

Part C and D Complaints Resolution Performance Measure
Advance Letter
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop XX-XX-XX
Baltimore, Maryland XXXXX-XXX

[DATE]
Dear [NAME]:
The Centers for Medicare & Medicaid Services (CMS) is committed to learning how Medicare
health plans respond to your concerns. CMS is working with IMPAQ International, LLC, a
research firm, to conduct a survey about how plans handle beneficiary complaints.
We are contacting you about a complaint you – or someone on your behalf – made against your
[PLAN NAME] health plan or your Prescription Drug Plan on [DATE]. Your complaint was
closed by your plan on [DATE]. We would like to know about your satisfaction with the
outcome and handling of your complaint. We value your opinions, and your experiences are
very important to us. This is your chance to help us serve you better.
Within the next two weeks, an interviewer will call you to conduct a brief 5-10 minute survey. If
you are unavailable, the interviewer will schedule a better time to call back. If a convenient time
cannot be scheduled, you will receive a survey in the mail with a postage-paid envelope to return
it. Instructions will be included with the survey.
Your responses will help improve how complaints are handled and will support the development
of a rating system for Medicare plans. Your survey responses are confidential and are protected
by the Privacy Act. Your information will not be shared with anyone other than authorized
persons at CMS and IMPAQ. Your participation is voluntary and if you decide not to
participate, this will not affect your Medicare benefits in any way.
If you have any questions or would like to set up an appointment for the interview, please call us
toll-free at [NUMBER] and ask for the [NAME] Survey.
On behalf of CMS, I would like to thank you in advance for your participation. Your input is
critical for improving the way complaints are handled. We look forward to speaking with you
soon.

Sincerely,
Signatory

IMPAQ International, LLC

Advance Letter