Attachment 7 CMS Advance Letter_Facility_English

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

[Month], [Year]
Dear [Administrator]:
I am writing to request your assistance in helping us conduct an important study called the Medicare Current
Beneficiary Survey (MCBS). A resident in your facility, [R First] [R Last], has been selected to participate
in this study.
Since 1991, the Centers for Medicare and Medicaid Services (CMS), part of the U.S. Department of Health
and Human Services, have conducted the MCBS in order to better understand the needs of Americans
enrolled in Medicare. It is the nation’s primary source of information about how Medicare affects the people
it serves, and we intend to use the information collected to improve the Medicare program. Because we
cannot interview everyone on Medicare, a sample of 16,000 Medicare beneficiaries was selected to represent
all of those on Medicare.
A portion of the selected Medicare beneficiaries reside in long-term care facilities. These beneficiaries are
extremely important to the study because long-term care issues are at the forefront of the national health
policy agenda. We need your help to collect information about a resident in your facility. The interview
focuses on the utilization and costs of the health care being received by [R First] [R Last], along with a small
section describing the characteristics of your facility. Much of the information can be abstracted directly
from the resident’s chart and will only require about an hour of your staff’s time.
No residents of your facility will be contacted directly. All of the information your organization provides
will be strictly confidential as prescribed by The Federal Privacy Act of 1974. Your participation is
voluntary, and your relationship with programs administered by CMS will not be affected in any way by
whether or not you participate.
NORC at the University of Chicago, a respected social science research organization, has been contracted to
conduct the MCBS. A professional interviewer will contact you within the next few weeks to schedule a
visit to your facility. Let me emphasize again that your residents’ Medicare benefits cannot be affected in
any way by the answers that you provide, or by whether or not you choose to participate.
If you have any questions about the study or would like to schedule an appointment, please call NORC tollfree at 1-877-389-3429, or email NORC at [email protected]. Enclosed is a brochure that provides you with
more information about the survey. You can also visit the MCBS respondent website at www.mcbs.norc.org
to learn more. The Medicare Current Beneficiary Survey is important. Please help us in this national effort
to improve the Medicare program.
Sincerely,

Walter Stone
CMS Privacy Officer

Enclosure
OMB No. 0938-0568 | Expires 7/31/2017