Response to Comment Document

Responses to Public Comments to the Qualified Health Plan Enrollee Survey

(OMB Control Number: 0938-1221)

The following table contains the list of changes to the QHP Enrollee Survey and recommendations based on comments received during the 30-day public comment period that ended September 9, 2020.

Question # or Section Title	Summary of Public Comments	CMS Response
17	Commenters noted that the question (In the last 6 months, how often did you need medical care but could not get it because you were concerned about a public health emergency (such as the coronavirus outbreak)? was timely and of interest to stakeholders. Commenters noted that the current question seems largely outside of the control of the health plan. Commenters requested more information on how the data from this question would be used (e.g., case-mix adjustment, evaluating plan performance, etc.). Commenters expressed concerns that the current question conflates access to care and beneficiaries’ choice to get care because they were concerned. One commenter recommended asking both about access to care during a public health emergency and concerns about accessing care separately. Commenters noted that the negatively worded question could be a challenge to respondents and may impact responses to other access questions. Commenter suggested adding “do not include dental care” instructions to align with other survey questions.	CMS updated this question to emphasize access to care during a public health emergency and to include clarification that respondents should not include dental care when answering the question: In the last 6 months, how often did you need medical care but could not get it because of a public health emergency (such as the coronavirus outbreak)? Do not include dental care. CMS agrees focusing the question on access to care is more actionable for issuers and aligns with the question included in the Medicare Current Beneficiary Survey (MCBS)1. CMS will not include an additional question about concerns regarding accessing care during a public health emergency in order to avoid increasing survey length. CMS would like to clarify the new question will not be included in QRS measure or QHP composite scoring, but will be included as a stand-alone item in the Quality Improvement (QI) reports.
“Your Health Care in the Last 6 Months” Section	Commenter recommended removing “or” after doctor’s office in the instructions (these questions ask about your own health care. This includes care you got in a clinic, emergency room, doctor’s office, or by telephone or video appointments. Do not include care you got when you stayed overnight in a hospital. Do not include the times you went for dental care visits. Please answer the questions based on your experience with the health plan you had from July through December 2020.) and underlining wording related to virtual care.	CMS agrees with the recommendation to remove “or” from the instructions. Below are the updated the instructions: These questions ask about your own health care. This includes care you got in a clinic, emergency room, doctor’s office, by telephone, or by video appointments. Do not include care you got when you stayed overnight in a hospital. Do not include the times you went for dental care visits. Please answer the questions based on your experience with the health plan you had from July through December 2020.
21	Commenters recommended adding the response options “Don’t know” and “Not Applicable, I do not have a personal doctor” to better distinguish among beneficiaries who may not have contacted a personal doctor for care in the last 6 months. One commenter recommended changing “usual doctor or primary care provider” to “personal doctor” to align with other survey questions. Commenters noted that some enrollees may be confused as to whether to include telehealth health appointments that required a follow up in-person visit (such as bloodwork). One commenter recommended follow-up questions to gather information as to whether the respondent had a video visit and the types of visits received to further analyze responses based on the appointment types. For example: “In the last 6 months, have you received any of the following types of care?” Please select all that apply. Came in for an in-person visit Had a phone appointment (a scheduled time when a provider called you) Had a video visit (you met with a provider by video using a camera on your computer or mobile device) Did not have a visit or other care in the past 6 months	CMS changed “usual doctor or primary care provider” to “personal doctor”. To align with MCBS, CMS does not recommend implementing additional changes to the question text. CMS added “Don’t know”, and “Not Applicable; do not have a personal doctor” to the response scale. The change in the response scale will allow CMS to distinguish between whether enrollees were not offered telehealth services or if enrollees did not seek out telehealth services. Below is the revised text and response options for Question 21: In the last 6 months, did your personal doctor offer telephone or video appointments, so that you did not need to physically visit their office or facility? Yes No Don’t know Not Applicable; do not have a personal doctor. CMS agrees that follow up questions regarding the types of telehealth care enrollees have access to may be useful to include in future surveys but does not recommend adding additional questions to avoid increasing survey length.
“Your Personal Doctor” Section	Commenter recommended adding “or talk to” in addition to “see” to the definition of a personal doctor and bolding or underlining wording related to virtual care.	CMS added “or talk to” to the definition of a personal doctor. To align with other instructions in the survey, CMS does not recommend bolding or underlining wording related to telehealth. Below is the revised instruction language: These questions ask about your personal doctor. A personal doctor is the one you would see or talk to if you need a check-up, want advice about a health problem, or get sick or hurt. Please answer the questions based on your experience with the health plan you had from July through December 2020.
“Getting Health Care from Specialists” Section	Commenter recommended adding instructions to include telehealth in the Getting Health Care from Specialists section instructions and bolding or underlining wording related to virtual care. Commenter recommended alignment with language added to CAHPS surveys, notably the CAHPS Health Plan Survey.	CMS added instructions to include telephone and video appointments to the Getting Health Care from Specialist section instructions. To align with other instructions in the survey, CMS does not recommend bolding or underlining wording related to telehealth. Below is the revised instruction language: Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care. When you answer the next questions, include care you got in a clinic, emergency room, doctor’s office, by telephone, or by video appointments. Do not include dental visits or care you got when you stayed overnight in a hospital. CMS will prioritize opportunities to align with other health plan surveys as these programs update instruments to address the increase use of telehealth.
44	Commenter recommended refining the question text for Question 44 to include telehealth visits. “We want to know your rating of the specialist you saw or talked to most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate the specialist?”	CMS does not recommend modifying core items in the CAHPS Health Plan Survey without cognitive and field testing.
General Suggestions: Survey-wide	Commenter suggested a minor edit throughout, specifically to change “in person” to “in-person” when it is used as a modifier (e.g., an in-person visit versus seeking care in person).	CMS agrees with the recommendation and modified the instructions to in-person. Below is the revised instruction language: Include in-person, telephone, or video appointments.
General Suggestions: Questions 25-27, 33, 37	Commenter recommended only adding the instructions “include in person, telephone, or video appointments” to the section instructions as opposed to in the question text to reduce the length of questions and repetition.	CMS does not recommend removing the instructions from individual questions to remind enrollees to include telehealth appointments when answering the questions. Prior cognitive testing suggests respondents need reminders to ensure accurate recall. CMS also recommends printing the instructions in italics to be consistent with the survey instructions to not include dental care.
General Suggestions: Questions 22-24, 28, & 41-42	Commenter recommended removing sites of healthcare from the question (e.g. in an emergency room, doctor’s office, or clinic) to reduce confusion about whether to consider telehealth visits, as well as in-person care. Commenter recommended only adding the instructions “include in person, telephone, or video appointments” to the section instructions as opposed to in the question text to reduce the length of questions and repetition.	CMS does not recommend removing the instructions from individual questions to remind enrollees to include telehealth appointments when answering the questions. Prior cognitive testing suggests respondents need reminders to ensure accurate recall. CMS does not recommend modifying questions from the CAHPS Health Plan Survey without cognitive and field testing.

1 OMB No. 0938-1275 expiration 05/31/2021

Health Insurance Exchange Consumer Experience Surveys: Qualified Health Plan Enrollee Experience Survey (OMB Control Number: 0938-1221)

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