Qualified Health Plan Enrollee Experience Survey: 2027 Vendor Participation Form

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Health Insurance Exchange

Qualified Health Plan Enrollee
Experience Survey:
2027 Vendor Participation Form

July 2026

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Vendors seeking approval by the Department of Health & Human Services (HHS) to administer
the 2027 Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) on behalf of
QHP issuers must fulfill all requirements outlined in the 2027 QHP Enrollee Survey Minimum
Business Requirements (MBR) and listed below.
In order to apply for HHS-approval to administer the 2027 QHP Enrollee Survey, prospective
vendors must submit a completed Participation Form to the QHP Enrollee Survey Project Team
(Project Team) via email to [email protected]. Vendors must submit the completed form in
PDF format with the following naming convention: 2027 QHP Participation Form_ [Vendor
Name]_MMDDYY (e.g., 2027 QHP Participation Form_VendorXYZ_071526.pdf). Vendors
must also submit a curriculum vitae (CV) for all identified vendor and subcontractor key project
staff.
ALL VENDOR PARTICIPATION FORMS AND APPLICATION MATERIALS ARE
DUE TO THE PROJECT TEAM BY JULY 15, 2026, AT 11:59 P.M. (ET).
The Centers for Medicare & Medicaid Services (CMS) will review vendor applications for
compliance with the Minimum Business Requirements (MBR). Vendors that are granted
conditional approval must complete 2027 QHP Enrollee Survey Vendor Training to earn final
approval to administer the 2027 QHP Enrollee Survey. The 2027 QHP Enrollee Survey Vendor
Training is tentatively scheduled for September 24, 2026.
The Qualified Health Plan Enrollee Experience Survey: Technical Specifications for 2027 (2027
Technical Specifications) will be published by October 2026. Prospective vendors must comply
with the 2027 Technical Specifications for approval as a 2027 QHP Enrollee Survey Vendor.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid Office of Management and Budget (OMB) control number. The valid OMB control number for this information
collection is 0938-1221. The time required to complete this information collection is estimated to average 100 minutes per
response, including the time to review instructions, search existing data resources, gather the data needed, and complete and
review the information collection. The expiration date for this form is XX/XX/XXXX.
If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:
CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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I.

General Information

Please complete the section below to provide general organizational information.
1. Organization Name
2. Organization Mailing Address
3. Organization Telephone Number
4. Organization Website Address
5. Number of Years in Business and Date
Company Founded
6. Number of Years Conducting Patient
Experience Surveys by Mode

Mail:
Telephone:
Internet:

7. Number of Years Conducting Mixed-Mode
(i.e., Mail, Telephone, and Internet) Patient
Experience Surveys
8. Primary Contact Person
(First Name, Last Name; Title; Credentials)
9. Primary Contact Mailing Address
10. Primary Contact Telephone Number
11. Primary Contact Email Address
12. Organization will use Remote Operations

☐ Yes

☐ No

13. Survey Administration Roles that will use
Remote Operations

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II.

QHP Enrollee Survey Minimum Business Requirements

Vendors must meet all Minimum Business Requirements. Please check “Yes” or “No” for each
item below to indicate your organization’s compliance with the following Minimum Business
Requirements.

1. Relevant Survey Experience
Number of Years in Business
☐ Yes

☐ No

Vendor has a minimum of three years’ recent experience administering
standardized patient experience surveys; all experience must be within
the last five years (2022-2026).

☐ Yes

☐ No

Vendor has a minimum of three years’ recent experience conducting
large-scale mixed-mode survey protocols in all three modes
(mail/telephone/internet); all experience must be within the last five
years (2022-2026).

☐ Yes

☐ No

Vendor has recent experience* administering patient experience
surveys for vulnerable populations.

☐ Yes

☐ No

Vendor has a minimum of two years’ recent experience employing a
statistical sampling process; count only experience within the last five
years (2022-2026).

☐ Yes

☐ No

Vendor has recent experience* submitting patient experience survey
data to an external third-party organization.

☐ Yes

☐ No

☐ Yes

☐ No

Vendor has been in business for a minimum of four years.

Organizational Survey Experience

Vendor has recent experience complying with CMS-sponsored survey
project protocols.
Note: Poor past performance on CMS-sponsored survey projects (e.g.,
not adhering to the timeline and/or survey administration procedures,
not adhering to required oversight activities, not adhering to
Discrepancy Report procedures and/or corrective actions) will fail to
meet minimum business requirements. Approval as a vendor in recent
years does not guarantee future approval.

*Experience with polling questions, qualitative data collection, surveys that did not use statistical sampling methods,
or Interactive-Voice Response (IVR) surveys is not considered relevant experience for approval.

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In reviewing applications, CMS will consider the applicant’s recent experience on other CMSsponsored surveys as a vendor. Experience with polling questions, qualitative data collection,
surveys that did not use statistical sampling methods, or Interactive-Voice Response (IVR)
surveys are not considered relevant experience for approval.
Recent experience on CMS-Sponsored Surveys
CMS has approved the applicant as a vendor to
implement other CMS-sponsored or CAHPS surveys.

☐ Yes

☐ No

Complete table below

In the table below, provide details of at least five (but not more than 10) recent CMS-sponsored
standardized patient experience surveys your organization conducted within the last five-year
period (2022-2026). For mixed-mode survey administrations, indicate in the Mode of Survey
Administration column the specific mixed modes used (e.g., mail and internet). If needed,
vendors may include this information as an attachment.
Survey name,
type, contract
number

Average
sample size
(and response
rate %) per
data collection
period

Data
collection
period
(Start and
end dates)

Number of
contracted
clients

Survey
administration
mode
(Mixed mode,
mail-only,
telephone-only,
internet-only)

Language(s)
administered

Number
of years
administering
survey

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Experience with Survey Administration in Multiple Languages
Vendor has recent experience administering mail, telephone, and
internet surveys in English and Spanish.

☐ Yes

☐ No

Is your organization seeking CMS approval to administer the QHP
Enrollee Survey in Chinese?

☐ Yes

☐ No

☐ Yes

☐ No

If applying to administer the QHP Enrollee Survey in Chinese:
Vendor has recent experience administering mail and internet
surveys in Simplified Chinese and telephone surveys in Mandarin.

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Explanation
Please explain any “No” responses to the above Relevant Survey Experience requirements.
Indicate the requirement(s) to which the explanation applies:
Requirement

Explanation

2. Organizational Survey Capacity
Anticipated Clients for 2026 Survey Administration
Do you have any anticipated clients for 2027 survey administration?

☐ Yes

☐ No

Vendor has sufficient physical and personnel resources to administer
large-scale outgoing and incoming mail surveys, perform telephone
interviews using an electronic telephone interviewing system, and
administer the internet survey during the survey fielding period (e.g.,
February to May).

☐ Yes

☐ No

Vendor conducts all survey-related activities within the Continental United
States, Hawaii, Alaska, and U.S. Territories. This requirement applies to
all staff and subcontractors (including remote staff).

☐ Yes

☐ No

Vendor has the capacity to adhere to requirements specified in the 2027
Technical Specifications.

☐ Yes

☐ No

☐ Yes

☐ No

☐ Yes

☐ No

If your organization anticipates clients for 2027 survey administration,
please specify estimated number of clients:

Capacity to Handle Estimated Workload

Personnel
Vendor has designated a Project Manager (PM) who oversees all survey
operations. The PM’s Curriculum Vitae (CV) shows evidence of:
• at least three years of experience overseeing all functional aspects
of survey operations including mail, telephone, internet, data file
preparation, and data security;
• strong background in survey research and methodology; and
• previous experience leading mixed-mode administration.
Note: PM must be the vendor’s direct employee, not a subcontractor.
Vendor has a designated Mail Survey Supervisor with a minimum of one
year’s experience managing large-scale mail survey projects.

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Vendor has a designated Telephone Center Survey Supervisor with a
minimum of one year’s experience managing large-scale telephone
interviewing projects.

☐ Yes

☐ No

Vendor has a designated Internet Survey Supervisor with a minimum of
one year’s experience managing large-scale internet survey projects.

☐ Yes

☐ No

Vendor has a designated Sampling Manager, directly employed by the
vendor (i.e., not a subcontractor), with a minimum of one year’s
experience with sample frame development and sample selection.

☐ Yes

☐ No

Vendor has designated Information System personnel (i.e.,
programmers) who are directly employed by the vendor (i.e., not a
subcontractor) and have a minimum of one year’s previous experience
preparing and submitting data files in a specified format to external thirdparty organization(s).

☐ Yes

☐ No

Vendor has sufficient and experienced organizational back-up staff for
coverage of key staff.

☐ Yes

☐ No

☐ Yes

☐ No

Vendor and its subcontractors (if applicable) have the capacity to conduct
business operations and all survey-related work, including mail and
internet survey administration and telephone interviewing, at the vendor’s
or approved subcontractor’s official business location.

☐ Yes

☐ No

Vendor has the capacity to reproduce and mail questionnaires, cover
letters and reminder letters at the vendor’s or subcontractor’s official
business location.

☐ Yes

☐ No

Vendor has the capacity to process (e.g., scan or key enter) incoming
paper surveys at the vendor’s or subcontractor’s official business
location.

☐ Yes

☐ No

Vendor has the capacity to program electronic telephone interview
systems in accordance with specifications provided and to conduct
telephone interviews using an electronic telephone interviewing system at
the vendor’s or subcontractor’s official business location.

☐ Yes

☐ No

Vendor has the capacity to produce and program the internet survey
instrument and all required emails in-house.

☐ Yes

☐ No

System Resources
Vendor’s commercial physical plant and system resources meet CMS
specifications and accommodate the volume of surveys being
administered.
Note: All system resources are subject to oversight activities, including
onsite visits to physical locations and remote quality oversight activities.

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Vendor has the capacity to produce a mobile-ready version of the internet
survey in-house.

☐ Yes

☐ No

Vendor has the capacity to manage concurrent survey projects while
maintaining high-quality survey data and response rates.

☐ Yes

☐ No

Vendor has the capacity to employ an electronic survey management
system to track fielded surveys through each stage of the protocol using
random, unique de-identified enrollee identification numbers and interim
disposition codes. This electronic survey management system prevents
duplicative records.

☐ Yes

☐ No

☐ Yes

☐ No

Vendor has the capacity to provide regular progress reports to QHP
issuers within guidelines specified by CMS.

☐ Yes

☐ No

Vendor has the capacity to maintain a secure work environment for
receiving, processing, and storing hardcopy and electronic versions of
questionnaires and sample files that protect the confidentiality of survey
response data and Personally Identifiable Information (PII).

☐ Yes

☐ No

Vendor has the capacity to prepare, accommodate, and plan for onsite or
remote visits from CMS or the CMS-sponsored Project Team for quality
oversight purposes.

☐ Yes

☐ No

Vendor can print, assemble, and mail survey materials in accordance
with the 2027 Technical Specifications.

☐ Yes

☐ No

Vendor can program the electronic telephone interviewing system in
accordance with the 2027 Technical Specifications.

☐ Yes

☐ No

Vendor can produce and program the internet survey instrument in
accordance with the 2027 Technical Specifications.

☐ Yes

☐ No

Vendor can comply with all quality oversight requirements described in
the 2027 Technical Specifications. This includes the submission of
sample mail materials, sample telephone scripts and interviewer screen
shots, and an internet survey test link and test emails to the Project Team
for review and approval prior to survey administration.

☐ Yes

☐ No

Vendor has a demonstrated ability to collect and accurately process
survey data through all phases of survey administration.

☐ Yes

☐ No

Vendor has demonstrated experience identifying and contacting
nonrespondents for mail and telephone follow-up.

☐ Yes

☐ No

If electing to use remote operations for select survey administration roles
(e.g., customer support, telephone interviewing):
Vendor has the capacity to oversee remote operations and confirm the
continued quality control and data security of remote staff.

Mixed-Mode Administration

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Vendor has demonstrated ability to adhere to the survey administration
timeline.

☐ Yes

☐ No

Vendor has experience using commercial software/resources to verify
that addresses and telephone numbers are updated and correct for all
sampled enrollees.

☐ Yes

☐ No

Vendor has demonstrated capability to administer the survey in English
and Spanish (and Chinese, if applicable).

☐ Yes

☐ No

Vendor can assign appropriate disposition codes to each sampled
enrollee to indicate final survey status.

☐ Yes

☐ No

Vendor has the capacity to adhere to the Telephone Consumer
Protection Act of 1991 (TCPA) requirements set forth by the Federal
Communications Commission (FCC).

☐ Yes

☐ No

☐ Yes

☐ No

Vendor has consistent experience in the last five years (2022-2026)
selecting random samples based on specific eligibility criteria.

☐ Yes

☐ No

Vendor has adequate documentation of its statistical approach to drawing
a sample.

☐ Yes

☐ No

Vendor has demonstrated ability to work with QHP issuer(s) to
electronically obtain sample frame(s) for sampling within a specified time
frame.

☐ Yes

☐ No

Vendor will adhere to all sampling procedures specified in the 2027
Technical Specifications.

☐ Yes

☐ No

Vendor will conduct quality checks on sample frame file(s) received from
QHP issuer(s) and sampling procedures to verify accuracy and
completeness of sample frame information and processes.

☐ Yes

☐ No

Vendors will conduct the sampling process in-house and will not
subcontract this activity.

☐ Yes

☐ No

☐ Yes

☐ No

If electing to use remote operations for select survey administration roles
(e.g., customer support, telephone interviewing):
Vendor has demonstrated the ability to implement remote operations
while maintaining quality and data security.

Sampling Experience

Data Submission
Vendor has the capability to scan or key enter data per protocols detailed
in the 2027 Technical Specifications.

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Vendor has the capacity to adhere to all data preparation and submission
rules specified in the 2027 Technical Specifications, including verifying
data are de-identified and contain no duplicate cases.

☐ Yes

☐ No

Vendor staff can complete remote identity proofing (RIDP) to register an
account in CMS’s Identity Management (IDM) system by providing
required information, including full legal name, social security number,
date of birth, current residential address, and personal phone number.*

☐ Yes

☐ No

Vendor has the capacity to submit data electronically to the designated
website in the format specified in the 2027 Technical Specifications.

☐ Yes

☐ No

Vendor will execute Business Associate Agreement(s) with QHP
issuer(s) and receive annual authorization from QHP issuer(s) to collect
and submit data to CMS on their behalf.

☐ Yes

☐ No

Vendor will work with the Project Team to resolve data and data file
submission problems within the specified timeframe.

☐ Yes

☐ No

Vendor maintains established electronic security procedures related to
access levels, passwords, and firewalls as required by the Health
Insurance Portability and Accountability Act (HIPAA) to protect against
unauthorized access to electronic files.

☐ Yes

☐ No

Vendor performs daily data backup and offsite redundancy procedures
that adequately safeguard system data.

☐ Yes

☐ No

Vendor develops a disaster recovery plan for conducting ongoing
business operations in the event of a natural or human-related disaster
that includes coordination with relevant emergency preparedness
systems.

☐ Yes

☐ No

☐ Yes

☐ No

Vendor has established procedures for identifying, handling, and
reporting breaches of confidential data.

☐ Yes

☐ No

Vendor will prepare and submit data via secure, HIPAA compliant
methods.

☐ Yes

☐ No

☐ Yes

☐ No

Data Security

Vendor has the capacity to use required encryption protocols, as
applicable, to transmit data files.
Note: CMS-defined PII must be transmitted securely (e.g., encrypted file
via email, data portal, or Secure File Transfer Protocol).

Data Retention
Vendor has the capacity to retain and easily retrieve all data files for a
minimum of three years.

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Vendor has the capacity to store returned paper questionnaires in a
secure and environmentally safe location, either onsite or using an offsite
contractor.

☐ Yes

☐ No

Vendor has the capacity to securely destroy QHP Enrollee Surveyrelated data files after a minimum of three years, or as otherwise
specified by CMS.

☐ Yes

☐ No

Vendor has the capacity to store data files (paper and/or electronic)
securely and confidentially in accordance with specified requirements.

☐ Yes

☐ No

Vendor has the capacity and resources to ensure data confidentiality for
sampled enrollee PII and survey responses during each phase of the
survey process.

☐ Yes

☐ No

Vendor will obtain signed confidentiality agreements from staff and
subcontractors.

☐ Yes

☐ No

Vendor has the capacity and resources to comply with all applicable
HIPAA Security and Privacy Rules, as well as Protected Health
Information (PHI) and PII protocols in conducting all survey
administration and data collection activities.

☐ Yes

☐ No

Vendor has the capacity to establish toll-free customer support telephone
lines with a live operator during regular vendor business hours and a
survey-specific customer support email address to accommodate
inquiries received in both English and Spanish throughout the duration of
survey fielding.

☐ Yes

☐ No

If administering the survey in Chinese, vendor has the capacity and
resources to accommodate telephone and email inquiries from Chinesespeaking survey participants.

☐ Yes

☐ No

Confidentiality

Technical Assistance/Customer Support

*Vendors requesting electronic access to protected CMS information or systems, including the QHP Enrollee
Survey Website, must complete identity proofing. CMS uses the Experian identity verification system to remotely
perform identity proofing. CMS uses this information for the purpose of identity verification via Experian only.
Information will be kept private and will not be shared with any federal or private agency. For more information
regarding how CMS uses the information provided, please read the CMS Privacy Act Statement.

Explanation
Please explain any “No” responses to the above Organizational Survey Capacity requirements.
Indicate the requirement(s) to which the explanation applies:
Requirement

Explanation

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3. Quality Control Procedures
Demonstrated Quality Control Procedures
Vendor has the capacity to establish and document quality control
procedures for all phases of survey implementation, as specified in the 2027
Technical Specifications, including:
•

Internal staff training;

•

Printing, mailing and recording receipt of surveys;

•

Telephone administration of surveys (electronic telephone
interviewing system);

•

Internet administration of surveys;

•

Adequate monitoring of subcontractors (if applicable);

•

Scanning and coding of survey data;

•

Preparing final data files for submission; and

•

All other functions and processes that affect the administration of the
QHP Enrollee Survey.

☐ Yes

☐ No

Vendor has the capacity to develop and submit an annual Quality
Assurance Plan (QAP) for administration in accordance with the 2027
Technical Specifications. The QAP will provide written evidence of the
processes used to collect and process survey data accurately through all
phases of fielding.

☐ Yes

☐ No

Vendor has the capacity to accommodate onsite and/or remote visits by
CMS and the Project Team to the physical business premises on which
major operations of survey business are conducted, as specified in the 2027
Technical Specifications.

☐ Yes

☐ No

☐ Yes

☐ No

☐ Yes

☐ No

☐ Yes

☐ No

Training Requirements and Participants
If granted conditional approval status, vendor staff will complete QHP
Enrollee Survey Vendor Training (September 2026) and Data Submission
Training (February 2027).
Vendor will complete an evaluation of the QHP Enrollee Survey Vendor
Training.
Vendor will establish in-house training for new staff involved in all aspects of
survey administration to ensure compliance with contract training
requirements.

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At a minimum, the Project Manager, Mail Survey Supervisor, Sampling
Manager, Telephone Center Supervisor, and Internet Survey Supervisor,
will attend QHP Enrollee Survey Vendor Training, as required in the 2027
Technical Specifications.
Note: Attendance by vendor staff responsible for data coding and file
preparation is strongly recommended. Subcontractor attendance is optional.
At a minimum, the Project Manager, Sampling Manager, and Information
System personnel, will attend Data Submission Training, as required in the
2027 Technical Specifications.

☐ Yes

☐ No

☐ Yes

☐ No

Note: Attendance by vendor staff responsible for data coding and file
preparation is strongly recommended. Subcontractor attendance is optional.

Explanation
Please explain any “No” responses to the above Quality Control Procedures requirements.
Indicate the requirement(s) to which the explanation applies:
Requirement

Explanation

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III.
Name

List of Key Project Staff
Role

Years with
Organization

Email Address

Telephone
Number

1.
2.
3.
4.
5.

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IV.

Subcontractors

Subcontractors

Response

Check here if your organization does not plan to use subcontractors for
2027 QHP Enrollee Survey administration.

☐

Please complete the following section for each subcontractor your organization plans to use for
2027 QHP Enrollee Survey administration. The following requirements must be met:
•
•

•
•

Each subcontractor must meet the criteria outlined for the survey administration activity
that it will conduct.
The subcontracting of printing, outgoing mail processing, data entry and scanning, and
telephone interviewing and/or customer support by a vendor is limited to a reasonable
number of subcontractors based on the vendor’s estimated number of surveyed enrollees,
and subject to CMS review.
The vendor may not subcontract sample file generation, email or internet survey
administration, or data file preparation and submission.
All subcontractors are subject to CMS approval.

Subcontractor Name(s), Role(s) and Experience
Subcontractor 1
1. Subcontractor organization name
2. Mailing address
3. Telephone number
4. Number of years in business
5. Number of years subcontractor has worked
with your organization

6. Survey administration role(s)
7. Experience related to survey administration
role(s), including names of relevant projects

8. Primary contact person
(First name, Last name; Title; Credential(s))

9. Primary contact telephone number
10. Primary contact email address
11. Subcontractor will use remote operations

☐ Yes

☐ No

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Subcontractor 2
1. Subcontractor organization name
2. Mailing address
3. Telephone number
4. Number of years in business
5. Number of years subcontractor has worked
with your organization

6. Survey administration role(s)
7. Experience related to survey administration
role(s), including names of relevant projects

8. Primary contact person
(First name, Last name; Title; Credential(s))

9. Primary contact telephone number
10. Primary contact email address
11. Subcontractor will use remote operations

☐ Yes

☐ No

☐ Yes

☐ No

Subcontractor 3
1. Subcontractor organization name
2. Mailing address
3. Telephone number
4. Number of years in business
5. Number of years subcontractor has worked
with your organization

6. Survey administration role(s)
7. Experience related to survey administration
role(s), including names of relevant projects

8. Primary contact person
(First name, Last name; Title; Credential(s))

9. Primary contact telephone number
10. Primary contact email address
11. Subcontractor will use remote operations

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Subcontractor 4
1. Subcontractor organization name
2. Mailing address
3. Telephone number
4. Number of years in business
5. Number of years subcontractor has worked
with your organization

6. Survey administration role(s)
7. Experience related to survey administration
role(s), including names of relevant projects

8. Primary contact person
(First name, Last name; Title; Credential(s))

9. Primary contact telephone number
10. Primary contact email address
11. Subcontractor will use remote operations

☐ Yes

☐ No

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V.

Curriculum Vitae (CV)

Please submit a CV for all identified key vendor staff and subcontractor staff, if applicable, via
email to the Project Team at [email protected]. Please ensure subject line in email reads,
“[Vendor Name] Key Staff CV Submission.”

VI.

Participation Rules

Any vendor participating in 2027 QHP Enrollee Survey administration must adhere to the
following Participation Rules. To be eligible, the organization must:
1. Meet the 2027 QHP Enrollee Survey Minimum Business Requirements (MBR).
2. Participate in a teleconference call with the Project Team (as determined by CMS) to discuss
relevant survey experience, organizational survey capability and capacity, quality control
procedures, and role of subcontractors (if applicable).
3. Participate in and successfully complete QHP Enrollee Survey Vendor Training and Data
Submission Training. At a minimum, the organization’s Project Manager, Mail Survey
Supervisor, Telephone Survey Supervisor, Internet Survey Supervisor, and Sampling
Manager must attend the QHP Enrollee Survey Vendor training as representatives of the
organization. At a minimum, the organization’s Project Manager, Sampling Manager, and
Information System personnel, must attend Data Submission Training, as required in the
2027 Technical Specifications. Subcontractor attendance is optional to both QHP Enrollee
Survey Vendor Training and Data Submission Training.
4. Review and comply with the 2027 Technical Specifications and any policy updates.
5. Develop and submit a vendor Quality Assurance Plan as specified by the deadline
determined by CMS. In addition, submit materials relevant to the survey administration (as
determined by CMS), including mailing materials (e.g., cover letters, questionnaires,
reminder letters and envelopes), telephone scripts and the internet survey instrument.
6.

Contract with at least one QHP issuer client and field the QHP Enrollee Survey within two
survey administration cycles of initial approval.

7. Participate and cooperate (including subcontractors) in all oversight activities conducted by
the Project Team, including but not limited to survey material review, remote site visits,
seeded mailings, telephone interview monitoring, data review, and other oversight activities
as determined by CMS.

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8. Oversee remote operations and confirm the continued quality control and data security of
remote staff if electing to use remote operations for select survey functions (e.g., customer
support, telephone interviewing).

9. Comply with all rules and regulations pertaining to PII and PHI per the HIPAA.
10. Submit an interim survey data file to CMS, as determined by CMS.
11. Submit data on time, as specified by the deadline determined by CMS.
12. Attest to the accuracy of the organization’s data collection (as determined by CMS) and
follow the guidelines set forth in the 2027 Technical Specifications.
13. Notify the Project Team of any discrepancies or variations from standard QHP Enrollee
Survey protocols that occur as the discrepancy is identified. The vendor must complete and
submit a Discrepancy Report (in the format and manner specified by CMS) within one
business day of becoming aware of the discrepancy. Vendors must notify QHP issuer clients
whenever a Discrepancy Report is submitted to the Project Team regarding their reporting
unit(s), as applicable.
14. Attest that the vendor is organizationally independent from the QHP issuer client; the vendor
must not administer the QHP Enrollee Survey or produce survey results to meet CMS
requirements for any QHP client issuer that controls, is controlled by, or is under common
control with the vendor.
15. Acknowledge that contracting with and successfully administering the QHP Enrollee Survey
on behalf of at least one QHP issuer within 24 months of receiving initial approval status is a
requirement for continued approval status. A vendor must continue to field the survey for at
least one QHP issuer during every 24-month increment following the initial 24-month period.
16. Acknowledge that CMS may, at its sole discretion, terminate or discontinue the “approved”
status of a vendor. CMS may exercise these actions at any point during survey
administration.
17. Acknowledge that review of and agreement with the Rules of Participation is necessary for
participation.

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OMB No. 0938-1221: Approval Expires XX/XX/XXXX

I.

Applicant Organization Qualification and Acceptance

I certify that:

Authorized Representative

•

I have reviewed and agree to meet the Rules
Name:
of Participation for participating in the 2027
QHP Enrollee Survey.
Title:

•

The statements herein are true, complete, Organization:
and accurate to the best of my knowledge,
and I accept the obligation to comply with Date:
the 2027 QHP Enrollee Survey MBR.
Signature:

For assistance, please contact the Project Team by email at [email protected].

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