The National Implementation of the ICH CAHPS Survey

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Supporting Statement Part-A 
The In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems Survey Mode Experiment 
(CMS-10105; OMB# 0938-0926) 
 BACKGROUND 
 The Centers for Medicare & Medicaid Services (CMS) implements the In-Center 
Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) 
Survey to measure patients’ experience of care with in-center hemodialysis facilities under Contract Number GS-00F-354CA - 75FCMC25FJ128. The survey is designed to meet the following goals:   
    • Produce comparable data from the patient’s perspective that will allow objective and meaningful comparisons between dialysis centers on domains that are important to consumers.
    • Create incentives for dialysis centers to improve their quality of care.
    • Enhance public accountability in health care by increasing the transparency of the quality of care provided in return for public investment.
Since 2014, CMS and its contractor has conducted the ICH CAHPS survey twice a year. The results are publicly reported on Care Compare on Medicare.gov. The data are refreshed on Care Compare in April and October based on a rolling average of the two most recent survey periods. Patients with end-stage renal disease (ESRD) can compare the services and quality of care that dialysis facilities provide. Survey results from ICH CAHPS complement the clinical quality measures that CMS has been publicly reporting on Care Compare on Medicare.gov. Both clinical and patient experience quality measures enable consumers to make more informed decisions when choosing a dialysis facility. Furthermore, survey results can aid facilities in their quality improvement efforts and help CMS monitor the performance of ICH facilities. ICH CAHPS is part of the ESRD Quality Incentive Program (QIP) and is required as part of the value-based purchasing program for payments under the Medicare program. 
Recently, CMS reduced the length of the ICH CAHPS survey to decrease the burden on patients and improve response rates. The shortened survey was approved under OMB 0938-0926 and was implemented in the Spring 2026 data collection period. The survey is currently offered in three modes of administration: mail-only, telephone-only, and mail with telephone follow-up. In recent years, CMS has received feedback from ESRD stakeholders requesting 1) the option to administer the survey using a web mode as an alternative to the existing approved modes of administration, and 2) to test a survey that includes home dialysis patients in addition to ICH patients. Both suggestions are the focus of this OMB/PRA submission.  
The addition of a web-based mode has the potential to improve response rates, which have been declining across surveys in recent years. According to Pew Research, 90% of adults age 65 and older and 96% of adults 50-64 years of age use the internet and 70% and 79%, respectively, have broadband internet at home.1 Additionally, 78% of adults age 65 and older and 90% of adults 50-64 years of age own a smartphone.2 In 2021-2022, CMS tested a web-based mode of the survey with the ICH dialysis population under CMS-10694, OMB Control number: 0938-1370. Due to a lack of adequate patient email addresses in the sampling frame, CMS was unable to determine whether a web mode was appropriate for this population. In the intervening years, CMS and its contractor have been working towards strategies to obtain more patient email addresses to conduct another web mode experiment. At this time 10% of patients in the ESRD Quality Reporting System (EQRS) have email addresses and the percentage may increase as certain dialysis organizations continue adding patient email addresses to the ESRD Quality Reporting System (EQRS), which is used as the sampling frame for the ICH CAHPS Survey. In addition to emailing links to a web-based survey to those patients with email addresses, CMS also plans to send letters to patients assigned to the web mode that contain short URLs and QR codes to direct respondents to complete the survey online.  
The mode experiment will also include a revised survey that was designed with questions that are applicable to both home dialysis and in-center dialysis patients. The revised survey was developed and refined with input from ESRD stakeholders and home dialysis patients. All four proposed modes of administration for the experiment will use the revised combined home/ICH survey: 
    1) Mail only 
    2) Telephone only 
    3) Mail with telephone follow-up 
    4) (New) Web with mail and telephone follow-up 
The web/mail/telephone mode is proposed because historically the ICH CAHPS Survey has the highest response rates for the mail with telephone follow-up mode, which many of the facilities choose to administer in this setting.  
The ICH CAHPS Survey is currently approved for data collection using mail-only, telephone-only, or mail with telephone follow-up modes of survey administration. Through this revision submission, CMS proposes investigating the feasibility of implementing a web-based mode with mail and telephone follow-up for OMB approval. 
The revised survey and a crosswalk of changes from the approved ICH CAHPS survey are available in Attachment A.  
  
   A.  JUSTIFICATION  
A.1  Circumstances Making the Collection of Information Necessary  
 CMS plans to use information from this mode experiment to determine whether an additional mode of administration – web with mail and telephone follow-up – should be included in the national implementation of the ICH CAHPS Survey, and whether a revised survey works with both home dialysis and ICH patients. The ICH CAHPS Survey is used by dialysis facilities to improve their internal quality assurance. Additionally, Medicare-certified ICH facilities serving 30 or more survey-eligible patients in the preceding year are required to collect and submit to CMS the ICH CAHPS Survey data as part of the value-based purchasing program for payments under the Medicare program. ICH facilities are required to contract with a CMS approved, independent third-party survey vendor to implement the ICH CAHPS survey on their behalf and to submit ICH CAHPS Survey data to CMS.  ICH CAHPS survey results for all participating ICH facilities that had 30 or more completed surveys from the two most recent semiannual surveys are publicly reported on Care Compare on Medicare.gov. Increasing response rates such as through a web-based mode of administration may help to maximize the number of ICH facilities with data on Care Compare, thus empowering patients to make informed choices about where to receive their dialysis care. Implementing a survey that can also include home dialysis patients would assist additional ESRD patients in making informed dialysis decisions. The survey is available in English in Attachment A.  
 A.2  	Purpose and Use of Information  
 Data collected from the ICH CAHPS mode experiment will be used for the following purposes:  
    • To determine if the questions work for both ICH patients (existing respondents) as well as home dialysis patients (new respondents);  
    • To determine whether a web-based mode of data collection is appropriate for the dialysis population; 
    • To compare survey responses across the four proposed modes to determine if adjustments are needed to ensure data collection mode does not influence the results; and 
    • To determine if and by how much patient characteristics affect the patients’ rating of the care they receive and adjust results based on those factors.  
 A.3  	Use of Improved Information Technology  
 The ICH CAHPS Survey is currently approved for data collection using mail-only, telephone-only, or mail with telephone follow-up modes of survey administration. Through this submission, CMS proposes investigating the feasibility of implementing a web-based mode with mail and telephone follow-up. If CMS determines the response rates for completing the survey on the web are sufficient, an additional mode option for web with mail and telephone follow-up may be incorporated into the national implementation of the ICH CAHPS Survey through the rulemaking process.  
As with a Computer Assisted Telephone Interview (CATI) system, web administration offers numerous advantages, including the following: 
    • costs less than in-person data collection;  
    • allows for a shorter data collection period;  
allows for less item nonresponse because the system controls the flow of the interview and complex routing;  
    • increases data quality by allowing consistency and data range checks on respondent answers;  
    • creates a centralization of process/quality control; and  
    • reduces post-interview processing time and costs.  
 Since response rates are typically higher when multiple modes are used and not all dialysis facility patients have access to the internet or email addresses available in EQRS, CMS is electing to combine the web mode with mail and telephone follow-up options for nonrespondents.  
 A.4  	Efforts to Identify Duplication  
The proposed mode experiment will most likely run concurrently with the 2027 Spring national implementation of the ICH CAHPS Survey, assuming OMB approval is received in time. Sample patients will be included in either the mode experiment or the national implementation; no sample patients will be included in both efforts. Sample patients in the national implementation will use the currently approved ICH CAHPS survey. Sample patients included in the mode experiment will receive the revised survey.  
In addition, facilities will be asked to consider the survey burden that may be caused by implementing their own facility-specific surveys during the data collection period, and that additional surveys could negatively affect the ICH CAHPS Survey response rates and number of completed interviews per survey period for the facility (which could impact whether data for the facility are publicly reported). ICH facilities will continue to be strongly encouraged to refrain from fielding their own surveys during critical data collection points in both the national implementation and mode experiment.  
 A.5 	Involvement of Small Entities  
This information collection request does not involve any small businesses.  
 A.6 	Consequences If Information is Collected Less Frequently  
CMS is proposing a one-time mode experiment under this request. No impact to facilities is expected from this mode experiment.  If this mode experiment is not conducted, CMS will not be able to investigate the feasibility of a web-based data collection mode or determine whether a revised survey will work for home dialysis patients. Survey response rates may continue to decline without a web-based mode, which may have a detrimental impact on public reporting. Without a test of a revised survey with home dialysis patients, CMS will not be able to respond to stakeholder requests to add home dialysis patients to the national implementation of the ICH CAHPS Survey.      
 A.7 	Special Circumstances   
There are no special circumstances.  
 A.8  	Federal Register Notice and Outside Consultations  
A.8.1  Federal Register Notice  
The 60-day Federal Register notice (91 FR 45818) was published on July 21, 2026. Two comments were received. Below is a summary of their recommendations and CMS’s responses:  
 
1. A comment was received from an existing third-party survey vendor on the ICH CAHPS Survey. Below is a summary of their recommendations and CMS’s responses: 
Comment: The commenter recommended that a web mode should also include both mail and telephone follow-up, rather than just mail follow-up like was tested in the 2022 mode experiment. They also provided suggested timing to make sure that all three modes could be included within the data collection period.  
Response: The 2027 mode experiment will test mail-only, telephone-only, mail with telephone follow-up, and web with mail and telephone follow-up. The timeline for this web-based mode will be similar to what the commenter recommends in their question submission. As suggested by the commenter, the total length of time in the field will not be reduced.  
Comment: The commenter suggested CMS include a survey URL and personal access code (WebID) on the Prenotification Letter.  
Response: The prenotification letter for ICH CAHPS is required as the sampling frame for the survey comes directly from a CMS database. As such, the prenotification letter must be the same for all sample patients and provide information about the forthcoming survey, including that a vendor will be contacting them soon. The prenotification tested in the mode experiment will be very similar to the prenotification letter that is used in national implementation. If the web-based mode is implemented nationally, because each dialysis facility will determine which mode(s) their authorized survey vendor will administer, not all sample patients will have a web-based mode option and therefore will not be provided with this website information. For these reasons, a survey URL and personal access code will be included in all other correspondence with sample patients (emails, web invite by mail, mail survey cover letter) in the web-based mode, but will not be included in the prenotification letter.  
Comment: The commenter suggested CMS adding a QR code to all survey materials sent to the sample patients.   
Response: The mode experiment will test a QR code that will be included in all correspondence with the sample patients in the web-based mode, other than the prenotification letter for the same reasons as noted above.  
Once the mode experiment has concluded and data have been analyzed, CMS will determine whether a web-based mode will be adopted for the national implementation of the ICH CAHPS Survey, and whether any changes should be made to the protocols tested. 
2. A comment was submitted by Mayo Clinic. Below is a summary of their recommendations and CMS’s responses: 
Comment: The commenter suggested the following wording changes to two of the home dialysis only questions.  
To best reflect the partnership between the dialysis clinic staff and the patient's equipment and supply vendors, we recommend the wording of questions 23 and 24 be changed as follows: 
• 	Q23: In the last 3 months, if you had problems with your home dialysis equipment and needed support from your dialysis center staff, how often were the staff able to help you? 
Q24: In the last 3 months, if you had problems receiving your home dialysis supplies and needed support from your dialysis center staff, how often were the staff able to help you? 
Response: For these questions, we want to know that if a patient had a problem, and contacted their dialysis center staff, whether the staff were able to help solve the problem. The suggested edits change the interpretation of these questions and remove our ability to understand whether the patient’s problems were solved. To address their comment, we will add another Not 
Applicable (NA) option to Questions 23, 24, and 25. These will now each have two NA options:  
    23. In the last 3 months, when you had problems with your home dialysis equipment, how often did dialysis center staff help you solve them? ☐    Never 
☐ 
Sometimes 
☐ 
Usually 
☐ 
Always 
☐ 
I did not have any problems with my dialysis equipment 
☐ 
I had a problem with my dialysis equipment but did not need dialysis center staff help  *NEW* 
    24. In the last 3 months, when you had problems receiving supplies for your home dialysis, how often did dialysis center staff help you solve them? 
☐ 
Never 
☐ 
Sometimes 
☐ 
Usually 
☐ 
Always 
☐ 
I did not have any problems receiving dialysis supplies 
☐ 
I had a problem receiving dialysis supplies but did not need dialysis center staff help *NEW* 
    25. Think about any other problems you had with your home dialysis, not including problems with your equipment or receiving supplies. In the last 3 months, when you had any other problems with your home dialysis, how often did dialysis center staff help you solve them? 
☐ 
Never 
☐ 
Sometimes 
☐ 
Usually 
☐ 
Always 
☐ 
I did not have any other problems  
	☐ 	I had other problems but did not need dialysis center staff help *NEW* 
The 30-day Federal Register notice (91 FR 69848) was published on November 5, 2026.

A.8.2  Outside Consultations  
CMS’s ICH CAHPS contractor convened a TEP in January 2026 with 11 members. They obtained guidance and input from the TEP on testing a combined ICH/home dialysis survey and the feasibility of a web-based mode for this population. The TEP members consulted represented the following organizations:  
    • National Kidney Foundation 
    • American Society of Nephrology    
    • DaVita (a large dialysis organization)  
    • Dialysis Patient Citizens (ESRD patient advocacy organization)  
    • American Nephrology Nurses Association 
    • Fresenius Medicare Care (a large dialysis organization)  
    • RAND Corporation  
In addition to the TEP, cognitive interviews and focus groups were held with nine or fewer home dialysis patients per round. 
 A.9 	Payments/Gifts to Respondents  
No payments or gifts will be provided to respondents.  
 A.10  	Assurance of Confidentiality  
Individuals contacted as part of this data collection are assured of the confidentiality of their replies under 42 U.S.C. 1306, 20 CFR 401 and 422, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular A-130.  
Concern for the confidentiality and protection of respondents’ rights is critically important on any patient experience of care survey. Because ESRD patients are dependent on dialysis treatments for their survival, they are an especially vulnerable patient population. Some dialysis patients might not be willing to participate in the survey for fear of retribution from the facility staff. There is also a concern that some patients might respond to the survey but might respond in a way that does not reflect their actual experiences with dialysis care. Therefore, assurances of confidentiality are even more critically important with this patient population.  
Mode experiment respondents will be told not to ask the dialysis facility to assist in questionnaire completion because it might introduce bias, especially because among other things, patients are being asked to evaluate both the facility and the staff employed there. However, we recognize that because of fatigue and existing comorbidities, completing the survey without assistance might prove difficult for this patient population. As a result, it is permissible for respondents to ask family members or friends to help with completing the survey such as by reading the questions aloud to the respondent, translating questions into the language they speak, or writing the answers on the mail survey for the respondent.  
The cover letters and web invitation letters that will be sent to sample patients will encourage patients to call CMS’s contractor if they have any questions about the mode experiment survey (the official mode experiment letters and emails in English are included in Attachment B).  
Communications with ICH CAHPS sample patients will include the following:  
the purposes of the survey and how survey results will be used;  
    • participation in the ICH CAHPS Survey is voluntary;  
    • the information they provide is protected by the Federal Privacy Act of 1974 (and that all ICH CAHPS project staff have signed affidavits of confidentiality and are prohibited by law from using survey information for anything other than this research study);  
    • their survey responses will never be linked to their name or other identifying information;  
    • all respondents’ survey responses will be reported in aggregate, no ICH facility will see their individual answers;  
    • they can skip or refuse to answer any question they do not feel comfortable with.  
A.10.1 Data Security  
CMS’s contractor, RTI, has extensive systems and methods in place to protect the identity of sampled patients and the confidential nature of the data that they provide during the mode experiment. All data for this project will be housed on RTI’s FIPS Moderate environment, a segregated area of the RTI network that handles data whose impact level has been determined to be “moderate” regarding the Integrity, Confidentiality, and Availability classification areas. All sample data and survey data exported from the data collection systems will be stored on a HIPAA-compliant share drive, and only a small number of people at RTI will have access to these data. 
	  	A.11  Questions of a Sensitive Nature  
There are no questions of a sensitive nature included in this survey; that is, there are no questions that ask about what is typically considered as “sensitive,” such as questions about illegal or criminal activities, sexual behavior or orientation, or income. However, although the questions in the ICH CAHPS survey might not be deemed sensitive themselves, it must be acknowledged that responding to a survey about life-sustaining dialysis care might be a sensitive issue to a vulnerable ESRD patient population. Administration of the ICH CAHPS mode experiment survey by CMS’s subcontractor and the steps described in Section A.10 should help minimize or assuage any concerns that patients have about responding to this survey.  
	  	A.12  Estimates of Annualized Burden Hours and Costs  
The mode experiment will be conducted with an estimated 20,235 home and ICH patients. Patients will be administered the revised survey, which is 41 items long and is estimated to require 11 minutes of their time to complete the survey. Estimated burden hours and costs to the respondent in the mode experiment for the ICH CAHPS Survey are shown in Exhibits A.1 and A.2. We have estimated the maximum burden possible by assuming that 21.0% of approximately 20,235 ICH patients will complete the survey.  
Exhibit A.1 	Estimated Annualized Burden Hours: ICH CAHPS Survey Web Mode Experiment and National Implementation  
Form name  
Number of respondents  
Number of responses per respondent  
Hours per response  
Total burden hours  
Mode Experiment: ICH CAHPS Survey for ICH and Home (mail only, telephone only, mail with telephone follow-up, and web with mail and telephone follow-up data collection modes)  
4,270 
1  
.18  
768.6  
Previously Approved Data 
Collection for the National 
Implementation of the ICH CAHPS Survey (mail only, telephone only, mail with telephone follow-up) 
103,750 
2 
.20 
41,500 
Total Annualized Burden 
(combined Mode Experiment and National Implementation of the 
ICH CAHPS Survey)  
211,770 
NA 
NA 
42,268.6 
  
Exhibit A.2  Estimated Annualized Cost Burden: ICH CAHPS Survey Web Mode Experiment and National Implementation 
Form name  
Number of respondents  
Total burden hours  
Average hourly wage rate + fringe*
Total cost burden  
 
ICH CAHPS Survey for ICH and 
Home (mail only, telephone only, mail with telephone follow-up, and web with mail and telephone data collection modes)  
4,270  
768.6  
$37.35 
$28,707.21  
Previously Approved Data 
Collection for the National 
Implementation of the ICH CAHPS Survey (mail only, telephone only, mail with telephone follow-up) 
207,500 
41,500 
$71.66 
$2,973,890 
Total Annualized Burden 
(combined Mode Experiment and 
National Implementation of the 
ICH CAHPS Survey)  
211,770 
42,268.6 
NA 
$3,002,597.21 
  
 The estimated annualized annual costs are outlined in Exhibit A.2. The estimated annualized costs to respondents is based on the Bureau of Labor Statistics (BLS) data from March 2026.3 The median wage for all occupations is $37.35 per hour. This is a rough adjustment, both because fringe benefits and overhead costs vary significantly from employer to employer, and because methods of estimating these costs vary widely from study to study. 
Nonetheless, there is no practical alternative.  
 A.13  	Estimates of Annualized Respondent Capital and Maintenance Costs  There are no capital or maintenance costs associated with this collection.  
 A.14  	Estimates of Annualized Cost to the Government  
The cost to the federal government for the Mode Experiment and the National 
Implementation for the ICH CAHPS Survey in the upcoming year is approximately $2,392,000. RTI International is the federal contractor for the proposed ICH CAHPS mode experiment as well as CMS’s national implementation contractor for the ICH CAHPS Survey. 
 A.15  	Changes in Hour Burden  
The current annualized burden for the national implementation of the ICH CAHPS Survey is 41,500 hours. Adding the one-time mode experiment to the national implementation data collection, which is estimated at 768.6 hours, increases the annualized hour burden to 42,268.6 hours.   
The proposed one-time mode experiment will be conducted with a limited number of sample patients in Spring 2027 and will be conducted concurrently with the National Implementation of the ICH CAHPS Survey.  The survey has decreased from the current 12 minutes to 11 minutes for the ICH/home survey that will be tested. Although the revised survey is 41 questions as opposed to 38 questions in the current ICH CAHPS Survey, ICH patients are answering a maximum of 38 questions and home patients are answering a maximum of 35 questions. The average timing for both populations during timing trials was 11 minutes.  
 	Nineteen questions are the same as the existing current ICH CAHPS Survey, and apply to both the ICH and home populations. Another six questions are the same as the current survey and apply only to the ICH population. Three brand-new questions were added for the home population only as no such questions existed in the current survey, and one brand-new question was added for both ICH and home populations due to being deemed important by stakeholders. The remaining twelve questions are similar to existing questions in the current ICH CAHPS Survey, but wording was tweaked so they apply to both ICH and home populations. The revised survey and a crosswalk of changes from the currently approved ICH CAHPS survey are available in Attachment A.  
 A.16  	Time Schedule, Publication, and Analysis Plans  
The mode experiment will be a one-time (cross-sectional) survey of a sample of home dialysis and ICH patients. Data collection for the mode experiment will take place in the spring of 2027 or as soon as possible after OMB clearance is received.  
Data collection for mail-only mode, telephone-only mode, mail with telephone follow-up, and the new web with mail and telephone follow-up will be implemented concurrently during the spring 2027 data collection period  (mid April to mid July 2027), using the following data collection schedule.   
1) Mail only 
    • Day 1: Prenotification letter mailed.  
    • Day 14: Two weeks after the prenotification letter is mailed, a survey package will be sent to sample patients.  
    • Day 42: Approximately four weeks later, a second survey package will be sent to non-respondents.  
    • Day 84: End data collection 2) Telephone only 
    • Day 1: Prenotification letter mailed.  
    • Day 14: Two weeks after the prenotification letter is mailed, telephone calls will be made to sample patients, with a max of 10 call attempts made to each sample patient throughout the data collection period.  
    • Day 84: End data collection 3) Mail with telephone follow-up 
    • Day 1: Prenotification letter mailed.  
    • Day 14: Two weeks after the prenotification letter is mailed, a survey package will be sent to sample patients.  
    • Day 42: Approximately four weeks later, telephone calls will be made to nonrespondents, with a max of 10 call attempts made to each sample patient throughout the data collection period.  
○ Day 84: End data collection 
4) (New) Web with mail and telephone follow-up 
    • Day 1: Prenotification letter mailed.  
    • Day 7: One week after the prenotification letter, a web survey invitation will be sent: ○ Via email to sample patients who have an email address available in EQRS.  
○ Via mail to sample patients with no email address asking them to complete the web survey.  
    • Day 14: One week after sending the invitation, a second email invitation will be sent to non-respondents with email addresses.  
    • Day 21: Approximately two weeks after initial web invitations, a mail survey package will be sent to all remaining non-respondents and will include a push to the web survey.  
    • Day 49: Approximately four weeks after mail survey is mailed, telephone calls will be made to non-respondents. 
    • Day 84: End data collection 
 
The ICH/home survey will be programmed in CATI, web, and optical scanning for mail, in both English and Spanish.  
The sampling strategy will involve selecting a sample of both ICH and home dialysis patients from EQRS data, delivering a mix of facility types and patient-mix factors and will randomly assign each patient to one of the proposed data collection modes. Patient eligibility will be the same as the current national implementation of the ICH CAHPS Survey, with the exception that both in-center and home dialysis patients will be included. Exhibit A.3 presents the proposed mode experiment design and sample sizes for each mode. Response rates are based on current ICH CAHPS response rates for the three approved modes (mail-only, telephone-only, and mail with telephone follow-up). The web with mail and telephone follow-up is estimated.  Exhibit A.3 	Proposed Mode Experiment Sampling Metrics 
Metric 
Mail 
Phone 
Mail/Phone 
Web/Mail/Phone 
Sample Size 
5335 
6277 
4355 
4268 
Completed Surveys: Mail 
1067 
NA 
740 
403 
Completed Surveys: Phone 
NA 
1067 
325 
241 
Completed 
Surveys: Web 
NA 
NA 
NA 
427 
Total 
Completed Surveys 
1067 
1067 
1065 
1071 
Response Rate 
20% 
17% 
24.5% 
25.1% 
 
Exhibit A.4 describes the multivariate analyses that we will conduct on the mode experiment data.  
	Exhibit A.4 	Planned Mode Experiment Analyses 
Psychometric Analyses  
Mode Effect and Patient-Mix 
Analyses 
Nonresponse Analyses 
    • Confirm that public reporting metrics continue to be based on solid patient experience. Leverage exploratory analyses  to determine item placement in composites or uncover a new composite structure.  
    • Assess revised survey items for reliability and validity in mixedmethod format, including itemlevel analysis (Rasch measurement) and classical psychometrics (internal consistency and factor analysis). 
    • Examine item-level measurement assessments to rigorously evaluate composite dimensionality, continued and newly developed response option functioning, items not producing useful measurement into the existing composite constructs, and item-level bias for key demographic and mode groups.  
    • Conduct patient-mix analyses  to determine whether modifications should be made for patient-mix adjustments and mode effects, based on revised surveys.  
    • Examine top-box, bottom-box, and linear means for all global ratings and composites.  
    • Replicate psychometric analyses for mode to determine whether new web-based mode provides same psychometric quality as mail and phone modes.  
 
    • Establish whether patient characteristics affecting nonresponse should also be used in creating patient-mix adjusted scores by using nonresponseadjusted weights. 
    • If no statistically significant correlations exist between nonresponse weights and residuals of our regression models, including patient-mix and mode adjusters, there will be no need to adjust the data.  
    • To date, nonresponse-adjusted weights have not been needed for ICH CAHPS.  
 
 
Exhibit A.5 provides an overview of the project schedule, including data collection and analysis.  
Exhibit A.5  Proposed Project Timeline 
Tasks  


Project Month 



May 
June 
July 
Aug 
Sept 
Oct 
Nov 
Dec 
Conduct Survey 
X 
X 
X 
- 
- 
- 
- 
- 
Data Cleaning 
- 
- 
- 
X 
- 
- 
- 
- 
Data Analysis 
- 
- 
- 
- 
X 
X 
X 
- 
Final Report  
- 
- 
- 
- 
- 
- 
- 
X 
 
 A.17  	Exemption for Display of Expiration Date  
CMS does not seek this exemption. The Expiration Date and OMB control number will be displayed at the top of every survey.  
 A.18  	Exceptions to Certification Statement 19  
There are no exemption to the certification statement.