Consumer Assessment of Healthcare Providers and Systems (CAHPS®)Home and Community Based Services (HCBS) Survey Database

OMB 0935-0245

The CAHPS Home and Community-Based Services Survey is the first cross-disability survey of home and community-based service beneficiaries’ experience receiving long-term services and supports. It is designed to facilitate comparisons across state Medicaid HCBS programs throughout the country that target adults with disabilities, e.g., including frail elderly, individuals with physical disabilities, persons with developmental or intellectual disabilities, those with acquired brain injury and persons with severe mental illness. The HCBS CAHPS Survey was developed by the Centers for Medicare & Medicaid Services (CMS) for voluntary use by state Medicaid programs, including both fee-for-service HCBS programs as well as managed long-term services and supports (MLTSS) programs. States with adequate sample sizes may consider using survey metrics in value-based purchasing initiatives. The HCBS-CAHPS Database will serve as a primary source of data available to states, agency programs and researchers to help answer important questions related to beneficiary experiences. AHRQ, through its contractor, will collect and make available de-identified survey data, enabling HCBS programs to identify areas where quality can be improved. Rationale for the information collection. Aggregated HCBS Database results will be made publicly available on AHRQ’s CAHPS website. Technical assistance will be provided by AHRQ through its contractor, Westat at no charge to programs to facilitate the access and use of these materials for quality improvement and research. Technical assistance will also be provided to support HCBS-CAHPS data submission.

The latest form for Consumer Assessment of Healthcare Providers and Systems (CAHPS®)Home and Community Based Services (HCBS) Survey Database expires 2022-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 4 Data Files Submission Form and Instruction
Form 3 Data Use Agreement Form and Instruction
Form 2 Program Information Form Form and Instruction
Form 1 Adult HCBS Registration Form Form
HCBS Database_OMB Statement B_7.11.2022_Clean.docx Supporting Statement B
HCBS Database_OMB Statement A_7.11.2022_Clean 1115.docx Supporting Statement A
Data Files Submission Form and Instruction
Data Use Agreement Form and Instruction
Program Information Form Form and Instruction
Adult HCBS Registration Form Form

All Historical Document Collections

202211-0935-001 Approved without change	Reinstatement without change of a previously approved collection	2022-11-22
201907-0935-001 Approved without change	New collection (Request for a new OMB Control Number)	2019-07-25

OMB Details

Adult HCBS Registration Form

Federal Enterprise Architecture: Health - Health Care Services

Form 1

Attachment A: Adult HCBS Registration Form

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.