As part of the DHHS Transparency Initiative on Quality Reporting, CMS plans to implement a process to measure and publicly report patients' experiences with home health care they receive from Medicare-certified home health agencies through the data collection effort described in this request: the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey. The Home Health Care CAHPS Survey, which was developed and tested by the Agency for Healthcare Research and Quality (AHRQ) and is part of the family of CAHPS surveys, is a standardized survey for home health patients to assess their home health care providers and the quality of the home health care they receive. Prior to the Home Health Care CAHPS survey, there was no national standard for collecting data about home health care patients' experience with their home health care. This is a revision to the original PRA package which covered the voluntary implementation of the survey among Medicare-certified agencies and a randomized mode experiment to test the impact of different modes of data collection on survey responses. This is a revised PRA package because it now includes the burden to the home health agencies (HHAs) to contract with an approved HHCAHPS survey vendor to administer the HHCAHPS survey on their behalf.
The latest form for CAHPS Home Health Care Survey (CMS-10275) expires 2023-08-31 and can be found here.
Document Name |
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Form |
Form |
Supporting Statement A |
Supplementary Document |
Supporting Statement B |
Approved without change |
Extension without change of a currently approved collection | 2023-03-31 | |
Approved without change |
Extension without change of a currently approved collection | 2020-05-14 | |
Approved with change |
Extension without change of a currently approved collection | 2017-05-31 | |
Approved without change |
Revision of a currently approved collection | 2014-01-29 | |
Comment filed on proposed rule and continue |
Revision of a currently approved collection | 2013-09-30 | |
Approved with change |
Revision of a currently approved collection | 2010-11-30 | |
Comment filed on proposed rule and continue |
Revision of a currently approved collection | 2010-07-23 | |
Approved with change |
New collection (Request for a new OMB Control Number) | 2009-04-22 |
Federal Enterprise Architecture: Health - Health Care Services
Form CMS-10275 | Consent to Share Question #35 (English) | Fillable Fileable | Form |
Form CMS-10237 | Consent to Share Question #35 (Armenian) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Vietnamese) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Chinese Traditional) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Chinese Simplified) | Fillable Fileable | Form |
Form CMS-10275 | Consent to Share Question #35 (Chinese) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Telephone/Proxy) | Fillable Printable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Telephone) | Fillable Printable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Spanish) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Russian) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (English) | Fillable Fileable | Form |
Form CMS-10275 | Home Health Care CAHPS Survey (Armenian) | Fillable Fileable | Form |
Form CMS-10275 | Consent to Share Question #35 (Vietnamese) | Fillable Fileable | Form |
Form CMS-10275 | Consent to Share Question #35 (Traditional Chinese) | Fillable Fileable | Form |
Form CMS-10275 | Consent to Share Question #35 (Russian) | Fillable Fileable | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.