CAHPS Home Health Care Survey (CMS-10275)

OMB 0938-1066

OMB 0938-1066

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.

OMB Details

HHCAHPS Survey

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10275Consent to Share Question #35 (English)Fillable FileableForm
Form CMS-10237Consent to Share Question #35 (Armenian)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (Vietnamese)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (Chinese Traditional)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (Chinese Simplified)Fillable FileableForm
Form CMS-10275Consent to Share Question #35 (Chinese)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (Telephone/Proxy)Fillable PrintableForm
Form CMS-10275Home Health Care CAHPS Survey (Telephone)Fillable PrintableForm
Form CMS-10275Home Health Care CAHPS Survey (Spanish)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (Russian)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (English)Fillable FileableForm
Form CMS-10275Home Health Care CAHPS Survey (Armenian)Fillable FileableForm
Form CMS-10275Consent to Share Question #35 (Vietnamese)Fillable FileableForm
Form CMS-10275Consent to Share Question #35 (Traditional Chinese)Fillable FileableForm
Form CMS-10275Consent to Share Question #35 (Russian)Fillable FileableForm

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


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