National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)

OMB 0938-1240

The information collected in the national implementation of OAS CAHPS will be used for the following purposes: -To provide a source of information from which selected measures can be publicly reported to beneficiaries to help them make informed decisions for outpatient surgery facility selection; -To aid facilities with their internal quality improvement efforts and external benchmarking with other facilities; and -To provide CMS with information for monitoring and public reporting purposes. For the mode experiment, CMS plans to use information from this mode experiment to determine whether additional mode of administration (i.e. Web data collection) should be included in the current national implementation of OAS CAHPS protocols.

The latest form for National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500) expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10500 HOPDs/ASCs Patient Records Form and Instruction
Form CMS-10500 National Implementation Form
CMS-10500-SupportingStatement-A.docx Supporting Statement A
CMS-10500-SupportingStatement-B.docx Supporting Statement B
Attachment G - Response to Comments.pdf Supplementary Document
HOPDs/ASCs Patient Records Form and Instruction
National Implementation Form

All Historical Document Collections

202402-0938-009 Approved without change	Extension without change of a currently approved collection	2024-02-27
202107-0938-015 Approved without change	Revision of a currently approved collection	2021-07-30
201807-0938-016 Approved without change	Revision of a currently approved collection	2018-07-31
201510-0938-003 Approved with change	No material or nonsubstantive change to a currently approved collection	2015-10-29
201505-0938-003 Approved with change	Revision of a currently approved collection	2015-05-07
201312-0938-022 Approved with change	New collection (Request for a new OMB Control Number)	2013-12-31

OMB Details

Mode Experiment

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10500	OAS CAHPS (Web Survey Screenshots)	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS (Telephone Script)	Fillable Fileable	Form and instruction
Form CMS-10500	OAS CAHPS (Mail Survey)	Fillable Fileable	Form

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