CAHPS Hospice Survey Vendor Authorization Form

Hospice agencies must authorize an approved CAHPS Hospice Survey vendor to submit data on their behalf for the administration of the CAHPS Hospice Survey.

In order to authorize a survey vendor or switch to a new vendor, a hospice representative must submit the CAHPS Hospice Survey Vendor Authorization Form  one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse by that vendor.

  • A quarter is based on the calendar year (CY) and will correspond to the month of patient death. For example, Quarter 4 2023 begins with October 2023 patient deaths (caregivers to be surveyed January 2024).
Calendar Quarter Caregivers are Surveyed: Corresponding to Patient Deaths: Vendor Authorization Form MUST be Submitted by:
Q4 2023 January-March 2024 October-December 2023 January 31, 2024
Q1 2024 April-June 2024 January-March 2024 April 30, 2024
Q2 2024 July-September 2024 April-June 2024 July 31, 2024
Q3 2024 October-December 2024 July-September 2024 October 31, 2024

If a hospice wishes to change CAHPS Hospice Survey vendors, it may do do ONLY at the beginning of a calendar quarter.

The individual who completes the CAHPS Hospice Survey Vendor Authorization Form for the hospice will be considered the CAHPS Hospice Survey Administrator for that hospice.

  • This person must attest that they are authorized to submit the CAHPS Hospice Survey Authorization Form on behalf of their hospice.
  • Hospices may also designate an additional individual within the hospice organization to serve as the main point of contact with the CAHPS Hospice Survey Project Team.

Please note that a separate CAHPS Hospice Survey Vendor Authorization Form must be submited for each hospice CCN. 

After submission of the CAHPS Hospice Survey Vendor Authorization Form, no further action is required by the hospice to notify CMS of their survey vendor selection.

  • The CAHPS Hospice Survey Administrator will receive an automated email to confirm the form has been received.
  • The RAND Corporation communicates to CMS which hospice agencies have authorized a survey vendor to administer the CAHPS Hospice Survey on their behalf.
  • The RAND Corporation notifies vendors of hospices who have authorized them for data collection.
  • Vendors cannot submit data for hospices that have not authorized them.

Click here to complete the CAHPS Hospice Survey Vendor Authorization Form