[Federal Register Volume 75, Number 15 (Monday, January 25, 2010)]
[Pages 3908-3911]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-1158]



Agency for Healthcare Research and Quality

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.


SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Collection of Information for Agency for Healthcare Research 
and Quality's (AHRQ) Consumer Assessment of Healthcare Providers and 
Systems (CAHPS) Health Plan Survey Comparative Database.'' In 
accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3520, AHRQ 
invites the public to comment on this proposed information collection.

DATES: Comments on this notice must be received by March 26, 2010.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at 
[email protected].
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

Clearance Officer, (301) 427-1477, or by e-mail at 
[email protected].


Proposed Project

    Collection of Information for Agency for Healthcare Research and 
Quality's (AHRQ) Consumer Assessment of Healthcare Providers and 
Systems (CAHPS) Health Plan Survey Comparative Database.

[[Page 3909]]

    The Agency for Healthcare Research and Quality (AHRQ) requests that 
the Office of Management and Budget (OMB) approve, under the Paperwork 
Reduction Act of 1995, AHRQ's collection of information for the AHRQ 
Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
Database for Health Plans. The CAHPS Health Plan Database consists of 
data from the AHRQ CAHPS Health Plan Survey. Health plans in the U.S. 
are asked to voluntarily submit data from the survey to AHRQ, through 
its contractor, Westat. The CAHPS Database was developed by AHRQ in 
1998 in response to requests from health plans, purchasers, and the 
Centers for Medicare & Medicaid Services (CMS) to provide comparative 
data to support public reporting of health plan ratings, health plan 
accreditation and quality improvement.
    The CAHPS Health Plan Survey is a tool for collecting standardized 
information on enrollees' experiences with health plans and their 
services. The development of the CAHPS Health Plan Survey began in 
1995, when AHRQ awarded the first set of CAHPS grants to Harvard, RTI, 
and RAND. In 1997 the CAHPS 1.0 survey was released by the CAHPS 
Consortium. The CAHPS Consortium refers to the research organizations 
involved in the development, dissemination, and support of CAHPS 
products. The current Consortium includes AHRQ, CMS, RAND, Yale School 
of Public Health, and Westat.
    Since that time, the Consortium has clarified and updated the 
survey instrument to reflect field test results; feedback from industry 
experts; reports from health plan participants, data collection 
vendors, and other users; and evidence from cognitive testing and focus 
groups. In November 2006, the CAHPS Consortium released the latest 
version of the instrument: The CAHPS Health Plan Survey 4.0. The 
development of this update to the Health Plan Survey has been part of 
the ``Ambulatory CAHPS (A-CAHPS) Initiative,'' which arose as a result 
of extensive research conducted with users. AHRQ released the CAHPS 
Health Plan Survey 4.0, along with guidance on how to customize and 
administer it. The National Quality Forum endorsed the 4.0 version of 
the Health Plan Survey in July 2007.
    The CAHPS Health Plan Database uses data from AHRQ's standardized 
CAHPS Health plan survey to provide comparative results to health care 
purchasers, consumers, regulators and policy makers across the country. 
The Database also provides data for AHRQ's annual National Healthcare 
Quality and National Healthcare Disparities Reports. Voluntary 
participants include public and private employers, State Medicaid 
agencies, State Children's Health Insurance Programs (SCHIP), CMS, and 
individual health plans.
    The collection of information for the CAHPS Database for Health 
Plans is being conducted pursuant to AHRQ's statutory authority to 
conduct and support research on health care and systems for the 
delivery of such care, including activities with respect to the 
quality, effectiveness, efficiency, appropriateness and value of health 
care services. See 42 U.S.C. 299a(a)(1).

Method of Collection

    Information for the CAHPS Health Plan Database has been collected 
by AHRQ through its contractor Westat on an annual basis since 1998. 
Health plans are asked to voluntarily submit their data to the 
comparative database in June of each year. The data are cleaned with 
standardized programs, then aggregated and used to produce comparative 
results for commercial (adult and child), Medicaid (adult and child), 
and Medicare (adult) populations for the two most recent years. In 
addition, individual participant reports are produced that display the 
participating organizations' own results compared to appropriate 
comparisons derived from the National, regional and product-type 
distributions on a password-protected section of the online reporting 
    The CAHPS Health Plan Database receives the data from three 
sources. First, commercial health plan data is purchased by the CAHPS 
Health Plan Database directly from the National Committee for Quality 
Assurance (NCQA). The data is collected by NCQA from those who 
participate in its accreditation program. Second, Medicare data is 
provided by CMS through an agency data use agreement. The Medicare data 
is collected by CMS and their contractor from beneficiaries who were 
enrolled in a managed care health plan. Third, Medicaid data is 
collected by the CAHPS Health Plan Database. Medicaid agencies and 
their vendors directly submit their Medicaid health plan survey data to 
the CAPHS Health Plan Database through an online data submission 
system. Data submitted by Medicaid plans are compiled along with the 
data received from CMS and NCQA to comprise the CAHPS Health Plan 
Survey comparative database.

Estimated Annual Respondent Burden

    Each year State Medicaid agencies and individual health plans 
decide whether to participate in the database and prepare their 
materials and dataset for submission to the CAHPS Health Plan Database. 
Participating organizations are typically State Medicaid agencies with 
multiple health plans. However, individual health plans are also 
encouraged to submit their data to the CAHPS Database. The number of 
data submissions per registrant varies from participant to participant 
and year to year because some participants submit data for multiple 
health plans, while others may only submit survey data for one plan.
    Each organization that decides to participate in the database must 
have their POC complete a registration form providing their contact 
information for access to the on-line data submission system, sign and 
submit a data use agreement (DUA), and provide health plan 
characteristics such as health plan name, product type, type of 
population surveyed, health plan state, and plan name to appear in the 
reporting of their results.
    Each vendor that submits files on behalf of a Medicaid agency or 
individual health plan must also complete the registration form in 
order to obtain access to the on-line submission system. The vendor, on 
behalf of their client, may also complete additional information about 
survey administration (CAHPS survey version used, mode of survey 
administration, total enrollment count, description of how the sample 
was selected), submit a copy of the questionnaire used, and submit one 
data file per health plan. Commercial health plan data is received 
directly from NCQA. Medicare health plan data is received from CMS.
    The burden hours and costs below pertain only to the collection of 
Medicaid data from State Medicaid agencies and individual Medicaid 
health plans because those are the only entities that submit data 
through the data submission process (other data are obtained directly 
from NCQA and CMS as noted earlier in Section 2). In 2009, a total of 
60 participants, representing 45 individual organizations and 15 
vendors, submitted data for 244 health plans (an average of about 4 
health plans per participant).
    Exhibits 1 and 2 are based on the estimated number of individual 
participants (participating organizations and/or vendors) who will 
complete the database submission steps and forms in the coming years, 
and is not based on the total number of health plans that are 
submitted. The number of respondents and burden hours are based on an 
estimated slight increase in the number of participants to 70 in 2010 
and 2011.

[[Page 3910]]

    In Exhibit 1, the 70 participants that will complete the 
registration form and submit information to the CAHPS Health Plan 
Database are a combination of an estimated 50 State Medicaid agencies 
and individual health plans, and 20 estimated vendors. The 50 State 
Medicaid agencies or individual health plans will sign and submit a 
DUA. Vendors do not sign or submit DUAs. Health plan information and 
data files are submitted for each health plan. Exhibit 1 shows an 
estimated total of 280 health plans (70 estimated participants with 4 
health plans per participant). The total burden hours for completing 
the registration, DUA and data submission process are estimated to be 
722 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
                                                     Number of       Number of
                    Form name                      respondents/    responses per     Hours per     Total burden
                                                       POCS             POC          response          hours
Registration Form and Data Submission *.........              70               1             7.6             532
Data Use Agreement **...........................              50               1               1              50
Health Plan Information ***.....................              70               4           30/60             140
    Total.......................................             190              NA              NA             722
* The online Registration Form requires about 5 minutes to complete; however, over 7 hours is required to plan/
  prepare for the data submission. This includes the amount of time the participating organization, and others
  (CEO, lawyer, vendor) typically spend deciding whether to participate in the database and preparing their
  materials and dataset for submission to the CAHPS Health Plan Database and performing the submission.
** The Data Use Agreement requires about 3 minutes to complete; however, about 57 minutes is required for the
  participating organization to review the agreement prior to signing. This includes the review by the
  organization's CEO or legal department.
*** A few health plans may submit their data directly; however, most health plan data will be submitted by the

    Exhibit 2 shows the estimated annualized cost burden based on the 
respondents' time to complete the submission process. The cost burden 
is estimated to be $31,046 annually.

                                   Exhibit 2--Estimated Annualized Cost Burden
                    Form name                        Number of     Total burden     hourly wage     Total cost
                                                    respondents        hours          rate **         burden
Registration Form and Data Submission *.........              70             532          $43.00         $22,876
Data Use Agreement..............................              50              50           43.00           2,150
Health Plan Information.........................              70             140           43.00           6,020
    Total.......................................             190             722              NA          31,046
* Wage rates were calculated using the mean hourly wage based on occupational employment and wage estimates from
  the Dept of Labor, Bureau of Labor Statistics' May 2008 National Industry-Specific Occupational Employment and
  Wage Estimates NAICS 622000--located at http://www.bls.gov/oes/current/oes_nat.htm.
** Wage rate of $43.00 is based on the mean hourly wages for Medical and Health Services Managers. Wage rate of
  $42.67 is the weighted mean hourly wage for: Medical and Health Services Managers ($42.67 x 2.6 hours =
  $110.95), Lawyers ($59.98 x .5 hours = $29.99), Chief Executives ($89.16 x .5 hours = $44.58), and Computer
  programmer ($35.32 x 4 hours = $141.28) [Weighted mean = ($110.95 + 29.99 + 44.58 + 141.28)/7.6 hours =
  $326.80/7.6 hours = $43.00/hour].

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the estimated annualized cost to the government for 
developing, maintaining and managing the Health Plan Database and 
analyzing the data and reporting results. The cost is estimated to be 
$260,000 annually. Annualized costs for collecting and processing the 
CAHPS Health Plan Database are based upon 10 years of historical 
project costs. Start-up costs were present in the early years of the 
database only.

                  Exhibit 3--Estimated Annualized Cost
                       Cost component                            cost
Database Maintenance........................................     $50,000
Data Submission.............................................     100,000
Data Analysis and Reporting.................................     110,000
  Total.....................................................     260,000

Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQ's information collection are requested 
with regard to any of the following: (a) Whether the proposed 
collection of information is necessary for the proper performance of 
AHRQ healthcare research and healthcare information dissemination 
functions, including whether the information will have practical 
utility; (b) the accuracy of AHRQ's estimate of burden (including hours 
and costs) of the proposed collection(s) of information; (c) ways to 
enhance the quality, utility, and clarity of the information to be 
collected; and (d) ways to minimize the burden of the collection of 
information upon the respondents, including the use of automated 
collection techniques or other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

[[Page 3911]]

    Dated: January 11, 2010.
Carolyn M. Clancy,
[FR Doc. 2010-1158 Filed 1-22-10; 8:45 am]