QHP Enrollee Survey Minimum Business Requirements Survey vendors must meet all Minimum Business Requirements. Please check “Yes” or “No” for each item below to indicate whether your organization meets the following Minimum Business Requirements. Relevant Survey Experience Number of Years in Business Vendor has been in business for a minimum of four years. Yes No Survey Experience Vendor has a minimum of two years’ prior experience administering standardized patient experience surveys as an organization within the most recent three-year period. Yes No Vendor has a minimum of two years’ prior experience conducting (mail/telephone/Internet) survey protocols within the most recent period. Yes No Vendor has prior experience administering patient experience surveys for vulnerable populations. Yes No Vendor has a minimum of two years’ prior experience employing a statistical sampling process within the most recent three-year period. Yes No Vendor has prior experience submitting patient experience survey data to an external third-party organization. Yes No Vendor has a minimum of two years’ prior experience conducting large-scale patient experience survey projects using mixed-mode administration (mail/telephone/Internet) within the most recent three-year period. Yes No In reviewing applications, CMS will take into consideration the applicant’s prior experience on other CMS-sponsored surveys as a survey vendor. Prior Experience on CMS-Sponsored Surveys Vendor has been approved as a survey vendor to implement other or CAHPS surveys. Yes No
System Resources Vendor’s commercial physical plant and system resources meet CMS specifications and accommodate the volume of surveys being administered. Note: All system resources are subject to oversight activities, including onsite visits to physical locations. Yes No Vendor and its designated subcontractors (if applicable) conduct business operations and all survey vendor related work, including mail and Internet survey administration and telephone interviewing, at the survey vendor’s or approved subcontractor’s official business location. Home-based places of work (e.g., residences) and virtual organizations will not be considered. Yes No Vendor has the capacity to reproduce and mail questionnaires, cover letters and reminder letters at the survey vendor’s or subcontractor’s official business location, as outlined in 2019 Qualified Health Plan Enrollee Experience Survey Technical Specifications. Yes No Vendor has the capacity to process (e.g., scan or key enter) incoming paper surveys at the survey vendor’s or designated subcontractor’s official business location, as outlined in 2019 Qualified Health Plan Enrollee Experience Survey Technical Specifications. Yes No Vendor has the capacity to program electronic telephone interview systems in accordance with specifications provided and to conduct telephone interviews using an electronic telephone interviewing system at the survey vendor’s or subcontractor’s official business location, as outlined in the 2019 Qualified Health Plan Enrollee Experience Survey Quality Technical Specifications. Yes No Vendor has the capacity to produce and program the Internet survey instrument in-house. Yes No Vendor has the capacity to produce a mobile ready version of the Internet survey in-house, which can be completed on iOS or Android devices. Yes No Vendor can handle concurrent survey projects while maintaining high-quality survey data and response rates. Yes No Vendor has an electronic survey management system that tracks fielded surveys through each stage of the protocol via random, unique de-identified enrollee identification numbers and interim disposition codes. The electronic survey management system prevents duplicative records. Yes No Vendor has the capacity to provide regular progress reports to QHP issuers, within guidelines specified by CMS. Yes No Vendor maintains a secure work environment for receiving, processing and storing hardcopy and electronic versions of questionnaires and sample files Yes No
Subcontractor 2 Subcontractor Name Mailing Address Telephone Number Number of Years in Business Number of Years Subcontractor Has Worked with Your Organization Survey Administration Role(s) Experience Related to Survey Administration Role(s), Including Names of Relevant Projects Subcontractor 3 Subcontractor Name Mailing Address Telephone Number Number of Years in Business Number of Years Subcontractor Has Worked with Your Organization Survey Administration Role(s) Experience Related to Survey Administration Role(s), Including Names of Relevant Projects Subcontractor 4 Subcontractor Name Mailing Address Telephone Number Number of Years in Business Number of Years Subcontractor Has Worked with Your Organization Survey Administration Role(s) Experience Related to Survey Administration Role(s), Including Names of Relevant Projects