The 2019 ICH CAHPS Survey Facility Non-Participation Form
Please note that the 2019 ICH CAHPS Survey Facility Non-Participation Form is now available on the ICH CAHPS website. To access this form, log in to the website using your user credentials and choose “Facility Non-Participation Form” under the For Facilities menu.
As noted in an e-mail message sent to in-center hemodialysis (ICH) facilities on January 3, 2019 and posted under the Quick Links menu on the ICH CAHPS Website’s home page, all in-center hemodialysis (ICH) facilities must determine whether they will be required to administer the ICH CAHPS Survey in calendar year (CY) 2019 by counting the number of survey-eligible patients they served in CY2018.
ICH facilities that determine that they are not required to administer the 2019 ICH CAHPS Survey and those that choose not to administer the survey must complete and submit the 2019 ICH CAHPS Facility Non-Participation Form to the ICH CAHPS Coordination Team.
ICH facilities should note that the Facility Non-Participation Form is an annual form that is valid only for the year in which it was submitted. ICH facilities that submitted the Facility Non-Participation Form in CY2018 must submit the 2019 Facility Non-Participation Form if they do not plan to administer the 2019 ICH CAHPS Spring and Fall Surveys.
The deadline to submit the 2019 Facility Non-Participation Form is 5:00 PM Eastern Time on February 28, 2019.
Please contact the ICH CAHPS Coordination Team at 1-866-245-8083 or via e-mail at firstname.lastname@example.org if you have any questions or need more information about the Facility Non-Participation Form.