<June 2020>



The 2020 ICH CAHPS Survey Facility Non-Participation Form

Jan 6

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Please note that the 2020 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 6, 2020 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) 2020 by counting the number of survey-eligible patients they served in CY2019.

ICH facilities that determine that they are not required to administer the 2020 ICH CAHPS Survey and those that choose not to administer the survey must complete and submit the 2020 ICH CAHPS Facility Non-Participation Form to the ICH CAHPS Coordination Team.

ICH facilities should please note the following:

  • 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 CY2019 must submit the 2020 Facility Non-Participation Form if they do not plan to administer the 2020 ICH CAHPS Spring and Fall Surveys.
  • Submission of the Facility Non-Participation Form only alerts the ICH CAHPS Coordination Team that the facility does not wish for a sample file to be provided to their authorized vendor for the current calendar year; it does not affect compliance, which is determined on an annual basis by the ESRD Quality Incentive Program (QIP) team.
  • Once the Facility Non-Participation Form is submitted, any existing vendor authorization for the submitted CCN(s) is removed from the ICH CAHPS website. This means that if at any point in the future the submitted CCN(s) wishes to participate in the ICH CAHPS Surveys, the designated ICH CAHPS Facility Survey Administrator will need to authorize a survey vendor for the CCN(s).

The deadline to submit the 2020 Facility Non-Participation Form is 5:00 PM Eastern Time on February 28, 2020.

Please contact the ICH CAHPS Coordination Team at 1-866-245-8083 or via e-mail at if you have any questions or need more information about the Facility Non-Participation Form.