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Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey, Version 5.0 (Medicaid and Commercial)

New or Maintenance
Endorsement and Maintenance (E&M) Cycle
Is Under Review
Measure Description

The CAHPS Health Plan Survey is a survey that asks health plan enrollees to report about their care and health plan experiences as well as the quality of care received from physicians. HP-CAHPS Version 4.0 was endorsed by NQF in July 2007 (NQF #0006) and Version 5.0 received maintenance endorsement in January 2015. The survey is part of the CAHPS family of patient experience surveys and is available in the public domain at

The survey is designed to be administered to includes individuals (18 and older for the Adult version; parents or guardians of children aged 0-17 for the Child version) who have been enrolled in a health plan for a specified period (6 months or longer for Medicaid version, 12 months or longer for Commercial version) with no more than one 30-day break in enrollment.

The CAHPS Adult Health Plan Survey has 39 items, and the CAHPS Child Health Plan Survey has 41 items. Ten of the adult survey items and 11 of the child survey items are used to form 4 composite measures. Each survey also has 4 single-item rating measures. The aspect of quality assessed by each measure is described below:

Measure 1: Getting Needed Care (2 items)
Measure 2: Getting Care Quickly (2 items)
Measure 3: How Well Doctors Communicate (4 items in Adult survey & 5 items in Child survey)
Measure 4: Health Plan Information and Customer Service (2 items)
Measure 5: How People Rated Their Personal Doctor (1 item)
Measure 6: How People Rated Their Specialist (1 item)
Measure 7: How People Rated Their Health Care (1 item)
Measure 8: How People Rated Their Health Plan (1 item)

  • Electronic Clinical Quality Measure (eCQM)
    Level Of Analysis
    Care Setting

    We recommend that CAHPS Health Plan Survey items and composites be calculated using a top box scoring method. The top box score refers to the percentage of patients whose responses indicated that they “always” received the desired care or service for a given measure. The top box numerator for each of the four Overall Ratings items is the number of respondents who answered 9 or 10 for the item; with a 10 indicating the “Best possible.”


    The eligible population for the survey includes all individuals who have been enrolled in a health plan for at least 6 (Medicaid) or 12 (Commercial) months with no more than one 30-day break in enrollment. Denominators will vary by item and composite.


    Individuals are excluded from the survey target population if:
    1) They were not continuously enrolled in the health plan (excepting an allowable enrollment lapse of less than 30 days).
    2) Their primary health coverage was not through the plan.
    3) Another member of his or her household had already been sampled.
    4) They had been institutionalized (put in the care of a specialized institution) or are deceased.

    Testing Data Sources
  • Most Recent Endorsement Activity
    Endorsed Patient Experience and Function Spring Cycle 2019
    Initial Endorsement
    Next Planned Maintenance Review
    Patient Experience and Function Fall 2024
    Endorsement Status
    Last Updated