Exception Request Process:

The Exception Request process is designed to allow for as much flexibility as possible, while still maintaining the integrity of the data for standardized public reporting. Hospitals/Survey vendors proposing a variation from the standard HCAHPS protocol must request an exception prior to survey administration.

• To request an exception, hospitals/survey vendors are required to complete and submit an Exception Request Form (see the current HCAHPS Quality Assurance Guidelines) that must be submitted online www.hcahpsonline.org, or to access the Exception Request Form online see below. The form will collect information on the proposed alternative to the standard protocols. NOTE: This form does not accept any special characters or symbols in the text boxes. Use only alphanumeric characters when completing this form.
• Survey Vendors must complete and submit all Exception Request Forms on behalf of their client hospitals.
• Survey vendors may submit one Exception Request Form on behalf of multiple hospitals with the same Exception Request. Survey vendors must include a list of contracted hospitals on whose behalf they are submitting the Exception Request.

Allowable Exceptions

The HCAHPS Project Team (HPT) has identified acceptable variations from established methodologies. Requested exceptions may fall into categories such as:

• Disproportionate Stratified Random Sampling - Include the following information in the Exception Request:
• Name of each stratum
• Estimated number of total inpatient discharges for each stratum
• Estimated number of eligible patients for each stratum
• Estimated number of sampled patients for each stratum (minimum of 10 sampled discharges)
• Determination of Service Line Categories - MS-DRGs are the preferred means to establish the service line category (Maternity Care, Medical, or Surgical). Hospitals/Survey vendors will need to request an exception for alternative strategies not identified in the current HCAHPS Quality Assurance Guidelines manual.
• If hospitals/survey vendors are requesting Determination of Service Line, additional documentation is required:
• Current electronic or written confirmation from the hospital that they are unable to provide MS-DRG codes or other preferred means of establishing the HCAHPS Service Line Category
• Current electronic or written confirmation from the hospital delineating which patient populations are served (Medical, Surgical or Maternity)
• Participating in Another CMS or CMS-sponsored Inpatient Initiative - If a hospital accepts an offer to participate in another CMS or CMS-sponsored project that includes an inpatient survey which may contravene HCAHPS protocols, the HPT requests that hospitals file an Exception Request to alert and inform the HCAHPS Project Team of its participation.
• Survey Materials - An Exception Request must be filed for the use of survey materials that do not align with the examples provided in the current HCAHPS Quality Assurance Guidelines manual.
• Conducting Survey Operations from Remote Location - An Exception Request must be filed to request approval to conduct survey operations from a remote location (other than hospital's/survey vendor's place of business).

• Other – Hospitals/Survey vendors must request an exception for alternative strategies not identified in the current HCAHPS Quality Assurance Guidelines manual.

No alternative modes of survey administration will be permitted other than those prescribed for the survey (Mail Only, Telephone Only, Mixed Mode, and IVR mode).

Review Process

The Exception Request will be reviewed by the HCAHPS Project Team who will assess the methodological soundness of the proposed alternative and the potential for introducing bias. Depending on the type of exception, a review of procedures and/or conference call or site visit may also be required. If further clarification or additional information is required for the HCAHPS Project Team to better assess the exception, the hospitals/survey vendors will be notified and requested to provide additional information.

If the Exception Request is approved:

• The HCAHPS Project Team will notify hospitals/survey vendors. All approved Exception Requests may only be implemented at the beginning of a quarter and are limited to a two-year approval timeframe, unless otherwise specified.

If the Exception Request is not approved:

• The HCAHPS Project Team will notify the hospital/survey vendor with information and reasoning for the denial unless otherwise specified.
• Hospitals/Survey vendors have the option of appealing the denial decision. Hospitals/Survey vendors have five business days to submit an appeal. In such cases, hospitals/survey vendors will resubmit the Exception Request Form (checking the box marked "Appeal of Exception Denial") and update it to provide further information about the nature of the exception. The appeal is then returned to the HCAHPS Project Team for re-review. The second review will take approximately 10 business days.
  
  

This page was last modified on (03/27/23)

I. Exception request

Please complete items 1 and 2 for each requested exception.

Unique Report ID 64052

Submission Date 04/23/2024

1. Exception Request For (Check one in each box)

New Exception

Renewal Exception

Previous Exception Request ID Number

Update of List of Applicable Hospitals

Previous Exception Request ID Number

Appeal of Exception Denial Please select an option above

Exception Request ID Number * The Initial Exception Request ID is required.

Disproportionate Stratified Random Sampling
Determination of Service Line

You must select one of the following.
Please Note: CAH and IPPS hospitals must be submitted on separate Exception Request Forms.

CAH
IPPS

Participating in another CMS or CMS-Sponsored Initiative
Survey Materials
Conducting Survey Operations from Remote Location
Other Exception (specify) OtherExceptionType {{2000 - model.OtherExceptionType.length}} characters remaining Please select an option above Please Provide your Exception Type

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2. List of Hospitals Applicable to this Exception Request This section is to be completed by survey vendors or hospitals administering the survey for multiple sites.

Do you currently have hospitals applicable to this exception request? Yes No You must enter at least one Hospital if 'Yes'

To manually enter hospitals, use the text boxes below or to upload multiple hospitals (for example 10 or more) please complete the steps below.

• Click on the link to download the template.
• Fill out the template, save it to your computer, and click the Upload button below to add your hospitals to the table. Note that other file types and/or file names will not be accepted.
• To edit a hospital, select the hospital from the table and edit the name or CCN in the text boxes below.
• Hospitals uploaded through the template: To remove a hospital, delete the hospital and CCN on the saved copy of the template, then re-upload the document.
• Hospitals added manually: To remove a hospital, select the checkbox next to the hospital(s) you wish to remove. The "Delete" button will become enabled. Click the "Delete" button, then click "OK" on the warning message to remove hospitals from the table.

For technical assistance, contact the HCAHPS Project Team: hcahps@hsag.com or 1-888-884-4007.

Name of Hospital * Name of Hospital is required.

CCN *

CCN required.

Invalid CCN. Invalid CCN for Hospital type.

Add

Upload

Delete

{{fileUploadError}}

Edit

Cancel

Delete

(click on a row in the grid to edit it)

II. General Information

1. Organization (Survey vendor or self-administering hospital)

1a. Organization Name * The Name of the Organization is required.

1b. Organization Type * Choose One {{option.name}} The Organization Type is required.

1c. Medical Provider Number (CCN) * The Medical Provider Number is required. Invalid CCN for selected Hospital type.

1d. Mailing Address 1 * The Address is required.

1e. Mailing Address 2

1f. City * The City is required.

1g. State * The State is required.

1h. Zip Code * The Zip Code is required.

1i. Telephone * Telephone is required.

1j. Fax Number

1k. Website

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2. Contact Person for this Exception Request (Confirmation email will be sent to the Contact Person)

2a. First Name * First Name is required.

2b. Middle Initial

2c. Last Name * Last Name is required.

2d. Title * Title is required.

2e. Degree (e.g. RN, MD, PhD)

2f. Mailing Address 1 * Mailing Address 1 is required.

2g. Mailing Address 2

2h. City * City is required.

2i. State * State is required.

2j. Zip Code * Zip Code is required.

2k. Telephone * Telephone is required.

2l. Fax Number

2m. Email Address * Email is required.

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3. Description of Exception Request

3a. Purpose of Proposed Exception Requested (e.g. sampling, other) * Purpose of Proposed Exception is required. {{4000 - model.PurposeOfRequest.length}} characters remaining

3b. Rationale for Proposed Exception Requested * Rationale for Proposed Exception is required. {{4000 - model.RationaleOfRequest.length}} characters remaining

3c. Explanation of Implementation of Proposed Exception Requested * Explanation of Implementation is required. {{4000 - model.ExplanationofImplementation.length}} characters remaining

3d. Evidence that Exception Will Not Affect Results * Evidence that Exception Will Not Affect Results is required. {{4000 - model.EvidenceWhyWillNotAffectResults.length}} characters remaining

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Upon submission, a confirmation email will be sent to the email address listed in the Contact Person section. If a confirmation email is not received, please contact HCAHPS Technical Assistance at hcahps@hsag.com to verify submission was successful.

Please print this form for your records prior to submission. To print the Exception Request Form, click here.

Once the form has been printed, please complete the captcha below and click "Submit" to submit the form.

Captcha Enter answer to equation on left.