System Resources physical plant and system resources meet CMS Vendor’s commercial specifications and accommodate the volume of surveys being administered. Yes No Note: All system resources are subject to oversight activities, including onsite visits to physical locations. 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 or Yes No vendor’s approved business location. Home-based places of subcontractor’s official work (e.g., residences) and virtual organizations will not be considered. Vendor has the capacity to reproduce and mail questionnaires, cover letters and reminder letters at the survey or vendor’s subcontractor’s official Yes No business location, as outlined in 2019 Qualified Health Plan Enrollee Experience Survey Technical Specifications. Vendor has the capacity to process (e.g., scan or key enter) incoming paper surveys at the survey or designated vendor’s subcontractor’s official Yes No business location, as outlined in 2019 Qualified Health Plan Enrollee Experience Survey Technical Specifications. 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 Yes No or business location, as outlined in the 2019 vendor’s subcontractor’s official Qualified Health Plan Enrollee Experience Survey Quality Technical Specifications. Vendor has the capacity to produce and program the Internet survey Yes No instrument in-house. Vendor has the capacity to produce a mobile ready version of the Internet Yes No survey in-house, which can be completed on iOS or Android devices. Vendor can handle concurrent survey projects while maintaining high-quality Yes No survey data and response rates. Vendor has an electronic survey management system that tracks fielded surveys through each stage of the protocol via random, unique de-identified Yes No enrollee identification numbers and interim disposition codes. The electronic survey management system prevents duplicative records. Vendor has the capacity to provide regular progress reports to QHP issuers, Yes No within guidelines specified by CMS. Vendor maintains a secure work environment for receiving, processing and Yes No storing hardcopy and electronic versions of questionnaires and sample files
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
2019-QHP-Survey-Vendor-Participation-Form.docx