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pdfOld Public Related Insurance (PR) Section
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Throughout the specifications for this CAPI section, for screens that
specify the reference period {END DATE} as part of the context header,
CAPI displays the {END DATE} only for Round 5. In any other round, CAPI
does not display the {END DATE} in the context header. For most
persons, the end date for Round 5 will be December 31 of the second
year of the panel.
BOX_01
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET BOTH OF THE FOLLOWING
CONDITIONS:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON WAS COVERED BY MEDICARE DURING THE PREVIOUS ROUND,
CONTINUE WITH LOOP_01
OTHERWISE, GO TO BOX_02
LOOP_01
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK PR01A END_LP01
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT THE COVERAGE PROVIDED
THROUGH MEDICARE. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT
MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON WAS COVERED BY MEDICARE AT ANY TIME DURING THE PREVIOUS ROUND
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Old Public Related Insurance (PR) Section
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PR01A
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EPRS.EPRSID
Label
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
Size
20
EPRS.EPRSRURN
EPRS.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EPRS RECORD
2
6
EPRS.NAMECHNG
EPRS.MCARELST
HAS THERE BEEN A CHANGE IN PLAN NAME
MEDICARE INSUR LISTED ON THIS CARD
2
2
EPRS.MCAREHMO
MEDICARE: PERSON SIGNED WITH HMO
2
EPRS.PROGDR
EPRS.MCARENAM
PRIV PLAN REQUIRES SIGNING W/PHYS,GROUP
NAME OF MEDICARE HMO
2
25
EPRS.MCARE
PERSON IS COVERED BY MEDICARE
2
EPCP.EPCPID
EPCP.EPCPRURN
EPCP ID KEY: EPRSID + PERSID
ROUND STAMP: RU LETTER + ROUND NUMBER
28
2
EPCP.CREATEQ
CREATION STAMP
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
{STR-DT} {END-DT}
{PLAN NAME: {NAME OF PREV RD’S MEDICARE INSURER FOR
ESTABLISHMENT-PERSON}}
During the last interview, it was record that (PERSON) (were/was) enrolled in
Medicare. We would like to update information about the (PERSON)'s
Medicare coverage.
{Since (START DATE)/{Between (START DATE) and (END DATE)},
{(have/has)/(were/was) (PERSON) {been} covered by the new
Medicareprescribed drug coverage (also called Part D)?
YES
NO
1
2
{BOX_01B}
{BOX_01B}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_01B}
{BOX_01B}
DISPLAY INSTRUCTIONS:
DISPLAY 'At any time since (START DATE)' AND '(have/has)' IF
NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' AND '(were/was)'
IF ROUND 5.
DISPLAY 'been' IF NOT ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
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ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND STATE IN WHICH INTERVIEW IS BEING
CONDUCTED DOES NOT OFFER A MEDICARE MANAGED CARE PLAN, CODE
PR02 ‘2’ (NO) AUTOMATICALLY BY CAPI AND GO TO PR03
IF CODED ‘1’ (YES) AND STATE IN WHICH INTERVIEW IS BEING
CONDUCTED DOES OFFER A MEDICARE MANAGED CARE PLAN, CONTINUE
WITH PR02
BOX_01B
NOTE: STATES THAT DO NOT OFFER MEDICARE MANAGED CARE PLANS ARE ALASKA,
ARKANSAS, DELAWARE, MAINE, MISSISSIPPI, MONTANA, VERMONT, AND WYOMING
IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT OFFER A MEDICARE
MANAGED CARE PLAN, CODE PR02 AND PR03 ‘2’ (NO) AUTOMATICALLY BY CAPI AND
GO TO END_LP01.
IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES OFFER A MEDICARE
MANAGED CARE PLAN, CONTINUE WITH PR02
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PR02
Help Enabled
Variable Name
EPRS.MCARELST
Comment Enabled
Jump Back Enabled
Label
MEDICARE INSUR LISTED ON THIS CARD
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
SHOW CARD PR-1.
As you may know, Medicare allows beneficiaries in certain parts of the country
to enroll in managed care plans such as HMOs (health maintenance
organizations) or PPOs (preferred provider organizations) to receive their
Medicare funded health care. These plans have names like those listed on
this card.
Is the name of (PERSON)'s insurance through Medicare {, between (START
DATE) and (END DATE)} listed on this card?
YES
1
{PR02OV}
NO
2
{PR03}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR03}
{PR03}
HELP AVAILABLE FOR DEFINITION OF MEDICARE MANAGED CARE.
DISPLAY INSTRUCTIONS:
DISPLAY ',between (START DATE) and (END DATE)' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
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PR02OV
Help Enabled
Variable Name
EPRS.MCARELET
Comment Enabled
Jump Back Enabled
Label
PLAN LETTER OF MEDICARE INSURANCE
Size
4
Which insurance plan is (PERSON)’s Medicare managed care plan?
CODE LETTER OF PLAN FROM SHOW CARD.
PLAN LETTER: _______________________
{END_LP01}
PROGRAMMER NOTES:
WHEN INTERVIEWER ENTERS LETTER OF PLAN, DISPLAY THE FOLLOWING
MESSAGE: ‘PLEASE VERIFY PLAN SELECTED: {DISPLAY PLAN NAME
SELECTED}’ WHEN INTERVIEWER PRESSES ENTER TO CLEAR THE
MESSAGE, PROCEED TO THE NEXT LOGICAL SCREEN
IN THE MESSAGE FOR 'DISPLAY PLAN NAME SELECTED' DISPLAY THE
ACTUAL PLAN NAME THAT CORRESPONDS TO THE LETTER ENTERED FOR
THAT STATE.
FLAG INSURER CODED ABOVE AS ‘CURRENT RD’S MEDICARE INSURER’
FOR THIS ESTABLISHMENT-PERSON-PAIR.
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PR03
Help Enabled (HMO)
Variable Name
EPRS.MCAREHMO
Comment Enabled
Jump Back Enabled
Label
MEDICARE: PERSON SIGNED WITH HMO
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Even though (PERSON)'s Medicare plan was not listed on the card, {(are/is)
(PERSON) currently/between (START DATE) and (END DATE) (were/was)
(PERSON)} enrolled in a Medicare managed care plan such as an HMO
(health maintenance organization) or PPO (preferred provider organization)?
(When answering this question, please include only insurance from Medicare,
not any privately purchased insurance.)
YES
NO
1
2
{PR04}
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP01}
{END_LP01}
HELP AVAILABLE FOR DEFINITION OF MEDICARE MANAGED CARE.
DISPLAY INSTRUCTIONS:
DISPLAY 'are/is (PERSON) currently' IF NOT ROUND 5. DISPLAY
'BETWEEN (START DATE) and (END DATE), (were/was)(PERSON)' IF
ROUND 5.
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PR04
Help Enabled
Variable Name
EPRS.MCARENAM
Comment Enabled
Jump Back Enabled
Label
Size
25
NAME OF MEDICARE HMO
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
What is the name of the (PERSON)’s Medicare managed care plan?
PLAN NAME: _______________________
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP01}
{END_LP01}
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT RD’S MEDICARE INSURER’
FOR THIS ESTABLISHMENT-PERSON-PAIR.
END_LP01
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH
BOX_02
BOX_02
IF ANY RU MEMBER HAD MEDICAID/SCHIP AS A SOURCE OF INSURANCE AT ANY TIME
DURING THE PREVIOUS ROUND, CONTINUE WITH PR07
OTHERWISE, GO TO BOX_05
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PR07
Help Enabled
Variable Name
HOME.CONFMCAI
Comment Enabled
Jump Back Enabled
Label
CONFIRM IF ALL STILL COVERED BY MEDCAID
Size
2
{STR-DT} {END-DT}
During the last interview, we recorded that (READ NAME(S) BELOW)
(was/were) covered by {Medicaid/{STATE NAME FOR MEDICAID}} or
{STATE CHIP NAME}.
Have all of these people been covered by {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME} at any time {since (START DATE)/
between (START DATE) AND (END DATE)}?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL
NO, ONLY SOME
1
2
NO, NONE
3
{BOX_03}
{PR08}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’.
DISPLAY ‘STATE NAME FOR MEDICAID’ (SUBSTITUTING THE STATE NAME
FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING
CONDUCTED DOES NOT USE THE NAME ‘Medicaid’. FOR THE SPECIFIC
MEDICAID PROGRAM NAME BY STATE TO DISPLAY, SEE BOX ON HX06.
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS,
SUBSTITUTING THE REAL STATE NAME FOR PROGRAM. FOR THE
SPECIFIC NAME TO DISPLAY BY STATE, SEE BOX ON HX06.
DISPLAY 'since (START DATE)' IF NOT ROUND 5. DISPLAY
'between (START DATE) AND (END DATE)' IF ROUND 5.
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PROGRAMMER NOTES:
IF CODED ‘1’ (YES, ALL), FLAG ALL RU MEMBERS LISTED HERE AS
‘COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND.’
IF CODED ‘3’ (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS
‘NOT COVERED BY MEDICAID SCHIP DURING CURRENT ROUND.’
ROUTING INSTRUCTION:
IF CODED ‘3’ (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR07,
GO TO PR09
IF CODED ‘3’ (NO, NONE)
AND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR07,
GO TO BOX_05
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
1. Person is an RU member flagged as covered by Medicaid
during the previous round.
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PR08
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EPRS.EPRSID
Label
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
Size
20
EPRS.EPRSRURN
EPRS.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EPRS RECORD
2
6
EPRS.MCAID
EPCP.EPCPID
PERSON COVERED BY MEDICAID
EPCP ID KEY: EPRSID + PERSID
2
28
EPCP.EPCPRURN
ROUND STAMP: RU LETTER + ROUND NUMBER
2
EPCP.CREATEQ
CREATION STAMP
2
{STR-DT} {END-DT}
Who has been covered by {Medicaid/{STATE NAME FOR MEDICAID}} or
{STATE CHIP NAME} { since (START DATE)/between (START DATE) and
(END DATE)}?
PROBE: Who else has been covered by {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME} {since (START DATE)/between
(START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{BOX_03}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06.
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS SUBSTITUTING
THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO
DISPLAY BY STATE, SEE BOX ON HX06.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) AND (END DATE)' IF ROUND 5.
DISPLAY 'between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY MEDICAID/SCHIP DURING
CURRENT ROUND.’ FLAG ALL PERSONS NOT SELECTED AS ‘NOT COVERED
BY MEDICAID/SCHIP DURING CURRENT ROUND.’
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Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
1. Display only those RU members who are covered by
Medicaid/SCHIP
at any time during the previous round.
BOX_03
IF ALL CURRENT RU MEMBERS ARE ALREADY FLAGGED AS COVERED OR NOT COVERED BY
MEDICAID/SCHIP DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE
LISTED AT PR07), GO TO LOOP_02
OTHERWISE, CONTINUE WITH PR09
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PR09
Help Enabled (MEDICAT)
Variable Name
HOME.MOREMCAI
Comment Enabled
Jump Back Enabled
Label
ANY ADDITIONAL MEMS COVERED BY MEDICAID?
Size
2
{STR-DT} {END-DT}
Besides the family members we’ve just talked about, have any additional
family members been covered by {Medicaid/{STATE NAME FOR MEDICAID}}
or {STATE CHIP NAME} {since (START DATE)/ between (START DATE)
AND (END DATE)}?
YES
NO
1
2
{PR10}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF MEDICAID.
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06. DISPLAY 'or STATE CHIP
NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE
BOX ON HX06.
DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5.
(START DATE) AND (END DATE)‘ IF ROUND 5.
DISPLAY ‘between
ROUTING INSTRUCTION:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW) AND AT
LEAST ONE RU MEMBER IS FLAGGED AS ‘COVERED BY MEDICAID/SCHIP
DURING CURRENT ROUND,’ GO TO LOOP_02
IF CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW) AND NO
RU MEMBERS ARE FLAGGED AS ‘COVERED BY MEDICAID/SCHIP DURING
CURRENT ROUND,’ GO TO BOX_05
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Old Public Related Insurance (PR) Section
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PR10
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
Label
Size
28
EPRS.EPRSRURN
EPRS.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EPRS RECORD
2
6
EPRS.MCAID
EPCP.EPCPRURN
PERSON COVERED BY MEDICAID
ROUND STAMP: RU LETTER + ROUND NUMBER
2
2
EPRS.EPRSID
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
20
{STR-DT} {END-DT}
Who has been covered by {Medicaid/{STATE NAME FOR MEDICAID}} or
{STATE CHIP NAME} {since (START DATE)/between (START DATE) and
(END DATE)}?
PROBE: Who else has been covered by {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME} {since (START DATE)/between (START
DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{LOOP_02}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06. DISPLAY 'or STATE CHIP
NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE
BOX ON HX06.
DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5.
(START DATE) AND (END DATE)' IF ROUND 5.
DISPLAY ‘between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY MEDICAID/SCHIP’
DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS ‘NOT
COVERED BY MEDICAID/SCHIP’ DURING CURRENT ROUND.
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Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-Members-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
1. RU members not flagged as covered by Medicaid/SCHIP
during the previous round.
LOOP_02
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK BOX_04 END_LP02
LOOP DEFINITION: LOOP_02 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY MEDICAID/SCHIP. THIS LOOP CYCLES ON ESTABLISHMENTPERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICAID/SCHIP
AND
- PERSON IS COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND
BOX_04
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP02
END_LP02
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH
PR11
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PR11
Help Enabled (MEDICAT)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.PROGDR
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/DR
Size
2
HOME.HMOSIGND
HOME.MCAIDCHG
MEDICAID/GOVT PROG REQUIRE SIGNING W/HMO
CHANGE IN HI PLAN NAME HAD THRU MEDICAID
2
2
HOME.PROGLETT
HOME.PROGNAME
PLAN LETTER OF MEDICAID/GOVT INSURANCE
PROGRAM HMO/INSURANCE NAME
4
25
HOME.PROGLIST
NAME OF HI FROM MEDICAID/GOVT IS LISTED
2
{STR-DT} {END-DT}
{PLAN NAME: {NAME OF PREV RD’S MEDICAID/SCHIP INSURER FOR
RU}}
{Last time we recorded that (READ NAME(S) BELOW) may be covered by
(PLAN NAME).}
{Since (START DATE)/between (START DATE) and (END DATE)}, has there
been any change in the plan name of the health insurance the family has
through {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES
1
NO
2
{BOX_05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
HELP AVAILABLE FOR A DEFINITION OF MEDICAID.
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Old Public Related Insurance (PR) Section
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DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: {NAME OF PREV RD’S MEDICAID/SCHIP INSURER
FOR RU}’ AND ‘LAST TIME .... (PLAN NAME).’ IF THERE IS AN
INSURER ASSOCIATED WITH MEDICAID/SCHIP IN THE PREVIOUS ROUND.
FOR ‘NAME OF PREV RD’S MEDICAID/SCHIP INSURER FOR RU’, DISPLAY
THE INSURER RECORDED FOR MEDICAID/SCHIP DURING THE PREVIOUS
ROUND.
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
DISPLAY 'Between
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06.
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS SUBSTITUTING
THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO
DISPLAY BY STATE, SEE BOX ON HX06.
PROGRAMMER NOTES:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW), FLAG
PREVIOUS ROUND’S INSURER AS ‘CURRENT RD’S MEDICAID/SCHIP
INSURER’
NOTE: STATES THAT DO NOT OFFER MEDICAID MANAGED CARE PLANS
ARE ALASKA, MISSISSIPPI, NEW HAMPSHIRE, AND WYOMING.
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND IF STATE IN WHICH THE INTERVIEW IS
BEING CONDUCTED DOES NOT OFFER A MEDICAID/SCHIP MANAGED CARE
PLAN, CODE PR12 ‘2’ (NO) AUTOMATICALLY BY CAPI AND GO TO PR13
IF CODED ‘1’ (YES) AND IF STATE IN WHICH THE INTERVIEW IS
BEING CONDUCTED DOES OFFER A MEDICAID/SCHIP MANAGED CARE PLAN,
CONTINUE WITH PR12
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1.Display only.
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Old Public Related Insurance (PR) Section
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2. Select, add, delete, and edit disallowed.
Roster Filter:
1.Display only those RU members who are covered by
Medicaid/SCHIP during the current round.
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Old Public Related Insurance (PR) Section
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PR12
Help Enabled
Variable Name
HOME.PROGLIST
Comment Enabled
Jump Back Enabled
Label
NAME OF HI FROM MEDICAID/GOVT IS LISTED
Size
2
{STR-DT} {END-DT}
SHOW CARD PR-2.
Some people on {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME} can enroll in plans called HMOs. These plans have names like those
listed on this card.
Is the name of the health insurance through {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME} {, between (START DATE) and (END
DATE)} listed on this card?
YES
1
{PR12OV}
NO
2
{PR13}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR13}
{PR13}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06. DISPLAY 'or STATE CHIP
NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE
BOX ON HX06.
DISPLAY ', between (START DATE) and (END DATE), IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
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Old Public Related Insurance (PR) Section
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PR12OV
Help Enabled
Variable Name
HOME.PROGLETT
Comment Enabled
Jump Back Enabled
Label
PLAN LETTER OF MEDICAID/GOVT INSURANCE
Size
4
Which plan is the health insurance through {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME}?
CODE LETTER OF PLAN FROM SHOW CARD.
PLAN LETTER: _______________________
{BOX_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06.
DISPLAY 'or STATE CHIP NAME' UNDERS ALL CONDITIONS
SUBSTITUTING THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC
NAME TO DISPLAY BY STATE, SEE BOX ON HX06.
PROGRAMMER NOTES:
WHEN INTERVIEWER ENTERS LETTER OF PLAN, DISPLAY THE FOLLOWING
MESSAGE: ‘PLEASE VERIFY SELECTED: {DISPLAY PLAN NUM
SELECTED}.’ WHEN INTERVIEWER CLEARS THE MESSAGE, PROCEED TO
THE NEXT LOGICAL SCREEN.
FOR 'DISPLAY PLAN NAME SELECTED' IN THIS MESSAGE, DISPLAY THE
PLAN NAME THAT CORRESPONDS TO THE LETTER ENTERED FOR THIS
STATE.
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S INSURER FOR
MEDICAID/SCHIP.’
19
Old Public Related Insurance (PR) Section
Beta
PR13
Help Enabled (HMO)
Variable Name
HOME.HMOSIGND
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/HMO
Size
2
{STR-DT} {END-DT}
Under {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}
{(are/is)/(were/was)} (READ NAME(S) BELOW) signed up with an HMO, that
is a Health Maintenance Organization {between (START DATE) and (END
DATE)}?
[With an HMO, you must generally receive care from HMO physicians. If
another doctor is seen, the expense is not covered unless you were referred
by the HMO, or there was a medical emergency.]
{First Name [Middle Name] Last Name}
{First Name [Middle Name] Last Name}
{First Name [Middle Name] Last Name}
YES, ALL ARE
1
{PR15}
YES, SOME ARE
2
{PR15}
NO, NONE ARE
3
{PR14}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR14}
{PR14}
HELP AVAILABLE FOR DEFINITION OF HMO.
20
Old Public Related Insurance (PR) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06. DISPLAY 'or STATE CHIP
NAME" UNDER ALL CONDITIONS SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE
BOX ON HX06.
DISPLAY '(are/is)'
ROUND 5.
IF NOT ROUND 5.
DISPLAY '(were/was)'
DISPLAY 'between (START DATE) and (END DATE)'
OTHERWISE, USE A NULL DISPLAY.
IF
IF ROUND 5.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by
Medicaid/SCHIP during the current round.
21
Old Public Related Insurance (PR) Section
Beta
PR14
Help Enabled (PROGDR)
Variable Name
HOME.PROGDR
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/DR
Size
2
{STR-DT} {END-DT}
{Does /Between (START DATE) and (END DATE), did} {Medicaid/{STATE
NAME FOR MEDICAID}} or {STATE CHIP NAME} require (READ NAME(S)
BELOW) to sign up with a certain primary care doctor, group of doctors, or
with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were
referred to.
{First Name [Middle Name] Last Name}
{First Name [Middle Name] Last Name}
{First Name [Middle Name] Last Name}
YES, ALL REQUIRED
YES, SOME REQUIRED
1
2
{PR15}
{PR15}
NO, NONE REQUIRED
3
{BOX_05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND
ROUTINE CARE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME BY
STATE, SEE BOX ON HX06.
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDTITIONS
SUBSTITUTING THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC
NAME TO USE BY STATE, SEE BOX ON HX06.
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between (START DATE)
AND (END DATE), did' IF ROUND 5.
22
Old Public Related Insurance (PR) Section
Beta
PROGRAMMER NOTES:
IF CODED ‘3’ (NO, NONE REQUIRED), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW), THERE IS NO INSURER ASSOCIATED WITH THE CURRENT
ROUND FOR MEDICAID/SCHIP.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by
Medicaid/SCHIP during the current round.
23
Old Public Related Insurance (PR) Section
Beta
PR15
Help Enabled
Variable Name
HOME.PROGNAME
Comment Enabled
Jump Back Enabled
Label
Size
25
PROGRAM HMO/INSURANCE NAME
{STR-DT} {END-DT}
What is the name of the {Medicaid/{STATE NAME FOR MEDICAID}} or
{STATE CHIP NAME} {HMO/health insurance}?
PLAN NAME: _______________________
{BOX_05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘Medicaid’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE
STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE
NAME ‘Medicaid’. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO
DISPLAY BY STATE, SEE BOX ON HX06. DISPLAY 'or STATE CHIP
NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE
BOX ON HX06.
DISPLAY ‘HMO’ IF PR13 IS CODED ‘1’ (YES, ALL ARE) OR ‘2’ (YES,
SOME ARE). DISPLAY ‘HEALTH INSURANCE’ IF PR14 IS CODED ‘1’
(YES, ALL REQUIRED) OR ‘2’ (YES, SOME REQUIRED).
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S MEDICAID/SCHIP
INSURER’.
BOX_05
IF ANY RU MEMBER HAD TRICARE/CHAMPVA
PREVIOUS ROUND, CONTINUE WITH PR19
OTHERWISE, GO TO BOX_08
24
AS A SOURCE OF INSURANCE DURING
Old Public Related Insurance (PR) Section
Beta
PR19
Help Enabled (CHAMPTRI)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.CONFCHAM
Label
CONFIRM COVER: CHAMPUS/CHAMPVA/TRICARE
Size
2
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.CHAMP
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY CHAMPUS/CHAMPVA
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
During the last interview, we recorded that (READ NAME(S) BELOW)
(was/were) covered by TRICARE or CHAMPVA.
Have all of these people been covered by TRICARE or CHAMPVA at any
time {since (START DATE)/between (START DATE) and (END DATE)}?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL
NO, ONLY SOME
1
2
NO, NONE
3
{PR19A}
{PR19A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_08}
{BOX_08}
HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF ROUND IS NOT 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND IS 5.
PROGRAMMER NOTES:
IF CODED ‘3’ (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS
‘NOT COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND.’
25
Old Public Related Insurance (PR) Section
Beta
ROUTING INSTRUCTION:
IF CODED ‘3’ (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED IN PR19,
GO TO PR21
IF CODED ‘3’ (NO, NONE),
AND
IF ALL CURRENT RU MEMBERS ARE LISTED IN PR19,
GO TO BOX_08
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered
by TRICARE/CHAMPVA during the previous round.
26
Old Public Related Insurance (PR) Section
Beta
PR19A
Help Enabled
Comment Enabled
Variable Name
HOME.PR19ABLSWVS
Jump Back Enabled
Label
Size
HOME.CHAMPVA
HOME.TRIEXTRA
SOMEONE IN RU HAS TRICARE EXTRA
2
HOME.TRIPRIME
HOME.TRISTAND
SOMEONE IN RU HAS TRICARE PRIME
SOMEONE IN RU HAS TRICARE STANDARD
2
2
HOME.TRILIFE
HX12A/PR19A/21A MEMBER HAS TRICARE(LIFE)
2
{STR-DT} {END-DT}
Which plan is it? Is it …
INTERVIEWER:
CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU MEMBERS HAVE
DIFFERENT PLANS.
CHECK ALL THAT APPLY.
TRICARE Standard;
TRICARE Prime;
1
2
TRICARE Extra;
TRICARE for Life; or
3
4
CHAMPVA?
5
----------------------------------------------------------------------------------------------------------------------------------
Refused
RF
Don't Know
DK
ROUTING
IF PR19
HERE AS
THEN GO
INSTRUCTION:
IS CODED ‘1’ (YES, ALL), FLAG ALL RU MEMBERS LISTED
‘COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND.’
TO BOX_06
IF PR19 IS CODED ‘2’ (NO, ONLY SOME), CONTINUE WITH PR20
27
Old Public Related Insurance (PR) Section
Beta
PR20
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_PR20
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.CHAMP
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY CHAMPUS/CHAMPVA
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who has been covered by TRICARE or CHAMPVA {since (START
DATE)/between (START DATE) and (END DATE)}?
PROBE: Who else has been covered by TRICARE or CHAMPVA {since
(START DATE)/ between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE) IF ROUND 5.
{BOX_06}
DISPLAY 'between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY TRICARE/CHAMPVA’
DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS ‘NOT
COVERED BY TRICARE/CHAMPVA’ DURING CURRENT ROUND.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
28
Old Public Related Insurance (PR) Section
Beta
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Multiple select allowed
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by
TRICARE/CHAMPVA during the previous round.
BOX_06
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY
TRICARE/CHAMPVA DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE
LISTED IN PR19), GO TO LOOP_03
OTHERWISE, CONTINUE WITH PR21
29
Old Public Related Insurance (PR) Section
Beta
PR21
Help Enabled (CHAMPTRI)
Variable Name
HOME.MORECHAM
Comment Enabled
Jump Back Enabled
Label
MORE COVERED: CHAMPUS/CHAMPVA/TRICARE
Size
2
{STR-DT} {END-DT}
Besides the family members we’ve just talked about, have any additional
family members been covered by TRICARE or CHAMPVA {since (START
DATE)/between (START DATE) and (END DATE)}?
YES
NO
1
2
{PR21A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
ROUTING INSTRUCTION:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND AT
LEAST ONE RU MEMBER FLAGGED AS COVERED BY TRICARE/CHAMPVA
DURING CURRENT ROUND, GO TO LOOP_03
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND NO
RU MEMBERS FLAGGED AS COVERED BY TRICARE/CHAMPVA DURING
CURRENT ROUND, GO TO BOX_08
30
Old Public Related Insurance (PR) Section
Beta
PR21A
Help Enabled
Comment Enabled
Variable Name
HOME.PR21ABLSWVS
Jump Back Enabled
Label
Size
HOME.CHAMPVA
HOME.TRIEXTRA
SOMEONE IN RU HAS TRICARE EXTRA
2
HOME.TRIPRIME
HOME.TRISTAND
SOMEONE IN RU HAS TRICARE PRIME
SOMEONE IN RU HAS TRICARE STANDARD
2
2
HOME.TRILIFE
HX12A/PR19A/21A MEMBER HAS TRICARE(LIFE)
2
{STR-DT} {END-DT}
Which plan is it? Is it …
INTERVIEWER:
CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU MEMBERS HAVE
DIFFERENT PLANS.
CHECK ALL THAT APPLY.
TRICARE Standard;
TRICARE Prime;
1
2
{PR22}
{PR22}
TRICARE Extra;
TRICARE for Life; or
3
4
{PR22}
{PR22}
CHAMPVA?
5
{PR22}
----------------------------------------------------------------------------------------------------------------------------------
Refused
RF
{PR22}
Don't Know
DK
{PR22}
31
Old Public Related Insurance (PR) Section
Beta
PR22
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_PR22
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.CHAMP
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY CHAMPUS/CHAMPVA
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who has been covered by TRICARE or CHAMPVA {since (START
DATE)/between (START DATE) and (END DATE)}?
PROBE: Who else has been covered by TRICARE or CHAMPVA {since
(START DATE)/between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{LOOP_03}
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF ROUND IS NOT 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND IS 5.
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY TRICARE/CHAMPVA’
DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS ‘NOT
COVERED BY TRICARE/CHAMPVA’ DURING CURRENT ROUND.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
32
Old Public Related Insurance (PR) Section
Beta
Roster Definition:
This item displays RU-Members-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by
TRICARE/CHAMPVA during the previous round.
LOOP_03
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK BOX_07 END_LP03
LOOP DEFINITION: LOOP_03 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY TRICARE/CHAMPVA. THIS LOOP CYCLES ON ESTABLISHMENTPERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS TRICARE/CHAMPVA
AND
- PERSON IS COVERED BY TRICARE/CHAMPVA DURING THE CURRENT ROUND
BOX_07
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP03
END_LP03
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH
BOX_08
BOX_08
IF ANY RU MEMBER HAD GOVT-HOSPITAL/PHYSICIAN AS A SOURCE OF INSURANCE AT
ANY TIME DURING PREVIOUS ROUND, CONTINUE WITH PR23
OTHERWISE, GO TO BOX_11
33
Old Public Related Insurance (PR) Section
Beta
PR23
Help Enabled (INSTYPES)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.CONFGOVT
Label
CONFIRM STILL COVERED: GOVT PROGRAM
Size
2
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.GOVTPROG
QUESTION THAT CREATED EPRS RECORD
PERSON IS COVERED BY GOVT PROGRAM
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
During the last interview, we recorded that (READ NAME(S) BELOW)
(was/were) covered by a program sponsored by a state or local government
agency which provided hospital and physician benefits.
Have all of these people been covered by a program sponsored by a state or
local government agency at any time {since (START DATE)/between (START
DATE) and (END DATE)}?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL
1
{BOX_09}
NO, ONLY SOME
2
{PR24}
NO, NONE
3
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_11}
{BOX_11}
HELP AVAILABLE FOR DEFINITION OF THIS TYPE OF PROGRAM.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
34
DISPLAY 'between
Old Public Related Insurance (PR) Section
Beta
PROGRAMMER NOTES:
IF CODED ‘3’ (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS
‘NOT COVERED BY GOVT-HOSPITAL/PHYSICIAN’ DURING CURRENT ROUND.
IF CODED ‘1’ (YES, ALL), FLAG ALL RU MEMBERS LISTED HERE AS
‘COVERED BY GOVT-HOSPITAL/PHYSICIAN’ DURING CURRENT ROUND.
ROUTING INSTRUCTION:
IF CODED ‘3’ (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR23,
GO TO PR25
IF CODED ‘3’ (NO, NONE)
AND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR23,
GO TO BOX_11
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members and persons who are flagged as
covered by GOVT-Hospital/Physician during the previous round.
35
Old Public Related Insurance (PR) Section
Beta
PR24
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_PR24
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.GOVTPROG
QUESTION THAT CREATED EPRS RECORD
PERSON IS COVERED BY GOVT PROGRAM
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who has been covered by this program {since (START DATE)/between
(START DATE) and (END DATE)}?
PROBE: Who else has been covered by a program sponsored by a state or
local government agency which provides hospital and physician benefits
{since (START DATE)/ between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{BOX_09}
[First Name, [Middle Name], Last Name]
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY GOVTHOSPITAL/PHYSICIAN’ DURING CURRENT ROUND. FLAG ALL PERSONS
NOT SELECTED AS ‘NOT COVERED BY GOVT-HOSPITAL/PHYSICIAN’
DURING CURRENT ROUND.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
36
Old Public Related Insurance (PR) Section
Beta
Col #
1
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by
GOVT-Hospital/Physician during the previous round.
BOX_09
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY THE
GOVT-HOSPITAL/PHYSICIAN DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS
WERE LISTED IN PR23), GO TO LOOP_04
OTHERWISE, CONTINUE WITH PR25
37
Old Public Related Insurance (PR) Section
Beta
PR25
Help Enabled
Variable Name
HOME.MOREGOVT
Comment Enabled
Jump Back Enabled
Label
Size
2
MORE COVERED: GOVT PROGRAM
{STR-DT} {END-DT}
Besides the family members we’ve just talked about, have any additional
family members been covered by this program {since (START DATE)/between
(START DATE) and (END DATE)}?
YES
NO
1
2
{PR26}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
ROUTING INSTRUCTION:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND AT
LEAST ONE RU MEMBER FLAGGED AS ‘COVERED BY GOVTHOSPITAL/PHYSICIAN’ DURING CURRENT ROUND,’ GO TO LOOP_04
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND NO
RU MEMBERS FLAGGED AS ‘COVERED BY GOVT-HOSPITAL/PHYSICIAN’
DURING CURRENT ROUND, GO TO BOX_11
38
Old Public Related Insurance (PR) Section
Beta
PR26
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_PR26
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.GOVTPROG
QUESTION THAT CREATED EPRS RECORD
PERSON IS COVERED BY GOVT PROGRAM
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who has been covered by this program?
PROBE: Who else has been covered by a program sponsored by a state or
local government agency which provides hospital and physician benefits
{since (START DATE)/between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{LOOP_04}
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (END DATE) and (END DATE)' IF ROUND 5.
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY GOVTHOSPITAL/PHYSICIAN’ DURING CURRENT ROUND. FLAG ALL PERSONS
NOT SELECTED AS ‘NOT COVERED BY GOVT-HOSPITAL/PHYSICIAN’
DURING CURRENT ROUND.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
39
Old Public Related Insurance (PR) Section
Beta
Roster Definition:
This item displays RU-Members-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are not flagged as covered
by GOVT-Hospital/Physician at any time during the previous
round.
LOOP_04
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK
BOX_10 - END_LP04
LOOP DEFINITION: LOOP_04 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY GOVT-HOSPITAL/PHYSICIAN. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
AND
- PERSON IS FLAGGED AS COVERED BY GOVT-HOSPITAL/PHYSICIAN DURING THE
CURRENT ROUND
BOX_10
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP04
END_LP04
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON PAIRS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH
PR27
40
Old Public Related Insurance (PR) Section
Beta
PR27
Help Enabled (INSTYPES)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.GOVTCHNG
Label
CHANGE IN HI PLAN NAME THRU GOVT AGENCY
Size
2
HOME.PROGLETT
HOME.PROGNAME
PLAN LETTER OF MEDICAID/GOVT INSURANCE
PROGRAM HMO/INSURANCE NAME
4
25
HOME.PROGLIST
NAME OF HI FROM MEDICAID/GOVT IS LISTED
2
{STR-DT} {END-DT}
{PLAN NAME: {NAME OF PREV RD’S GOVT-HOSPITAL/PHYSICIAN
INSURER FOR RU}}
{Last time we recorded that (READ NAME(S) BELOW) may be covered by
(PLAN NAME).}
{Since (START DATE)/Between (START DATE) and (END DATE)}, has there
been any change in the plan name of the health insurance the family has
through the program sponsored by a state or local government agency which
provides hospital and physician benefits?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES
1
NO
2
{PR32}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR32}
{PR32}
HELP AVAILABLE FOR A DEFINITION OF THIS TYPE OF PROGRAM.
41
Old Public Related Insurance (PR) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: {NAME OF PREV RD’S GOVTHOSPITAL/PHYSICIAN INSURER FOR RU}’ AND ‘LAST TIME .... (PLAN
NAME).’ IF THERE IS AN INSURER ASSOCIATED WITH GOVTHOSPITAL/PHYSICIAN IN THE PREVIOUS ROUND.
FOR ‘NAME OF PREV RD’S GOVT-HOSPITAL/PHYSICIAN INSURER FOR
RU’, DISPLAY THE INSURER RECORDED FOR GOVT-HOSPITAL/PHYSICIAN
AT ANY TIME DURING THE PREVIOUS ROUND.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
DISPLAY 'between
PROGRAMMER NOTES:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW), FLAG
PREVIOUS ROUND’S INSURER AS CURRENT ROUND’S INSURER FOR GOVTHOSPITAL/PHYSICIAN.
NOTE: STATES THAT DO NOT OFFER GOVT-HOSPITAL/PHYSICIAN
(MEDICAID/SCHIP) MANAGED CARE PLANS ARE ALASKA, MISSISSIPPI,
NEW HAMPSHIRE, AND WYOMING.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND IF STATE IN WHICH THE INTERVIEW IS
BEING CONDUCTED DOES NOT OFFER A GOVT-HOSPITAL/PHYSICIAN
(MEDICAID/SCHIP) MANAGED CARE PLAN, CODE PR28 '2' (NO)
AUTOMATICALLY BY CAPI AND GO TO PR29
IF CODED '1' (YES) AND IF STATE IN WHICH THE INTERVIEW IS
BEING CONDUCTED DOES OFFER A GOVT-HOSPITAL/PHYSICIAN
(MEDICAID/SCHIP) MANAGED CARE PLAN, CONTINUE WITH PR28
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those persons who are RU members and flagged as
covered by
GOVT-Hospital/Physician during the current round.
42
Old Public Related Insurance (PR) Section
Beta
PR28
Help Enabled
Variable Name
HOME.PROGLIST
Comment Enabled
Jump Back Enabled
Label
NAME OF HI FROM MEDICAID/GOVT IS LISTED
Size
2
{STR-DT} {END-DT}
SHOW CARD PR-3.
Is the name of the health insurance through the program sponsored by a state
or local government agency which provides hospital and physician benefits
{, between (START DATE) and (END DATE),} listed on this card?
YES
1
{PR28OV}
NO
2
{PR29}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR29}
{PR29}
DISPLAY INSTRUCTIONS:
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
43
Old Public Related Insurance (PR) Section
Beta
PR28OV
Help Enabled
Variable Name
HOME.PROGLETT
Comment Enabled
Jump Back Enabled
Label
PLAN LETTER OF MEDICAID/GOVT INSURANCE
Size
4
Which plan is the health insurance through this program?
CODE LETTER OF PLAN FROM SHOW CARD.
PLAN LETTER: _______________________
{PR32}
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S INSURER FOR GOVTHOSPITAL/PHYSICIAN.’
WHEN INTERVIEWER ENTERS LETTER OF PLAN, DISPLAY THE FOLLOWING
MESSAGE: ‘PLEASE VERIFY PLAN SELECTED: {DISPLAY PLAN NAME
SELECTED}.’ WHEN INTERVIEWER CLEARS THE MESSAGE, PROCEED TO
THE NEXT LOGICAL SCREEN.
IN THIS MESSAGE FOR 'DISPLAY PLAN NAME SELECTED', DISPLAY THE
ACTUAL PLAN NAME THAT CORRESPONDS TO THE LETTER ENTERED FOR
THIS STATE.
44
Old Public Related Insurance (PR) Section
Beta
PR29
Help Enabled (HMO)
Variable Name
HOME.HMOSIGND
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/HMO
Size
2
{STR-DT} {END-DT}
Under the program sponsored by a state or local government agency which
provides hospital and physician benefits {(are/is)/(were/was) (READ NAME(S)
BELOW) signed up with an HMO, that is a Health Maintenance Organization
{between (START DATE) and (END DATE)}?
[With an HMO, you must generally receive care from HMO physicians. If
another doctor is seen, the expense is not covered unless you were referred
by the HMO, or there was a medical emergency.]
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL ARE
YES, SOME ARE
1
2
{PR31}
{PR31}
NO, NONE ARE
3
{PR30}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR30}
{PR30}
HELP AVAILABLE FOR DEFINITION OF HMO.
DISPLAY INSTRUCTIONS:
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY 'are/is' IF NOT ROUND 5.
5.
DISPLAY 'were/was' IF ROUND
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
45
Old Public Related Insurance (PR) Section
Beta
Col #
1
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU member who are covered by
GOVT-Hospital/Physician during the current round.
46
Old Public Related Insurance (PR) Section
Beta
PR30
Help Enabled (PROGDR)
Variable Name
HOME.PROGDR
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/DR
Size
2
{STR-DT} {END-DT}
{Does/Between (START DATE) and (END DATE), did} the program
sponsored by a state or local government agency which provides hospital and
physician benefits require (READ NAME(S) BELOW) to sign up with a certain
primary care doctor, group of doctors, or with a certain clinic which they must
go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were
referred to.
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL REQUIRED
YES, SOME REQUIRED
1
2
{PR31}
{PR31}
NO, NONE REQUIRED
3
{PR32}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR32}
{PR32}
HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND
ROUTINE CARE.
DISPLAY INSTRUCTIONS:
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between (START DATE)
and (END DATE), did' IF ROUND 5.
PROGRAMMER NOTES:
IF CODED ‘3’ (NO, NONE REQUIRED), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW), THERE IS NO INSURER ASSOCIATED WITH THE CURRENT
ROUND FOR GOVT-HOSPITAL/PHYSICIAN.
47
Old Public Related Insurance (PR) Section
Beta
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2.Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by
GOVT-Hospital/Physician during the current round.
48
Old Public Related Insurance (PR) Section
Beta
PR31
Help Enabled
Variable Name
HOME.PROGNAME
Comment Enabled
Jump Back Enabled
Label
Size
25
PROGRAM HMO/INSURANCE NAME
{STR-DT} {END-DT}
What is the name of the {HMO/health insurance} from the program sponsored
by a state or local government agency which provides hospital and physician
benefits?
Plan Name: _______________________
{PR32}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR32}
{PR32}
DISPLAY INSTRUCTIONS:
DISPLAY ‘HMO’ IF PR29 IS CODED ‘1’ (YES, ALL ARE) OR ‘2’ (YES,
SOME ARE). DISPLAY ‘HEALTH INSURANCE’ IF PR30 CODED ‘1’ (YES,
ALL REQUIRED) OR ‘2’ (YES, SOME REQUIRED).
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S INSURER FOR GOVTHOSPITAL/PHYSICIAN.’
49
Old Public Related Insurance (PR) Section
Beta
PR32
Help Enabled (PREMPAY)
Variable Name
HOME.PREMPAY
Comment Enabled
Jump Back Enabled
Label
DOES SOMEONE PAY PREM FOR GOVT SPONS PRG
Size
2
{STR-DT} {END-DT}
{PLAN NAME: {{PLAN NAME ENTERED AT PR28OV}/{NAME OF PLAN
FROM PR31}}}
For the coverage through {(PLAN NAME) /the program sponsored by a state
or local government agency which provides hospital and physician benefits},
does anyone in the family pay anything for this coverage?
[Do not include the cost of any copayments, coinsurance, or deductibles
anyone in the family may have had to pay.]
YES
1
{PR33}
NO
2
{PR34}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_11}
{BOX_11}
HELP AVAILABLE FOR DEFINITION OF
PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
DISPLAY INSTRUCTIONS:
DISPLAY 'PLAN NAME: …' IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN
INSURANCE. OTHERWISE, USE A NULL DISPLAY.
DISPLAY '(PLAN NAME ENTERED AT PR28OV)' IF A PLAN WAS
ENTERED AT PR28OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT PR28OV FOR THIS STATE.
DISPLAY '(NAME OF PLAN FROM PR31) IF A PLAN NAME WAS ENTERED
AT PR31.
DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.
DISPLAY '(PLAN NAME)' IF THEE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN
INSURANCE. OTHERWISE DISPLAY 'THE PROGRAM SPONSORED …'.
50
Old Public Related Insurance (PR) Section
Beta
PR33
Help Enabled
Variable Name
HOME.COVRAMT
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT: AMOUNT FAMILY PAID
Size
12
{STR-DT} {END-DT}
{PLAN NAME: {PLAN NAME ENTERED AT PR28OV}/{NAME OF PLAN
FROM PR31}}
How much does anyone in the family pay for {the (PLAN NAME)/that}
coverage?
AMOUNT: $ _______________________
{PR33OV1}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{PR34}
{PR34}
DISPLAY INSTRUCTIONS:
DISPLAY 'PLAN NAME: …' IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN
INSURANCE. OTHER WISE, USE A NULL DISPLAY.
DISPLAY '(PLAN NAME ENTERED AT PR28OV)' IF A PLAN WAS
ENTERED AT PR280V. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT PR28OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.
DISPLAY '(NAME OF PLAN FROM PR31)' IF A PLAN NAME WAS ENERED
AT PR31.
DISPLAY 'the (PLAN NAME)' IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN
INSURANCE. OTHERWISE, DISPLAY 'that'.
51
Old Public Related Insurance (PR) Section
Beta
PR33OV1
Help Enabled
Variable Name
HOME.COVRUNIT
Comment Enabled
Jump Back Enabled
Label
Size
2
MEDICAID/GOVT: UNIT OF PAYMENT
ENTER UNIT OF COVERAGE:
PROBE: Is that per year, per month, per week, or what?
PER YEAR
1
{PR34}
QUARTERLY/EVERY 3 MONTHS
BIMONTHLY/EVERY 2 MONTHS
2
3
{PR34}
{PR34}
PER MONTH
4
{PR34}
PER WEEK
BIWEEKLY/EVERY 2 WEEKS
5
6
{PR34}
{PR34}
SEMI-ANNUALLY/2 TIMES PER YEAR
SEMI-MONTHLY/2 TIMES PER MONTH
7
8
{PR34}
{PR34}
OTHER
91
{PR33OV2}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
52
{PR34}
{PR34}
Old Public Related Insurance (PR) Section
Beta
PR33OV2
Help Enabled
Variable Name
HOME.COVRUNOS
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT: UNIT OF PAYMENT OTH SPEC
Size
25
OTHER SPECIFY: _______________________
{PR34}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
53
{PR34}
{PR34}
Old Public Related Insurance (PR) Section
Beta
PR34
Help Enabled
Comment Enabled
Variable Name
HOME.PR34BLSWVS
Jump Back Enabled
Label
Size
HOME.BYFED
HOME.BYSTATE
FEDERAL GOVT PAID MEDICAID/GOVT PREMIUM
STATE GOVT PAID MEDICAID/GOVT PREMIUM
2
2
HOME.BYLOCAL
HOME.BYSOMGOV
LOCAL GOVT PAID MEDICAID/GOVT PREMIUM
SOME GOVT PAID MEDICAID/GOVT PREMIUM
2
2
HOME.BYOTHER
OTHER PAID MEDICAID/GOVT PREMIUM
2
{STR-DT} {END-DT}
{PLAN NAME: {NAME OF CRNT RD’S GOVT-HOSPITAL/PHYSICIAN
INSURER FOR RU}{{PLAN NAME ENTERED AT PR28OV}/NAE OF PLAN
FROM PR31}}}
Who {else} pays {some of/for} the premium or cost of this insurance?
CHECK ALL THAT APPLY.
FEDERAL GOVERNMENT
1
STATE GOVERNMENT
LOCAL GOVERNMENT
2
3
SOME GOVERNMENT
OTHER
4
91
{PR34OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
54
{BOX_11}
{BOX_11}
Old Public Related Insurance (PR) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY 'PLAN NAME: …' IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN
INSURANCE. OTHERWISE, USE A NULL DISPLAY.
DISPLAY '{PLAN NAME ENTERED AT PR28OV}' IF A PLAN WES
ENTERED AT PR28OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT PR28OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR31 FOR '{NAME OF
PLAN FROM PR31}' IF A PLAN NAME WAS ENTERED.
DISPLAY ‘ELSE’ IF PR32 IS CODED ‘1’ (YES).
NULL DISPLAY.
OTHERWISE, USE A
DISPLAY ‘SOME OF’ IF PR32 IS CODED ‘1’ (YES).
IF PR32 IS CODED ‘2’ (NO).
DISPLAY ‘FOR’
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES THIS
AUTOMATICALLY): CAPI DOES NOT ALLOW 'RF' OR 'DK' IN
COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER
CODE, CONTINUE WITH PR34OV
OTHERWISE, GO TO BOX_11
55
Old Public Related Insurance (PR) Section
Beta
PR34OV
Help Enabled
Variable Name
HOME.BYOTHOS
Comment Enabled
Jump Back Enabled
Label
OTH SPEC OF WHO PAID SOME/ALL MEDICAID/G
Size
25
OTHER SPECIFY: _______________________
{BOX_11}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_11}
{BOX_11}
BOX_11
IF ANY RU MEMBER HAD OTHER PUBLIC (GROUP 1 OR 2) AS A SOURCE OF INSURANCE
AT ANY TIME DURING PREVIOUS ROUND, CONTINUE WITH BOX_12
OTHERWISE, GO TO BOX_18
BOX_12
IF ANY CURRENT RU MEMBER HAD ANY GROUP 1 OTHER PUBLIC INSURANCE AT ANY
TIME DURING PREVIOUS ROUND, CONTINUE WITH PR35
OTHERWISE, GO TO BOX_15
NOTE: FOR BOTH GROUP 1 AND 2 PUBLIC PROGRAMS, WE ASSUME THE PROGRAM IS THE
SAME FROM THE PREVIOUS ROUND. ALTHOUGH WE SHOW THE SHOW CARD AND ASK IF
THE FAMILY STILL HAD COVERAGE FROM ANY OF THOSE PROGRAMS, WE DO NOT ASK
WHICH ONES. IF WE WERE TO ASK WHICH ONES, WE WOULD NEED TO ADD SEVERAL
QUESTIONS, LIKE THE OTHER PUBLIC SERIES IN HX.
56
Old Public Related Insurance (PR) Section
Beta
PR35
Help Enabled (STATEPRGM)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.CONFGRP1
Label
CONFIRM STILL COVERED: STATE GROUP 1
Size
2
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.STSPEC
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY STATE SPECIFIC PLAN
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
During the last interview, we recorded that (READ NAMES BELOW) were
covered by one or more of the following programs:
{STATE NAME FOR PROGRAM 1}
{STATE NAME FOR PROGRAM 2}
{STATE NAME FOR PROGRAM 3}
{STATE NAME FOR PROGRAM 4}
Have all of these people been covered by any of these programs at any time
{since (START DATE)/between (START DATE) and (END DATE)}?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL
NO, ONLY SOME
1
2
NO, NONE
3
{BOX_13}
{PR36}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_15}
{BOX_15}
HELP AVAILABLE FOR DEFINITION OF STATE SPECIFIC PROGRAMS
LISTED.
57
Old Public Related Insurance (PR) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS
(AS LISTED IN HX16) FOR 'STATE NAME FOR PROGRAM #N'.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
DISPLAY 'between
PROGRAMMER NOTES:
IF PR35 IS CODED ‘1’ (YES, ALL), MARK ALL RU MEMBERS LISTED
HERE AS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING
CURRENT ROUND.
IF PR35 IS CODED ‘3’ (NO, NONE), FLAG ALL RU MEMBERS LISTED
HERE AS ‘NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE’ DURING
CURRENT ROUND.
ROUTING INSTRUCTION:
IF CODED ‘3’ (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR35,
GO TO PR37
IF CODED ‘3’ (NO, NONE),
ND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR35,
GO TO BOX_15
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by Group 1
Other Public Insurance at any time during the previous round.
58
Old Public Related Insurance (PR) Section
Beta
PR36
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_PR36
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.STSPEC
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY STATE SPECIFIC PLAN
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who has been covered by any of these programs {since (START
DATE)/between (START DATE) and (END DATE)}?
PROBE: Who else has been covered by any of these programs {since
(START DATE)/between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
{BOX_13}
DISPLAY 'between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY GROUP 1 OTHER PUBLIC
INSURANCE’ DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED
AS ‘NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE’ DURING
CURRENT ROUND.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
59
Old Public Related Insurance (PR) Section
Beta
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by Group 1
Other Public Insurance at any time during the previous round.
BOX_13
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY
GROUP 1 OTHER PUBLIC INSURANCE DURING CURRENT ROUND (I.E., ALL CURRENT RU
MEMBERS WERE LISTED IN PR35), GO TO LOOP_05
OTHERWISE, CONTINUE WITH PR37
60
Old Public Related Insurance (PR) Section
Beta
PR37
Help Enabled (STATEPRGM)
Variable Name
HOME.MOREGRP1
Comment Enabled
Jump Back Enabled
Label
Size
2
MORE COVERED: STATE GROUP1
{STR-DT} {END-DT}
Besides the family members we’ve just talked about, have any additional
family members been covered by any of the following programs {since
(START DATE)/between (START DATE) and (END DATE)}? (READ
PROGRAM NAMES BELOW.)
{STATE NAME FOR PROGRAM 1}
{STATE NAME FOR PROGRAM 2}
{STATE NAME FOR PROGRAM 3}
{STATE NAME FOR PROGRAM 4}
YES
NO
1
2
{PR38}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF STATE SPECIFIC PROGRAMS
LISTED.
DISPLAY INSTRUCTIONS:
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS
(AS LISTED IN HX16) FOR 'STATE NAME FOR PROGRAM #N'.
DISPLAY 'since (START DATE)' IF ROUND IS NOT 5. DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
ROUTING INSTRUCTION:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND AT
LEAST ONE RU MEMBER FLAGGED AS COVERED BY GROUP 1 OTHER PUBLIC
INSURANCE DURING CURRENT ROUND, GO TO LOOP_05
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND NO
RU MEMBERS FLAGGED AS COVERED BY GROUP 1 OTHER PUBLIC
INSURANCE DURING CURRENT ROUND, GO TO BOX_15
61
Old Public Related Insurance (PR) Section
Beta
62
Old Public Related Insurance (PR) Section
Beta
PR38
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_PR38
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.STSPEC
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY STATE SPECIFIC PLAN
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who has been covered by any of these programs {since (START
DATE)/between (START DATE) and (END DATE)}?
PROBE: Who else has been covered by any of these programs {since
(START DATE)/between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
{LOOP_05}
DISPLAY 'between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY GROUP 1 OTHER PUBLIC
INSURANCE’ DURING CURRENT ROUND. FLAG ALL PERSONS NOT
SELECTED AS ‘NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE
DURING CURRENT ROUND.’
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
63
Old Public Related Insurance (PR) Section
Beta
Roster Definition:
This item displays RU-Members-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are not covered by Group 1
Other Public Insurance at any time during the previous round.
LOOP_05
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK BOX_14 END_LP05
LOOP DEFINITION: LOOP_05 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 1 OTHER PUBLIC INSURANCE
AND
- PERSON IS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING THE CURRENT
ROUND
BOX_14
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP05
END_LP05
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH
BOX_15
BOX_15
IF ANY CURRENT RU MEMBER HAD ANY ELIGIBLE GROUP 2 OTHER PUBLIC INSURANCE
AT ANY TIME DURING THE PREVIOUS ROUND, CONTINUE WITH PR39
OTHERWISE, GO TO BOX_18
64
Old Public Related Insurance (PR) Section
Beta
PR39
Help Enabled (OTHSTPRGM)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.CONFGRP2
Label
CONFIRM STILL COVERED: STATE GROUP 2
Size
2
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.AFDCGRP
QUESTION THAT CREATED EPRS RECORD
PERS COVERED BY AFDC/WIC/SSI/IHS/PHC/VA
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
SHOW CARD PR-3.
During the last interview, we recorded that (READ NAMES BELOW) were
covered by one or more of the public programs listed on this card.
Have all of these people been covered by any of these programs at any time
{since (START DATE)/between (START DATE) and (END DATE)}?
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
YES, ALL
1
{BOX_16}
NO, ONLY SOME
NO, NONE
2
3
{PR40}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_18}
{BOX_18}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
65
DISPLAY 'between
Old Public Related Insurance (PR) Section
Beta
PROGRAMMER NOTES:
IF CODED ‘1’ (YES, ALL), FLAG ALL RU MEMBERS LISTED HERE AS
‘COVERED BY GROUP 2 OTHER PUBLIC INSURANCE’ DURING CURRENT
ROUND.
IF CODED ‘3’ (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS
‘NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE’ DURING CURRENT
ROUND.
ROUTING INSTRUCTION:
IF CODED ‘3’ (NO, NONE) AND IF ANY CURRENT RU MEMBERS NOT
LISTED AT PR39, GO TO PR41
IF CODED ‘3’ (NO, NONE), AND IF ALL CURRENT RU MEMBERS ARE
LISTED AT PR39, GO TO BOX_18
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
display of RU-members.
Roster Behavior:
1. Display only.
2. Select, add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by Group 2
Other Public Insurance during the previous round.
66
Old Public Related Insurance (PR) Section
Beta
PR40
Help Enabled (OTHSTPRGM)
Comment Enabled
Variable Name
EPRS.bl_PR40
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.AFDCGRP
QUESTION THAT CREATED EPRS RECORD
PERS COVERED BY AFDC/WIC/SSI/IHS/PHC/VA
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
SHOW CARD PR-3.
Who has been covered by any of these programs {since (START
DATE)/between (START DATE) and (END DATE)}?
PROBE: Who else has been covered by any of these programs {since
(START DATE)/between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{BOX_16}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
DISPLAY 'between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY GROUP 2 OTHER PUBLIC
INSURANCE’ DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED
AS ‘NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE’ DURING
CURRENT ROUND.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
67
Old Public Related Insurance (PR) Section
Beta
Col #
1
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are covered by Group 2
Other Public Insurance during the previous round.
BOX_16
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY
GROUP 2 OTHER PUBLIC INSURANCE DURING CURRENT ROUND (I.E., ALL CURRENT RU
MEMBERS WERE LISTED AT PR39), GO TO LOOP_06
OTHERWISE, CONTINUE WITH PR41
68
Old Public Related Insurance (PR) Section
Beta
PR41
Help Enabled (OTHSTPRGM)
Variable Name
HOME.MOREGRP2
Comment Enabled
Jump Back Enabled
Label
Size
2
MORE COVERED: STATE GROUP 2
{STR-DT} {END-DT}
SHOW CARD PR-3.
Besides the family members we’ve just talked about, have any additional
family members been covered by any of these programs {since (START
DATE)/between (START DATE) and (END DATE)}?
YES
1
NO
2
{PR42}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
DISPLAY 'between
ROUTING INSTRUCTION:
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND AT
LEAST ONE RU MEMBER FLAGGED AS COVERED BY GROUP 2 OTHER PUBLIC
INSURANCE DURING CURRENT ROUND, GO TO LOOP_06
IF CODED ‘2’ (NO), ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) AND NO
RU MEMBERS FLAGGED AS COVERED BY GROUP 2 OTHER PUBLIC
INSURANCE DURING CURRENT ROUND, GO TO BOX_18
69
Old Public Related Insurance (PR) Section
Beta
PR42
Help Enabled (OTHSTPRGM)
Comment Enabled
Variable Name
EPRS.bw_PR42
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.AFDCGRP
QUESTION THAT CREATED EPRS RECORD
PERS COVERED BY AFDC/WIC/SSI/IHS/PHC/VA
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
SHOW CARD PR-3.
Who has been covered by any of these programs {since (START
DATE)/between (START DATE) and (END DATE)}?
PROBE: Who else has been covered by any of these programs {since
(START DATE)/between (START DATE) and (END DATE)}?
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{LOOP_06}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
(START DATE) and (END DATE)' IF ROUND 5.
DISPLAY 'between
PROGRAMMER NOTES:
FLAG ALL PERSONS SELECTED AS ‘COVERED BY GROUP 2 OTHER PUBLIC
INSURANCE’ DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED
AS ‘NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING
CURRENT ROUND.’
Roster Details
Title:
RU_Members_1
70
Old Public Related Insurance (PR) Section
Beta
Col #
1
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Definition:
This item displays RU-Members-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed.
Roster Filter:
Display only those RU members who are not flagged as covered
by Group 2 Other Public Insurance at any time during the
previous round.
LOOP_06
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK BOX_17 END_LP06
LOOP DEFINITION: LOOP_06 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 2 OTHER PUBLIC INSURANCE
AND
- PERSON IS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING THE CURRENT
ROUND
BOX_17
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP06
END_LP06
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH
BOX_18
BOX_18
RETURN TO THE HEALTH INSURANCE (HX) SECTION.
71
| File Type | application/pdf |
| File Title | \\rk29\vol2905\MEPSWVS\SpecWriter\BETA\PR (Beta).snp |
| Author | miller_n |
| File Modified | 2005-10-26 |
| File Created | 2005-10-26 |