Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

Medicare Current Beneficiary Survey (MCBS)

Attachment 4 English Questionnaire Layout

Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

OMB: 0938-0568

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ORDER SECTIONS ARE ADMINISTERED                             
Component

Abbrev.

SECTION 

Section
Who gets what section based on Interview Type and SP's Status
Administered
in What
Round?
ALL
MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10

Introduction

IN

Listed in the order the section is
administered.
INTRODUCTION

Household

ENS

ENUMERATION

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 9, or 10

Supplemental Section

HA

HOUSING CHARACTERISTICS

FALL

Health Ins

HIS

HEALTH INSURANCE SUMMARY

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 and MRES.SPALIVE
^= 2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased.
MRES.INTTYPE = 1, 4, 7, 9, or 10

Health Ins

HI

HEALTH INSURANCE

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 9, or 10

Insurance Plans

DM

DISCOUNT/SAVINGS MEMBERSHIP

ALL

Utilization

DU

DENTAL UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 9, or 10 (exclude
MRES.INTTYPE=8)
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

Utilization

ER

EMERGENCY ROOM UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

Utilization

IP

INPATIENT UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 8, 9, or 10 *MRES.INTTYPE=8 only
receive IP questions if ongoing IP visit from the previous round.

Utilization

OP

OUTPATIENT UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

Utilization

IU

INSTITUTIONAL UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

Utilization

HHS

HOME HEALTH SUMMARY

ALL

MRES.INTTYPE = 1, 4, or 9

Utilization

HH

HOME HEALTH UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9 , or 10

Utilization

MP

MEDICAL PROVIDER UTILIZATION

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

Supplemental Section

AC

ACCESS TO CARE SUPPLEMENT

FALL

Utilization

OM

OTHER MEDICAL EXPENSES

ALL

MRES.INTTYPE = 1, 2, 4, 5, or 6 and MRES.SPALIVE ^=
2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased.
MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

Utilization

PMS

PRESCRIBED MEDICINES

ALL

MRES.INTTYPE = 1, 4, or 9

Utilization

PM

PRESCRIBED MEDICINES

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

COST Series

ST

STATEMENT CHARGE SERIES

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

COST Series

PS

POST-STATEMENT CHARGE

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10

COST Series

NS

NO STATEMENT CHARGE SERIES

ALL

COST Series

CPS

CHARGE PAYMENT SUMMARY NOT
IMPLEMENTED IN R51

ALL

MRES.INTTYPE = 1, 2, 4, 5, 6, 7, 9, or 10 (exclude
MRES.INTTYPE=8)
MRES.INTTYPE = 1, 4, 5, 8, or 9

Supplemental Section

AC

ACCESS TO CARE SUPPLEMENT

FALL

Supplemental Section

HF

FALL

Supplemental Section

SC

Supplemental Section

US

HEALTH STATUS AND FUNCTIONING
SUPPLEMENT
SATISFACTION WITH CARE
SUPPLEMENT
USUAL SOURCE OF CARE SUPPLEMENT

Supplemental Section

DI

DEMOGRAPHICS AND INCOME

FALL

Supplemental Section

KN

WINTER

Supplemental Section

IA

BENEFICIARY KNOWLEDGE AND
INFORMATION NEEDS
INCOME AND ASSETS SUPPLEMENT

Supplemental Section

PA

PATIENT ACTIVATION SUPPLEMENT
NOT IMPLEMENTED IN R51

SUMMER

Supplemental Section

RX

DRUG COVERAGE SUPPLEMENT

SUMMER

Address Verification

AV

ALL

Closing

CL

ADDRESS VERIFICATION * Can be called
either after IN or before CL.
CLOSING

ALL

Closing

EX

CLOSING FOR EXIT INTERVIEW

SUMMER

End

END

END SECTION

ALL

FALL
FALL

SUMMER

MRES.INTTYPE = 3 and MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 3, 4, 5, or 6 and MRES.SPALIVE ^=
2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 3, 4, 5, or 6 and MRES.SPALIVE ^=
2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 3, 4, 5, or 6 and MRES.SPALIVE ^=
2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 3
MRES.INTTYPE = 1, 2, 4, 5, 6, or 7 and MRES.SPALIVE ^=
2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 1, 2, 4, 5, 6, 8, 9, or 10
MRES.INTTYPE = 1, 2, 4, 5, 6, 8, 9, or 10 and MRES.SPPROXY =
1/SP and MRES.SPALIVE ^= 2/AliveAndInstitute and
MRES.SPALIVE ^= 3/Deceased.
MRES.INTTYPE = 1, 2, 4, 5, 6, 9, or 10 and MRES.SPALIVE ^=
2/AliveAndInstitute and MRES.SPALIVE ^= 3/Deceased
MRES.INTTYPE = 2 or 3 and MRES.SPALIVE ^= 2/AliveAndInstitute
and MRES.SPALIVE ^= 3/Deceased.
(MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7,or 10) or (MRES.INTTYPE = 8 or
9 and MRES.SPALIVE = 3/Deceased).
MRES.INTTYPE = 8 or 9 and MRES.SPALIVE ^= 3/Deceased.
MRES.INTTYPE = 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10


File Typeapplication/pdf
AuthorCMS
File Modified2010-03-29
File Created2010-03-29

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